Representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada / Social representations of reproductive planning among women with unplanned pregnancies / Representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado

Objetivo: conhecer as representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada na Estratégia Saúde da Família. Método: estudo qualitativo, orientado pela Teoria das Representações Sociais, realizado com 15 gestantes, entre abril e maio de 2019. Utilizou-se a entrevista semiestruturada. Os dados foram organizados por meio do Discurso do Sujeito Coletivo, com auxílio do software DSCsoft©. Protocolo de pesquisa aprovado pelo Comitê de Ética em Pesquisa. Resultados: as representações sociais das mulheres em gravidez não planejada evidenciadas pelo Discurso do Sujeito Coletivo foram representadas por oito ideias centrais, a saber: "eu não me preveni, nem ele", "nós nos prevenimos", "eu comprava", "pegava no posto", "construir uma família", "ter esse acesso", "estou por fora" e "eu sei que é disponível". Conclusão: as representações sociais nos discursos das mulheres em gravidez não planejada estavam pautadas no desconhecimento acerca do planejamento reprodutivo, dos anticoncepcionais disponíveis e seu uso correto.

Objective: to understand the social representations of reproductive planning among women with unplanned pregnancies in the Family Health Strategy. Method: qualitative study, guided by the Theory of Social Representations, carried out with 15 pregnant women between April and May 2019. Semi-structured interviews were used. The data was organized using the Discourse of the Collective Subject, with the aid of DSCsoft© software. Research protocol approved by the Research Ethics Committee. Results: the social representations of women with unplanned pregnancies as evidenced by the Collective Subject Discourse were represented by eight central ideas, namely: "I didn't prevent myself, nor did he", "we prevented ourselves", "I would buy it", "I would get it at the health center", "build a family", "have this access", "I am not aware" and "I know it is available". Conclusion: the social representations in the women's speeches about unplanned pregnancies were based on a lack of knowledge about reproductive planning, the contraceptives available and their correct use.

Objetivo: conocer las representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado en la Estrategia Salud de la Familia. Método: estudio cualitativo, basado en la Teoría de las Representaciones Sociales, realizado con 15 mujeres embarazadas, entre abril y mayo de 2019. Se utilizaron entrevistas semiestructuradas. Los datos fueron organizados mediante el Discurso del Sujeto Colectivo, con ayuda del software DSCsoft©. El protocolo de investigación fue aprobado por el Comité de Ética en Investigación. Resultados: las representaciones sociales de las mujeres con embarazo no planificado reveladas por el Discurso del Sujeto Colectivo fueron representadas por ocho ideas centrales, a saber: "yo no me cuidé y él tampoco", "nos cuidamos", "yo los compraba", "los buscaba en el centro de salud", "construir una familia", "tener acceso", "no participo" y "sé que está disponible". Conclusión: las representaciones sociales en los discursos de las mujeres con embarazo no planificado se basaron en la falta de conocimiento sobre la planificación reproductiva, en los anticonceptivos disponibles y su uso correcto.

Fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática / Intervening factors in the management of nursing care for children hospitalized with rheumatic heart disease / Factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática

Objetivo: analisar os fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática. Método: estudo descritivo-exploratório com abordagem qualitativa, que utilizou a Teoria Fundamentada em Dados e o Interacionismo Simbólico, respectivamente, como referencial metodológico e teórico. A coleta de dados foi realizada em uma instituição especializada em atendimento cardiológico, no munícipio do Rio de Janeiro. Foram entrevistados 19 profissionais de enfermagem através de um roteiro semiestruturado. Resultado: emergiram os seguintes fatores intervenientes na prática da gerência do cuidado: condição socioeconômica da família, comportamento da criança, condições de trabalho, comunicação ineficaz, educação permanente, trabalho em equipe e experiência profissional. Conclusão: os resultados apontam para a necessidade de proposição de estratégias de ação e interação que facilitem a prática gerencial de cuidado à criança com cardiopatia reumática e sua família face aos fatores intervenientes identificados.

Objective: to analyze the factors involved in the management of nursing care for children hospitalized with rheumatic heart disease. Method: this is a descriptive-exploratory study with a qualitative approach, which used Data-Based Theory and Symbolic Interactionism, respectively, as methodological, and theoretical references. Data was collected in an institution specializing in cardiac care in the city of Rio de Janeiro. Nineteen nursing professionals were interviewed using a semi-structured script. Result: the following intervening factors in the practice of care management emerged: the family's socioeconomic status, the child's behavior, working conditions, ineffective communication, continuing education, teamwork, and professional experience. Conclusion: the results point to the need to propose strategies for action and interaction that facilitate management practice in caring for children with rheumatic heart disease and their families, given the intervening factors identified.

Objetivo: analizar los factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática. Método: estudio descriptivo-exploratorio con enfoque cualitativo, cuyos marcos metodológico y teórico fueron la Teoría Fundamentada y el Interaccionismo Simbólico, respectivamente. La recolección de datos se realizó en una institución especializada en atención cardiológica, en la ciudad de Río de Janeiro. Fueron entrevistados 19 profesionales de enfermería mediante un cuestionario semiestructurado. Resultado: surgieron los siguientes factores intervinientes en la práctica de la gestión del cuidado: condición socioeconómica de la familia, comportamiento del niño, condiciones de trabajo, comunicación ineficaz, educación continua, trabajo en equipo y experiencia profesional. Conclusión: los resultados indican que es necesario proponer estrategias de acción e interacción que faciliten la práctica de la gestión del cuidado al niño con cardiopatía reumática y a sus familiares, con respecto a los factores intervinientes identificados.

Reprint: The Cells of Ecosystem Functioning: Towards a holistic vision of marine space.

Marine space is three dimensional, the turnover of life forms is rapid, defining a fourth dimension: time. The definition of ecologically significant spatial units calls for the spatio-temporal framing of significant ecological connections in terms of extra-specific (biogeochemical cycles), intra-specific (life cycles), and inter-specific (food webs) fluxes. The oceanic volume can be split in sub-systems that can be further divided into smaller sub-units where ecosystem processes are highly integrated. The volumes where oceanographic and ecological processes take place are splittable into hot spots of ecosystem functioning, e.g., upwelling currents triggering plankton blooms, whose products are then distributed by horizontal currents, so defining Cells of Ecosystem Functioning (CEFs), whose identification requires the collaboration of physical and chemical oceanography, biogeochemistry, marine geology, plankton, nekton and benthos ecology and biology, food web dynamics, marine biogeography. CEFs are fuzzy objects that reflect the instability of marine systems.

A novel multi-objective dung beetle optimizer for Multi-UAV cooperative path planning.

Path planning for multiple unmanned aerial vehicles (UAVs) is crucial in collaborative operations and is commonly regarded as a complicated, multi-objective optimization problem. However, traditional approaches have difficulty balancing convergence and diversity, as well as effectively handling constraints. In this study, a directional evolutionary non-dominated sorting dung beetle optimizer with adaptive stochastic ranking (DENSDBO-ASR) is developed to address these issues in collaborative multi-UAV path planning. Two objectives are initially formulated: the first one represents the total cost of length and altitude, while the second represents the total cost of threat and time. Additionally, an improved multi-objective dung beetle optimizer is introduced, which integrates a directional evolutionary strategy including directional mutation and crossover, thereby accelerating convergence and enhancing global search capability. Furthermore, an adaptive stochastic ranking mechanism is proposed to successfully handle different constraints by dynamically adjusting the comparison probability. The effectiveness and superiority of DENSDBO-ASR are demonstrated by the constrained problem functions (CF) test, the Wilcoxon rank sum test, and the Friedman test. Finally, three sets of simulated tests are carried out, each including different numbers of UAVs. In the most challenging scenario, DENSDBO-ASR successfully identifies feasible paths with average values of the two objective functions as low as 637.26 and 0. The comparative results demonstrate that DENSDBO-ASR outperforms the other five algorithms in terms of convergence accuracy and population diversity, making it an exceptional optimization approach to path planning challenges.

Asymmetry in contraceptive information at two sites in Burkina Faso.

Background: Family planning programs are foundationally important to public health, but like any medical intervention, contraception has drawbacks in addition to its benefits. Knowledge of these drawbacks in addition to benefits is essential for informed choice. Despite a general consensus among family planning researchers and providers that contraceptive counseling should be unbiased, little quantitative research has assessed the extent of bias in contraceptive counseling, and in people's contraceptive knowledge more broadly. Objective: To understand the extent to which women report being told more about the advantages of contraception than the disadvantages-a concept we call "asymmetry" in contraceptive counseling, at two research sites in Burkina Faso. Methods: We use data from a cross-sectional population-based survey of 3,929 women residing in the catchment areas of the Ouagadougou (urban) and the Nouna (rural) Health and Demographic Surveillance Systems in Burkina Faso. We use descriptive statistics to explore asymmetry in knowledge of the benefits/advantages and risks/disadvantages of contraceptive use overall, as well as method-specific asymmetry among current method users regarding their counseling experience. Findings: Results show substantial asymmetry in knowledge of advantages/benefits of contraception compared to disadvantages/risks. 86% of respondents said they could name any advantage of family planning, while half of that proportion (43%) could name any disadvantage. We find a similarly stark asymmetry in method-specific results among contraceptive users, especially for hormonal/biomedical methods. We also find substantial variation between research sites, with urban respondents much less likely to self-report complete family planning knowledge than their rural counterparts. Conclusion: Our results suggest that family planning messaging in Burkina Faso may place an emphasis on the advantages without a commensurate focus on disadvantages. Family planning programs worldwide must ensure that people can make informed choices based on balanced, accurate information about both the benefits and the disadvantages of contraception.

Professional development is the key to securing a future rheumatology workforce. Long term evaluation of a summer school for medical students-a national scientific society's educational initiative.

Objectives: A cumulative imbalance between rheumatologic need and an inadequate number of young colleagues entering the field leads to a dearth of rheumatologists in the near future. The Austrian Society for Rheumatology and Rehabilitation (ÖGR) has been organizing an annual Rheumatology Summer School (RSS) for medical students since 2017. The aim of this study was to analyze the annual RSS evaluations, the RSS' overall effects on attracting new talent into the field and the lasting promotion of rheumatology. Methods: A questionnaire was distributed immediately after each RSS meeting. Additionally, we conducted an electronic survey among RSS participants (2017-2022) to assess their career development trajectories. Results: From 2017-2023, a total of 220 students attended the RSS. They all completed the annual evaluation. Accordingly, students' expectations were met in 80% (2017) to 97% (2023) of cases. The electronic survey was completed by 64/133 (48%) students; 49 (77%) indicated that the RSS had markedly increased their desire to specialize in rheumatology. Among the 36 graduates, 10 (28%) had already been working in the field of rheumatology and 6 (17%) were considering this specialty but had not decided yet. RSS attendees in their 6th study year were influenced to a greater extent by the RSS to choose rheumatology as their primary specialty than 4th or 5th year students. The participants indicated that they benefited most from the RSS in terms of knowledge gain, personal awareness of rheumatology, networking among fellow students as well as gaining access to RSS faculty. Conclusion: The RSS enhanced students' intention to choose rheumatology, particularly in those close to graduation, and led to increased awareness and deeper knowledge about rheumatology.

Factors Associated with Advance Care Planning Engagement Among Community-Dwelling Older Adults: A Cross-Sectional Study.

AIM: To explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community-dwelling older adults. DESIGN: A cross-sectional study was conducted with 262 community-dwelling older Australians across metropolitan, regional and rural communities between August and October 2022. METHODS: Validated self-reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36). Data analysis included descriptive statistics, bivariate association analysis, general linear modelling and path analysis. RESULTS: Anxiety and decisional conflict were directly associated with advance care planning engagement even after controlling for potential effects of demographic characteristics, health literacy and overall health status. The model, including age, gender, country of birth, language spoken at home, education, overall health status, anxiety, depression, decisional conflict and interaction between anxiety and decisional conflict, explained 24.3% of the variance in their advance care planning engagement. Decisional conflict mediated the association between anxiety and advance care planning engagement. CONCLUSION: Increased anxiety and decisional conflict were associated with reduced advance care planning engagement directly, even among community-dwelling older adults with higher levels of education and health literacy. Increased anxiety was associated with reduced advance care planning engagement indirectly via increased decisional conflict. Healthcare professionals should assess community-dwelling older adults' anxiety and implement interventions to manage their anxiety and decisional conflict, as these may facilitate their engagement in advance care planning. IMPACT: Understanding factors associated with advance care planning engagement among community-dwelling older adults may inform strategies facilitating their future engagement in advance care planning. Findings from this study may be used as evidence for future implementation to facilitate the engagement of community-dwelling older adults in advance care planning. REPORTING METHOD: The STROBE statement checklist was used as a guide to writing the manuscript. PATIENT OR PUBLIC CONTRIBUTION: The study was advertised publicly through social media (e.g. Twitter and Facebook) and newsletters (e.g. Advance Care Planning Australia, Centre for Volunteering, Palliative Care Australia and a large home care service provider with approximately 7000 older clients receiving support or services) to recruit participants. People aged 65 years and older living independently in the Australian community who could communicate in English were invited to participate and answer the questionnaire.

Parents' and healthcare professionals' experiences with the content of an individual care plan for pediatric palliative care: a mixed-method study.

Background: The Individual Care Plan (ICP) for pediatric palliative care translates the general guideline recommendations into a personalized plan for the child. Various documents exist in pediatrics globally, aimed at facilitating anticipatory care or coordinating end-of-life care. The ICP aims both, but user experiences have not been studied post-development. Objective: The overall aim is to enhance knowledge and understanding of the content of the ICP from the perspectives of parents and healthcare professionals (HCPs). Design and method: We conducted a mixed-method study using a convergent parallel design consisting of questionnaires and individual and focus group interviews among parents and HCPs having user experience with the ICP. The questionnaire and interview data were analyzed separately. Quantitative data were descriptively analyzed using mean, ±SD, and median. Qualitative data were thematically analyzed. A narrative approach and joint display were used to describe the results. Results: In total, 27 parents and 161 HCPs participated. Overall, the content of the ICP was seen as important and complete, but changes and additions were called for on language, structure, and content. The chapter on the needs and wishes of child and parents was considered most important. HCPs would like to see this chapter expanded to incorporate more advance care planning outcomes, and parents wished for this chapter to reflect better who their child is. HCPs mentioned missing a chapter for palliative sedation, mainly to guide other HCPs. The ICP was appraised as not user-friendly and might possibly improve by making the ICP available in a secure digital environment. Conclusion: To meet the needs of parents and HCPs considering importance and completeness of the content of the ICP and its user-friendliness, changes are necessary in the content of the ICP, and preferably the ICP should be made digitally available. Although various documents exist globally to facilitate anticipatory care or coordinating end-of-life care, it appears that the combination of describing the values and preferences of the child and parents, along with medical decisions and life-sustaining treatments, makes the ICP a unique and comprehensive care plan.

An enhanced snow ablation optimizer for UAV swarm path planning and engineering design problems.

The Snow Ablation Optimizer (SAO) is an advanced optimization algorithm. However, it suffers from slow convergence and a tendency to become trapped in local optima. To address these limitations, we propose an Enhanced Snow Ablation Optimization algorithm (ESAO). Initially, an adaptive T-distribution control strategy is employed to improve the algorithm's exploratory position adjustments, facilitating the identification of the global optimum. Furthermore, we introduce a Cauchy mutation strategy, endowing individuals with a robust capability to escape local extrema and steer the population towards more favorable directions. A leader-based boundary control strategy is also proposed to enhance the optimizer's search performance, significantly increasing the accuracy, speed, and stability of the algorithm in tackling complex problems. To validate the performance of ESAO, we utilize 29 CEC2017 benchmark functions for comparison against eight popular algorithms across various dimensions. Our algorithm ranked first in all comparisons, demonstrating ESAO's effectiveness. Additionally, to evaluate the practical applicability of the proposed method, we mathematically modeled the UAV swarm and solved the UAV swarm path planning problem using various competitor algorithms. Furthermore, we applied different competitor algorithms to two engineering design problems. The results demonstrate that ESAO performs the best. In general, ESAO outperforms its counterparts in terms of solution quality and stability, showcasing its superior application potential.

Enhancing surgical occlusion setting in orthognathic surgery planning using mixed reality technology: a comparative study.

OBJECTIVES: Orthognathic surgery necessitates precise occlusal alignment during surgical planning, traditionally achieved through manual alignment of physical dental models as the recognized gold standard. This study aims to evaluate the efficacy of mixed reality technology in enhancing surgical occlusion setting compared to traditional physical alignment and an established virtual method, addressing the research question: Can mixed reality technology improve the accuracy and efficiency of occlusion setting in orthognathic surgery planning? MATERIALS & METHODS: This experimental study compared the surgical occlusion settings of 30 orthognathic cases using three methods: a new virtual method with mixed reality technology, the traditional gold standard of physical alignment, and an established virtual occlusion method using the IPS Case Designer (KLS Martin SE & Co. KG, Tuttlingen, Germany). RESULTS: Results indicated that surgical occlusions set with mixed reality technology were comparable to the conventional method in terms of maxillary movement and occlusal relationship. Differences observed were within the inter-observer variability of the gold standard. Both virtual methods tended to position the maxilla more anteriorly, resulting in fewer occlusal contacts. However, virtual occlusion demonstrated clinical applicability, achieving an average of 11 occlusal contacts with a bilaterally symmetrical distribution along the dental arch. CONCLUSIONS: The mixed reality environment provides an intuitive and flexible experience for setting surgical occlusion, eliminating the need for costly 3D-printed physical models or the automatic calculations required by other virtual occlusion methods, thereby offering maximum freedom. CLINICAL RELEVANCE: As a novel form of virtual occlusion, it presents a comprehensive tool that contributes to a timely and cost-effective full digital workflow of orthognathic surgery planning.

Development of home-based care educational programme for the family caregivers of activity limited older people: an educational programme model for community nurses.

BACKGROUND/AIM: A home-based care educational programme for family caregivers of activity-limited older people was developed and implemented to provide caregiver education and to teach basic caregiving techniques. The purpose of the home-based care educational programme was to improve the caregivers' knowledge, skills and attitudes necessary to perform the caregiving tasks with reduced physical strain. METHODS: The educational programme model comprises the knowledge and skills necessary to carry out the caretaking responsibilities of older people, especially those with limited activities. It was conducted as an interventional study recruiting two groups (n=72) as intervention (n=36) and control group (n=36), and the knowledge of the caregivers was evaluated. The teaching sessions were planned considering the adult educational learning theories and guided by a developed educational handbook. RESULTS: The pre and post mean±SD knowledge scores of the intervention group (43.78±12.41; 89.78±5.61) showed a significant difference (p<0.001), whereas the pre and post knowledge mean±SD scores of the control group (50.69±17.90; 51.43±17.79) showed no significant improvement (p>0.05). The difference between the pre-test and post-test between the two groups was significant (p<0.0001). CONCLUSIONS: At the end of the educational programme, participants valued the opportunity that they received, and the assessment of knowledge before and after the programme showed an improvement in caregivers' knowledge. The study suggests conducting home-based or community-based health education programmes for caregivers of older people with limited activities, with the involvement of responsible healthcare professionals and leaders.

Utilization of health-related data in the regional context for health service planning in the Federal State of Brandenburg, Germany-a qualitative study.

BACKGROUND: Utilizing regional health data goes hand in hand with challenges: can they be used for health planning, are they applicable to the relevant topics? The study explores current data utilization and needs of stakeholders working in regional health services planning. METHODS: We conducted 16 semi-structured expert-interviews with stakeholders of regional health planning in Brandenburg, a federal state in the north-east of Germany, by telephone or online-meeting tools between 05/2022 and 03/2023. The data were analysed according to qualitative content analysis. RESULTS: Utilization of data sources depends on individual knowledge and personnel resources instead of being guided by standardized procedures. Interviewees primarily use internal data; some use many different platforms, studies and reports. Regional health-related data are used for reliable health planning, to prepare resolutions, draft contracts, but also for events and requests from policy makers or the press. Challenges exist in terms of availability, awareness, and acceptance of the data, perceived applicability, the ability to use it and the utilization itself. Many regional health planners indicated they would appreciate a regional integrated cross-organizational data source if the benefits for health planning outweighed the efforts. DISCUSSION: Actors in health planning primarily utilized their own data for planning; additional data sources are not available or the level of aggregation is too high, not known by them or are often not used due to a lack of time. A standardized regional monitoring would require the definition of indicators as well as the strengthening of cross-sectoral planning.

Comment on, "Radiographic characterization of OPLL progression in patients receiving laminoplasty with a minimum of two-years follow-up".

The article by Liu et al. (2024) investigates the progression of ossification of the posterior longitudinal ligament (OPLL) in 29 patients post-cervical laminoplasty. The study meticulously tracks transverse and longitudinal OPLL progression, providing crucial insights into surgical planning and patient outcomes. While the research design is commendable, reliance on X-ray imaging limits precision compared to CT or MRI scans. The sample size, though adequate for initial findings, may not fully capture OPLL variability, and the follow-up period could be extended to better assess long-term outcomes. Future studies should incorporate advanced imaging techniques, larger cohorts, and patient-reported outcomes to enhance the understanding of OPLL progression, thereby refining surgical strategies and improving personalized care for OPLL patients.

Quantitative assessment of interplay between urbanization dynamics and land surface temperature variations using generalized additive model coupled PDP for sustainable urban planning and management.

The mountainous region of Asir is experiencing rapid and unsystematic urbanization leading to an increase in land surface temperatures (LST), which poses a challenge to human well-being and ecological balance. Therefore, it is necessary to study the interaction between land use and land cover (LULC)-induced urbanization and LST using advanced geostatistical techniques. In addition, understanding the urbanization process and urban density is essential for effective urban planning and management. The aim of this study was to investigate the interaction between the urbanization process, urban density and the associated LST. Using the Random Forest Algorithm, LULC mapping was conducted for the years 1990, 2000 and 2020. Metrics such as land cover change rate (LCCR), land cover index (LCI), landscape expansion index (LEI), mean landscape expansion index (MLEI) and area-weighted landscape expansion index (AWLEI) were used to understand urbanization processes and LULC changes. Convolutional kernels were used to model urban density, and the mono-window algorithm was applied to analyse LST in the selected years. In addition, the study assessed the Surface Urban Heat Island (SUHI) contribution index to LULC and used Generalized Additive Models (GAMs) in conjunction with Partial Dependence Plots (PDPs) to understand the relationship between urbanization processes, urban density and LST. In a detailed 30-year study, the application of the RF algorithm showed significant shifts in LULC with an overall validation accuracy of over 85%. Urban areas grew dramatically from 69.40 km2 in 1990 to 338.74 km2 in 2020, while water areas decreased from 1.51 to 0.54 km2. Dense vegetation increased from 43.36 to 52.22 km2, indicating positive ecological trends. The LST analysis showed a general warming, with the mean LST increasing from 40.51 °C in 1990 to 46.73 °C in 2020 and the highest temperature category (50-60 °C) increasing from 0.78 to 33.35 km2. The built-up area of cities tripled between 1990 and 2020, with the Landscape Expansion Index reflecting significant growth in suburban areas. The modeling of urban density shows increasing urbanization in the centre, which will expand significantly to the east by 2020. The contribution of LULC to LST and the Urban Heat Island (SUHI) effect was evident, with built-up areas showing a constant temperature increase. GAMs confirmed a statistically significant relationship between urban density and LST, with different effects for different types of urban expansion. This comprehensive study quantitatively sheds light on the complicated dynamics of urbanization, land cover change and temperature variation and provides important insights for sustainable urban development.

Waiting for surgery after hip fracture-Health and/or economic risk?

OBJECTIVES: Waiting for surgery is a disconcerting experience. It can have a negative impact on patients' outcomes and length of stay (LOS) as driver for treatment costs. Process-optimisation may be a strategy to improve quality and cost-efficacy. The study investigates the correlation between waiting for hip fracture surgery and patient characteristics, organisational variables, outcomes, LOS, and the distribution of waiting times and LOS over time, including cost estimates. Thereby the study aims to identify the potential for organisational improvements with respect to managing the waiting time. METHODS: Ten-year routine health data (patient characteristics and follow-up information) and process-indicators that is, waiting time and LOS from a Swiss trauma-centre were analysed retrospectively. Cost-estimates were calculated based on Swiss diagnosis related groups and daily costs to evaluate hospital revenues. RESULTS: In total, 2572 patients aged ≥60 years with low-energy hip fractures were included. Waiting times >48 h were associated with sub-optimal outcomes. Over the years long waiting times decreased. This reduction was not reflected by a reduction in LOS which remained stable around 10 days, primarily driven by late discharge to in-patient rehabilitation. Reimbursement persisted at an average revenue in the low 4-5-digit range, depending on implant costs. CONCLUSIONS: While there has been a reduction of waiting times, this has not translated into a reduction of LOS or potential savings in health care costs, due to the various dependencies along the patient journey. Managing waiting times may be an area for improvement, increasing cost-efficacy, especially since long waiting times are still associated with inferior outcomes and LOS.

Digital Simulation and Designing of a Novel Osteotomy Guide for Autotransplantation in the Anterior Region.

Autotransplantation of teeth (ATT) is a viable treatment option for replacing teeth lost due to various reasons. Periodontal ligament (PDL) on the donor tooth is one of the most crucial factors determining the success of ATT. To preserve the PDL during surgery and improve the success rate of ATT, digital dentistry has been applied to ATT. In this article, a digital workflow including surgical simulation, a three-dimensional (3D) replica fabrication, and a novel osteotomy guide design is introduced. Digital simulation of ATT on a patient's integrated model enables visualization of anatomical structures and the 3D position of the donor tooth prior to the actual surgery. The 3D-printed osteotomy guide allows the transfer of the direction and depth of the planned osteotomy into the intraoral environment. The 3D replica helps prepare the recipient site before the actual transplantation, which minimizes the extra-alveolar time of the donor tooth and decreases trauma during the try-in process. The proposed virtual planning and the use of the guide and the 3D replica can facilitate the surgical procedures while minimizing complications.

Review of National Health Service England's Emergency Preparedness, Resilience and Response Annual Assurance for 2021-2022.

OBJECTIVE: National Health Service (NHS) England conducts annual assurance of NHS bodies in England's readiness to respond to emergencies using its Core Standards for emergency preparedness, resilience, and response (EPRR). This review assessed whether the first complete EPRR assurance after England's coronavirus disease (COVID-19) pandemic national response was performed successfully. METHODS: The primary outcome of interest was the quantity of information regarding applicable Core Standards held by NHS England at the end of that assurance. Secondary outcomes were variations between the number of applicable Core Standards and information held by NHS bodies about the number of applicable Core Standards. RESULTS: NHS England recorded the correct number of applicable Core Standards for 88 of the 124 NHS trusts in England which provided general hospital accommodation and services in relation to accidents or emergencies. It recorded an incorrect number of standards for 13 trusts and did not record the number of standards for 23 trusts. CONCLUSION: NHS England's EPRR assurance resulted in correct data not being recorded for over a quarter of the above NHS trusts. This review may also be of interest to other state-level bodies that rely on the high-level assurance of their ability to provide health care during emergencies.

The need for stronger international support to integrate health and well-being and transform education: a perspective on developing countries.

The reciprocal relationship between education and health is well-established, emphasizing the need for integrating health, nutrition, and well-being components into educational sector planning. Despite widespread acknowledgment of this need, countries lack concrete measures to achieve this integration. We examine challenges that countries have faced and the progress they have made in integrating these components into education sector plans and review the extent to which existing educational planning guidelines and tools address health and well-being. The review reveals a significant underrepresentation of health, well-being, and related themes in existing educational planning frameworks. Recent tools and frameworks developed to support a more holistic approach to education have not yet been widely adopted in standard education sector planning processes. The implementation of such approaches remains inconsistent, with significant barriers including limited cross-sectoral collaboration, lack of capacity, and insufficient funding, among others. Addressing these gaps requires improved guidance, technical support, and a multisectoral approach to education planning that includes health, nutrition, and well-being as fundamental components of foundational learning, supported by political commitment, capacity, and adequate financing.

'They will be like a person with a disease': a qualitative investigation of variation in contraceptive side-effect experiences in Central Oromia, Ethiopia.

Contraceptive side effects are consistently given as the main reason why women are dissatisfied with contraception or choose not to use it. However, why some women suffer more from side effects remains unknown. Through inductive analysis of in-depth interviews and focus group discussions with 40 contraceptive users and 3 key informants in Central Oromia, Ethiopia, we explored women's rationales for variation in side-effect experiences. The data first reveal the wide diversity in type and severity of side-effect experiences reported by users of contraception. Second, we found that women's rationales for why some individuals suffer more side effects from contraception invoke economic and physical hardship (food insecurity and heavy workloads), as well as interindividual differences in biology (one's blood must 'fit' with contraception). Finally, the analysis revealed the tension many women face in trying to negotiate the trade-off between the consequences of these side effects and those of an unwanted pregnancy. The results show the value of using a biosocial approach, which centres women's voices and experiences, for informing the measurement of contraceptive side effects within population health surveys and clinical trials. Additionally, the findings help gain an understanding of how an individual's social, biological, and cultural contexts drive variation in when and why different side effects manifest.

Evaluating cranial landmarks for yaw orientation in natural head position: a 3D study.

OBJECTIVES: To assess the symmetry of various cranial anthropometric points used as references for yaw orientation in the natural head position (NHP), relative to the mid-sagittal plane. MATERIALS AND METHODS: A prospective analysis using tomography data from 55 patients was conducted. Radiopaque markers, placed on patients in NHP, facilitated head position recording in three planes, with subsequent digital transfer for orientation analysis. Symmetry of eight points (zygomaxillare, zygion, ectoconchion, frontozygomatic suture, stephanion, porion, mastoidale, condylion laterale) was measured against the mid-sagittal plane. RESULTS: Significant asymmetry was observed in the stephanion, frontozygomatic suture, and ectoconchion points (p < 0.05). No significant differences were found in the symmetry of other points (p > 0.05). CONCLUSIONS: Findings suggest that stephanion, frontozygomatic suture, and ectoconchion are unreliable for yaw orientation in NHP. Other points, combined with clinical measurements, may offer better reliability.