Previne brasil e financiamento da atenção primária: facilidades e dificuldades de gestores municipais de saúde / Previne Brasil and primary care financing: facilities and difficulties for municipal health managers / Previne Brasil y financiamiento de la atención primaria: facilidades y dificultades para los gestores municipales de salud

Objetivo: compreender as facilidades e dificuldades enfrentadas por gestores municipais de saúde com o novo modelo de financiamento da Atenção Primária à Saúde. Método: estudo qualitativo, tipo Pesquisa Convergente Assistencial, fundamentado na Política Nacional de Atenção Básica. Participaram 77 gestores ou seus representantes, de 47 municípios de uma Macrorregião de saúde de Santa Catarina, Brasil. Foram realizadas três oficinas nas Gerências Regionais de Saúde, em agosto e setembro de 2022. Os dados foram analisados pela análise de conteúdo. Resultados: apresentam-se como facilidades do Previne Brasil informatização, comprometimento dos profissionais, e qualificação do cuidado. Foram descritas como dificuldades falta de informações, sistema informatizado e denominador estimado e, equipe de trabalho. Conclusão: o programa apresenta facilidades que qualificam o processo de trabalho e cuidado à saúde da população. Contudo, persistem dificuldades que devem ser consideradas pela gestão municipal para avanços na atenção integral e no financiamento da Atenção Primária à Saúde.

Objective: understand the facilities and difficulties faced by municipal health managers with the new Primary Health Care financing model. Method: this is a qualitative study, of the Convergent Care Research type, based on the National Primary Care Policy. The participants were 77 managers or their representatives from 47 municipalities in a health Macroregion in Santa Catarina, Brazil. Three workshops were held in the Regional Health Departments in August and September 2022. The data was analyzed using content analysis. Results: Previne Brasil's facilities include computerization, commitment of professionals, and qualification of care. Difficulties were described as lack of information, computerized system and estimated denominator, and work team. Conclusion: the program offers facilities that improve the work process and health care for the population. However, there are still difficulties that must be considered by municipal management in order to make progress in comprehensive care and Primary Health Care financing.

Objetivo: comprender las facilidades y dificultades que enfrentan los gestores municipales de salud con el nuevo modelo de financiamiento de la Atención Primaria de Salud. Método: estudio cualitativo, tipo Investigación Convergente Asistencial, basado en la Política Nacional de Atención Primaria. Participaron 77 gestores o sus representantes, de 47 municipios de una Macrorregión de salud de Santa Catarina, Brasil. Se realizaron tres talleres en las Gerencias Regionales de Salud, en agosto y septiembre de 2022. Los datos fueron analizados mediante análisis de contenido. Resultados: las instalaciones de Previne Brasil incluyen informatización, compromiso de los profesionales y calificación de la atención. Las dificultades fueron descritas como falta de información, sistema informatizado y denominador estimado y equipo de trabajo. Conclusión: el programa presenta facilidades que cualifican el proceso de trabajo y la atención de la salud de la población. Sin embargo, aún hay dificultades que la gestión municipal debe considerar para lograr avances en la atención integral y el financiamiento de la Atención Primaria de Salud.

Empoderamento estrutural: potencializando as competências dos enfermeiros de um hospital de alta complexidade / Structural empowerment: enhancing the skills of nurses in a high-complexity hospital / Empoderamiento estructural: potenciar las competencias de los enfermeros en un hospital de alta complejidad

Objetivo: analisar o empoderamento estrutural de enfermeiros em um hospital de alta complexidade. Métodos: estudo quantitativo, analítico e transversal, realizado com 93 enfermeiros, utilizando um questionário sociodemográfico e ocupacional e o Questionário de Condições de Eficácia no Trabalho II. Os dados foram coletados entre fevereiro e março de 2023. A análise dos dados deu-se por meio de estatística descritiva, teste de Kolgomorov-Smirnov, teste do qui-quadrado e regressão de Poisson. Resultados: os enfermeiros apresentaram nível moderado de empoderamento estrutural, com média de 20,67 (p<0,000). O componente mais pontuado foi a oportunidade (4,22 dp±0,80). Não foram encontradas diferenças significativas nos níveis de empoderamento estrutural relacionadas às unidades de trabalho (p-Valor 0,381), vínculo empregatício (p-Valor 0,352) e grau de instrução (p-Valor 0,839). O modelo de regressão de Poisson indica que tanto pode haver altos ou baixos níveis de empoderamento a depender do setor. Conclusão: os enfermeiros demonstraram possuir níveis moderados de empoderamento estrutural.

Objective: to analyze the structural empowerment of nurses in a high-complexity hospital. Methods: a quantitative, analytical, cross-sectional study was carried out with 93 nurses, using a sociodemographic and occupational questionnaire and the Questionnaire of Conditions of Effectiveness at Work II. The data was collected between February and March 2023. The data was analyzed using descriptive statistics, the Kolgomorov-Smirnov test, the chi-square test, and Poisson regression. Results: the nurses had a moderate structural empowerment level, with a mean of 20.67 (p<0.000). The highest scoring component was opportunity (4.22 sd±0.80). No significant differences were found in the structural empowerment levels related to work units (p-Value 0.381), employment relationship (p-Value 0.352) and education level (p-Value 0.839). The Poisson regression model indicates that there can be either high or low empowerment levels depending on the sector. Conclusion: nurses showed moderate structural empowerment levels.

Objetivo: analizar el empoderamiento estructural del enfermero en un hospital de alta complejidad. Métodos: estudio cuantitativo, analítico y transversal, realizado con 93 enfermeros, utilizando un cuestionario sociodemográfico y ocupacional y el Cuestionario de Condiciones de Efectividad en el Trabajo II. Los datos se recolectaron entre febrero y marzo de 2023. El análisis de los datos se realizó mediante estadística descriptiva, prueba de Kolgomorov-Smirnov, prueba de chi-cuadrado y regresión de Poisson. Resultados: los enfermeros presentaron un nivel moderado de empoderamiento estructural, la media fue de 20,67 (p<0,000). El componente con mayor puntaje fue oportunidad (4,22 DE±0,80). No se encontraron diferencias significativas en los niveles de empoderamiento estructural relacionados con las unidades de trabajo (valor p 0,381), la relación laboral (valor p 0,352) y el nivel de formación (valor p 0,839). El modelo de regresión de Poisson indica que pueden existir niveles altos o bajos de empoderamiento dependiendo del sector. Conclusión: los enfermeros demostraron niveles moderados de empoderamiento estructural.

Fully Integrated Biosensing System for Dynamic Monitoring of Sweat Glucose and Real-Time pH Adjustment Based on 3D Graphene MXene Aerogel.

The development of noninvasive glucose sensors capable of continuous monitoring without restricting user mobility is crucial, particularly for managing diabetes, which demands consistent and long-term observation. Traditional sensors often face challenges with accuracy and stability that curtail their practical applications. To address these issues, we have innovatively applied a three-dimensional porous aerogel composed of Ti3C2Tx MXene and reduced graphene oxide (MX-rGO) in electrochemical sensing. It significantly reduces the electron-transfer distance between the enzyme's redox center and the electrode surface while firmly anchoring the enzyme layer to effectively prevent any leakage. Another pivotal advancement in our study is the integration of the sensor with a real-time adaptive calibration mechanism tailored specifically for analyzing sweat glucose. This sensor not only measures glucose levels but also dynamically monitors and adjusts to pH fluctuations in sweat. Such capabilities ensure the precise delivery of physiological data during physical activities, providing strong support for personalized health management.

New progress in pediatric allergic rhinitis.

The prevalence of allergic rhinitis (AR) in children is steadily increasing, and its onset is closely associated with genetic factors, living environment, and exposure to allergens. In recent years, an increasing number of diagnostic methods have been employed to assist in diagnosing AR. In addition to pharmaceutical treatments, personalized approaches such as environmental control and allergen-specific immunotherapy are gradually gaining popularity. In this article, we reviewed recent research on the etiology, diagnostic classification, treatment methods, and health management of AR in children. These insights will benefit the implementation of personalized diagnosis and treatment for children with AR, promoting health management strategies that improve symptoms and quality of life.

Comprehensive Assessment of Dermatologic and Dysmorphic Manifestations in Patients With Down Syndrome.

BACKGROUND: Down syndrome (DS), a common chromosomal anomaly caused by trisomy of chromosome 21, is characterized by a broad spectrum of phenotypic characteristics across multiple organ systems, including cardiac defects and leukemia. Dermatological findings are prevalent among individuals with DS; however, these issues are frequently underrecognized and inadequately researched, resulting in a significant gap in the provision of comprehensive healthcare strategies. Given the increased life expectancy of patients with DS and delayed manifestation of many dermatoses, physicians are increasingly encountering dermatological findings in this population. OBJECTIVE: This study aimed to assess the prevalence and types of dermatological findings in individuals with DS, compare them with those in a control group, and emphasize the necessity of incorporating dermatological evaluations into routine health monitoring. METHODS: This prospective cross-sectional study was conducted from June 2023 to June 2024 and involved 100 genetically confirmed individuals with DS and 100 age- and sex-matched controls. Comprehensive demographic, clinical, and karyotype data were collected for the DS group, and all the participants underwent detailed morphological evaluations. RESULTS: The DS group had a mean age of approximately 6.37 years, whereas the controls were around 7 years old, with no significant differences in age or sex distribution between the groups. Karyotype analysis showed that trisomy 21 was present in 92% of the cases, mosaicism in 6%, and translocation in 2%. Common dermatological findings in the DS group included xerosis cutis (49%), thin and sparse hair (48%), dental caries (34%), delayed tooth eruption (28%), nail dystrophy (25%), fissured tongue (23%), and cheilitis (18%). Significant differences were noted in the prevalence of scabies, bacterial infections, and café au lait macules between the DS and control groups (p < 0.01). Dysmorphic findings in the DS group included epicanthal folds (97%), upslanted palpebral fissures (97%), brachycephaly (91%), and single transverse palmar crease (89%). Significant gender differences were noted in the prevalence of brachycephaly and the sandal gap (p < 0.01). CONCLUSIONS: This study highlights the importance of regular dermatological care in enhancing the health management and quality of life of individuals with DS due to the prevalence and variability of dermatological conditions.

A model of prevention of mother-to-child transmission and health management team for improving adverse outcomes of pregnancy syphilis in Ningxia, China.

Regional variations exist in the implementation of Syphilis Mother-to-Child Transmission Prevention (PMTCT). Thus, it is crucial to assess the effectiveness of this model in the Ningxia region and explore the supplementary role of Health Management Teams (HMT). This study established the PMTCT + HMT model and examined its impact on adverse outcomes in pregnant women with syphilis infection. The majority of participants were urban residents, married, had a minimum high school education, and held public positions; 36.7% and 26.7% were from minority ethnic groups. The PMTCT + HMT model enhanced participants' knowledge, rates of voluntary counseling, and testing. The incidence of adverse pregnancy outcomes (miscarriages, preterm births, stillbirths) significantly decreased, and adverse neonatal outcomes (low birth weight, neonatal mortality, congenital syphilis) were notably reduced. Simultaneously, we identified factors associated with adverse outcomes, including non-residency, unmarried status, lower educational attainment, minority ethnicity, primary syphilis, and positive titers. Thus, HMT may be an effective intervention to enhance the effect of PMTCT for syphilis. The unique population structure in Ningxia is closely linked to adverse outcomes, highlighting the significance of providing equitable treatment for vulnerable populations.

Usefulness of noninvasive blood pressure measurement in captive Red Panda (Ailurus fulgens).

The red panda (Ailurus fulgens) can be found in zoos around the world, and various behavioral restraint procedures are used as part of their health care. Wild animals that are kept in zoos, including red pandas, are known to have a longer life span than those in the wild. Therefore, the health management of aging animals is considered especially important for zoos that maintain many precious wild animals. Blood pressure measurement is important for determining cardiovascular dynamics, however there are no reports of blood pressure measurements performed in red pandas without anesthesia. In this study, we measured blood pressure in four red pandas, over 4 years to establish a blood pressure measurement method using behavioral restraints. As a result, the blood pressure of red pandas was found to be similar to that of dogs and cats. In addition, in one case of red panda that evaluated high blood pressure during the measurement period, we added the antihypertensive drug and showed good effect for improvement of hypertension on long- term monitoring. Blood pressure values obtained using noninvasive methods were useful for red pandas. Moreover, these data were considered important for animal welfare.

A method for predicting remaining useful life using enhanced Savitzky-Golay filter and improved deep learning framework.

Ensuring operational integrity in large-scale equipment hinges on effective fault prediction and health management. Prognostics and health management (PHM) face the challenge of accurately predicting remaining useful life (RUL) using multivariate sensor data. Traditional methods often require extensive prior knowledge for indicator construction and processing. Deep learning offers a promising alternative. This study presents a multi-channel multi-scale deep learning approach. Initially, an improved Savitzky‒Golay filter (ISG) addresses challenges posed by large and rapidly changing data volumes, enhancing data preprocessing. Subsequently, a framework integrates convolutional neural networks (CNNs) with long short-term memory (LSTM) to capture hierarchical signal information and make integrated predictions. The CNN extracts spatial features from multi-channel input data, while the LSTM captures temporal dependencies. By fusing outputs from both components, the framework enhances predictive accuracy and robustness for complex operational datasets. Experimental validation on the C-MAPSS dataset tests various fusion methods and CNN depths, determining parameters and evaluating filtering effectiveness. Comparative analyses show promising performance, particularly under dynamic conditions. While not optimal for predicting multiple fault types, it outperforms classical algorithms, especially in single fault type prediction tasks.

Subjective learning gain from a simulation-based health management course: a mixed methods study.

Objectives: Simulations are increasingly being offered as part of the educational experience of healthcare students. We used a Health Management Scenario Simulation system to create a course. This study aimed to evaluate learning gains before and after the course. Methods: Based on the learning strategies of framing, simulation, and debriefing, the Health Management Scenario Simulation course lasted 4 weeks and was conducted online. Learning gain was assessed using a comparative self-assessment questionnaire administered electronically at the beginning and end of the course. We organized focus group interviews and collected quantitative data after students completed the simulations and the questionnaire. These data were subjected to descriptive statistical analysis and thematic grouping using frequency counting. Results: There were 195 health management students enrolled in the course. In total, 265 anonymously completed questionnaires were received, 141 (72.31%) on the pre-simulation and 124 (63.59%) on the post-simulation. All questionnaire item gain values were positive, except the item "I can identify common health risk factors," which showed no change. The skills domain showed the highest learning gain, ranging from 16 to 22%. Six students participated in the focus-group study. The main themes that emerged from students' reflections were learner-centeredness, competencies, and career development. Conclusion: Students acquired health management skills through the simulation, which contributed to the development of basic attitudes and skills in their professional careers. Students' comments highlighted the value of practicing health management skills in a simulated environment.

Addressing Worker Safety and Health Through the Lens of Strategic Enforcement-Part 2.

Ensuring the safety and health of workers in this country, who are employed at millions of workplaces presenting a dizzying array of hazards, is beyond daunting. And yet, it is exceptionally important, because the lives and well-being of countless workers, and their families, hang in the balance. Every day, workers are maimed or die of their workplace injuries or occupational illnesses. These outcomes are unacceptable. Agencies must use all the means at their disposal to keep workers safe and healthy in their workplaces. This paper addresses this challenge through the lens of strategic enforcement, with the goal of maximizing enforcement effectiveness to save lives and limbs.First, we examine how, under the Occupational Safety and Health Act, federal and state enforcement schemes are designed to interact. Next, we dive into the impressive array of strategic enforcement tools that are available to federal, state, and local enforcers, and we observe that many of them are either unrecognized or underutilized. We emphasize that these are all significant, because, given our limited enforcement resources, we need to use every tool we can muster-from strategic targeting, to enterprise-wide enforcement, to heightening deterrence through more robust penalty assessments and publicity, to valuing and making the most of partnerships and coenforcement efforts with a wide range of organizations and agencies. And we need to engage in a process of continual evaluation and improvement of our tools and assets, always striving to maximize our enforcement leverage in aid of worker safety and health. Finally, we examine an impressive list of initiatives state and local governments have taken, beyond what the OSH Act mandates, in their efforts to go the extra mile for the safety of the workers in their states and cities. These examples are intended to inspire federal, state and local agencies to do the same, or, hopefully, even better. The stakes are high. Workers deserve to work in safe and healthy environments. This paper is intended to provide practical ways in which state and local agencies can better-and potentially far better-satisfy that obligation.

The preventive health management self-efficacy related to preterm labor scale in reproductive-aged women: Validation of Turkish reliability and factor structure.

AIM: This study aims to test and adapt the Turkish psychometric properties of the preventive health management self-efficacy related to premature labor (PHMSE-PL) scale for women of reproductive age. METHODS: The study follows a methodological approach. The original scale comprises 34 items distributed across 5 subscales and is structured on a five-point Likert scale. The study sample consisted of 351 women aged 19 to 49, all without any physical or mental disabilities, irrespective of marital status or pregnancy status. Exclusion criteria encompassed women engaged in healthcare professions such as medical faculty, nursing, or midwifery, as well as those with a history of preterm birth during pregnancy. RESULTS: During the validity assessment of the scale, language, content, and construct validity were scrutinized. In the reliability phase, internal consistency and stability over time -analyses were conducted. Following confirmation of language validity, all items achieved a content validity index value exceeding 0.80. Exploratory and confirmatory factor analyses were employed to assess structural validity, revealing that the scale retained its original grouping into five sub-factors. These factors collectively accounted for 81.5% of the variance. The Cronbach's alpha coefficient for the entire scale reached 0.98, indicating high internal consistency. Test-retest analyses yielded a correlation coefficient of 0.99 between overall scale scores, demonstrating excellent consistency between the two measurement measurements. CONCLUSIONS: The PHMSE-PL scale adapted to Turkish culture demonstrated high levels of validity and reliability.

Socioeconomic status and depression in later life: longitudinal mediation effects of activities of daily living.

BACKGROUND: Socioeconomic status (SES) is associated with both depression and activities of daily living (ADL and IADL). However, the role of ADL as a biological mechanism in the relationship between SES and late-life depression, examined through longitudinal data, remains understudied. This study explored the longitudinal mediation effects of basic ADL or IADL on the SES-depression link in older adults. METHODS: Data from the China Health and Retirement Longitudinal Study (N = 4104) were utilized. Mediation analysis was performed using parallel process latent growth curve modeling. RESULTS: The average age of participants was 57.76 years, and 55.7% being females. Significant linear growth over time was observed in ADL, IADL, and depression. Adjusting for covariates, SES was positively linked to the initial levels (intercepts) of ADL (ßiADL=-0.100[-0.143, -0.057]), IADL (ßiIADL=-0.140[-0.185, -0.095]), and depression (ßiDEP=-0.103[-0.158, -0.048]). However, SES showed no significant correlation with the rate of change (slopes) in ADL, IADL, or depression (P > 0.05). The intercepts of ADL (ßiDEP = 0.566[0.503, 0.629]) and IADL (ßiDEP = 0.607[0.544, 0.670]) were positively correlated with the depression intercept but negatively with the depression slope. Conversely, the slopes of ADL and IADL were positively associated with the depression slope. These results suggest a negative indirect relationship between SES and the initial level of depression, but a positive indirect relationship with the rate of increase in depression through ADL (or IADL) intercept. CONCLUSIONS: Higher SES is associated with a lower initial risk of depression and ADL difficulties. However, this same higher SES may relate to a faster increase in ADL difficulties and depression among middle-aged and older adults. The findings underscore the need for increased governmental healthcare funding and improved healthcare accessibility. Additionally, maintaining adequate sleep and physical activity can help prevent disability and reduce depression risk later in life, particularly among older adults with lower SES.

Management of Patients with Colorectal Cancer through Fast-Track Surgery.

Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women globally. CRC is considered a priority public health issue due to its incidence and the high associated costs. Surgery is the predominant therapeutic approach for CRC. Given the involvement of the intestinal tract in the surgical process, there is a significant increase in postoperative morbidity rates, and the average length of hospital stay (LOS) tends to lengthen. In this research, we employed the Lean Six Sigma (LSS) methodology, specifically utilizing the DMAIC cycle, to identify and subsequently examine the effects of fast-track surgery on hospitalization times for interventions related to CRC at the AORN "Antonio Cardarelli" Hospital in Naples (Italy). The process analysis, guided by the DMAIC cycle, facilitated a reduction in the median LOS from 14 days to 12 days. The most notable improvement was observed in the 66-75 age group without comorbidities. The LSS approach provides methodological rigor, as previously recognized, enabling substantial enhancements to the process. This involves standardizing outcomes, minimizing variability, and achieving an overall reduction in the LOS from 14 to 12 days.

Tailoring molecularly imprinted polymer on titanium-multiwalled carbon nanotube functionalized gold electrode for enhanced chlorophyll determination in microalgae health assessment.

A unique method for determining chlorophyll content in microalgae is devised employing a gold interdigitated electrode (G-IDE) with a 10-µm gap, augmented by a nano-molecularly imprinted polymer (nano-MIP) and a titanium dioxide/multiwalled carbon nanotube (TiO2/MWCNT) nanocomposite. The nano-MIP, produced using chlorophyll template voids, successfully trapped chlorophyll, while the TiO2/MWCNT nanocomposite, synthesized by the sol-gel technique, exhibited a consistent distribution and anatase crystalline structure. The rebinding of procured chlorophyll powder, which was used as a template for nano-MIP synthesis, was identified with a high determination coefficient (R2 = 0.9857). By combining the TiO2/MWCNT nanocomposite with nano-MIP, the G-IDE sensing method achieved a slightly better R2 value of 0.9892 for detecting chlorophyll in microalgae. The presented G-IDE sensor showed a significant threefold enhancement in chlorophyll detection compared with commercially available chlorophyll powder. It had a detection limit of 0.917 mL (v/v) and a linear range that spanned from 10-6 to 1 mL. The effectiveness of the sensor in detecting chlorophyll in microalgae was confirmed through validation of its repeatability and reusability.

Development Trends and Prospects of Technology-Based Solutions for Health Challenges in Aging Over the Past 25 Years: Bibliometric Analysis.

BACKGROUND: As the global population ages, we witness a broad scientific and technological revolution tailored to meet the health challenges of older adults. Over the past 25 years, technological innovations, ranging from advanced medical devices to user-friendly mobile apps, are transforming the way we address these challenges, offering new avenues to enhance the quality of life and well-being of the aging demographic. OBJECTIVE: This study aimed to systematically review the development trends in technology for managing and caring for the health of older adults over the past 25 years and to project future development prospects. METHODS: We conducted a comprehensive bibliometric analysis of literatures related to technology-based solutions for health challenges in aging, published up to March 18, 2024. The search was performed using the Web of Science Core Collection, covering a span from 1999 to 2024. Our search strategy was designed to capture a broad spectrum of terms associated with aging, health challenges specific to older adults, and technological interventions. RESULTS: A total of 1133 publications were found in the Web of Science Core Collection. The publication trend over these 25 years showed a gradual but fluctuating increase. The United States was the most productive country and participated in international collaboration most frequently. The predominant keywords identified through this analysis included "dementia," "telemedicine," "older-adults," "telehealth," and "care." The keywords with citation bursts included "telemedicine" and "digital health." CONCLUSIONS: The scientific and technological revolution has significantly improved older adult health management, particularly in chronic disease monitoring, mobility, and social connectivity. The momentum for innovation continues to build, with future research likely to focus on predictive analytics and personalized health care solutions, further enhancing older adults' independence and quality of life.

Pharmacist Use of a Population Management Dashboard for Safe Anticoagulant Prescribing: Evaluation of a Nationwide Implementation Effort.

BACKGROUND: Direct oral anticoagulants (DOACs) have complex dosing regimens and are often incorrectly prescribed. We evaluated a nationwide DOAC population management dashboard rollout whose purpose includes pharmacist review and correction of off-label dosing prescriptions. METHODS AND RESULTS: Using data from Veterans Health Affairs, we identified all patients prescribed DOACs for atrial fibrillation or venous thromboembolism between August 2015 and December 2019. Sites were grouped on the basis of the timing of moderate-high usage of the DOAC population management tool dashboard. Effectiveness was defined as the monthly rate of off-label DOAC prescribing and the rate of clinical adverse events (bleeding, composite of stroke or venous thromboembolism). Implementation was evaluated as the percentage of off-label DOAC prescriptions changed within 7 days. Among the 128 652 patients receiving DOAC therapy at 123 centers, between 6.9% and 8.6% had off-label DOAC prescriptions. Adoption of the DOAC population management tool dashboard before July 2018 was associated with a decline in off-label dosing prescriptions (8.7%-7.6%). Only 1 group demonstrated a significant reduction in monthly rates of bleeding following implementation. All sites experienced a reduction in the composite of venous thromboembolism or stroke following dashboard adoption. There was no difference in the implementation outcome of DOAC prescription change within 7 days in any of the adoption groups. CONCLUSIONS: Early adoption of the DOAC population management tool dashboard was associated with decreased rates of off-label DOAC dosing prescription and reduced bleeding. Following adoption of the DOAC population management tool dashboard, all sites experienced reductions in venous thromboembolism and stroke events.

Piloting the Inclusion of the Key Populations Unique Identifier Code in the South African Routine Health Information Management System: Protocol for a Multiphased Study.

BACKGROUND: The global community has set an ambitious goal to end HIV/AIDS as a public health threat by 2030. Significant progress has been achieved in pursuing these objectives; however, concerns remain regarding the lack of disaggregated routine data for key populations (KPs) for a targeted HIV response. KPs include female sex workers, transgender populations, gay men and other men who have sex with men, people who are incarcerated, and people who use drugs. From an epidemiological perspective, KPs play a fundamental role in shaping the dynamics of HIV transmission due to specific behaviors. In South Africa, routine health information management systems (RHIMS) do not include a unique identifier code (UIC) for KPs. The purpose of this protocol is to develop the framework for improved HIV monitoring and programming through piloting the inclusion of KPs UIC in the South African RHIMS. OBJECTIVE: This paper aims to describe the protocol for a multiphased study to pilot the inclusion of KPs UIC in RHIMS. METHODS: We will conduct a multiphased study to pilot the framework for the inclusion of KPs UIC in the RHIMS. The study has attained the University of Johannesburg Research Ethics Committee approval (REC-2518-2023). This study has four objectives, including a systematic review, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (objective 1). Second, policy document review and in-depth stakeholder interviews using semistructured questionnaires (objective 2). Third, exploratory data analysis of deidentified HIV data sets (objective 3), and finally, piloting the framework to assess the feasibility of incorporating KPs UIC in RHIMS using findings from objectives 1, 2, and 3 (objective 4). Qualitative and quantitative data will be analyzed using ATLAS.ti (version 6; ATLAS.ti Scientific Software Development GmbH) and Python (version 3.8; Python Software Foundation) programming language, respectively. RESULTS: The results will encompass a systematic review of literature, qualitative interviews, and document reviews, along with exploratory analysis of deidentified routine program data and findings from the pilot study. The systematic review has been registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD42023440656). Data collection is planned to commence in September 2024 and expected results for all objectives will be published by December 2025. CONCLUSIONS: The study will produce a framework to be recommended for the inclusion of the KP UIC national rollout. The study results will contribute to the knowledge base around the inclusion of KPs UIC in RHIMS data. TRIAL REGISTRATION: PROSPERO CRD42023440656; https://tinyurl.com/msnppany. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55092.

The role of syndromic knowledge in Ethiopian veterinarians' treatment of cattle.

Veterinarians play a significant role in the treatment and prevention of livestock diseases at the farm level, safeguarding public health and ensuring food safety. In sub-Saharan Africa, access to quality veterinary services is a major challenge for livestock farmers due to the low number of publicly employed veterinarians, underfunding and privatisation of veterinary services. Low investment in veterinary services and infrastructure, including a lack of laboratories for diagnosis, has made veterinarians rely on their experience and knowledge of cattle disease symptoms developed over years of practice to diagnose and treat cattle diseases. A cross-sectional survey using a role-play approach was used to collect data on knowledge regarding cattle diseases among veterinarians in veterinary clinics and private practices in Addis Ababa, Oromia and Adama regions in Ethiopia. Veterinarians were given a number of disease scenarios based on "fictive disease symptoms" that are commonly manifested in a sick cow and asked to identify the disease what personal biosecurity they would use, diagnostic tests they would perform, treatments they would prescribe, treatment costs, and additional services and inputs they would recommend to the farmer. The results show that veterinarians could identify endemic cattle diseases through symptoms. The majority of veterinarians did not find it important to report notifiable diseases, a behaviour which could hamper disease surveillance and outbreak response. The advice and services the veterinarians said they would offer and recommend to farmers included improvement in feeding, vaccination, use of artificial insemination, and adoption of farm biosecurity measures that can reduce disease prevalence, and improve food safety, animal health and welfare. Low use of personal protective equipment and other protective biosecurity measures among veterinarians could expose them to zoonotic diseases. The study concludes that there is a need for increased funding for continuous training, improved access to animal health-related information, and investment in infrastructure such as laboratories to enable veterinarians to deliver quality animal health services.

Detection of thyroid cancer among children and adolescents in Fukushima, Japan: a population-based cohort study of the Fukushima Health Management Survey.

Background: Thyroid ultrasound examinations using a cohort study design (from the Fukushima Health Management Survey [FHMS]) were conducted after the nuclear power plant accident caused by the Great East Japan Earthquake in 2011. This study investigated the association between radiation exposure and the detection of thyroid cancer in children and adolescents. Methods: The cohort study has been conducted in Fukushima prefecture in Japan since 2011. The primary outcome was the external dose. We enrolled 253346 examinees who lived in Fukushima at the time of the accident (Dataset A), including 113120 examinees who had data on external radiation exposure (ERE) (Dataset B). The median dose in the examinee's district was used for missing dose. The association between ERE and detection of thyroid cancer or suspected thyroid cancer was analyzed using Poisson regressions with two types of explanatory variables: sex, age, overweight status, and district (Model 1), and past medical history, family history of thyroid cancer, frequency of seafood consumption, and frequency of seaweed consumption in addition to Model 1 (Model 2). Findings: During the second and third rounds of examinations, a total of 97 thyroid patients were detected, for a detection rate of 10.328 [ 10 5 year - 1 ] (95% confidence interval: 8.464-12.602 [ 10 5 year - 1 ]). Multivariate Poisson regression showed that the detection rate ratio of the ERE (1+ mSv) to <1 (mSv) was 1.577 (0.715-3.394) in Model 1 and 1.596 (0.726-3.512) in Model 2, for Dataset A; and 1.677 (0.746-3.773) in Model 1 and 1.669 (0.743-3.748) in Model 2, for Dataset B. Interpretation: Our study showed no association between radiation exposure with extremely low dose which were more than 99.9% of all the exposure was less than 5 mSv, and thyroid cancer detection, when the follow-up period was an average of 3.7 years at the present, using the cohort study design. Funding: The National Health Fund for Children and Adults Affected by Nuclear Incidents in Japan.

[Telephone navigation and health check attendance among public assistance recipients: Lessons from two-year effort in Toyonaka City].

Objective　Poverty is a significant health determinant. As public assistance recipients experience difficulties in health management, a healthcare management support program to provide health checks has been implemented by welfare offices in Japan since 2021. However, effective approaches to maximize health check rates are limited. This study aimed to identify the impact of telephone navigation on recipients' health check-receiving behaviors, using data from welfare offices in Toyonaka City.Methods　This study included recipients aged 40-60 years who received telephone navigation for health check programs in 2021 and 2022. In 2021, telephone navigation was provided to eligible recipients. In 2022, the recipients were divided into two groups based on their household identification numbers (even/odd). We examined the difference in the health check rate in 2021 depending on whether the navigation system was connected. Additionally, we examined the differences across groups and navigation periods in 2022.Results　In 2021, 32 (7.9%) recipients received health checks. Twenty-six (10.2%) of the 255 recipients and six (4.1%) of the 148 recipients in the navigated and non-navigated groups, respectively, underwent health checks. In the navigated group, health check rates were higher among recipients in their 50s (13.3% vs. 3.1%; P = 0.006), unemployed recipients (13.9% vs. 3.6%; P = 0.014), those who did not receive previous health checks (9.1% vs. 1.5%; P = 0.003), and those who did not receive regular medical consultations (8.3% vs. 0%; P = 0.012). In 2022, 247 and 225 patients were assigned to the odd- and even-numbered groups, respectively, with no differences in their characteristics. During the intervention period, four (1.6%) of the 247 recipients and 10 (4.6%) of the 219 recipients in the odd- and even-numbered groups, respectively, underwent health checks. During the non-intervention period, five (2.1%) and six (2.7%) recipients of the odd- and even-numbered groups, respectively, underwent health checks. Health check rates were higher toward the deadlines. The estimated conditional odds ratio for receiving the health checks by the navigation was 1.35 (95% confidence interval; 0.59-2.93, P = 0.503).Conclusion　Telephone navigation may be effective in some recipients. Meanwhile, targeting recipients with attributes, such as "in their 50s," "unemployed," "received no previous health checks," and "received no regular medical consultations" may increase the response rate. Therefore, policymakers should consider using reliable telephone navigation methods and navigating near deadlines.