Association of Alcohol Use Diagnostic Codes in Pregnancy and Offspring Conotruncal and Endocardial Cushion Heart Defects

Background The pathogenesis of congenital heart disease (CHD) remains largely unknown, with only a small percentage explained solely by genetic causes. Modifiable environmental risk factors, such as alcohol, are suggested to play an important role in CHD pathogenesis. We sought to evaluate the association between prenatal alcohol exposure and CHD to gain insight into which components of cardiac development may be most vulnerable to the teratogenic effects of alcohol. Methods and Results This was a retrospective analysis of hospital discharge records from the California Office of Statewide Health Planning and Development and linked birth certificate records restricted to singleton, live‐born infants from 2005 to 2017. Of the 5 820 961 births included, 16 953 had an alcohol‐related International Classification of Diseases , Ninth and Tenth Revisions (ICD‐9; ICD‐10 ) code during pregnancy. Log linear regression was used to calculate risk ratios (RR) for CHD among individuals with an alcohol‐related ICD ‐9 and ICD10 code during pregnancy versus those without. Three models were created: (1) unadjusted, (2) adjusted for maternal demographic factors, and (3) adjusted for maternal demographic factors and comorbidities. Maternal alcohol‐related code was associated with an increased risk for CHD in all models (RR, 1.33 to 1.84); conotruncal (RR, 1.62 to 2.11) and endocardial cushion (RR, 2.71 to 3.59) defects were individually associated with elevated risk in all models. Conclusions Alcohol‐related diagnostic codes in pregnancy were associated with an increased risk of an offspring with a CHD, with a particular risk for endocardial cushion and conotruncal defects. The mechanistic basis for this phenotypic enrichment requires further investigation.

Adolescents Nutritional Association (Micronutrients) with Menarche: Role of Health Schemes and Services in India

Menarcheal age in adolescent girls marks an important health concern in women's biology. The timing of menarche is an important determinant of Population size, Reproductive health and is an important factor of Health planning. The paper aimed to find the current mean age at menarche in India and its Nutritional association with micronutrients (given the role of government schemes and services). To fining out about the same the Menarcheal age group of (10-19 years) in India are examined. Binary logistic regression model is used to to estimate the association in the Menarcheal age among the Adolescent using the Comprehensive National Nutritional Survey. The mean age at menarche among adolescents stands at 9.07 years (95% C.I.: 8.990,9.166), including the non menstruating girls within the concerned age group,the mean age was 12.815 years (95% C.I.: 12.837,12.793). Girls with anemia are more likely to have their menarche 0.364 years higher than girls who are non amenic. The mean age at menarche is 0.72 years more likely to occur among those who have multivitamin tables/ syrup. The study concludes that over the time the age at menarche has declined rapidly with economic growth, urbanisation, Improvements in the Nutritional intake ( addition of Micronutrients also seen a contributing factor). The area of concern with regard to Micronutrients supplementation is that, it is done so to provide proper nutritional factors but on the other hand is also causing early Mnearche that most of the Health scientists warned and seen it as a cause for ovarian, breat cancers and other diseases amongst girls in future. Hence its imprtant to keep a proper check on the dietary intake among girls at early stages of life.

Towards quality primary health care: the dilemma of Community-Based Health Planning and Services (CHPS) in health service provision in Ghana

PurposeOver the past two decades, Community-Based Health Planning and Services (CHPS) has been a pragmatic strategy towards universal Primary Health Care (PHC) in Ghana. However, the ability and capacity of these facilities to deliver quality primary health care remain an illusion as they are still crumbling in myriad challenges. These challenges are translated to the poor-quality services provision and low community utilization of CHPS facilities. The study presents a comparative analysis of three communities in the Kassena-Nankana East Municipality, Ghana.Design/methodology/approachUsing a mixed-method research design, the study gathered and analysed data from 110 households, three community health officers (CHOs) and three community leaders using semi-structured questionnaires and interview guides.FindingsThe findings indicated that the facilities do not have the requisite inputs such as drugs and supplies, logistics, appropriate health personnel, good infrastructure, funding support necessary to deliver quality and appropriate healthcare services that meet the health needs of the communities. For the CHPS to realize their full potentials as PHC facilities, it is required that the needed inputs such as logistics, drugs and appropriate staff are in place to facilitate the activities of CHOs.Research limitations/implicationsDue to the limited number of participants and selection of the study communities, the results may generalization. Also, the researchers acknowledged the inability to interview the district level health officials and the Kassena-Nankana Municipal Assembly during the field visits. This could have provided in-depth knowledge on the findings of this research as well as the validation of the results from the communities' perspective. Several attempts were made to contact and interview district-level authorities which proven futile due to the unavailability of targeted respondents. This resulted in limiting the studies at the community level. However, this limitation does not disprove the findings of this study.Practical implicationsThe article implications for planning primary health care strategies include a keen assessment of community health needs and institutional management of primary health care facilities, equip PHC facilities with adequate resources such as drugs and appropriate staffing to provide the health needs of the communities.Originality/valueThe paper fulfils the gap in the literature by providing empirical data on how the challenges of primary health care facilities affected the provision of high quality service and how this can affect community’s use of the facilities.

The Nurse Practitioner Workforce in Western Canada: A Cross-Sectional Practice Analysis Comparison

Regular examination of health workforce data is essential given the pace of health system and legislative changes. Health workforce studies pertaining to nurse practitioner (NP) practice are needed to examine the gaps between work activities, policy, human resource supply, or for population needs. Jurisdictional comparison studies can provide essential information about NP practice for governments to respond to health workforce deficiencies or engage in service planning. In Canada, there is limited provincial-territorial jurisdictional NP workforce data to support health planning or policy change. This descriptive cross-sectional study was to examine the similarities and differences in practice patterns of Canadian NPs. In 2016 and 2017, an electronic survey was sent to all 852 registered NPs in three Canadian provinces, yielding a large convenience sample of 375 NP respondents. The results of this study underscore the value of NPs’ extensive registered nurse expertize as well as their ability to serve diverse patient populations, work in varied healthcare settings, and provide care to medically complex patients. The study findings also show that NPs in all three jurisdictions work to their full scope of practice, in both rural and urban settings. This study is the first to compare NP workforce data across multiple Canadian jurisdictions simultaneously. Studies of this type are valuable tools for understanding the demographics, education, integration, and employment activities of NPs and can aid governments in addressing workforce planning.

Community resilience demonstrated through a Te Ao Māori (Ngāti Manawa) lens: The Rāhui

INTRODUCTION: This research project is associated with a small rural community utilising the Te Ao Māori (Ngāti Manawa) understanding of Rāhui, as a means of decreasing the possibility of negative impacts for their mostly Māori population, during the Covid-19 pandemic that was experienced in March 2020 in Aotearoa New Zealand. Rāhui is a conservation measure shrouded in tapu designed to limit, restrict or prevent access to the natural environment. For example, Te Wao Tapu nui a Tāne protecting in the process the mauri of our rivers, lakes, streams following a mishap or misfortune such as a drowning. Equally as important, Rāhui was used as a proactive means of conservation.METHOD: Using mixed methods, this study highlights both positive and challenging experiences in the statistical and thematic analysis that may inform future public health planning for the inevitable and ongoing effects of pandemic responses in Aotearoa New Zealand which are potentially transportable beyond Aotearoa New Zealand.IMPLICATIONS: This research identified how Nga ̄ti Manawa of Murupara, utilised Rāhui as a mechanism of resilience in order to keep local residents thriving and healthy during and after the Covid-19 pandemic lockdown by setting up checkpoints on the borders of their rohe, and restricting the vehicle and human traffic into Murupara. Support for the Rāhui was significant from five hapū leaders and from the community survey illuminating a sense of safety that the checkpoints offered to a vulnerable and mostly Māori rural community.

Combined higher frequency fish consumption and healthy lifestyle may lower the triglyceride/HDL-C ratio in middle-aged Japanese males: Anti-atherosclerotic effect of fish consumption

Background: Fish consumption may be associated with a low risk of coronary artery disease. We aimed to investigate whether higher fish consumption results in improved lifestyle behaviors and thus lower triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio––a predictor of atherosclerotic cardiovascular disease (ASCVD). Methods and results: This cross-sectional study included 2947 middle-aged Japanese males with no history of ASCVD or lipid-modifying therapy, who presented at the Health Planning Center of Nihon university hospital between April 2018 and March 2019. We performed an analysis of variance using fish consumption as a categorical variable (0-2 days, 3-4 days, or 5-7 days per week). The serum TG/HDL-C ratio in the 5-7 days fish consumption group was significantly lower than those in the 0-2- and 3-4-days fish consumption groups (p < 0.0001 and p < 0.01, respectively). Multiple regression stepwise analysis revealed that weekly fish consumption negatively and independently determined the TG/HDL-C ratio (β = -0.061, p = 0.001). As fish consumption increased, the proportion of subjects with smoking habits decreased (p = 0.014), those engaging in aerobic exercises and aggressive daily physical activity increased (p < 0.0001 for both), and those with alcohol habit increased (p < 0.0001). In addition, we developed the risk stratification for ASCVD by combining the serum HDL-C level and the serum TG/HDL-C ratio with fish intake. Conclusion: Increased frequency of fish consumption and improved lifestyle behaviors due to daily fish intake may work additively to lower the serum TG/HDL-C ratio. These associations may explain why high fish consumption is associated with a lower risk of ASCVD. Our findings may help physicians and nutritionists in treating patients with heart diseases and metabolic conditions by recommending a high fish diet in middle-aged Japanese males.

Behavior Analysis of Legislators in Health Planning in South Sulawesi Province

Health is political because its social determinants are easily accepted in political intervention. Therefore, the health system of a region mandates that health development will take place well if it is supported by good and targeted planning. The purpose of this study is to analyze the behavior of legislators in planning health services in South Sulawesi Province. The research was conducted in the DPRD of Makassar City and Bantaeng Regency. This type of research is a qualitative research. Data was collected using in-depth interviews, observation and document review. Data processing was carried out using triangulation and content analysis methods. The results showed that based on indicators of knowledge, attitudes, perceptions and actions of legislators were in the poor category. In addition, it was known that there was an interest from legislators in terms of health planning, but this interest was indirectly in the interest of improving public health status.

Australian General Practitioner Perceptions to Sharing Clinical Data for Secondary Use: A Mixed Method Approach

ObjectiveThe potential for data collected in general practice to be linked and used to address health system challenges of maintaining quality care, accessibility and safety, including pandemic support, has led to an increased interest in public acceptability of data sharing, however practitioners have rarely been asked to share their opinions on the topic. This paper attempts to gain an understanding of general practitioners’ perceptions on routinely sharing practice data for both population health planning and healthcare research both from an Australian and international perspective.Materials and MethodsA mixed methods approach combining an initial online survey followed by face-to-face interviews (before and during COVID-19), designed to identify the barriers and facilitators to sharing data, were conducted on a representative sample of general practitioners across Western Australia (WA).ResultsEighty online surveys and ten face-to-face interviews with general practitioners were conducted from Nov 2020 – May 2021. Although respondents overwhelmingly identified the importance of population health research, their willingness to participate in data sharing programs was determined by a perception of trust associated with the organisation collecting and analysing shared data; a clearly defined purpose and process of collected data; including a governance structure providing confidence in the data sharing initiative simultaneously enabling a process of data sovereignty and autonomy.DiscussionResults indicate strong agreement around the importance of sharing patient’s medical data for population and health research and planning. Concerns pertaining to lack of trust, governance and secondary use of data continue to be a setback to data sharing with implications for primary care business models being raised.ConclusionTo further increase general practitioner’s confidence in sharing their clinical data, efforts should be directed towards implementing a robust data governance structure with an emphasis on transparency and representative stakeholder inclusion as well as identifying the role of government and government funded organisations, as well as building trust with the entities collecting and analysing the data.

Patients’ Perceptions of Hospital Care in a Covid-19 Pandemic Population

Background: COVID-19 pandemic was associated with pandemonium and misinformation, affecting patients' health-seeking behavior. This study was designed to explore patients' perceptions of hospital care during this period and to provide evidence-based and appropriate public health planning strategies. Materials and Method: A cross-sectional survey was conducted among 155 patients using 22 items structured and self-completion questionnaires to determine (A) Socio-demographic variables, (B) Knowledge and perception of the disease, and (C) The participants’ behaviors towards COVID-19. A Hardcopy version of the questionnaire was administered to the respondents by direct issuance. Results: 103(66.45%) of the respondents knew the cause of COVID-19, while 104 (67.09%) agreed that people can be infected with COVID-19 in the hospital. 84 (54.19%) were afraid of a hospital visit and 66 (42.58%) are unwilling to self-report if they have minor symptoms. A large number 43(27.74%) perceived a clean environment as the impetus to make them comfortable in the hospital. Conclusion: Our study illuminates gaps in the patients’ perceptions of hospital care during the COVID-19 pandemic, which impacted negatively on the patient population as they avoided hospitalization for fear of contracting COVID-19 in the hospital. Furthermore, appropriate public health strategies can improve patients’ perceptions and health-seeking behavior in a pandemic period.

Socioeconomic inequalities related to dental care needs among adolescents and adults living in the state of Minas Gerais, Brazil

Background There is significant evidence of inequalities in the need for dental treatment, and their monitoring is essential for public health planning. Objective To measure the extent of the association between socioeconomic inequality and need for dental care. Method This study used data from the 2011 Survey of Oral Health Conditions, including a representative sample of adolescents (n=2,310) and adults (n=1,188) from the state of Minas Gerais, Brazil. Need for dental treatment was evaluated according to criteria of the World Health Organization (WHO). Family income was used as a measure of socioeconomic status. The magnitude of socioeconomic inequalities related to the need for treatment was assessed using the slope index of inequality (SII) and the relative index of inequality (RII). Results Among adolescents, the SII was -22.9% (95% CI -34.8; -11.0) and the estimated RII was 0.61 (95% CI 0.47; 0.79). Among adults, the SII was -28.0% (95% CI -39.8; -16.3) and the RII was 0.58 (95% CI 0.45; 0.74). Conclusion There are socioeconomic inequalities regarding the need for dental treatment, and individuals with lower family income present a higher prevalence of need.