The ongoing conflict in Ukraine has severely disrupted healthcare infrastructure, displaced medical personnel and restricted access to care, prompting an unprecedented international support. Since October 2023, the non-governmental organization EMERGENCY has conducted a field assessment to identify critical barriers to healthcare delivery in remote villages of Donetsk to inform an effective intervention. The assessment revealed that many health needs, particularly those related to chronic diseases and mental health, were pre-existing but had been exacerbated by the war, resulting in a secondary surge of unmet needs in rural communities facing growing barriers to basic care. In response, a Community Health Worker (CHW)-led intervention was developed to bridge gaps between communities and health services. Locally recruited CHWs conduct door-to-door assessments, monitor treatment adherence for chronic diseases, address mental health needs, arrange home-based care for bedridden individuals, deliver health education sessions, and facilitate timely referrals in close collaboration with nurse-led clinics. To strengthen resilience, CHWs are trained in basic emergency and disaster preparedness, including life support skills, improving community-level readiness for health emergencies. To address sustainability challenges, the intervention is integrated into Ukraine's primary care network, and provides CHWs with ongoing training and compensation through regular contracts. Aligned with national health priorities and the Health Cluster's strategy, the model targets marginalized groups, engages communities, and strengthens local health systems, ensuring efficient use of resources and continuity of care. This report outlines a scalable, context-sensitive approach to enhancing healthcare access in conflict settings, with relevance for other humanitarian contexts.
Background: Health Technology Assessment (HTA) is vital for evidence-based policymaking and resource allocation. In Iran, HTA development involves diverse actors with varying levels of power, influence, and support. Understanding their interactions is key to strengthening HTA processes.
Methods: We applied Social Network Analysis (SNA) to map relationships among 27 stakeholders identified through document review and expert interviews. Data were collected via an online questionnaire completed by 83 experts (response rate: 72.2%), assessing five dimensions: power, position, interest, influence, and support. Network metrics, including degree, closeness, betweenness, and eigenvector centrality, were analyzed using R Version 4.4.1.
Results: The Ministry of Health and Medical Education, Food and Drug Administration, Insurance Organizations, and Parliament were perceived as the most influential actors. The Plan and Budget Organization (degree centrality 0.34) and National Institute of Health Research (0.26) emerged as key connectors with high bridging roles. Overall, the network exhibited low density (0.13) and limited clustering (0.11), indicating sparse connectivity. Peripheral actors, such as the Chamber of Commerce, were largely disconnected from the network.
Conclusion: HTA development in Iran is shaped by a few central institutions, but weak connectivity and limited engagement of peripheral actors hinder collaboration. Strengthening stakeholder communication, enhancing inclusiveness, and securing sustainable funding are critical for more effective HTA implementation and evidence-informed health policy.
This contribution focuses on the Italian Ministry of Health's Decree No. 77 of 23 May 2022, aimed at standardizing preventive healthcare nationwide. The implementation of Ministerial Decree 77 represents a crucial step in strengthening preventive care in Italy, by redefining community-based healthcare models and promoting proactive, population-centered interventions. It highlights regional disparities in healthcare access and explores innovative approaches, including Regulation 13/2023 of the Apulia Region (Southern Italy), to improve health outcomes. In this context the comparison of healthcare management systems of northern and southern Italy, particularly on vaccination rates, chronic disease management and the integration of environmental health is relevant. It examines the Apulian regulatory model, emphasizing environmental determinants such as air quality monitoring and predictive analytics to mitigate climate-related health risks. The Apulia model led to significant health improvements, including a 25% reduction in waterborne diseases and a 12% reduction in heatwave-related hospitalizations. Multidisciplinary collaboration and community engagement enhanced policy effectiveness and public confidence. This work underscores the importance of balancing national health guidelines with regional autonomy to address health inequalities. The Apulia model demonstrates the need for integrating environmental health factors and offers a replicable framework to improve health equity and resilience. Recommendations include strengthening administrative capacity, fostering inter-regional collaboration, and promoting innovative regional healthcare approaches.
Introduction: Skin cancer is one of the most prevalent malignancies worldwide, particularly in countries with high ultraviolet (UV) radiation exposure. Thus, to reduce sun exposure, the early adoption of protection behaviours is essential. In this task, future medical professionals must demonstrate competencies in skin cancer prevention. This study aimed to describe and compare photoprotection knowledge, attitudes, and practices (KAP) among medical and non-medical students.
Methods: A cross-sectional study was conducted at a private university in Lima, Peru, involving 624 students from five programs: medicine, industrial and systems engineering, law, psychology, and business administration. Participants were divided into two groups: medical and non-medical students. The Questionnaire on Habits, Attitudes, and Knowledge about Sun Exposure in Adolescence and Adulthood (CHACES), a validated tool to assess sun exposure and protection KAP, was used. Group comparisons were performed using Chi-squared and Mann-Whitney U tests.
Results: Participants' average age was 21.09 years old, with 56.1% being female. Medical students scored higher in photoprotection knowledge (U = 35,853.5; p = 0.003) and reported lower sun exposure (U = 37,263.5; p = 0.028) than non-medical students. However, no significant differences were observed in photoprotection behaviours (p = 0.807) or photoprotection attitudes (p = 0.238).
Conclusion: Medical students demonstrated greater knowledge and fewer sun exposure habits; however, their photoprotection behaviours did not differ significantly from non-medical students. These findings highlight the need for enhanced educational strategies for skin cancer prevention across all university programs.
Introduction: Middle-aged adults experience distinctive health issues, yet underutilize preventive care despite Iran's strong primary healthcare (PHC) system. This research investigates social and demographic determinants of healthcare services utilization among middle-aged adults in Qom, Iran, to inform the development of targeted community-based screening initiatives.
Methods: A cross-sectional study was conducted in underprivileged suburbs of Qom (June-September 2024) among 697 adults aged 30-59, randomly sampled by cluster sampling. Awareness of available services, utilization, and satisfaction with PHC service information were collected via phone interviews. Multivariate logistic regression identified predictors of service utilization.
Results: Only 11.8% (n = 82) of the participants were aware of middle-aged health services, and 24.2% (n = 169) had utilized them in the past year. Women had at least one PHC visit 2.5 times more than men (35.3% vs 13.9%, p < 0.001), and utilization increased with age (31.1% among 50-59-year-olds vs. 19.6% in 30-39 years-old, p = 0.023).The strongest predictor was awareness: aware adults had 22.4-fold higher odds of use (95% CI: 11.60-43.29, p < 0.001). Dissatisfaction (by 7.7% of users) was linked to gaps in staff communication (38%), overcrowding (38%), and perceived incompetence (30%) (multiple responses permitted). Work and education were not independently associated with service use after adjustment, suggesting indirect impacts.
Conclusion: PHC utilization among middle-aged population is handicapped by low awareness and gender/age disparities. Interventions should prioritize health literacy programs, staff training to improve patient-provider communication, and systemic modifications to reduce overcrowding. Increased outreach to men and younger adults is necessary to ensure equitable preventive care.
Introduction: Intellectual disability is a permanent disability and raising such a child may lead to varied physical, social, emotional response from caregivers. Data of Quality of life of family members of such children is underexplored.
Objectives: To measure quality of life of family members of intellectually disabled children.
Methodology: A cross-sectional study was conducted involving seven functional special schools in Ahmedabad. Out of 382 eligible children, 253 parents (Category A) and 195 siblings (Category B) were included. Data were collected using a pre-tested, semi-structured questionnaire. Quality of life for parents was assessed using the National Institute of Mental Health Disability Impact Scale, while siblings were evaluated using the Columbia Impairment Scale (Youth Version).
Results: Among Category A participants, the most negatively affected domains were social life (77.1%), physical care (65.2%) and embarrassment (60.5%). Positive effects included better family relationships and increased empathy. Among siblings, 80.5% exhibited functional impairment (score >16), with common problems related to emotional well-being, behaviour and peer interactions. Age, education, and employment status significantly influenced impairment scores.
Conclusion: Parents and siblings of children with ID experience considerable negative impacts on their quality of life. These findings highlight the need for targeted psychosocial and support interventions to address the challenges faced by these families.
Introduction: Congenital adrenal hyperplasia (CAH) attributed to 21-OHD is one of the most common genetic endocrine disorders that occurs due to the disruption and defects in the steroidogenic enzymes involved in the production of cortisol. The current study aims to assess the final height of patients with classic CAH forms in Iran.
Methods: The retrospective cohort study was conducted on 30 patients (determined using the previous studies by the sample size formula to compare two means) studies with classic type CAH who were followed up and treated in the endocrinology clinic of Ali Asghar Hospital during the 2000-2022 years. The history of the patients at the time of diagnosis was extracted from the patient's files and recorded in the checklist. All data was analyzed using IBM SPSS Statistics version 22 software.
Results: In the simple virilizing (SV) group, the target and final height for females was 162 and 159.2 cm, and for males were 173 and 171 cm. In the salt-wasting (SW) group, the target and final height for females was 164 and 163.2 cm, and for males were 171.7 and 173.1 cm. There was a significant and reverse correlation between the mean age at the time of diagnosis and the Final Height percentile among all cases (r: -0.55, p: 0.02) and the SW group (r: -0.75, p: 0.002). A positive and significant correlation was seen between the bone age advanced and final height percentile in the SV group (r: 0.04, p: 0.03). The final height percentile increased significantly with an increase in the Duration of treatment regardless of CAH type (r: -0.67, p: 0.009). Also, there was a positive and significant correlation between hydrocortisone dose and final height percentile in the SV group (r: 0.24, p: 0.04).
Conclusion: The results of the present study showed that early diagnosis of the disease at a young age, lower bone age of patients, preventing the increase of obesity in children with CAH, and receiving appropriate drugs with standard doses can play an effective role in increasing the final height of CAH patients.
Introduction: In the Philippines, research on knowledge, attitudes, and practices (KAP) regarding human mpox (hMPX) remains limited, despite rising case numbers. With vaccines unavailable locally, enhancing community awareness and promoting non-pharmaceutical interventions are crucial for reducing transmission risks.
Methods: This cross-sectional study utilized an anonymized online data collection tool to explore the general public's hMPX KAP and their relationships, and identify sociodemographic groups linked to low hMPX knowledge; 502 respondents were included in the analysis.
Results: Knowledge levels were evenly distributed across low, moderate, and high categories. Higher knowledge was associated with being female (β = 0.130, p = 0.004), higher educational attainment (β = 0.134, p = 0.006), and smaller household size (β = -0.098, p = 0.028). Knowledge was not significantly associated with perceived disease susceptibility or severity, but strongly predicted perceived effectiveness of preventive measures. Perceived effectiveness, in turn, consistently emerged as the strongest predictor of preventive practices. Full mediation of the effect of knowledge by perceived effectiveness was observed with protective sexual practices and avoiding crowded places, but only partial with hand hygiene and fomite/high-touch surface disinfection.
Conclusion: This study highlights the complex interplay between knowledge, attitudes, and practices in shaping public health behavior toward hMPX in the Philippines. Significant knowledge gaps and the mediating role of attitudes in influencing preventive practices underscore the need for targeted, stigma-free health communication strategies. Strengthening public understanding and perception through tailored interventions will be critical in mitigating hMPX transmission.
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