Good Uptake of the COVID-19 Vaccine Among Patients with Rheumatic Diseases in the United Arab Emirates (UAE)

Background: Many patients with rheumatic diseases are immunosuppressed and take forms of immunomodulator medication. Hence, these patients might be at a heightened risk of Covid-19 and have special concerns in regard to vaccines, such as safety and efficacy. Vaccines have been available for the population of UAE as of January 2021, these being Pfizer (the United States and Europe), Sinopharm (China), and AstraZeneca (United Kingdom). The aim of our paper was to examine the rate of vaccine uptake among our patients with rheumatic conditions in the United Arab Emirates. Methods: A questionnaire was distributed among patients with rheumatic diseases attending a rheumatology specialised clinic in the United Arab Emirates. We collected data on 149 consecutive patients who were seen during a one-month period from 10/06/2021 to 10/07/2021 in Dubai. Results: The mean age of the patients was 45.9 +/- 41.3. The majority of the patients had underlying rheumatic diseases (86.9%), the rest having conditions such as soft tissue pain or to rule out rheumatic conditions. 48.5% were taking immunomodulators. 41.7% of respondents had other chronic diseases. It was also found that 18.9% had Covid-19 previously, all of whom recovered, with the average duration of the illness being 11 days. 99.1% of individuals reported that receiving the Covid-19 vaccine was extremely important, and 95.0% had already received the vaccination. Their reasoning for receiving the vaccination varied from medical advice (17.5%), general worry about infection/ reinfection of Covid-19 (65.3%), in order to travel (8.4%), employee requirement (5.6%), and other reasons (3.2%). Specifically, 48.3% chose the Pfizer vaccine, 39.8% had Sinopharm, and 11.9% had AstraZeneca. These decisions on which vaccine to choose were influenced by the availability of the vaccine (35.1%), medical advice (16.9%), effectiveness (15.5%), safety and side effect profile (18.2%), age restrictions (2.7%), experience/ advice from friends and family (8.1%) and other reasons (3.4%). Conclusion: Overall, an overwhelming majority of our patients (95.0%) with rheumatic diseases in the specialised muscular-skeletal clinic in the UAE have received the Covid-19 vaccine. This reflects good public health service messaging and concentrated efforts from the medical community, UAE government, and the patient’s rheumatologists.

The use of homeopathy to prevent symptoms of human flu and acute respiratory infections: a double-blind, randomized, placebo-controlled clinical trial with 600 children from Brazilian Public Health Service

In Brazil, homeopathy was implemented in the Public Health Service through the National Policy on Complementary and Integrative Practices of the Health Ministry, published in 2006. Homeopathy appears as a very interesting therapy to be used in the Public Health Services since its medicines are compounded at a very low cost. Considering this interesting scenario to develop research in the Public Health, the Family Health Program (FHP) in Petropolis and the Faculty of Pharmacy at UFRJ started a partnership with the Roberto Costa Institute. A homeopathy clinical trial, employing a control protocol (double-blind, randomized, placebo-controlled), was developed as a result of this partnership starting in April 2009 and ending in April 2010. This clinical trial, approved by the Ethics Committee at UFRJ, number 194/08, aimed to evaluate the efficacy of two types of biotherapics to prevent symptoms of both flu and acute respiratory infections, compared to placebo (ethanol 30%). The biotherapics tested were ARI (Acute Respiratory Infection) and InfluBio. ARI is a homeopathic complex containing three different microorganisms related to respiratory infection while InfluBio is a biotherapic compounded from infectious influenza A virus. Before the development of this clinical trial, ARI had been used routinely in FHP, in Petropolis, to prevent acute respiratory infections in patients. The qualitative results obtained from this application suggested that this medicine has a prophylactic potential in the treatment of respiratory diseases. Additionally, we evaluated the antiviral activity of InfluBio using in vitro methodology and the promising results obtained motivated our group to test it in a clinical trial. With this aim, 600 children, from 1 to 5 years of age, were selected by physicians in 21 units of FHP, following the inclusion/exclusion criteria. For 1 month (April 2009), the children received daily, in a blind manner, the test solutions (placebo, ARI, InfluBio) in the posology of 1 drop per year of age. After 30 days, the use of these solutions was interrupted, and the health agents monitored the children for the subsequent twelve months, registering, in a specific questionnaire, symptoms of flu and acute respiratory infections. The respiratory symptoms that were to be reported were: runny nose, fever, prostration, myalgia, cough and headache. In the occurrence of one or more of these symptoms, the health agents evaluated the necessity of intervention by the physician. Of the 600 children, 450 completed the planned monitoring. The main reasons why 150 quit the treatment were change of address and parents’ abandonment. Additionally, no death was recorded and all the children presented good clinical evolution. In the case of the children who received placebo, the frequency of episodes diagnosed as acute respiratory infection/flu was three times higher when compared to those that received the ARI and InfluBio samples, considering the superior limit of the interquartile interval. Moreover, children treated with these biotherapics did not present any or presented only a single episode of ARI/Flu. These results showed that both biotherapics tested were statistically higher (p

Airborne Alt a 1 Dynamic and Its Relationship With the Airborne Dynamics of Alternaria Conidia and Pleosporales Spores

Fungal spores are universal atmospheric components associated to allergic reactions. Alternaria (Ascomycota) is considered the most allergenic spore taxa. Alt a 1 is the major allergen of Alternaria and is present also in other Pleosporales. In this study, standard Hirst-based sampling and analyzing methods for measuring spore daily concentrations of Alternaria, Curvularia, Drechslera-Helminthosporium, Epicoccum, Leptosphaeria, Pithomyces, Pleospora and Stemphyllium (all included in the taxon Pleosporales) have been used besides two high-volume samplers, Burkard Cyclone (2017) and MCV CAV-A/mb (2019-2020), and ELISA Kits for measuring the allergen. The detection and quantification of Alt a 1 was only possible in the samples from the MCV sampler. Although Alt a 1 was better correlated with Alternaria spores than with Pleosporales spores, the three of them showed high correlations. It is shown, for the first time, a high and significant correlation of Alt a 1 with temperature, a negative one with relative humidity and no correlation with precipitation. The aerobiological monitoring of these three elements ensures the best information for understanding the affectation to allergy sufferers but, if not possible, as a minimum public health service aiming at the detection, treatment and prevention of allergy, the study of the airborne Alternaria spores should be ensured.

Rebuilding India’s Public Health

Assuming impervious boundaries of public health service systems when searching for answers to its problems can be misleading as historically, economic and welfare planning to improve the quality of life of all was considered critical. Despite years of planning, the health sector in India has acquired a tumultuous trajectory with chaos prevailing at different levels – conceptualization, policy, financing, organization and community participation. Using the concept of order in Chaos, this paper attempts to trace four basic underlying elementary patterns in the developmental process rooted in the larger socio-political structures that led to this chaos. Its second section explores the roots from where these patterns explaining the links between health, poverty and inequality in health emanate - the zone of conflict of interests among those who hold power and those whom they represent. It explores how they altered the public health service system and settled in favour of a small but powerful elite (the corporates, the upper-middle class and the professionals) seeking international standards irrespective of the local context. Structural Adjustment and the Health Sector Reforms benefited them by shifting subsidies to the private/corporate sector, transforming services into a costly commodity, fragmented and marginalized primary health care and public hospitals while ushering in hi-tech medicine.

Basic Health Units services quality assessment through Kano and SERVQUAL models

PurposeThe present research aims to evaluate the quality of services provided by the Basic Health Units (UBS) of the Unified Health System (SUS) located in the city of Recife, in the state of Pernambuco, Brazil, using the Kano model integrated with the dimensions of quality proposed by the service quality (SERVQUAL) model.Design/methodology/approachThe research was classified as bibliographic, descriptive, quantitative and surveyable. A structured questionnaire based on the Kano Model integrated with the dimensions of quality proposed by the SERVQUAL model, applied online through Google Forms. The questionnaires were distributed on social networks, obtaining a non-probabilistic sample of 120 individuals, collected for convenience.FindingsThrough the analysis of the Kano Model, it was possible to observe that all the investigated attributes are classified as one-dimensional. Among the attributes that deserve to be highlighted are attributes “Clean and pleasant environment”, “Reliability and security of information”, “Knowledge of employees to perform services”, “Service performed in the promised time”, “Polite and kind staff in dealing with users” and “Effectiveness of the service provided” due to having the longest intervals when considering the satisfaction and dissatisfaction coefficients, above 1.575. These attributes must be considered as critical priorities when implementing improvements, since their presence considerably increases users' satisfaction, as well as their absence generates great dissatisfaction.Originality/valueThe research is original and justified by the potential use of a quality assessment tool in the public health service, especially primary care. It is noteworthy that there are few works that integrate the Kano and SERVQUAL models applied in the public health service and that this integration can contribute to the national and international literature, mainly in the identification and prioritization of areas for improvement.

Medication Errors Detected in Primary Health Care after Hospital Discharge

Background: Medication conciliation allows finding discrepancies and medication errors in healthcare transitions, but there are few studies performed after hospital discharge, in the context of primary health care. Therefore, the main aim of this research was to evaluate the process of medication conciliation in primary health care, after hospital discharge. We further sought to analyze some demographic aspects of the patients that could be associated with potential discrepancies. Methods: A cross-sectional study was performed using the database which contained the records generated by the medication reconciliations performed by the physicians of the Andalusian Public Health Service, in Spain. Results: A total of 6115 medication conciliations were analyzed, and discrepancies were found in 73.7% of them. A total of 50.6% were medication errors, the most frequent being medication omission. Medication errors were more prevalent in women of 65 years and older. Conclusions: After hospital discharge, most patients show medication discrepancies in their records, particularly older women. To prevent this, primary health care plays an essential role in the conciliation process, therefore more research is needed in this context.

'You had to do something': prescribing antibiotics in Scotland during the COVID-19 pandemic restrictions and remobilisation

Introduction The COVID-19 pandemic brought about seismic change for dentistry including the direction to provide remote advice and prescribe analgesia and antimicrobials. The possibilities for care have widened, but the impact of both restrictions and remobilisation on antibiotic prescribing is not known.Aims To report the impact of COVID-19 restrictions and remobilisation on dental antibiotic prescriptions and explore dentists' intentions and attitudes towards antibiotic prescribing.Design and setting Public Health Scotland national prescribing and claims data are reported alongside an online survey of Scottish general and public health service dentists including closed and open-ended questions.Results Antibiotic prescribing rose by 49% following the suspension of routine dental care, to a peak of 34,993 antibiotics (July 2020). The data also show that since the remobilisation of NHS dental care, antibiotic prescribing remains raised at levels around 28% higher than pre-pandemic. The survey highlights dentists' frustrations and concerns about this increased use of antibiotics. Most dentists intend to reduce their prescribing; however, significant challenges to this being realised were raised.Conclusions The previous success within dentistry to protect against the development of antimicrobial resistance has suffered a knock-back during the pandemic. A renewed focus on reducing unnecessary antibiotics within dentistry is required but, crucially, needs to be approached sensitively alongside the current backdrop of challenges within the service.

Relationship between Characteristics of Breastfeeding Mother with Exclusive Breastfeeding in Leran Village Kalitidu District Bojonegoro Regency

ABSTRACTBackground: Breast milk (ASI) is a liquid created specifically that comes directly from the breast of a mother for babies and is the best food for babies especially aged 0-6 months. Factors that influence exclusive breastfeeding to mothers include maternal sociodemographic factors, pre/post natal factors, and psychosocial factors. Bojonegoro Regency is one of the regions in Indonesia that has quite good exclusive breastfeeding coverage in 2018 to reach 87%. However, there are still a number of sub-districts and public health service in Bojonegoro that have not been able to reach the target of breastfeeding coverage by the Ministry of Health in 2015, one of them is Leran Village, Kalitidu District, Bojonegoro Regency.Objective: This study determined the relation between characteristics of breastfeeding mothers consisting of age, education, occupation, and parity with exclusive breastfeeding in Leran Village, Kalitidu District, Bojonegoro Regency.Methods: The method is observational type and analytic descriptive which uses cross sectional approach. Variables studies had a relationship with exclusive breastfeeding if p < 0,05.Result: As many as 56% of mothers do not give exclusive breastfeeding. Most of the mothers who do not provide exclusive breastfeeding have low education (78,6%), aged 36-45 years (57,1%), are housewives (64,3%), and multiparous (50%). Statistical analysis showed no relation to the variables age (p=0,099), occupation (p=0,165), parity (p=0,208) with exclusive breastfeeding. While the education (p=0,003) have a relation with exclusive breastfeeding.Conclusion: The conclusion of this study is that there is no relation between age, occupation, and parity of mothers with exclusive breastfeeding. However, there is a relation between mother’s education and exclusive breastfeedingKeywords: exclusive breastfeeding, mother’s age, mother’s education, mother’s occupation, parity

‘Decolonising’ the clinical encounter via multi-criteria decision support (Preprint)

UNSTRUCTURED According to researchers drawing on the ideas of Jürgen Habermas, Canadian patients and Danish General Practitioners are experiencing ‘colonisation’ of their ‘lifeworlds’ by ‘the system’, Their suggested remedy is to ensure that the clinical encounter, freed of strategic rationality, re-prioritises Habermasian ‘communicative action’ aimed at mutual understanding. However, Blau shows that such communicative action is, and should be, inextricably interwoven into means-end rationality, when Habermas’ caricature of the latter is rejected. We argue that the decision support framework provided by Multi-Criteria Decision Analysis can help produce the ‘communicative means-end rationality’ essential in a public health service based on role-respecting sincerity and autonomy. No ‘positivistic reduction’ is involved in the technique.