Exploring the perceptions and experiences of mobile teams on COVID-19 vaccine uptake at the community level: evidence from Benue and Niger states

BACKGROUND

As part of the fight against coronavirus disease, Nigeria received nearly 4 million doses of the COVID-19 vaccine via the COVID-19 Vaccines Global Access (COVAX) Facility, marking a historic step towards equitable global distribution of COVID-19 vaccines. Although evidence exists on COVID-19 hesitancy in Nigeria, yet, we are unaware of any study on the optimization of COVID-19 vaccination from the lenses of the mobile teams.

OBJECTIVE

This study seeks to explore the perceptions and experiences of mobile teams in selected communities during the implementation of COVID-19 vaccination in Benue and Niger.

METHODS

An exploratory approach was adopted, and the study was conducted in Niger and Benue states based on poor performance in COVID-19 vaccination. Focus Group Discussions (FDGs) were conducted among 12 mobile vaccination teams from 12 LGAs. The recorded discussions were transcribed and coded (inductively and deductively) using Dedoose software (v9.0). Four themes and seven sub-themes were generated from the participants' responses.

RESULTS

Seventy-two (72) health workers including vaccinators, validators, Electronic Management of Immunization Data (EMID) recorders, social mobilizers, and paper recorders participated in this study. Health workers' perceptions and experiences were thematized using the health building blocks. The mobilization teams in Benue and Niger states perceived that their mobilization efforts contributed to improved coverage, increased accessibility, and reduced hesitancy among the community dwellers. Challenges reported by the teams were vaccine misconceptions, requests for incentives in exchange for vaccine uptake, poor network services, distance to communities, and vaccine stockout.

CONCLUSION

This study concluded that social mobilizers play key roles in vaccine uptake, especially at the community level. Their roles in creating awareness, sensitization, and bringing the vaccine closer to hard-to-reach communities contributed to the success attained in the fight against COVID-19 in both states.

Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review

BACKGROUND

Primary Health Care (PHC) systems are pivotal in delivering essential health services during crises, as demonstrated during the COVID-19 pandemic. With varied global strategies to reinforce PHC systems, this scoping review consolidates these efforts, identifying and categorizing key resilience-building strategies.

METHODS

Adopting Arksey and O'Malley's scoping review framework, this study synthesized literature across five databases and Google Scholar, encompassing studies up to December 31st, 2022. We focused on English and Persian studies that addressed interventions to strengthen PHC amidst COVID-19. Data were analyzed through thematic framework analysis employing MAXQDA 10 software.

RESULTS

Our review encapsulated 167 studies from 48 countries, revealing 194 interventions to strengthen PHC resilience, categorized into governance and leadership, financing, workforce, infrastructures, information systems, and service delivery. Notable strategies included telemedicine, workforce training, psychological support, and enhanced health information systems. The diversity of the interventions reflects a robust global response, emphasizing the adaptability of strategies across different health systems.

CONCLUSIONS

The study underscored the need for well-resourced, managed, and adaptable PHC systems, capable of maintaining continuity in health services during emergencies. The identified interventions suggested a roadmap for integrating resilience into PHC, essential for global health security. This collective knowledge offered a strategic framework to enhance PHC systems' readiness for future health challenges, contributing to the overall sustainability and effectiveness of global health systems.

[Impact of Non-Pharmacological Measures during COVID-19 Pandemic in Adolescents - A Cross-sectional Study of 649 10th Grade Pupils in the City of Witten, Germany (GeWIT-Study)]

AIM

The aim of this study was to examine the impact of the COVID-19 pandemic and non-pharmacological interventions, with a particular focus on the subjective experiences of pupils in relation to the measures, the extent to which quarantine and illness with COVID-19 influenced their perception of the disease, the protective measures taken and the groups that were particularly affected.

METHODS

From November 2021 to February 2022, a written survey of tenth grade pupils from all nine secondary municipal schools in the city of Witten, Germany was conducted. Descriptive statistics were used to analyze and evaluate the data.

RESULTS

98.3% of the pupils present in class (n=649) were included in the survey. Of the study population, 12.9% stated that they had already had COVID-19 and 43.6% had been quarantined. 27.3% of the pupils reported that mask-wearing was not easy for them, while 65.2% found wearing a mask easy. Furthermore, 33.4% reported that distance learning had negatively impacted their well-being, and 6.9% of the pupils reported that they had experienced more violence during the pandemic. Fear of COVID-19 was reported by 10% of the pupils, and was less frequently reported if pupils had already been infected with COVID-19 or had been quarantined. 75.7% reported no fear of COVID-19.

DISCUSSION

The COVID-19 pandemic and the non-pharmacological measures to address it presented significant challenges and were a substantial burden on the pupils. The present study shows that the pandemic and/or the measures had a negative impact on the pupils. It is imperative to critically examine the measures, particularly in relation to vulnerable groups such as gender-diverse or socio-economically disadvantaged pupils. Education that is needs-based and target group-oriented can facilitate increased acceptance and perceptions of safety of implemented measures among pupils.

Comparative cost-effectiveness analysis of CDK4/6 inhibitors in the first-line treatment of HR-positive and HER2-negative advanced breast cancer: a Markov's model-based evaluation

Introduction

CDK4/6 inhibitors are the first-line treatment for HR+/HER2- advanced breast cancer. Despite their clinical benefit, they can increase healthcare expenditure. To date, there is no thorough comparison among the three approved CDK4/6 inhibitors in terms of their cost-effectiveness.

Objective

To investigate and compare the cost-effectiveness of CDK4/6 inhibitors in combination with letrozole as a first-line treatment for advanced breast cancer with hormonal-receptor-positivity and HER-2-negativity versus one another and versus letrozole monotherapy.

Methods

A 10-year within-cycle-corrected Markov's model was employed from the healthcare payer perspective. Costs were obtained from the National Center for Cancer Care and Research (NCCCR) in Qatar. Utilities and transition probabilities were calculated from published landmark trials of PALOMA-2, MONALEESA-2, MONARCH-3, PO25, and other relevant literature. Costs, measured in Qatari Riyal (QAR), and effectiveness, measured in quality-adjusted-life-years (QALYs), were incremented and the incremental cost-effectiveness ratio (ICER) was compared to a willingness-to-pay threshold (WTP) of 1.5 Qatari GDP (448,758 QAR). A deterministic sensitivity analysis was implemented to account for uncertainties.

Results

Ribociclib was the most effective option, generating 4.420 QALYs, followed by palbociclib (4.406 QALYs), abemaciclib (4.220 QALYs), then letrozole monotherapy (2.093 QALYs). As for cost-effectiveness, ribociclib dominated palbociclib. However, it was not cost-effective compared to abemaciclib (ICER=1,588,545 QAR/QALY). Ribociclib remained dominant over palbociclib with all uncertainties. The base-case conclusion of ribociclib versus abemaciclib remained robust over all uncertainties.

Conclusion

From the healthcare payer perspective in Qatar, ribociclib is the most effective CDK4/6 inhibitor. It was dominant over palbociclib in terms of cost-effectiveness; however, it was not cost-effective compared to abemaciclib at current prices.

Disparities and factors affecting hypertension diagnosis from qualified doctors in Bangladesh and its impact on receiving hypertension control advice: Analysis of demographic & health survey 2017-18

The burden of hypertension is increasing in many low- and middle-income countries, including Bangladesh, and a large proportion of Bangladeshi people seek healthcare from unqualified medical practitioners, such as paramedics, village doctors, and drug store salesmen; however, there has been limited investigation regarding diagnosis and care provided by qualified doctors. This study investigated the factors associated with hypertension diagnosis by qualified doctors (i.e., registered medically trained doctors or medical doctors with at least an MBBS degree) and how this diagnosis is related to hypertension-controlling advice and treatment among Bangladeshi adults. This cross-sectional study used data from Bangladesh Demographic and Health Survey 2017-18. After describing sample characteristics, we conducted simple and multivariable logistic regression analyses to investigate the associated factors and associations. Among 1710 participants (68.3% females, mean age: 50.1 (standard error: 0.43) years) with self-reported hypertension diagnosis, about 54.9% (95% confidence interval (CI): 51.8-58.0) had a diagnosis by qualified doctors. The following variables had significant associations with hypertension diagnoses from qualified doctors: 40-54- or 55-year-olds/above (ref: 18-29-year-olds), overweight/obesity (ref: not overweight/obese), college/above education (ref: no formal education), richest wealth quintile (ref: poorest), urban residence (ref: rural), and residence in Chittagong, Barisal, and Sylhet divisions (ref: Dhaka division). Lastly, compared to people who had not been diagnosed by qualified doctors, those with the diagnosis from qualified doctors had higher odds of receiving any hypertension-controlling advice and treatment, including drugs (1.73 (95% CI: 1.27-2.36), salt intake reduction (AOR: 2.36, 95% CI: 1.80-3.10), weight reduction (AOR: 2.58, 95% CI: 1.97-3.37), smoking cessation (AOR: 2.22, 95% CI: 1.66-2.96),), and exercise promotion (AOR: 2.34, 95% CI: 1.77-3.09). This study showed significant socioeconomic and rural-urban disparities regarding hypertension diagnosis from qualified doctors. Diagnosis by qualified doctors was also positively associated with receiving hypertension-controlling advice and treatment. Reducing these inequalities would be crucial to reducing the country's hypertension burden.

Ethical considerations during Mpox Outbreak: a scoping review

BACKGROUND

Historically, epidemics have been accompanied by the concurrent emergence of stigma, prejudice, and xenophobia. This scoping review aimed to describe and map published research targeting ethical values concerning monkeypox (mpox). In addition, it aimed to understand the research gaps related to mpox associated stigma.

METHODS

We comprehensively searched databases (PubMed Central, PubMed Medline, Scopus, Web of Science, Ovid, and Google Scholar) to identify published literature concerning mpox ethical issues and stigma from May 6, 2022, to February 15, 2023. The key search terms used were "monkeypox", "ethics", "morals", "social stigma", "privacy", "confidentiality", "secrecy", "privilege", "egoism", and "metaethics". This scoping review followed the framework proposed by Arksey and O'Malley in 2005 and was further improved by the recommendations of Levac et al. in 2010.

RESULTS

The search strategies employed in the scoping review yielded a total of 454 articles. We analyzed the sources, types, and topics of the retrieved articles/studies. The authors were able to identify 32 studies that met inclusion criteria. Six of the 32 included studies were primary research. The study revealed that the ongoing mpox outbreak is contending with a notable surge in misinformation and societal stigma. It highlights the adverse impacts of stigma and ethical concerns associated with mpox, which can negatively affect people with the disease.

CONCLUSION

The study's findings underscore the imperative need to enhance public awareness; involve civil society; and promote collaboration among policymakers, medical communities, and social media platforms. These collective endeavors are crucial for mitigating stigma, averting human-to-human transmission, tackling racism, and dispelling misconceptions associated with the outbreak.

A comprehensive evaluation of water, sanitation and hygiene (WASH) in health facilities: a systematic review and meta-analysis

Despite global recognition, WHO reports reveal significant gaps, with one in four healthcare facilities lacking basic water services, affecting over 1.8 billion people, and 21% lacking sanitation services, impacting 1.5 billion people, especially prevalent in low- and middle-income countries. This study aimed to critically evaluate the current state of water, sanitation and hygiene (WASH) facilities across a diverse range of healthcare settings. This review included various databases such as PubMed, MEDLINE, EMBASE, CINAHL, Scopus and grey literature; eligible studies employing various designs were scrutinized for WASH infrastructure and practices. Methodological quality was rigorously evaluated using the QuADS checklist. Data analysis, performed with R software, involved deriving pooled estimates of WASH intervention effects. Sensitivity analyses were conducted, employing statistical methods such as funnel plots to ensure robustness and mitigate biases. Of the 13,250 articles screened, 18 were included in this review. Meta-analyses revealed significant effect sizes for WASH interventions across domains - water (67.38%), sanitation (53.93%), waste management (40.82%), environment (56.58%), hygiene (66.83%), and management (42.30%). Widespread disparities in WASH persist across healthcare facilities, with rural areas facing notable deficits. Challenges in water quality, sanitation and waste management demand comprehensive, multi-sectoral approaches for improvement.

Mixed-methods study of university students' perceptions of COVID-19 and media consumption from March 2020 -April 2022

Longitudinal mixed-methods research is necessary to understand the changing dynamics of pandemic perceptions, the adoption of health behaviours, and use of media during a public health emergency. During the first two years of the COVID-19 pandemic, we used a mixed-methods approach to survey young adults attending a large Canadian public university. Six online convenience survey samples were collected (Spring 2020, Summer 2020, Fall 2020, Spring 2021, Fall 2021, Spring 2022) (n = 4932) and 110 semi-structured interviews were conducted. Female gender was associated with higher perceptions of severity, susceptibility, and the adoption of new health behaviours. Perceptions of severity and anxiety/fear about contracting COVID-19 after reading/hearing a news report decreased overall over time, while perceptions of susceptibility increased through time overall. Social media was the most used form of media and was the form of media that participants judged to make them feel most anxious/fearful about contracting COVID-19. Those who felt anxious after hearing a COVID-19 news report were 8.43 times more likely to judge COVID-19 as severe and 2.07 times more likely to judge their own susceptibility as high. Interviews revealed perceptions of information overload, passive information intake, and a narrowed geographical focus over time. The decrease in judgements of COVID-19 severity with the accompanying increase in judgements of susceptibility over the first two years of the pandemic demonstrate the dynamics of changing pandemic attitudes. Health communication efforts targeting university students in future major health events need to consider these shifting dynamics and ensure that health information distributed via social media meets the needs of university students.

Bracing for the next wave: A critical incident study of frontline decision-making, adaptation and learning in ambulance care during COVID-19

AIM

To explore frontline decision-making, adaptation, and learning in ambulance care during the evolving COVID-19 pandemic.

DESIGN

Descriptive and interpretative qualitative study.

METHODS

Twenty-eight registered nurses from the Swedish ambulance services described 56 critical incidents during the COVID-19 pandemic through free-text questionnaires. The material was analysed using the Critical Incident Technique and Interpretive Description through the lens of potential for resilient performance.

RESULTS

The findings were synthesized into four themes: 'Navigating uncharted waters under never-ending pressure', 'Balancing on the brink of an abyss', 'Sacrificing the few to save the many' and 'Bracing for the next wave'. Frontline decision-making during a pandemic contribute to ethical dilemmas while necessitating difficult prioritizations to adapt and respond to limited resources. Learning was manifested through effective information sharing and the identification of successful adaptations as compared to maladaptations.

CONCLUSIONS

During pandemics or under other extreme conditions, decisions must be made promptly, even amidst emerging chaos, potentially necessitating the use of untested methods and ad-hoc solutions due to initial lack of knowledge and guidelines. Within ambulance care, dynamic leadership becomes imperative, combining autonomous frontline decision-making with support from management. Strengthening ethical competence and fostering ethical discourse may enhance confidence in decision-making, particularly under ethically challenging circumstances.

IMPACT

Performance under extreme conditions can elevate the risk of suboptimal decision-making and adverse outcomes, with older adults being especially vulnerable. Thus, requiring targeted decision support and interventions. Enhancing patient safety in ambulance care during such conditions demands active participation and governance from management, along with decision support and guidelines. Vertical communication and collaboration between management and frontline professionals are essential to ensure that critical information, guidelines, and resources are effectively disseminated and implemented. Further research is needed into management and leadership in ambulance care, alongside the ethical challenges in frontline decision-making under extreme conditions.

REPORTING METHOD

Findings are reported per consolidated criteria for reporting qualitative research (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Healthcare Professionals' Attitude to Using Mobile Health Technology and Its Associated Factors in a Resource-Limited Country-An Implication for Digital Health Implementers: A Cross Sectional Study

Background: Mobile health has become widely used within the healthcare system, and there is an increasing worldwide trend toward employing this innovation for behavior management, disease monitoring, the control and prevention of various health issues, and rising enrollment in healthcare services. Although mHealth is becoming more widely available, there is no evidence about the attitude of healthcare professionals toward mHealth in southwest Ethiopia. Therefore, this study is aimed at assessing the attitude of healthcare professionals to using mHealth technology and associated factors in Ethiopia. Methods: An institutional cross-sectional study was conducted among 422 healthcare professionals. Data were collected using a pretested interviewer-administered questionnaire, and the study was conducted from January 08 to February 10, 2023. EpiData Version 4.6 for entering the data and STATA Version 14 for analyzing the data were used. A multivariable logistic regression analysis was carried out to identify factors associated with healthcare professionals' attitudes to using mobile health technology. Results: A total of 415 study participants were included in the study. About 180 (43.4%) respondents had a favorable attitude toward mHealth technology in southwest public hospitals. Master's degree and above (adjusted odds ratio [AOR]: 3.67; 95% CI: 1.22, 4.10), good knowledge of mobile health technology (AOR: 4.08; 95% CI: 1.35, 5.31), more than 5 years of work experience (AOR: 3.09; 95% CI: 1.76, 5.60), had ICT infrastructure (AOR: 2.70; 95% CI: 1.38, 5.31), had own smart mobile (AOR: 3.67; 95% CI: 3.20, 4.31), and had taken computer-related training (AOR: 1.96; 95% CI: 1.03, 3.73) were positively associated with healthcare professionals' attitude to using mobile health technologies in southwest Ethiopia. Conclusions: Overall, healthcare professionals' attitude to using mobile health technologies in southwest Ethiopia was relatively low. Education level, good knowledge, years of work experience, ICT infrastructure, having a smart mobile, and having taken computer-related training were significant factors of attitude to using mobile health technologies. Considering these factors could provide insight into developing and adopting mobile health technologies in Ethiopia.

Estimating vaccine effectiveness against COVID-19 using cause-specific sick leave as an indicator: a nationwide population-based cohort study, Norway, July 2021 - December 2022

BACKGROUND

Due to changes in testing policy and increased use of rapid tests, other indicators for SARS-CoV-2 infections are needed to monitor vaccine effectiveness (VE). We aimed to estimate VE against COVID-19 sick leave (> 3 days, certified by a medical professional) among employed individuals (25-64-years-old) in Norway.

METHODS

We performed a nationwide cohort study by collating data from the Emergency preparedness register for COVID-19. We used adjusted Cox proportional hazard models with vaccine status as a time-varying covariate and presented results as adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals. Separate models were run against sick leave and against SARS-CoV-2 infections during the Delta period (June-December 2021), and against sick leave during the Omicron period (January-December 2022) when SARS-CoV-2 PCR-testing was replaced by rapid self-tests and infections were underreported.

RESULTS

We included 2,236,419 individuals during the Delta period, of whom 73,776 (3.3%) had a reported infection and 54,334 (2.4%) were registered with sick leave. Of the 2,206,952 included individuals in the Omicron period, 300,140 (13.6%) were registered with sick leave. During the Delta period, 55% (26,611) of individuals who had registered sick leave also had a positive test, compared to 32% (96,445) during the Omicron period. The VE against sick leave during the Delta period followed a similar waning pattern to that against SARS-CoV-2 infections. After the second and third dose, the lowest aHRs were estimated for 2-7 days after vaccination for both sick leave (0.25; 95%CI 0.24-0.26 and 0.26; 95% CI 0.24-0.29) and infection ( 0.16; 95% CI 0.15-0.17 and 0.18; 95% CI 0.16-0.19) respectively. During the Omicron period, aHRs for sick leave were higher than during the Delta period, but the lowest aHRs were still found in 2-7 weeks after receiving the second (0.61; 95% CI 0.59-0.64) or third dose (0.63; 95% CI 0.62-0.64).

CONCLUSION

Our results showed that sick leave could be a relevant indicator for VE in the surveillance of COVID-19 and a finding that may be important in the surveillance of other respiratory infection.

Has learning gone to waste?-Health-promoting behaviors of seniors

Objective

Regardless of the fact that Universities of Third Age (UTA's) are becoming more and more popular among seniors there are not many available studies examining the impact of conducted educational activities on seniors' adherence to health-promoting activities. The aim of the study was to compare health behaviors (e.g.,: physical activity, eating habits, alcohol consumption, tobacco smoking, preventive tests performance) between seniors attending and not attending UTA's classes.

Methods

The study involved 631 (100%) seniors aged 60-92 years (x =70.28 ± 6.09 years). The majority of the study group were women (475; 75.28%). To conduct the study, a proprietary questionnaire was used, consisting of questions regarding the discussed topic and basic questions including: age, gender, place of residence and education. Polish versions of standardized questionnaire-"My eating behaviors" examine eating behaviors of the respondents. The Chi2 test was used for qualitative data, and for quantitative data-the Mann-Whitney U test (No normal distribution: T S-W < 0.001). Linear and logistic regression models were used to check whether the associations would remain after adjustments for potential cofounders. The level of statistical significance was set at α < 0.05.

Results

Number of seniors participating in UTA's activities was higher in terms of engaging in: actively spending free time (261; 73.73% vs. 93; 26.27%; p < 0.001), regular physical activity (270; 76.27% vs. 133; 48.01%; p < 0.001), self-assessment of physical activity (259; 73.16% vs. 95; 26.84%; p = 0.004), duration of physical activity (< 0.001), past tobacco smoking (133; 37.57 vs. 76; 27.44%; p = 0.007) and alcohol consumption depending on the habit frequency (p < 0.001). Number of seniors not participating in UTA's classes was lower in terms of: regular annual dental controls (161; 58.12%; vs. 265; 74.86%; p < 0.001), regular self-examination of breasts/testicles (148; 53.43% vs. 218; 61.58%; p = 0.04) and regular laboratory tests (232; 83.75% vs. 318; 89.83%; p = 0.02).

Conclusions

Health-promoting behaviors of seniors attending classes at the UTA's were more correct in terms of physical activity, adequate attendance with preventive test and worst in terms of alcohol consumption. Overall picture allows to conclude that participation in UTA's classes seems to have a positive impact on the examined health-promoting behaviors of the surveyed seniors.

Factors associated with anxiety disorders among healthcare workers (HCWS) involved in the first wave of the COVID-19 pandemic

BACKGROUND

In a context of reorganization of the activity, of increase of the psychological, emotional and physical constraints of the nursing staff induced by the first wave of the COVID-19 pandemic, an increase of the anxiety disorders could occur.

OBJECTIVE

This study aims to assess the prevalence of anxiety disorders in healthcare workers (HCWs) by wards and to investigate medical, personal, and occupational factors associated with anxiety disorder.

METHODS

In France, in May 2020, a monocentric observational cross-sectional study was proposed to 285 HCWs of the University Hospital of Saint Etienne, working in 3 types of randomly selected care wards. Information was collected using an anonymous self-questionnaire offered to eligible HCWs. Validated questionnaires were used to assess anxiety (Hospital anxiety and Depression Scale) and burnout (Maslach Burnout Inventory).

RESULTS

Of the 164 HCWs who participated in the study (57% participation rate), 69 (42%) caregivers had anxious symptomatology. The prevalence of anxiety disorders did not differ significantly by type of wards. Anxiety disorders are significantly associated with occupational factors (increased COVID-19 stress level, increased emotional load, increased mental load, high work/life stress during confinement, emotional exhaustion and loss of empathy), with medical factors (medical history of anxiety disorders, psychotropic treatment and impaired sleep quality) and personal factors (concern about working conditions and/or media reports).

CONCLUSIONS

Preventive actions focusing on organizational factors could be carried out to reduce the emotional and mental load, the level of stress and the burnout of HCWs.

The relationship between acculturative stress and psychological outcomes in international students: a systematic review and meta-analysis

Introduction

The current systematic review aimed to examine the relationship between acculturative stress (AS) and psychological outcomes in international students to determine the role AS may play in predicting the mental health of international students.

Methods

The studies included in the current systematic review and meta-analysis had considered AS and its impact on psychological outcomes among international students studying abroad. After checking the studies found in our primary search through the scientific databases in terms of our eligibility criteria, 29 studies were included, of which 26 were eligible for a meta-analysis (total N = 7,247).

Results

Meta-analysis indicated a moderate mean correlation of AS with psychological outcomes like depression, life satisfaction, quality of life, vocational outcome expectations, drinking behaviors, resilience, health promotion behavior, psychological adjustment, psychological distress, negative affect, and mental health symptoms (r =  0.39) and depression (r =  0.41), respectively.

Discussion

The review of studies revealed a robust relationship between AS and increased negative psychological outcomes such as depression, psychological distress, and general stress, as well as decreased positive psychological outcomes such as psychological adjustment, mental health, life satisfaction, and quality of life.

Prevalence of and Risk factors associated with hypertension: a community based- cross sectional study in Ndorwa West Health Sub District, Kabale district, southwestern Uganda

Background

Globally, one billion people have hypertension (HT), it kills 9.4 million people annually. Prevalence is higher in developed countries and is rapidly rising in developing countries, and approximately 31.5% of Ugandans have HT.

Objective

This study aimed to determine the prevalence of and risk factors associated with HT among adults aged 25-65 years in the Ndorwa West HSD, Kabale District.

Methods

A community-based cross-sectional survey was conducted with 381 adults aged 25-65 years in Ndorwa West HSD, using a modified WHO STEPwise approach to chronic disease risk factor surveillance. Chi-square tests with 95% Confidence Intervals (CI) and p-values less than 0.05, were used to assess the association between hypertension and associated factors. Odds Ratios (OR) with their corresponding 95% confidence intervals (95% CI) estimated the risk.

Results

The prevalence of HT and pre-HT in Ndorwa HSD was 28.3% and 45.7%, respectively. 61.8% (n = 243) were females and 36.1% (n = 142) were males with a mean age of 48.18 years and standard deviation of 11.5 years. The mean Body Mass Index (BMI) was 25.92 kg/m2 and the standard deviation was 3.69 kg/m2. Only Age (p = 0.010, OR = 1.81(1.14-2.87) and level of education (p = 0.04) were significantly associated with hypertension. age ≥ 45years increased the likelihood of developing HT by 0.81 times. Behavioral factors associated with HT included awareness of the BP status (p = 0.010, OR = 0.53(CI: 0.32-0.87),use of fats/oil for cooking (p = 0.02, OR = 1.73 (CI: 1.09-2.75)), reduced salt intake (p = 0.001, OR = 0.075(CI:0.01-0.55)), and overweight and obesity (BMI) level ( p = 0.010, OR = 1.77 (CI 1.12-2.80)). BMI ≥ 25kg/m2 increased the likelihood of developing HT by 0.77 times.

Conclusion

The prevalence of HT and pre-HT in this rapidly transitioning rural-urban population was high. The risk of CVDs is about 16 folds higher among pre-HT compared to no HT and doubles for every 10-mmHg increase in BP. Hence, the considerable risk and burden of HT and related CVDs that require a dire need to adopt strategies to prevent and control hypertension based on the identified associated risk factors in Ndorwa HSD.

Community-Working Occupational Therapists' Involvement in Research and Development Projects in Norway

The aim of this study was to explore community-working occupational therapists' involvement in research and development projects. A cross-sectional survey of occupational therapists working in community-based services in Norway (n = 617) was conducted. In all, 117 of the 617 participants responded that they were involved in research and development projects. Greater likelihood of participation in research and development work were found for occupational therapists who had completed further education. Current and prioritized research topics were professional development and the development of interprofessional and professional service designs for occupational therapy. Service and quality development, rehabilitation and technology were areas where more knowledge was considered needed. To increase the growth and success of occupational therapy research and development, it is important that more occupational therapists in the municipality continue to complete further education. High-quality occupational therapy practice should be based on research and development projects in the municipalities.

HM, Antoshechkin I, Marshall JM, Akbari OS. Eliminating malaria vectors with precision-guided sterile males

Controlling the principal African malaria vector, the mosquito Anopheles gambiae, is considered essential to curtail malaria transmission. However, existing vector control technologies rely on insecticides, which are becoming increasingly ineffective. Sterile insect technique (SIT) is a powerful suppression approach that has successfully eradicated a number of insect pests, yet the A. gambiae toolkit lacks the requisite technologies for its implementation. SIT relies on iterative mass releases of nonbiting, nondriving, sterile males which seek out and mate with monandrous wild females. Once mated, females are permanently sterilized due to mating-induced refractoriness, which results in population suppression of the subsequent generation. However, sterilization by traditional methods renders males unfit, making the creation of precise genetic sterilization methods imperative. Here, we introduce a vector control technology termed precision-guided sterile insect technique (pgSIT), in A. gambiae for inducible, programmed male sterilization and female elimination for wide-scale use in SIT campaigns. Using a binary CRISPR strategy, we cross separate engineered Cas9 and gRNA strains to disrupt male-fertility and female-essential genes, yielding >99.5% male sterility and >99.9% female lethality in hybrid progeny. We demonstrate that these genetically sterilized males have good longevity, are able to induce sustained population suppression in cage trials, and are predicted to eliminate wild A. gambiae populations using mathematical models, making them ideal candidates for release. This work provides a valuable addition to the malaria genetic biocontrol toolkit, enabling scalable SIT-like confinable, species-specific, and safe suppression in the species.

Barriers to access to cancer care for patients from the conflict-affected region of the Nagorno-Karabakh Republic: A qualitative study

Access to essential health services is a basic human right, yet many cancer patients living in conflict-affected regions face multiple obstacles to service use. The (former) Nagorno-Karabakh Republic was a conflict-affected region in the South Caucasus populated predominantly by ethnic Armenians. Multiple acute armed conflicts, the recent military occupation of the region, and the prolonged military blockade of the Lachin Corridor (a humanitarian corridor connecting Nagorno-Karabakh to Armenia) exacerbated existing social, health, economic, and political fragilities in this region. As a result, cancer services were disrupted, with limited clarity on how the ongoing military blockade of a humanitarian corridor affected cancer patients' experiences of accessing cancer care locally and in bordering Armenia. Our study aimed to describe the experiences of patients from Nagorno-Karabakh in accessing the cancer care services they needed. We conducted remote semi-structured interviews with adult (aged ≥18 years) cancer patients receiving cancer care from three university hospitals in Armenia and face-to-face interviews with cancer care professionals from these hospitals. Interviews were conducted during the blockade of the Lachin Corridor between March and May 2023. Data were analysed thematically using a deductive approach. Twelve adult cancer patients (9 women) and 12 cancer care professionals participated. A key barrier to accessing cancer services was attributed to the Azerbaijani military occupation of the region and the blockade of a major roadway connecting Nagorno-Karabakh to Armenia. Patients talked in length about the challenges of finding transport and travelling long distances to reach essential cancer services in Armenia. Policies of free anti-cancer medication provision and decentralised medication supply were paused because of the military occupation, affecting patients' timely access to anti-cancer medication. Out-of-pocket expenses for treatment, anti-cancer medication, travel, and temporary accommodation in Armenia placed a significant financial burden on cancer patients, exacerbated by the humanitarian crisis. Conflict-affected regions blockaded by military forces lack the capacity and targeted support to sustain their essential health services and provide care to those in need of life-saving treatments. Coordinated action from national and international organisations and governments is urgently needed to enhance humanitarian assistance and healthcare support to patients, their families and wider communities affected by military blockades and armed conflicts.

Transition to Motherhood and Lived Experiences of Teenage Mothers Delivering in Kasese and Bundibugyo Districts, Western Uganda

Introduction A large number of teenagers in low-resource settings experience pregnancy, with a significant number of these cases happening in sub-Saharan Africa. Teenage pregnancy is associated with unique physical and psychological experiences. Objective To explore the lived experiences of teenage mothers delivering at a tertiary referral hospital in southwestern Uganda. Methods This qualitative study used focus group discussions (FGDs) with teenage mothers in Kasese and Bundibugyo districts in Uganda. We purposively sampled 32 teenage mothers attending a tertiary referral hospital who had been pregnant at least once and had given birth. Sociodemographic information was obtained, and FGDs were conducted to capture the teenagers' experiences transitioning to motherhood. An inductive content analytic approach was used to analyze data.  Results The mean age of the participants was 18.4 (standard deviation [SD], 1.2) years, with the majority (22, 68.8%) being rural dwellers, married (23, 71.9%), unemployed (21, 65.6%), and having attained primary education (23, 71.9%). Teenage mothers' lived experiences were characterized by shattered dreams, concerns about changes in their body size and shape, abandonment and neglect by family members and spouses, considerations of terminating the pregnancy, forced early marriages, family stereotypes, and engaging in sex for survival. The process of transitioning to motherhood occurred along with resilience post-pregnancy and supportive environments from their loved ones, which enabled them to accept reality and care for their children. Conclusions The lived experiences of teenage mothers demonstrated social pressures, fear of abandonment, and poverty as major influences on their mindset and behavior. Further research to gain a comprehensive understanding of the challenges encountered by teenage mothers will aid the development of culturally appropriate strategies to reduce teenage pregnancy and improve perinatal outcomes.

Predicting sexually transmitted infections among men who have sex with men in Zimbabwe using deep learning and ensemble machine learning models

There is a substantial increase in sexually transmitted infections (STIs) among men who have sex with men (MSM) globally. Unprotected sexual practices, multiple sex partners, criminalization, stigmatisation, fear of discrimination, substance use, poor access to care, and lack of early STI screening tools are among the contributing factors. Therefore, this study applied multilayer perceptron (MLP), extremely randomized trees (ExtraTrees) and XGBoost machine learning models to predict STIs among MSM using bio-behavioural survey (BBS) data in Zimbabwe. Data were collected from 1538 MSM in Zimbabwe. The dataset was split into training and testing sets using the ratio of 80% and 20%, respectively. The synthetic minority oversampling technique (SMOTE) was applied to address class imbalance. Using a stepwise logistic regression model, the study revealed several predictors of STIs among MSM such as age, cohabitation with sex partners, education status and employment status. The results show that MLP performed better than STI predictive models (XGBoost and ExtraTrees) and achieved accuracy of 87.54%, recall of 97.29%, precision of 89.64%, F1-Score of 93.31% and AUC of 66.78%. XGBoost also achieved an accuracy of 86.51%, recall of 96.51%, precision of 89.25%, F1-Score of 92.74% and AUC of 54.83%. ExtraTrees recorded an accuracy of 85.47%, recall of 95.35%, precision of 89.13%, F1-Score of 92.13% and AUC of 60.21%. These models can be effectively used to identify highly at-risk MSM, for STI surveillance and to further develop STI infection screening tools to improve health outcomes of MSM.

The affecting factors of COVID-19 vaccine hesitancy in parents of children with cancer: A cross-sectional Jordanian study

BACKGROUND AND OBJECTIVE

Children with cancer have higher mortality and morbidity rates than have been reported in general children patients infected by coronavirus infection 2019 (COVID-19). Thus, for children with cancer, COVID-19 vaccination is a priority. This study aims to investigate the factors influencing COVID-19 vaccine hesitancy in parents of children with cancer in Jordan.

METHODS

A cross-sectional study was conducted during the third quarter of 2022 at the King Hussein Cancer Center in Amman, Jordan. The study employed a self-administered questionnaire, incorporating COVID-specific questions. Participants included parents of children aged 18 years or younger undergoing treatment or monitoring at the center. A straightforward random sampling approach was used to recruit participants. Ethical approval and institutional permission were obtained, ensuring voluntary participation with the right to withdraw.

RESULTS

A total of 409 participants, predominantly female, were enrolled in the study. Notably, most of the enrolled parents did not intend to have their children vaccinated either for seasonal flu or for COVID-19, 76.2% and 78.7%, respectively. The bulk of the parents were encouraged to vaccinate their child by the child's pediatrician (82.9%). Parents' age and their children's age were significantly influenced their willingness to vaccinate their children with the COVID-19 vaccine (p < .001), in which parents' age group 45-54 years and children's age group above 15 years old show the highest vaccination rate. Meanwhile, there was a significant association between children's vaccination with parents suffering from chronic disease (p < .001) and parents receiving the COVID-19 vaccine (p = .014). There are still some concerns regarding the COVID-19 vaccine's effectiveness, safety, and whether it is essential for their child.

CONCLUSION

A large proportion of parents in Jordan are hesitant about the COVID-19 vaccine when considering its administration to their children with cancer. This finding emphasizes the importance of communication and education to address vaccination hesitancy.

Community Health Work and Social Work Collaboration: Integration in Health Care and Public Health Settings: A Conceptual Framework

Community health worker (CHW) and social worker (SW) collaboration is crucial to illness prevention and intervention, yet systems often engage the 2 workforces in silos and miss opportunities for cross-sector alignment. In 2021, a national workgroup of over 2 dozen CHWs, SWs, and public health experts convened to improve CHW/SW collaboration and integration across the United States. The workgroup developed a conceptual framework that describes structural, systemic, and organizational factors that influence CHW/SW collaboration. Best practices include standardized training, delineated roles and scopes of practice, clear workflows, regular communication, a shared system for documentation, and ongoing support or supervision.

"People don't have the answers": A qualitative exploration of the experiences of young people with Long COVID

Young people living with Long COVID are learning to navigate life with a constellation of poorly understood symptoms. Most qualitative studies on experiences living with Long COVID focus on adult populations. This study aimed to understand the experiences of young people living with Long COVID. Qualitative, semi-structured interviews were conducted (n = 16); 11 young people (aged 13-19) and five parents were recruited from the Children and Young People with Long COVID (CLoCk) study (n = 11) or its patient and public involvement and engagement (PPIE) group (n = 5). Thematic analysis generated four themes: (i) Unravelling Long COVID: Exploring Symptom Journeys and Diagnostic Dilemmas; (ii) Identity Disruption and Adjustment; (iii) Long COVID's Ripple Effect: the impact on Mental Health, Connections, and Education; and (iv) Navigating Long COVID: barriers to support and accessing services. Treatment options were perceived as not widely available or ineffective, emphasising the need for viable and accessible interventions for young people living with Long COVID.

Exposure to comprehensive sexuality education in schools in South Africa: the implications on the uptake of HIV testing services among HIV positive adolescent girls

Comprehensive sexuality education (CSE) is seen as a key instrument through which to affect behaviour and improve sexual and reproductive health (SRH) outcomes amongst adolescents. However, few studies have to date evaluated key SRH outcomes following exposure to CSE within a school setting. This study estimates the association between CSE and HIV testing and HIV testing self-efficacy amongst HIV positive adolescent girls. Data were collected from a cross-sectional survey administered in four high HIV prevalence districts . Independent variables included exposure to CSE, with outcome variables measuring uptake of HIV testing in the 12 months preceding the survey, and HIV testing self-efficacy. The sample comprised 505 HIV positive adolescent girls aged 12-19. . Attending CSE was associated with both; being more confident to get an HIV test (AOR: 2.44, 95% CI: 1.47-4.06, p < 0.001) and having ever tested for HIV (AOR: 2.15, 95% CI: 1.39-3.33, p < 0.001) while controlling for numerous variables. Results suggest CSE can play an important role in not only affecting HIV-related behaviours themselves, but also critical factors that affect HIV behaviours, including self-efficacy.

The negative impact of misinformation and vaccine conspiracy on COVID-19 vaccine uptake and attitudes among the general public in Iraq

Background

Vaccine hesitancy is a major barrier to infectious disease control. Previous studies showed high rates of COVID-19 vaccine hesitancy in the Middle East. The current study aimed to investigate the attitudes towards COVID-19 vaccination and COVID-19 vaccine uptake among adult population in Iraq.

Methods

This self-administered survey-based study was conducted in August-September 2022. The survey instrument assessed participants' demographics, attitudes to COVID-19 vaccination, beliefs in COVID-19 misinformation, vaccine conspiracy beliefs, and sources of information regarding the vaccine.

Results

The study sample comprised a total of 2544 individuals, with the majority reporting the uptake of at least one dose of COVID-19 vaccination (n = 2226, 87.5 %). Positive attitudes towards COVID-19 vaccination were expressed by the majority of participants (n = 1966, 77.3 %), while neutral and negative attitudes were expressed by 345 (13.6 %) and 233 (9.2 %) participants, respectively. Factors associated with positive attitudes towards COVID-19 vaccination in multivariate analysis included disbelief in COVID-19 misinformation and disagreement with vaccine conspiracies. Higher COVID-19 vaccine uptake was significantly associated with previous history of COVID-19 infection, higher income, residence outside the Capital, disbelief in COVID-19 misinformation, disagreement with vaccine conspiracies, and reliance on reputable information sources.

Conclusion

COVID-19 vaccine coverage was high among the participants, with a majority having positive attitudes towards COVID-19 vaccination. Disbelief in COVID-19 misinformation and disagreement with vaccine conspiracies were correlated with positive vaccine attitudes and higher vaccine uptake. These insights can inform targeted interventions to enhance vaccination campaigns.

COVID-19 Vaccination Acceptance During Pregnancy in Europe

Pregnant women have been shown to have a higher risk of SARS-CoV-2 infection. Vaccination against the infection is the most effective strategy for preventing both severe disease and related complications. Nevertheless, vaccination hesitancy among pregnant women is an important issue affecting vaccine uptake and a major challenge for Public Health, as high rates of hesitancy can lead to complete refusal of vaccination, with health implications not only for the mother but also for the fetus. Based on the above, this review aims to capture the rates of vaccination against COVID-19 in pregnancy among European countries, from August 2020 to May 2022, as well as to highlight the predictive factors of its acceptance among pregnant women in these countries. The review of the available literature found that in Europe the acceptance of vaccination against COVID-19 among pregnant women varies with rates ranging from 21.3% to 87% for at least one dose and from 29.5% to 82.7%, for two doses of vaccine. Higher maternal education level, older age at pregnancy, previous vaccination against influenza and pertussis, positive attitude towards vaccines, and acceptance of vaccines during pregnancy are the most frequently reported positive predictors that are associated with higher vaccination rates. The information obtained from this study can contribute in the future, during epidemics or pandemics that may occur, to the development of targeted medical and communication strategies for the effective promotion of vaccination programs and the greatest possible coverage of the population, especially those belonging to vulnerable groups such as pregnant women.

Assessing the modification impact of vaccination on the relationship of the Discomfort Index with hand, foot, and mouth disease in Guizhou: A multicounty study

BACKGROUND

Hand, foot, and mouth disease (HFMD) is a major public health issue in China while temperature and humidity are well-documented predictors. However, evidence on the combined effect of temperature and humidity is still limited. It also remains unclear whether such an effect could be modified by the enterovirus 71 (EV71) vaccination.

METHODS

Based on 320,042 reported HFMD cases during the summer months between 2012 and 2019, we conducted a study utilizing Distributed Lag Non-Linear Models (DLNM) and time-varying DLNM to examine how China's HFMD EV71 vaccine strategy would affect the correlation between meteorological conditions and HFMD risk.

RESULTS

The incidence of HFMD changed with the Discomfort Index in an arm-shaped form. The 14-day cumulative risk of HFMD exhibited a statistically significant increase during the period of 2017-2019 (following the implementation of the EV71 vaccine policy) compared to 2012-2016 (prior to the vaccine implementation). For the total population, the range of relative risk (RR) values for HFMD at the 75th, 90th, and 99th percentiles increased from 1.082-1.303 in 2012-2016 to 1.836-2.022 in 2017-2019. In the stratified analyses, Han Chinese areas show stronger relative growth, with RR values at the 75th, 90th, and 99th percentiles increased by 14.3%, 39.1%, and 134.4% post-vaccination, compared to increases of 22.7%, 41.6%, and 38.8% in minority areas. Similarly, boys showed greater increases (24.4%, 47.7%, 121.5%) compared to girls (8.1%, 28.1%, 58.3%). Additionally, the central Guizhou urban agglomeration displayed a tendency for stronger relative growth compared to other counties.

CONCLUSIONS

Although the EV71 vaccine policy has been implemented, it hasn't effectively controlled the overall risk of HFMD. There's been a shift in the main viral subtypes, potentially altering population susceptibility and influencing HFMD occurrences. The modulating effects of vaccine intervention may also be influenced by factors such as race, sex, and economic level.

Health Economics in a World of Uneconomic Growth

Multiple, accelerating and interacting ecological crises are increasingly understood as constituting a major threat to human health and well-being. Unconstrained economic growth is strongly implicated in these growing crises, and it has been argued that this growth has now become "uneconomic growth", which is a situation where the size of the economy is still expanding, but this expansion is causing more harm than benefit. This article summarises the multiple pathways by which uneconomic growth can be expected to harm human health. It describes how health care systems-especially through overuse, low value and poor quality care-can themselves drive uneconomic growth. Health economists need to understand not only the consequences of environmental impacts on health care, but also the significance of uneconomic growth, and pay closer attention to the growing body of work by heterodox economists, especially in the fields of ecological and feminist economics. This will involve paying closer heed to the existence and consequences of diminishing marginal returns to health care consumption at high levels; the central importance of inequalities and injustice in health; and the need to remedy health economists' currently limited ability to deal effectively with low value care, overdiagnosis and overtreatment.

Challenges in Type 2 Diabetes Prevention among Senior High School Students: A Qualitative Study

Background

Schools, a place where students spend much more time than home, play an important role in preventing the nation's future generation from type 2 diabetes mellitus (T2DM). This study aimed to explore challenges in T2DM prevention among senior high school students.

Methods

The study was conducted in Riau Province, Indonesia, from June to August 2023 using a qualitative content analysis. 31 respondents, determined by data saturation, were recruited using purposeful sampling. They were public senior high schools' principals, vice principals, school health services staff, school canteen tenants, students, parents, and primary health care personnel in six districts. Data were collected through semi-structured face-to-face interviews and document review. Graneheim and Lundman's content analysis method was used to analyze the data in Nvivo version 11 software. The Lincoln and Guba Qualitative research criteria for trustworthiness were used to ensure the rigor of the study.

Results

The main concepts obtained from the data were classified into three themes entitled, "Nonoptimal existing diabetes prevention programs in schools", "Inadequate knowledge of school community on T2DM", and "Inadequate policies to prevent diabetes in schools".

Conclusion

An evidence-based, well-organized, and systematic school-based diabetes prevention program is fundamental to help overcome challenges and prevent future T2DM incidence. It requires relevant stakeholders' high level of awareness, strong collaborations with the school community, and effective school policies.

Communicable diseases in Ukraine during the period of 2018-2023: Impact of the COVID-19 pandemic and war

BACKGROUND

By examining 2018-2023 data, this study explored the intricate impact of the Russian invasion, ongoing COVID-19 pandemic, and environmental disruptions on communicable diseases in Ukraine. This conflict exacerbates challenges in disease surveillance and healthcare, compounding stress among the population.

METHODS

Leveraging the Centers for Disease Prevention Control's surveillance system, the study employs active and passive surveillance, utilizing medical records and laboratory reports. Notification rates gauge the incidence of communicable diseases, offering insights into trends during the study period.

RESULTS

While salmonellosis, shigellosis, and rotavirus incidence are decreasing overall, there is a surge in viral hepatitis A, chronic hepatitis B, and C. This conflict hampers hepatitis C management, as evidenced by decreased numbers of treatment centers and patient enrollment. The prevalence of cough cases will increase in 2023, emphasizing the importance of sustained vaccination. The incidence of tuberculosis will increase in 2023 despite a general decrease.

CONCLUSION

This study underscores the urgent need for sustained efforts and adequate resources, infrastructure, and international support to mitigate public health challenges in conflict-ridden Ukraine. Prioritizing vaccination programmes and enhancing healthcare accessibility in affected regions are crucial.

The Impact of COVID-19 on Healthcare Services in Bangladesh: A Qualitative Study on Healthcare Providers' Perspectives

OBJECTIVES

The objective of this study was to explore healthcare providers' experiences in managing the coronavirus disease 2019 (COVID-19) pandemic and its impact on healthcare services.

METHODS

A qualitative study was conducted with 34 healthcare professionals across 15 districts in Bangladesh. Among the participants, 24 were health managers or administrators stationed at the district or upazila (sub-district) level, and 10 were clinicians providing care to patients with COVID-19. The telephone interviews were conducted in Bangla, audio-recorded, transcribed, and then translated into English. Data were analyzed thematically.

RESULTS

Most interviewees identified a range of issues within the health system. These included unpreparedness, challenges in segregating COVID-19 patients, maintaining isolation and home quarantine, a scarcity of intensive care unit beds, and ensuring continuity of service for non-COVID-19 patients. The limited availability of personal protective equipment, a shortage of human resources, and logistical challenges, such as obtaining COVID-19 tests, were frequently cited as barriers to managing the pandemic. Additionally, changes in the behavior of health service seekers, particularly increased aggression, were reported. The primary motivating factor for healthcare providers was the willingness to continue providing health services, rather than financial incentives.

CONCLUSIONS

The COVID-19 pandemic presented a unique set of challenges for health systems, while also providing valuable lessons in managing a public health crisis. To effectively address future health crises, it is crucial to resolve a myriad of issues within the health system, including the inequitable distribution of human resources and logistical challenges.

The impact of COVID-19 post-infection on the cognition of adults from Peru

Introduction

The COVID-19 pandemic, with over 83 million confirmed cases and 1.8 million deaths, has raised concerns about long-term cognitive issues, especially in populations facing disparities. Despite a few years since Peru's first COVID-19 wave, the cognitive effects on adults remain unclear. This study is the first in Peru to explore COVID-19's impact on general cognition and executive function.

Methods

A retrospective cross-sectional study compared individuals with COVID-19 history to controls, assessing general cognition, verbal fluency, attention, and executive function. Among 240 assessed, 154 met the study inclusion criteria, with about 60% female and an average age of 38.89 ± 16.001 years. Groups included controls (n = 42), acute phase (AP, n = 74) (1-14 days of symptoms), and hyperinflammatory phase (HP, n = 38) (>14 days of symptoms).

Results

Significant cognitive differences were observed. The HP group exhibited lower general cognitive performance (p = 0.02), working memory (p = 0.01), and executive function (planning; p < 0.001; flexibility; p = 0.03) than controls. Those with <14 days of illness (AP vs. HP) had deficits in general cognitive performance (p = 0.02), working memory (p = 0.02), and planning (p < 0.001), mainly during the hyperinflammatory phase, showing differences in working memory (p = 0.003) and planning (p = 0.01). Gender differences emerged, with males in the HP phase having poorer working memory (p = 0.003) and planning (p = 0.01).

Discussion

This study underscores COVID-19's negative impact on cognitive function, even in mild cases, with potential heightened effects in men during acute or hyperinflammatory phases. The findings provide Peru's first evidence, highlighting the vulnerability of populations facing socioeconomic disparities.

Sociodemographic Inequalities in COVID-19 Booster Dose Vaccination Coverage: a Retrospective Study of 196 Provinces in Peru

BACKGROUND

The COVID-19 vaccination coverage shows variability in booster doses between residency areas or ethnicity. The aim of this study was to evaluate how sociodemographic conditions influence unequal vaccination coverage with booster doses against COVID-19 in Peru.

METHODS

A retrospective, ecological study with an evaluation of 196 provinces in Peru. The sociodemographic conditions were evaluated as sources of inequality (sex, age group, educational level, residence area, and ethnic group). The inequality measure used was the GINI, an index that show the inequal vaccination coverage with third and fourth booster doses against COVID-19 in Peruvians provinces. The index allow determinate a higher inequality when the value is near to 1, and a lower inequality when the value is near to 0. Also, the impact of each sociodemographic condition in the general inequality was evaluate with a decomposition analysis of GINI coefficient into Sk (composition effect), Gk (redistribution effect), Rk (differential effect).

RESULTS

In provinces evaluated the mean vaccine coverage for the third and fourth booster doses was 57.00% and 22.19%, respectively at twelve months since the beginning of vaccination campaign. The GINI coefficient was 0.33 and 0.31, for the third and fourth booster doses coverage, respectively. In the decomposition analysis, twelve months after the start of the third and fourth dose vaccination campaign, revealed higher Sk values for people living in rural areas (Sk = 0.94 vs. Sk = 2.39, respectively for third and fourth dose), while higher Gk values for Aymara (Gk = 0.92 vs. Gk = 0.92, respectively), Quechua (Gk = 0.53 vs. Gk = 0.53, respectively), and Afro-Peruvians (Gk = 0.61 vs. Gk = 0.61, respectively). Also, higher negative correlation in Rk values for people with elementary education (Rk=-0.43 vs. Rk=-0.33, respectively), aged between 15 and 19 years (Rk=-0.49 vs. Rk=-0.37, respectively), and Aymara (Rk=-0.51 vs. Rk=-0.66, respectively).

CONCLUSION

The rural residency area, lower education and Quechua, Aymara or Afro-Peruvians ethnicity determinated inequalities in vaccination coverage with booster doses against COVID-19 in Peruvian provinces.

Assessing the feasibility and acceptability of a diabetes-specific nurse-led multicomponent smoking cessation intervention in diabetes education: study protocol for an open-label pragmatic randomised controlled trial

INTRODUCTION

Smoking cessation is an essential, but often overlooked aspect of diabetes management. Despite the need for tailored smoking cessation support for individuals with diabetes, evidence of effective interventions for this cohort is limited. Additionally, individuals with diabetes do not easily adopt such interventions, resulting in low uptake and abstinence rates. This protocol describes a study that aims to assess the feasibility and acceptability of a unique smoking cessation intervention, based on the best evidence, theory and the needs of individuals with diabetes, among patients and service providers, the diabetes nurse educators.

METHODS AND ANALYSIS

This is an open-label pragmatic randomised controlled trial. Between 80 and 100 individuals with type 1 or type 2 diabetes who smoke will be recruited from the diabetes outpatients at the main acute public hospital in Malta, starting in August 2023. Participants will be randomly assigned (1:1 ratio) to the intervention or control arm for 12 weeks. The experimental intervention will consist of three to four smoking cessation behavioural support sessions based on the 5As (Ask, Advise, Assess, Assist and Arrange) algorithm, and a 6-week supply of nicotine replacement therapy. The control intervention will consist of an active referral to the Maltese National Health Service's one-to-one smoking cessation support service, which is based on motivational interviewing. The primary feasibility and acceptability outcomes include the recruitment and participation rates, resources used, problems identified by the nurses, the nurses' perceived challenges and facilitators to implementation and the nurses' and patients' acceptability of the study intervention. Data analyses will be descriptive, with quantitative feasibility and acceptability outcomes reported with 95% confidence intervals.

ETHICS AND DISSEMINATION

Ethical clearance was obtained from the Faculty of Health Sciences Research Ethics Committee, University of Malta. The study results will be disseminated through conference presentations and a publication in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT05920096.

An exploration of having social media influencers deliver a first-line digital intervention to improve body image among adolescent girls: A qualitative study

Social media influencers are popular among adolescents and could offer a unique way to reach young people at scale with body image interventions. This study explored girls' and influencers' views on having influencers deliver body image interventions through vlogs (video blogs) and to gain insight into their preferred format, content, and views on factors that encourage engagement with vlogs. Twenty-one UK based participants were recruited. Three online focus groups were conducted with adolescent girls (n = 16) aged 14-18 years and one with influencers (n = 5) aged 24-33 years, who had a collective following of over 1.5 million subscribers across social media platforms. Data were analysed using reflexive thematic analysis and four themes were generated: Choosing an influencer whose messages and core values are aligned with the topic of body image; the importance of influencer authenticity and personal experience; collaborating on content creation with mental health professionals; and the need for long-form (i.e., 10-20 min) content to address serious topics. Findings suggest having influencers deliver body image interventions to young people could be a useful approach. Results highlight the need to engage with end users from the outset of intervention development to increase the likelihood of intervention effectiveness and engagement.

National trends in sexual intercourse and usage of contraception among Korean adolescents

BACKGROUND

The exact influence of the COVID-19 pandemic on sexual intercourse and usage of contraception remains largely uncharted territory. To bridge this gap in knowledge, we conducted a comprehensive, cross-sectional examination of long-term trends in the prevalence of sexual intercourse and usage of contraception among South Korean adolescents from 2006 to 2022.

METHODS

In our research, we drew upon data encompassing 1,138,799 South Korean adolescents aged 12 to 18 years, derived from the Korean Youth Risk Behavior Web-based Survey (KYRBS) over a period spanning from 2006 to 2022. We focused on the prevalence of sexual intercourse, contraception utilization, and the underlying associated factors among this demographic. The KYRBS data was collected using a complex sampling strategy to determine the national prevalence estimates and shifts in prevalence before (2006-2019) and during (2020-2022) the COVID-19 pandemic era.

RESULTS

During the pre-pandemic period, a decrease in adolescent sexual intercourse was observed (6.34% in 2006, 5.53% in 2012, and 5.87% in 2019). However, in the post-pandemic period (2020-2022), there was a surge in sexual intercourse (4.55% in 2020 and 6.20% in 2022). This evident alteration in sexual intercourse trajectory between pre- and post-pandemic periods was statistically significant [βdiff, 0.950; 95% confidence interval (CI), 0.756-1.144]. Regarding contraceptive use among South Korean adolescents, there was an increase in the pre-COVID-19 pandemic phase across all demographic segments (14.61% in 2006, 22.30% in 2012, and 47.69% in 2022) but a notable decline when compared with the pre- and post-pandemic periods (βdiff, - 0.319; 95% CI, - 0.454 to - 0.184). Additionally, during the study period, a decrease in sexual intercourse was observed in the pre-pandemic period (β, - 0.129; 95% CI, - 0.148 to - 0.110), followed by an increase in the post-pandemic period (β, 0.821; 95% CI, 0.627 to 1.014). This shift is highlighted by an effect size of 0.96 [weighted odds ratio (wOR); 95% CI, 0.92 to 1.00], indicating a substantial change in adolescent sexual behaviors across study periods.

CONCLUSIONS

The increase in sexual intercourse and decrease in usage of contraception observed in our study between the pre- and post-COVID-19 periods suggests a potential threat to sexual health among South Korean adolescents. This trend emphasizes the ongoing necessity of raising awareness about adolescent sexual behavior in South Korea.

Knowledge, Attitudes, and Practices Regarding Air Pollution among Medical Students

Background: Air pollution has emerged as a global public health concern. Specifically, in Medellín, Colombia, episodes of elevated air pollution have been documented. Medical students' knowledge of air pollution is paramount for implementing future interventions directed toward patients. The aim of this research was to delineate the knowledge, attitudes, and practices regarding air pollution among medical students at a private university in Medellín. Methods: A cross-sectional study involving 352 medical students was conducted. A questionnaire was administered, generating scores ranging from 0 to 100, where a higher score signified better knowledge, attitudes, and practices. Data were analyzed using frequencies, summary measures, non-parametric tests, and linear regression. Results: In total, 31% rated the education received at the university on the relationship between health and air quality as fair to poor, and 81% perceived the air quality in the city as poor. The knowledge score was 77.8 (IQR 71.1-85.6), with 90% acknowledging that exposure to air pollution increases the risk of various diseases. The attitudes score was 82.1 (IQR 71.8-87.2), and 25.9% believed that air pollution is a multifactorial problem, rendering their actions ineffective. In terms of practices, the score was 50 (IQR 42.9-57.1), indicating that students either did not employ protective measures against pollution or used inappropriate practices such as masks or air purifiers. Regression analysis revealed no association between knowledge and practices. Conclusion: The findings of this study underscore that medical students possess commendable knowledge regarding the health effects of air pollution. However, their adoption of inappropriate practices for self-protection is evident. The lack of correlation between knowledge and practices highlights the necessity of educational initiatives to be complemented by regulatory and cultural interventions.

Prevalence of mental health symptoms and associated risk factors among healthcare workers in specialized COVID-19 hospitals in Anyang, China: A cross-sectional survey

Background

The novel coronavirus disease 2019 (COVID-19) pandemic spread worldwide and brought unprecedented challenges to healthcare systems. Healthcare workers experienced tremendous pressure and psychological issues.

Methods

A cross-sectional online survey was conducted from January 2022 to April 2022 among healthcare workers in Anyang, Henan Province, China. Insomnia, anxiety, depression, post-traumatic stress disorder (PTSD), and problematic internet use (PIU) were evaluated. Logistic regression analyses were used to explore the factors that were associated with mental health problems.

Results

A total of 242 participants (mean [SD] age, 34.7 [6.6] years, 187 female [77.3 %]) were included in the study. The prevalence of symptoms of insomnia, anxiety, depression, PTSD and PIU during the COVID-19 pandemic in China was 53.7 %, 100.0 %, 7.0 %, 20.3 %, and 19.4 %, respectively. Participants who smoked, used sedative-hypnotic drugs and may need psychological assistance were at a higher risk for mental health problems. Respondents who were older than 45 years and were married displayed a lower risk of insomnia and PTSD, respectively.

Conclusions

Mental health symptoms are pervasive among healthcare workers in specialized COVID-19 hospitals during the outbreak. Risk factors include smoking, sedative-hypnotic drug use, and the need for psychological assistance, while protective factors include age and marital status. Developing social media platforms and providing psychological assistance may be effective interventions for healthcare workers.

Pandemic preparedness improves national-level SARS-CoV-2 infection and mortality data completeness: a cross-country ecologic analysis

BACKGROUND

Heterogeneity in national SARS-CoV-2 infection surveillance capabilities may compromise global enumeration and tracking of COVID-19 cases and deaths and bias analyses of the pandemic's tolls. Taking account of heterogeneity in data completeness may thus help clarify analyses of the relationship between COVID-19 outcomes and standard preparedness measures.

METHODS

We examined country-level associations of pandemic preparedness capacities inventories, from the Global Health Security (GHS) Index and Joint External Evaluation (JEE), on SARS-CoV-2 infection and COVID-19 death data completion rates adjusted for income. Analyses were stratified by 100, 100-300, 300-500, and 500-700 days after the first reported case in each country. We subsequently reevaluated the relationship of pandemic preparedness on SARS-CoV-2 infection and age-standardized COVID-19 death rates adjusted for cross-country differentials in data completeness during the pre-vaccine era.

RESULTS

Every 10% increase in the GHS Index was associated with a 14.9% (95% confidence interval 8.34-21.8%) increase in SARS-CoV-2 infection completion rate and a 10.6% (5.91-15.4%) increase in the death completion rate during the entire observation period. Disease prevention (infections: β = 1.08 [1.05-1.10], deaths: β = 1.05 [1.04-1.07]), detection (infections: β = 1.04 [1.01-1.06], deaths: β = 1.03 [1.01-1.05]), response (infections: β = 1.06 [1.00-1.13], deaths: β = 1.05 [1.00-1.10]), health system (infections: β = 1.06 [1.03-1.10], deaths: β = 1.05 [1.03-1.07]), and risk environment (infections: β = 1.27 [1.15-1.41], deaths: β = 1.15 [1.08-1.23]) were associated with both data completeness outcomes. Effect sizes of GHS Index on infection completion (Low income: β = 1.18 [1.04-1.34], Lower Middle income: β = 1.41 [1.16-1.71]) and death completion rates (Low income: β = 1.19 [1.09-1.31], Lower Middle income: β = 1.25 [1.10-1.43]) were largest in LMICs. After adjustment for cross-country differences in data completeness, each 10% increase in the GHS Index was associated with a 13.5% (4.80-21.4%) decrease in SARS-CoV-2 infection rate at 100 days and a 9.10 (1.07-16.5%) decrease at 300 days. For age-standardized COVID-19 death rates, each 10% increase in the GHS Index was with a 15.7% (5.19-25.0%) decrease at 100 days and a 10.3% (- 0.00-19.5%) decrease at 300 days.

CONCLUSIONS

Results support the pre-pandemic hypothesis that countries with greater pandemic preparedness capacities have larger SARS-CoV-2 infection and mortality data completeness rates and lower COVID-19 disease burdens. More high-quality data of COVID-19 impact based on direct measurement are needed.

Key Determinants of COVID-19 Vaccination Take-Up in Remote Rural Areas: Evidence From Colombia

Objetives

The adoption of vaccines was a crucial factor in overcoming the COVID-19 pandemic. However, vaccination rates between rural and urban areas varied greatly. In this paper, our objective is to understand the individual and institutional factors associated with the uptake of vaccines in remote rural areas in Colombia.

Methods

We interviewed a random sample of 800 households (1,592 individuals) in remote rural areas of Antioquia (Colombia) during February 2022 when vaccinations were available. Then, we use a linear probability model to explain the uptake of the COVID-19 vaccine.

Results

The results indicate that the probability of having at least the first dose of the COVID-19 vaccine is positively associated with access to information, trust in police and army, and the perceived risk of contracting COVID-19. Trust in the church is negatively related to vaccination.

Conclusion

Institutions can play a critical role in the management of pandemics. Timely information on the risks associated with the disease and perceived riskiness are key factors that mobilize the population to take the COVID-19 vaccine.

The Risk Factors Associated with the Prevalence of Multimorbidity of Anaemia, Malaria, and Malnutrition among Children Aged 6-59 Months in Nigeria

In the last ten years, multimorbidity in children under the age of five years has become an emerging health issue in developing countries. The study of multimorbidity of anaemia, malaria, and malnutrition (MAMM) among children in Nigeria has not received significant attention. This study aims to investigate what risk factors are associated with the prevalence of multimorbidity among children aged 6 to 59 months in Nigeria. This study used two nationally representative cross-sectional surveys, the 2018 Nigeria Demographic and Health Survey and the 2018 National Human Development Report. A series of multilevel mixed-effect ordered logistic regression models were used to investigate the associations between child/parent/household variables (at level 1), community-related variables (at level 2) and area-related variables (at level 3), and the multimorbidity outcome (no disease, one disease only, two or more diseases). The results show that 48.3% (4917/10,184) of the sample of children aged 6-59 months display two or more of the disease outcomes. Being a female child, the maternal parent having completed higher education, the mother being anaemic, the household wealth quintile being in the richest category, the proportion of community wealth status being high, the region being in the south, and place of residence being rural were among the significant predictors of MAMM (p < 0.05). The prevalence of MAMM found in this study is unacceptably high. If suitable actions are not urgently taken, Nigeria's ability to actualise SDG-3 will be in grave danger. Therefore, suitable policies are necessary to pave the way for the creation/development of integrated care models to ameliorate this problem.

"It's another gay disease": an intersectional qualitative approach contextualizing the lived experiences of young gay, bisexual, and other sexual minoritized men in the United States during the mpox outbreak

BACKGROUND

The U.S. mpox outbreak in 2022 introduced new and exacerbated existing challenges that disproportionately stigmatize gay, bisexual, and other sexual minoritized men (GBSMM). This study contextualizes the perceptions, susceptibility, and lived experiences of the mpox outbreak among GBSMM in the U.S. using an intersectional framework.

METHODS

Between September 2022 to February 2023, we conducted 33 semi-structured qualitative interviews with purposively sampled GBSMM in the Northeast and the South region of the United States on various aspects related to their experience during the mpox outbreak.

RESULTS

We identified four themes: (1) understanding and conceptualizations of mpox, (2) mpox vaccine availability and accessibility, (3) mpox vaccine hesitancy and mistrust, and (4) call to action and recommendations. GBSMM collectively discussed the elevated mpox stigmatization and homophobic discourse from mainstream social media and news outlets. GBSMM also discussed the lack of availability of mpox vaccines, unclear procedures to receive the vaccine, and continued mistrust in government, non-government, and other institutions of health that were complicit in anti-LGBTQ + narratives related to mpox. However, they expressed that these challenges may be addressed through more LGTBQ + representation and leveraging ways to empower these communities.

CONCLUSION

GBSMM have mpox experiences that are distinct and multifaceted. Effectively addressing mpox and mitigating public health emergencies for GBSMM requires prioritizing destigmatizing communication channels and vaccine distribution strategies by centering their stories and lived experiences to advance health equity.

Transforming adolescent menstrual health through policy: the role of value added tax exemptions in improving access to sanitary products

In Namibia, the Value Added Tax (VAT) Amendment Act 2022, which reclassified the supply of sanitary pads as zero-rated, has significant implications for adolescent girls' menstrual health and education. The policy change responds to the need to address period poverty by making essential menstrual products more accessible and affordable. Menstruation is a normal biological process, and access to sanitary products is a human right. Taxing menstrual products reinforces gender inequalities and raises concerns about the basic rights and dignity of women and girls. The VAT-free policy creates a system to reduce the financial burden on girls and women, making it easier for them to manage their periods safely and with dignity. It has the potential to reduce absenteeism from school, ultimately improving educational outcomes for adolescent girls. However, VAT exemptions alone are insufficient to address the broader accessibility issues that impact menstrual hygiene. Evidence-based policies that focus on the availability and affordability of a full range of sanitary products, in conjunction with regulatory mechanisms for price and quality control, are necessary to ensure that menstrual products are safe, affordable, and accessible for all.

Public health partnerships with faith-based organizations to support vaccination uptake among minoritized communities: A scoping review

Faith-based vaccine initiatives are of growing interest to public health agencies who are looking to increase vaccine confidence among ethnoracially minoritized populations. Despite evidence that support faith-based organizations' (FBOs) partnerships with public health agencies (PHAs) to increase vaccine confidence, reviews on the scope and efforts to ensure equitable vaccination delivery for ethnoracially minoritized populations are scarce. We aimed to understand how public health agencies collaborate with FBOs or faith communities to improve vaccine confidence among minoritized communities in high-, low- and middle- income countries. We conducted a scoping review by searching OVID MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, and PROQUEST from 2011 to 2023. We included case studies, news reports, observational studies, experimental, and quasi-experimental studies and multimedia content that describes PHA-FBO partnerships that created vaccine initiatives for marginalized and minoritized communities. The data was extracted, summarized, and results were described narratively. We included 167 initiatives reported in 160 publications; 83.8% of the included articles were published between 2019 to 2023. The interventions carried out by PHA-FBO partnerships attempted to increase vaccine uptake using any or all the following methods. First, the initiatives provided digital and in-person platforms for interfaith learning and established training programs to empower faith leaders to become vaccine ambassadors. Second, the initiatives designed and disseminated education and awareness materials that aimed to be sensitive to religious and gender norms. Third, PHA-FBO partnered to apply equity and faith-based frameworks and provided wrap-around support to enable equitable vaccine access. Majority of the initiatives reported that PHA-FBO partnerships improved vaccine confidence and uptake (71.3%). About 22.2% of the initiatives reported quantitative outcomes post-intervention. PHA-FBO initiatives over the past decade increased vaccine uptake and acceptance among diverse ethnoracially minoritized populations. Reporting of faith-based initiatives are subject to publication bias and can be strengthened by examining more evaluation studies and establishment of key outcome indicators to critically appraise intervention outcomes.

Sleep Habits and Disturbances Among Tunisian Adults: A Cross-Sectional Online Survey

Background

Sleep quality and disturbances have gained heightened scholarly attention due to their well-established association with both mental and physical health. This study aims to assess sleep-wake habits and disturbances in Tunisian adults.

Methodology

This cross-sectional study employed an online questionnaire to assess 3074 adults ≥ 18 years. Primary outcomes, including sleep quality, daytime vigilance, mood, and subjective well-being, were measured using validated questionnaires [the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), the Patient Health Questionnaire (PHQ)-9, and the World Health Organisation-Five Well-Being Index (WHO-5)].

Results

Less than two-thirds (n= 1941; 63.1%) of participants were females and the mean age was 36.25±13.56. The prevalence of poor sleep quality was 53.8% when defined as a PSQI > 5. The prevalence of insomnia, short sleep duration, long sleep duration, EDS, severe depression, and poor well-being were 14.5%, 34.7%, 12.3%, 32.4%, 7.4%, and 40.2%, respectively. Some factors were associated with an increased likelihood of poor sleep quality, including female gender, chronic hypnotics use, internet use close to bedtime, daily time spent on the internet >3 hours, smoking, university- level education, nocturnal work, severe depression, impaired well-being status, insomnia, and EDS.

Conclusion

The high prevalence of sleep-wake disturbances among Tunisian adults emphasizes the need for an appropriate screening strategy for high-risk groups. Individuals with unhealthy habits and routines were significantly more likely to experience these kinds of disturbances. Consequently, there is a pressing need for educational programs on sleep to foster healthier sleep patterns.

Climate Communication, Public Health, and Social Media: Examining the Role of Health Agencies in Addressing the Impacts of Climate Change on Human Health

The impacts of climate change on human health are a critical public health concern, with previous studies highlighting its clear effects on well-being. Understanding how state and territorial health agencies (STHAs) are addressing these emerging risks is important. This study conducted 26 in-depth interviews across the U.S. to explore the perceptions and communication strategies of STHA officials regarding climate change's impact on human health. Additionally, the study sought to identify the primary challenges faced by these officials to effectively communicate the impacts. Thematic analysis of the data revealed three major themes: community building and coalitions, climate denialism on social media, and misinformation about climate change and its effects on human health. These findings offer valuable insights for climate change and public health communication. The importance of the STHAs' development of technical and informational capacity to effectively communicate climate-related risks and threats is emphasized.

Preferences for Follow-Up Procedures among Patients Lost to Follow-Up after Smoking Cessation Intervention among Therapists-An Interview Study

Achieving high follow-up rates after smoking cessation interventions (SCIs) is a general challenge. The aim of this study was to identify preferences among patients and therapists for improving follow-up rates and to assess smoking status at 6 months among patients lost to follow-up. From the Danish STOPbase for Tobacco and Nicotine, which collects data on SCI across health care, 20 representative patients lost to follow-up by routine procedures were identified together with 11 therapists. All participated in individual semi-structured phone interviews, which for patients also included 6-month smoking status. Deductive and inductive analyses were performed. Four themes emerged from the analyses with several subthemes, all regarding contacts. Both patients and therapists preferred to intensify the follow-up process by boosting it with additional attempts and using voice messages, e-mail and/or SMS, calling at specified times of the day and avoiding calls from unknown numbers. In addition, some patients mentioned that they were busy or were not carrying their mobile devices at the time of a call as a barrier. Some therapists mentioned that barriers could include an expectation of relapse, but also a poor mental state, the time of day and patient fear of public systems. Among the patients originally lost to follow-up, 35% (95% CI 16%-59%) experienced continuous smoking cessation for 6 months, and the overall national rate was 22% (21.6-23.3%). In conclusion, both patients and therapists preferred intensified follow-up. The 6-month smoking status for patients lost to follow-up seemed to be similar to that of the routinely followed-up patients. These findings will be examined experimentally in a larger study.

Core health system measures response to COVID-19 among East Asian countries

Objective

The purpose of this study is to summarize the health system response to COVID-19 in four East Asian countries, analyze the effectiveness of their health system response, and provide lessons for other countries to control the epidemic and optimize their health system response.

Methods

This study investigated and summarized COVID-19 data and health system response in four East Asian countries, China, Japan, Mongolia, and South Korea from national governments and ministries of health, WHO country offices, and official websites of international organizations, to assess the effectiveness of health system measures.

Result

As of June 30, 2022, all four countries are in a declining portion of COVID-19. China has two waves, and new cases increased slowly, with the total cases per million remaining within 4, indicating a low level. Japan has experienced six waves, with case growth at an all-time high, total cases per million of 250.994. Mongolia started the epidemic later, but also experienced four waves, with total cases per million of 632.658, the highest of the four countries. South Korea has seen an increasing number of new cases per wave, with a total case per million of 473.759.

Conclusion

In containment strategies adopted by China and Mongolia, and mitigation strategies adopted by Japan and South Korea, health systems have played important roles in COVID-19 prevention and control. While promoting vaccination, countries should pay attention to non-pharmaceutical health system measures, as evidenced by: focusing on public information campaigns to lead public minds; strengthening detection capabilities for early detection and identification; using technical ways to participate in contact tracing, and promoting precise judging isolation.

Cannabis use in Parkinson's disease: Patient access to medical cannabis and physician perspective on product safety

The rate of medical cannabis use has increased in parallel with the number of states legalizing its use. Parkinson's disease (PD) patients are of particular concern due to their higher cannabis use rate than in the general US population (25-40 % PD patient cannabis users vs. ∼18 % in the general population), as well as their susceptibility to environmental contaminants in cannabis, including pesticides, toxic elements, solvents, microbes, and mycotoxins. In order to address the complex nature of this industry, we examined the changes in PD-related qualifying conditions in the U.S. from 2019 to 2023. We also conducted an online survey to gain insight into the knowledge, risk perceptions, and opinions regarding medical cannabis and contamination issues from physicians who treated PD patients. The number of states including PD-related qualifying conditions increased over the past 5 years from 28 to 36 states. These conditions included PD (increasing from 14 to 16 states), muscle spasms (14 to 24), anxiety (1 to 5), and pain (17 to 35). State-by-state comparisons revealed high variability in the language used to describe the different qualifying conditions. Online surveys were sent out to 45 neurologists and movement disorder specialists who primarily treated PD patients. The response rate was 44 % from nine states (AZ, CA, FL, MA, MN, WI, PA, IL, and NM). When asked if they were aware of any contaminants in cannabis products, we found that 65 % of the physicians were unaware of any contaminants commonly found in cannabis and only 25 %, 15 %, and 15 % of them were aware of pesticide, toxic element, and solvent contaminants, respectively. In their free-text opinion response on the health impact of cannabis-borne contaminants, "long-term effect" (35 %) and "comorbidities and PD prognosis" (40 %) were identified as the two most common themes. These results point to the need for further regulatory deliberation regarding risks and susceptibility to cannabis contaminants. Additionally, education is needed to inform physicians on cannabis safety issues. Further research will identify the implementation strategies to reduce contaminant exposure and protect patient health.