Relationship between Preventive Behavioral Factors and Malaria Incidence in Endemic Areas of Lahat Regency in 2021

Background: Malaria is still one of the main infectious diseases of concern in the world. Lahat Regency is a moderate malaria-endemic area in South Sumatra, where there are still several villages with an API value above 1 and indigenous cases, although the average API value in all health facilities is below 1. Methods: Quantitative research with a case-control design was employed. The sampling technique used stratified random sampling with year strata, namely 2018, 2019 and 2020 with 50 case respondents and 100 control respondents. The total number of samples collected was 150. Case respondents were people who suffered from malaria and are recorded in the Malaria Surveillance Information System in the working area of the community health center, which has a village with an API value of 1 and the presence of indigenous cases. Control respondents were the closest neighbours of cases with the same age characteristics as the case. This study aimed to identify and analyse risk factors for preventive behaviour related to malaria incidence in the endemic area of the Lahat Regency. Results: : Bivariate analysis revealed that the habit of using insect repellent was connected with the incidence of malaria in the endemic region of Lahat Regency, with a p-value of 0.042 and an odds ratio of 2.160 in the endemic area. The results of multivariate analysis showed that the most dominant risk factor was the habit of using mosquito repellent. Conclusions: The habit of using mosquito repellent is a risk factor for malaria incidence in endemic areas of the Lahat Regency. It is necessary to increase individual self-prevention behaviour and counselling activities regarding preventive behaviour by local health service facilities.

Relationship between water quality, sanitation and hygiene on environmental health of community settled on Kahayan River Bank, Palangka Raya

People in Central Kalimantan province have long depended on the rivers around their villages. Yet, reports from the local health service show that the five diseases with the most patients are related to environmental factors, such as sanitation of water reservoirs and sanitation of home yards. This study aims to analyze the relationship between water quality, sanitation, and hygiene on environmental health in settlements on the banks of the Kahayan River. Data on sanitation, hygiene, and public health status were collected through observation and interviews, while river water quality was tested in the laboratory. The water to be analyzed was taken from three spots, namely upstream and downstream of the river, which are located out of the city, and the middle of river stream in the city centre. The results showed that the quality of water, sanitation, and hygiene in the city centre did not have a significant effect on environmental health even though the Environmental Heat Risk Assessment (EHRA) in the area showed poor scores. The study concludes that waste, as well as clean and healthy living behaviour is the biggest sanitation risks for environmental health. Synchronization of programs by related agencies could facilitate the arrangement of settlements on the riverbanks.

Integration between general practice and hospital specialty for drug prescription appropriateness: the Diabetes Project of the Local Health Service Tuscany Centre

According to standards of medical care in diabetes, sulphonylureas and glinides are suggested to be abolished in the treatment of type 2 diabetes, due to their long-term adverse effects. In 2019, the Local Health Service – ASL Toscana Centro (TC) – promoted a collaboration among diabetologists, general practitioners (GPs) and pharmacists. In detail, the prescription of hypoglycemic drugs was retrieved through codes (ATCA10). After the presentation of the relative data and the recommendation/training of the diabetologist, the GPs were urged to abolish sulphonylureas and glinides, replacing them with newly generation drugs. Comparison with data in 2020 showed a significant drop in prescription of such drugs. Moreover, this project has allowed an estimate of the diabetic population within ASL TC additionally tracking other drugs, such as statins, which generally should be co-prescribed with hypoglycemic agents in the care of the diabetic patients. In conclusion, this experience has increased the knowledge relating to the most recent standards of diabetic care in general practice, promoted the appropriateness in the use of newly drugs, generated epidemiological data, and helped in better planning the long-term pharmaceutical expenditure. KEY WORDS general practice; educational training; stardards of care; sulphonylureas and glinides; statins.

An Empirical Investigation of the Relationship Between Spirituality, Work Culture, and Burnout: The Need for an Extended Health and Disease Model

Apart from biological, psychological, and social factors, recent studies indicate that spirituality and work culture also play an important role in the onset of burnout. Hence, the commonly applied bio-psycho-social model of health and disease might not be sufficient to comprehensively explain and describe burnout. This study empirically investigates the relationship between spirituality (operationalized by perceived meaningfulness of work) and work culture (operationalized by sense of homeliness of the working environment) with burnout risk and work engagement. For this purpose, an anonymous cross-sectional data collection with fully standardized questionnaires and selected socio-demographic and work-related items was conducted among working adults (n = 439) from different industries via social media and local health service centers. For all scales and subscales, we found significant moderate to strong correlations. Furthermore, positive meaning within the perceived meaningfulness of work scale was the largest beta coefficient for burnout (β = −0.65) and work engagement (β = 0.62). Within sense of homeliness, the largest beta coefficient for burnout was needs fulfillment (β = −0.34) and work engagement emotional connection (β = 0.36). The strong associations suggest that the current health and disease model needs to be expanded to a bio-psycho-socio-spirito-cultural model to be able to sufficiently describe burnout. The perceived meaningfulness of work and a sense of homeliness should be adequately considered when examining the onset of burnout, describing burnout as a concept, and explaining work engagement.

“Chagas Express XXI”: A new ArtScience social technology for health and science education—A case study in Brazilian endemic areas of Chagas disease with an active search of chronic cases

Background Chagas Disease (CD) affects 6–7 million people worldwide and is related to poverty-promoting conditions. Chronic asymptomatic cases are mostly invisible to health systems. Aiming (1) to translate CD discoveries into education/information practices to raise alertness and empowerment of affected people; and (2) to perform an active search of CD cases, articulating intersectoral actions to improve the access of infected people to the local health service for the treatment of CD; our research group developed and tested under field conditions as innovative social technology: an itinerant education interdisciplinary setting named “Chagas Express XXI” (CE21). Methodology CE21 was created as an “imaginary train” with ~40 ArtScience workshops, games, laboratory activities and conversation circles. An entry/exit plus six activity modules combined associations of affected people, microscopic observations, One Health education, and wellness activities. CE21 was conceived as a social technology, since all the processes were co-created with CD patients and inter-sector local partners. Descriptive statistics showed quantitative data collected throughout the expeditions (CD knowledge, serological results). Qualitative data accessed the public perceptions about the education activities. Principal findings CE21 was exhibited in local educational institutions (schools, universities) in four cities, engaging 2,117 people that evaluated the 41 activities carried out. Citizens and health professionals enjoyed acquisition of information related to blood, parasites, vectors, reservoirs, environmental changes, and social determinants of CD. Further, local legacies of 600 participants volunteer for health promotion groups and CD associations, local empowerment groups to fight for better health conditions, and 05 mural paintings. We observed that 81% of the participants ignored the possibility of treating CD while 52% of the participants requested a blood test for CD showing seropositivity in 20% of them. Conclusions CE21 is a social technology potentially useful for health and science education and active search of asymptomatic CD chronic cases. Moreover, this technology may be adapted to understand and to cooperate in other potentially epidemic situations, especially NTDs related.

Adapting the definition of multimorbidity – development of a locality-based consensus for selecting included Long Term Conditions

Background Defining multimorbidity has proved elusive in spite of attempts to standardise definitions. For national studies, a broad definition is required to capture national diversity. For locally based studies, the definition may need to reflect demographic and morbidity patterns. We aimed to define multimorbidity for an inner city, multi-ethnic, deprived, young age community typical of many large cities. Methods We used a scoping literature review to identify the international literature, standards and guidelines on Long Term Condition (LTC) definitions for inclusion in our multimorbidity definition. Consensus was categorised into high, medium or low consensus, depending on the number of literature sources citing each LTC. Findings were presented to a workshop consisting of local health service stakeholders who were asked to select LTCs for inclusion in a second stage review. In the second stage, each LTC was tested against seven evaluation domains: prevalence, impact, preventability, treatment burden, progression to multiple LTCs, impact on younger people, data quality. These domains were used to create 12 target criteria. LTC rankings according to consensus group and target criteria scores were presented to a second workshop for a final decision about LTC inclusion. Results The literature review identified 18 literature sources citing 86 LTCs: 11 were excluded because they were LTC clusters. The remainder were allocated into consensus groupings: 13 LTCs were ‘high consensus’ (cited by ≥ 11 sources); 15 were ‘medium consensus’ (cited by 5–10 sources); 47 were ‘low consensus’ (cited by < 5 sources). The first workshop excluded 31 LTCs. The remaining 44 LTCs consisted of: 13 high consensus LTCs, all with high target score (score 6–12); 15 medium consensus LTCs, 11 with high target scores; 16 low consensus LTCs, 6 with high target scores. The final workshop selected the 12 high consensus conditions, 12 medium consensus LTCs (10 with high target scores) and 8 low consensus LTCs (3 with high target scores), producing a final selection of 32 LTCs. Conclusions Redefining multimorbidity for an urban context ensures local relevance but may diminish national generalisability. We describe a detailed LTC selection process which should be generalisable to other contexts, both local and national.

Incidence of idiopathic intracranial hypertension in Southern Tasmania, Australia

IntroductionAnecdotally, the incidence of idiopathic intracranial hypertension (IIH) is increasing, linked to an increase in the obesity rate in Australian society. However, formal incidence and prevalence studies are rare. We therefore sought to determine the incidence and clinical features of IIH in Southern Tasmania, Australia.MethodNeurology discharge summaries and lumbar puncture referrals from the single tertiary referral centre in this region were screened for an IIH diagnosis. All regional neurologists were surveyed to capture patients diagnosed through private neurology clinics. A retrospective review of medical records was conducted to confirm the diagnosis and determine whether patients met the Modified Dandy Criteria (MDC). Patients were included if they were above the age of 18 years and received a new diagnosis of IIH between June 2016 and June 2018. Population statistics were obtained from the Australian Bureau of Statistics.ResultsIIH incidence was 5.4/100 000. All patients were females, aged between 18 and 45 years. Headache was the most commonly reported symptom, with high rates of pre-existing or concurrent migraine diagnoses. Weight loss and commencement of oral acetazolamide were the most common treatment approaches. Four patients were medically refractory and required surgical intervention.ConclusionThe incidence of IIH in Southern Tasmania is comparable with the incidence reported in subgroups of females of childbearing age in recent prior studies. The demographic, diagnostic and therapeutic data presented can inform future local health service provision and serve as a baseline for ongoing assessment of change in incidence and treatment of IIH at a community level.

The Effects of an Innovative Integrated Care Intervention in Brazil on Local Health Service use by Dependent Older People

Background:Since 2011, the Brazilian city of Belo Horizonte has been operating an innovative scheme to support care-dependent older people in disadvantaged communities: Programa Maior Cuidado (PMC – Older Person’s Care Programme). This paper examines two potential effects of inclusion in PMC on types of outpatient health service utilisation by dependent older people. The first is that being in PMC is associated with a higher frequency of outpatient visits for physical rehabilitation. The second is that being in PMC is associated with a higher frequency of planned versus unplanned outpatient visits.Methods:We apply a quasi-experimental design to a unique set of government data. First, we preprocess our sample through different matching techniques such as ‘coarsened exact matching’ (CEM), ‘nearest neighbour’ based on logit scores (NN), ‘optimal pair’ (OP) and ‘optimal full’ (OF) methods. Second, we estimate marginal effects of being in PMC on our outcomes of interest. We use univariate log-binomial regressions with robust standard errors to calculate the incidence ratio of PMC on rehabilitation and planned visits.Results:We find significant positive incidence rates for belonging to PMC for both outcomes of interest under all matching specifications. The CEM shows a higher incidence rate for the proportion of visits for rehabilitation by PMC patients compared to the non-PMC controls: 3.35 (95% CI 1.79 - 6.27). For planned visits, there are significant positive associations for being in PMC in the CEM (1.25 (95% CI 1.17 - 1.33)) and the other models.Conclusions:Our analysis reveals significant positive associations between older people included in PMC and a matched set of controls for making outpatient visits that were planned, rather than unplanned. We find similar associations for the proportion of visits made for rehabilitation, as opposed to another reason. These findings indicate that PMC influences some elements of outpatient health service utilization by dependent older people.

Elderly with chronic kidney disease in outpatient treatment: risk factors and prevention pathways

Introduction. At present, doctors in all disciplines are facing an increasing problem of chronic kidney disease (CKD) management. It is particulary relevant for screening and treatment of aged patients, because they suffer from CKD most frequently. This is due both to physiological age characteristics and kidney disease risk factors of these patient’s category.Aim. To provide an analysis of the main causes and risk factors of CKD in elderly patients.Materials and methods. Analysis of outpatient charts of patients aged 55–90 with multiple chronic diseases observed in the local health service in Moscow, which is the base of the Department of Outpatient Therapy, RNRMU.Results. We analyzed the most significant risk factors of CKD and their frequency, the indications of this syndrome in the formulation of diagnosis, the prescription of drugs, providing nephroprotective strategy.Conclusion. CKD is one of the most frequent pathologies in the elderly. An analysis of the outpatient charts showed that the main causes of CKD among patients in this age group were not kidney diseases but comorbide pathology, primarily arterial hypertension. These patients also had high frequency of diabetes mellitus, hyperlipidemia, obesity. Not all patients have been identified with CKD in the structure of diagnosis, which could influence the correct tactics for treating related diseases. Nephroprotective therapy was also not fully available to patients. Current recommendations can be used by primary health-care doctors in practice.54

A study of antibiotic and disinfectant susceptibility of Elizabethkingia meningoseptica

For the local health service, Elizabethkingia meningoseptica remains a relatively new and little-known pathogen, whereas in many countries of Europe, Asia and other continents it is considered as a potential causative agent of nosocomial infections, especially in premature infants and immunocompromised patients. An analysis of the literature data, as well as our results indicate that E. meningoseptica should be considered as a potential pathogen, which is characterized by a unique profile of susceptibility to antimicrobial agents (AMP) and disinfectants. This article presents the results of a study of susceptibility to AMP and disinfectants of three isolates of E. meningoseptica, isolated during an investigation of an outbreak in one of the perinatal centers of the Russian Federation, where three cases of sepsis with a fatal outcome in premature infants caused by co-infection with Acinetobacter baumannii and E. meningoseptica were recorded between January and February 2016.