The journal of medicine access最新文献

Introduction: The registration of future organ donors offers hope to thousands of individuals and supports the mission of the Saudi Center for Organ Transplantation (SCOT). Despite the availability of the Tawakkalna app (a national digital platform designed to simplify donor registration), actual donation rates in Saudi Arabia remain low. Understanding the personal and attitudinal factors that influence registration is crucial to bridging the gap between willingness and behavior.

Purposes: This study aims to investigate the relationship between attitudes toward organ donation and seven personal characteristics that influence registration behaviors for posthumous organ donation (age, gender, marital status, education, employment, smoking status, and comorbid conditions) using the Tawakkalna app in the Western region of Saudi Arabia.

Methods: A quantitative approach with a cross-sectional design was employed to achieve the study's objectives. A total of 1,482 respondents participated in an online survey conducted through convenience sampling. A logistic regression model through SPSS version 25 was employed to compare factors associated with registration behaviors for posthumous organ donation.

Results: The study found that the registration rate for posthumous organ donation was 26%, Individuals with higher attitude scores were significantly more likely to register as organ donors (p < 0.001, OR = 2.760, 95% CI: 2.262-3.368). Younger participants, non-smokers, and those without comorbid conditions also showed higher odds of registration (all p < 0.05). In contrast, factors such as gender, education level, marital status, and employment status did not show a significant relationship.

Discussion and conclusion: Findings highlight that positive attitudes, younger age, and better health status are key determinants of organ donation registration through digital platforms. The results underscore that technological accessibility alone does not guarantee engagement; behavioral and health-related factors remain critical. Posthumous organ donation is a controversial topic within the Muslim context. The findings could be valuable for policymakers striving to increase organ donation registration rates and can help address gaps in the current literature on this subject. These insights can inform targeted awareness campaigns, culturally aligned behavioral interventions, and digital health policies aimed at enhancing donor registration rates and closing the attitude-behavior gap in Saudi Arabia.

Introduction: The World Health Organization (WHO) Model List of Essential Medicines guides countries in selecting priority drugs to ensure equitable access to effective treatments. In regions such as Central America, with similar health and socioeconomic contexts, comparing national lists reveals patterns and opportunities for regional harmonization.

Methodology: A cross-sectional comparative observational study was conducted using public secondary data from the official essential medicines lists of seven Central American countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama. These lists were compared against the 2017 WHO Model List. Therapeutic classification was based on the Anatomical, Therapeutic, and Chemical Classification (ATC) system (level 2). Macroeconomic variables, including health expenditure per capita and gross domestic product (GDP) per capita, were analyzed for their relationship with list composition.

Results: Panama had the most extensive NEML (570 drugs) and Nicaragua the shortest (271 drugs). Nicaragua showed the highest alignment with the WHO list, while Panama had the most exclusive drugs. A significant positive correlation was found between health expenditure per capita and NEML size (r = 0.77; p = 0.042), but not with alignment to the WHO list. The most represented therapeutic groups were antibacterials (31.2%) and antineoplastics (24.4%).

Conclusion: Although Central American countries share regional similarities, their selection of essential medicines varies considerably. These differences reflect diverse public health priorities, institutional capacities, and economic conditions. The findings support the need for evidence-based, context-sensitive approaches and underscore the potential for regional cooperation in essential medicines policy.

Background: Managing the coordination of the medicine supply chain in developing countries is highly challenging, particularly for malaria treatment drugs such as artemisinin-based combination therapies (ACTs). Numerous factors contribute to poor coordination in the ACT supply chain.

Objectives: This study aimed to identify and prioritize supply chain coordination factors at the micro-, logistics, market and macro-levels that influence the availability of ACTs in Uganda's general hospitals.

Methods: Using the Analytic Hierarchy Process (AHP), 20 factors across the micro-, logistics, market and macro-environments were evaluated through expert input collected from four public hospitals in Uganda.

Results: Micro-environmental factors - especially top management support, mutual understanding and information sharing - were identified as the most critical. Logistics, macro-environment and market factors followed in decreasing order of influence.

Conclusion: A structured, context-sensitive approach is essential for improving supply chain coordination and ACT availability in resource-limited settings. These findings offer insights for healthcare managers and policymakers in similar contexts.

Well-functioning pharmaceutical systems are crucial for ensuring universal access to medicines and their appropriate use. While existing frameworks for analysing pharmaceutical systems generally focus on the national level, in many countries, the core functions are often managed locally within a broader national framework. Despite this local focus, there has been no effort to conceptualize a 'local pharmaceutical system' as a distinct entity with its own goals, functions and operational components. A method for analysing and comparing the performance of local pharmaceutical systems (LOPHAS) within a country is still lacking. We aim to develop an analytical approach and framework to assess the performance of LOPHAS and guide improvements in access to essential medicines. We conducted an integrative literature review and consulted with purposively selected experts. We systematically searched for existing approaches for conceptualizing or assessing pharmaceutical systems and empirical studies in which these were applied and combined this with insights from 23 reviews and guidebooks suggested by experts to develop the LOPHAS approach and framework. We identified 13 existing frameworks and 16 studies that had applied these frameworks to analyse pharmaceutical systems. Building on these findings, we propose that a LOPHAS has six core functions: (1) local governance, (2) managing product supply, (3) financing, (4) developing human and physical resources, (5) appropriate dispensing and use of medicines and (6) monitoring performance. For each function, we defined operational components and indicators. The primary outcomes of a LOPHAS are access to medicine and appropriate use of medicine. The LOPHAS framework provides a practical tool for assessing and comparing the performance of LOPHAS. By identifying areas for improvement, it can guide policymakers, healthcare providers and local administrators in strengthening systems to ensure that essential medicines are accessible and used appropriately, supporting broader health goals.

Background: Previous studies from Brazil and West Africa have shown that patients with albinism can feel stigmatized and isolated, highlighting the importance of access to healthcare and support in improving their quality of life. Studies in the United States are lacking.

Objectives: Our study aims to understand gaps in access to genetic testing, vision care, and community resources for patients with albinism.

Design: A survey was distributed on the National Organization for Albinism and Hypopigmentation (NOAH) website and during in-person research sessions at the Medical College of Wisconsin or emailed to previous research participants.

Methods: Multiple choice and open-ended questions were aimed at assessing access to resources, genetic testing, and vision health. The data were de-identified and analyzed.

Results: A total of 47 responses were received between June 2022 and April 2023. Around 62% were based on self and 38% based on child; 66% of participants were women, 32% men, and 2% transgender. There was a wide distribution of age, location, household income, and education level. Almost 85% of participants had medical insurance, including 15% Medicare/Medicaid. Around 64% had genetic testing done, of those 40% had to travel an average of 459 miles (5-1700 miles, Mdn: 150 miles, M: 459 miles) to access it. About 34% felt their questions about albinism were not fully answered, for reasons such as questions not answered by their physician, using a 23&me kit, not seeing a genetic counselor, or genetic results that were inconclusive. Almost 83% felt they had good understanding of their visual health. Around 60% were aware of community resources related to improving quality of life related to visual health, but only 45% utilized them.

Conclusion: While access to eye doctors is adequate in our surveyed population, access to genetic testing could be strengthened and awareness of community resources could be improved upon. This could be facilitated by eye doctors and primary care physicians.

Objective: To investigate the effects of the Coronavirus disease 2019 (COVID-19) virus on seminal fluid analysis (SFA) parameters in patients who have had the infection.

Background: COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 and has had a significant global impact. Recent studies suggest a potential relationship between COVID-19 and male reproductive health, particularly in its effects on semen quality.

Methods: A prospective cohort study was conducted, and the trial had 50 participants outset (6 participants were lost to follow-up later, and the final analysis involved 44 participants). The study was conducted at the Baghdad Medical City Complex, and it lasted from August 2020 to August 2022. Patients who had received any COVID-19 vaccination were excluded.

Results: In the present study, 44 male participants were included in this study, their mean age is 31.8 ± 5.1 years ranging from 22 to 42 years, their mean body mass index is 24.7 ± 3.4 kg/m², and about 77.3% were smokers. All SFA parameters were significantly reduced from baseline to 3-month visits, while from 3 to 6 months, there was a significant increase in all SFA parameters.

Conclusion: COVID-19 infection has a negative effect on SFA parameters during the first 3 months of post-viral infection. Parameters of SFA recovered to levels comparable to baseline SFA between 3 and 6 months after viral infection.

Background: One fundamental element of strengthening maternal health initiatives and outcomes involves improving medication access. However, most of the people in many low- and middle-income countries do not have access to these essential medicines for maternal and child health.

Objectives: This study aimed to determine the availability of necessary medications for maternal health in public health facilities in Mwanza, Tanzania.

Methods: A retrospective cross-sectional study was conducted in April 2024 in public health facilities in Ilemela and Nyamagana districts. Availability of 13 essential medicines was collected from 36 public health facilities. Data was collected from the public health facilities' store records (ledgers and bin cards) using a checklist (data collection tool) adapted and modified from the World Health Organization (WHO) Health Action International tool.

Results: The overall median point availability of essential medicines for maternal health was 94.4% (interquartile range (IQR), 80.6-97.2). The overall public health facility median number of stock-outs (periods when medicines were unavailable) was 3, and the median number of stock-out days was 94 in the past 3 months. The most stocked-out medicines during the period were calcium gluconate (93.4%), misoprostol (32.9%), gentamicin (16.1%) and methyldopa (10.6%). Generally, medicines used only for the management of maternal health conditions were most stocked out compared to medicines with broader indications, 33.3% and 13.9%.

Conclusion: Despite a relatively high overall median point availability, frequent stock-outs were observed, particularly for critical medicines like calcium gluconate, misoprostol, gentamicin and methyldopa. Medicines used solely for maternal health were more likely to experience stock-outs compared to those with broader indications. These findings highlight the need for improved supply chain management and prioritization of maternal health-specific medicines to enhance the quality of maternal healthcare services in the region.

Background: Suboptimal complementary feeding practice during the first 2 years of life are key determinants of malnutrition in children and have a negative impact on a child's growth, health, and development.

Objective: To assess the prevalence of suboptimal complementary feeding practice and associated factors among caregivers of children 6-23 months in Dambi Dollo town.

Methods: Community-based cross-sectional study was conducted at Dambi Dollo Town from 9 August to 11 October 2023, among 284 caregivers of children aged 6-23 months. Binary logistic regression was used to measure the strength of association between dependent and independent variables using adjusted odds ratio (AOR) and 95% confidence interval (CI). A p-value < 0.05 was considered statistically significant.

Results: The prevalence of suboptimal complementary feeding among caregivers of children 6-23 months was 65.8%. Findings of multivariable logistic regression analysis indicated that lack of formal education (adjusted odds ratio (AOR) = 4.93, 95% CI = (2.35, 10.34)), lack of attending antenatal care (AOR = 2.47, 95% CI = (1.20, 5.08)), and medium knowledge of child feeding practice (AOR = 0.21, 95% CI = (0.09, 0.47)) were significantly associated with suboptimal complementary feeding practice.

Conclusion: This study showed that two-thirds of children were poorly provided complementary food which significantly associated with lack of attending antenatal care, lack of formal education, and medium knowledge on infant and young child feeding practice. These results highlight the need for targeted interventions, including strengthening antenatal care services, promoting maternal education, and enhancing community-based nutrition education programs to improve complementary feeding practices and ultimately support better child health and development outcomes.

Background: Understanding the factors associated with patient no-shows is essential for healthcare providers to develop strategies to optimize patient care, as these can delay care and increase cost. This retrospective study aimed to identify factors associated with higher likelihood of patients missing their scheduled cataract surgery appointments at a county hospital.

Methods: A retrospective chart review was performed using data collected from the surgery schedule and electronic medical record on patients aged 18-100 years scheduled for cataract surgery at Eskenazi Hospital between January 1, 2022, and December 31, 2022. Logistic regression was used to compare factors of age, race, ethnicity, primary spoken and written language, insurance status, best-corrected visual acuity and number of admissions to the emergency department of the same hospital in the preceding year to attendance of cataract surgery on scheduled date.

Results: This study found that in the studied population (n = 242), being incarcerated was a statistically significant predictor of missing the scheduled cataract surgery appointment (OR 6.14, 95% CI 1.14-33.16, p = 0.035). In addition, having at least one emergency department visit in the prior year (OR 6.50, CI 1.83-23.1, p = 0.004) was found to be significant, with a greater difference in patients who had at least three emergency department visits in the prior year (OR 13.2, CI 3.21-52.6, p < 0.001). Other studied factors were not found to be statistically significant predictors of missing the surgery appointment, although having best-corrected vision of count fingers or worse neared statistical significance of predicting missing cataract surgery appointment. These findings may potentially direct targeted intervention strategies to improve access to cataract care.

Atrial fibrillation is a common cardiac arrhythmia affecting over 33 million individuals globally; however, atrial fibrillation with slow-ventricular response (AF-SVR) remains an underexplored subset. AF-SVR is characterized by an irregular ventricular rate of less than 60 beats per minute without the influence of atrioventricular (AV) blocking agents. This review aims to consolidate current knowledge on AF-SVR, focusing on the epidemiology, pathophysiology, clinical manifestations, complications, diagnosis, and management strategies. AF-SVR is more prevalent in older adults, often attributed to age-related degeneration of the cardiac conduction system. Conditions such as AV nodal block, sick sinus syndrome (SSS), and the effects of certain medications are significant contributors to the development of AF-SVR. The pathophysiology involves complex electrical and structural remodeling of the atria, which can lead to bradycardia and symptomatic conduction delays. Clinically, AF-SVR presents similarly to other forms of bradycardia, with symptoms including fatigue, dizziness, and syncope. Diagnosis is primarily based on electrocardiogram (ECG) findings of AF with a slow-ventricular rate, supplemented by ambulatory ECG monitoring and exercise tolerance testing. Transthoracic echocardiography (TTE) is crucial for identification of underlying structural heart disease. Management of AF-SVR involves first addressing reversible causes such as medication effects, electrolyte imbalances, and underlying ischemia. Pharmacological options including the use of anticholinergic medications such as theophylline and hyoscyamine, which have shown efficacy in reversing bradycardia. Persistent or severe cases often require permanent pacemaker implantation to maintain adequate heart rates and prevent complications. This review highlights the need for further research on AF-SVR, particularly regarding non-invasive treatment options and the long-term outcomes of different management strategies. Understanding the unique challenges of AF-SVR is essential for optimizing patient care and improving clinical outcomes. Future studies should focus on establishing comprehensive guidelines for the diagnosis and management of AF-SVR.