Bibliometric analysis of drug package insert adaptation for the elderly based on Web of Science / 中国药房

OBJECTIVE To explore the hotspots of aging adaptation of drug package inserts， and to provide evidence for the development of aging adaptation of drug package inserts in China. METHODS The relevant English literature on drug package inserts for the elderly published from 2012 to 2022 was retrieved from Web of Science Core Collection； bibliometric analysis was performed by using VOSviewer and CiteSpace software， to explore research hotspots in this field， and summarize obstacles and solutions for the development of this field. RESULTS & CONCLUSIONS This study collected a total of 335 literature related to the aging adaption of drug package inserts， from 819 research institutions in 51 countries （regions）， involving 2 174 authors. The research development of drug package insert adaptation for the elderly has slowed down in the past decade， and developed countries such as the United States and Japan dominate this field. Authors such as Wolf from Northwestern University in the United States， have the largest number of publications（12 literature）. The research focuses in this field include the risk management of medication for the elderly， the updating of medication information for the elderly in drug package inserts， and the understanding and compliance of the elderly with drug package inserts and their influencing factors. The solutions to related obstacles in the development of aging adaption in drug package inserts include improving the visibility and readability of drug package inserts， filling in the information on elderly medication in drug package inserts， and so on. China can learn from the experiences and methods of other countries， conduct investigations into the influencing factors of elderly package inserts and pharmacokinetic studies based on the characteristics of the Chinese population， and improve the safety of medication for elderly patients in multiple dimensions.

Prediction of soil seed bank of piedmont and alluvial environments of Dera Ghazi Khan, Punjab, Pakistan

Abstract The current focus is on the overall pattern of seed storage present in the fragments of the soil of piedmont and alluvial landscapes of the environment. The present study predicted the seed banks of both soils of alluvial and piedmont zones in different ecological conditions and evaluate the potential of seeds in the restoration of both environments. The composition of the seed bank of soil is mainly affected by the alluvial environment and the structure of cleared area shows that more species of germinating annual grasses and growable seeds with the higher total number. Extant vegetation structures have an important role in the diversity of soil seed reservoirs, whose composition corresponded with the openness of the site. When in situ soil seed bank is recruited, it helps to restore only some components of the plant community in an alluvial environment. In our current research, it was confirmed that seed richness was higher in number at lower elevation (alluvial) than that at high elevation (piedmont). Seed richness showed a significant negative correlation with anions, cations, while significantly positive with altitude that suggests the richness pattern of the overall seed bank of the area is influenced by various environmental factors.

Resumo O foco atual está no padrão geral de armazenamento de sementes presente nos fragmentos de solo do Piemonte e nas paisagens aluviais do meio ambiente. O presente estudo previu os bancos de sementes de ambos os solos das zonas aluvial e piemontesa em diferentes condições ecológicas e avaliou o potencial das sementes na restauração de ambos os ambientes. A composição do banco de sementes do solo é afetada principalmente pelo ambiente aluvial e a estrutura da área desmatada mostra que mais espécies de gramíneas anuais em germinação e sementes cultiváveis apresentam o maior número total. As estruturas da vegetação existente têm um papel importante na diversidade dos reservatórios de sementes do solo, cuja composição correspondeu à abertura do local. Quando o banco de sementes do solo in situ é recrutado, o mesmo ajuda a restaurar apenas alguns componentes da comunidade de plantas em um ambiente aluvial. Em nossa pesquisa atual, foi confirmado que a riqueza de sementes era maior em número em altitudes mais baixas (aluviais) do que em altitudes elevadas (Piemonte). A riqueza de sementes mostrou uma correlação negativa significativa com ânions, cátions, enquanto significativamente positiva com a altitude, o que sugere que o padrão de riqueza do banco geral de sementes da área é influenciado por vários fatores ambientais.

Prediction of soil seed bank of piedmont and alluvial environments of Dera Ghazi Khan, Punjab, Pakistan / Predição do banco de sementes do solo do piemonte e ambientes aluviais de Dera Ghazi Khan, Punjab, Paquistão

Abstract The current focus is on the overall pattern of seed storage present in the fragments of the soil of piedmont and alluvial landscapes of the environment. The present study predicted the seed banks of both soils of alluvial and piedmont zones in different ecological conditions and evaluate the potential of seeds in the restoration of both environments. The composition of the seed bank of soil is mainly affected by the alluvial environment and the structure of cleared area shows that more species of germinating annual grasses and growable seeds with the higher total number. Extant vegetation structures have an important role in the diversity of soil seed reservoirs, whose composition corresponded with the openness of the site. When in situ soil seed bank is recruited, it helps to restore only some components of the plant community in an alluvial environment. In our current research, it was confirmed that seed richness was higher in number at lower elevation (alluvial) than that at high elevation (piedmont). Seed richness showed a significant negative correlation with anions, cations, while significantly positive with altitude that suggests the richness pattern of the overall seed bank of the area is influenced by various environmental factors.

Resumo O foco atual está no padrão geral de armazenamento de sementes presente nos fragmentos de solo do Piemonte e nas paisagens aluviais do meio ambiente. O presente estudo previu os bancos de sementes de ambos os solos das zonas aluvial e piemontesa em diferentes condições ecológicas e avaliou o potencial das sementes na restauração de ambos os ambientes. A composição do banco de sementes do solo é afetada principalmente pelo ambiente aluvial e a estrutura da área desmatada mostra que mais espécies de gramíneas anuais em germinação e sementes cultiváveis ​​apresentam o maior número total. As estruturas da vegetação existente têm um papel importante na diversidade dos reservatórios de sementes do solo, cuja composição correspondeu à abertura do local. Quando o banco de sementes do solo in situ é recrutado, o mesmo ajuda a restaurar apenas alguns componentes da comunidade de plantas em um ambiente aluvial. Em nossa pesquisa atual, foi confirmado que a riqueza de sementes era maior em número em altitudes mais baixas (aluviais) do que em altitudes elevadas (Piemonte). A riqueza de sementes mostrou uma correlação negativa significativa com ânions, cátions, enquanto significativamente positiva com a altitude, o que sugere que o padrão de riqueza do banco geral de sementes da área é influenciado por vários fatores ambientais.

A quality audit of the medicinal package insert information of drugs marketed in India

Background: A package insert (PI) accompanying medicinal products is a concise and accessible source of evidence-based information for health professionals and consumers alike. In India, the supplied information should be adequate and fulfill the statutory regulations of the Drug and Cosmetics Rules (1945) to ensure the safe and effective drug use. Aim and Objectives: The present observational study aimed to evaluate the uniformity and adequacy of information on PIs available in India. Materials and Methods: PIs of approved and marketed drugs were collected from pharmacies and analyzed with the help of a 30-item checklist comprising of components of statutory guidelines and other quality indicators. Each item was assigned a weightage of two points if the information was complete, one if inadequate, and 0 if absent. The total score was calculated for each PI. Results: The median score of the 150 analyzed PIs was 41 (Inter quartile range, 36.00–45.25) out of a maximum value of 60. The major deficiencies observed were in providing missed dose instructions (91.33%), further reading resources (84.67%), supporting references (83.33%), and drug disposal instructions (76%). Other notable missing information were laboratory parameter interference (68.67%), clinical trial data (62%), adverse drug reaction reporting contact information (56.67%), and list of excipients (49.33%). Conclusion: There are important inadequacies in the clinical information provided in Indian PIs which can affect patient health and hinder rational drug use. Thorough evaluation and revision of the PIs is warranted to make them more reliable and popular among users.

Medication package inserts do not present adequate information on potential risks for older adults in Brazil / Bulas de medicamentos não apresentam informações adequadas sobre potenciais riscos para idosos no Brasil

OBJECTIVE: To compare information on the risks of potentially inappropriate medications (PIMs) for older adults in the Beers criteria with data in the package inserts made available by the Brazilian Health Regulatory Agency. METHODS: This is an observational, cross-sectional study that compared information on the package inserts of 33 brand-name drugs in the Brazilian market with specific recommendations for older adults contemplated in the Beers criteria, categorizing them into: complete, incomplete, absent, or discrepant. RESULTS: Among the analyzed package inserts, 21.21% did not present a specific section dedicated to the use of these drugs by older adults and data were scattered throughout the text; 63.64% were classified as incomplete; 33.33% lacked data; and 3.03% had discrepant information. CONCLUSION: The analyzed package inserts presented incomplete data or lacked information characterizing the drugs as PIMs for older adults. This study demonstrated that some package inserts of drugs used in Brazil are not satisfactory, warranting higher caution in the medical community when prescribing these medications and guiding patients

OBJETIVO: Comparar as informações sobre os riscos de medicamentos potencialmente inapropriados (MPIs) para idosos contidas nos critérios Beers com as informações presentes nas bulas para profissionais de saúde disponibilizadas pela Agência Nacional de Vigilância Sanitária no Brasil. METODOLOGIA: Estudo observacional e transversal que comparou informações das bulas para profissionais de saúde de 33 medicamentos de referência no mercado brasileiro com recomendações específicas para idosos contempladas nos critérios Beers e que foram categorizadas em: completas, incompletas, ausentes ou discrepantes. RESULTADOS: Dentre as bulas dos MPIs analisadas, 21,21% não apresentam seção específica destinada ao uso desses medicamentos por idosos, nas quais as informações estão dispersas pelo texto; 63,64% delas foram classificadas como incompletas; 33,33% tinham informações ausentes; e 3,03% com informações discrepantes. CONCLUSÃO: As bulas analisadas apresentaram dados incompletos ou não apresentam qualquer informação que caracterizasse o medicamento como MPI para idosos. Este estudo demonstra que algumas bulas de medicamentos utilizados no Brasil não estão satisfatórias, sugerindo maior cautela à comunidade médica na prescrição e na orientação aos seus pacientes

Application of Leicester assessment package in discipline construction of general practice / 中华全科医师杂志

The contents of general practice discipline construction comprise of orientation, team development, personnel training, scientific research, teaching base establishment and management of the discipline, etc. At present, the weakness in above aspects of general practice discipline construction is still the major challenges in most of the primary healthcare institutions. Our experiences in last 10 years shows that the application of Leicester Assessment Package can effectively promote the general practice discipline development for primary care institutions.

Using Package Inserts to Disseminate Information Regarding Drug Interactions Mediated by CYP3A Inhibition: Status and Issues / 医薬品情報学

Objective: In Japan, the Guideline on Drug Interaction for Drug Development and Appropriate Provision of Information (GL) was notified in 2018. In the GL and the associated document, it was determined that package inserts of drugs which need to be categorized as precaution due to the significant degree of drug interactions by CYP3A inhibition should describe possible perpetrator drugs using designated expressions, such as “strong CYP3A inhibitor.” For contraindication, it was decided that all drugs should be described individually. In 2021, as supplementary information to the GL, a list of CYP substrates, inhibitors and inducers, classified based on interaction strength and CYP isoenzymes (i.e., the drug list), was published. In this study, we aimed to survey the information on drug interactions by CYP3A inhibition described in the package inserts based on information in the drug list, and to clarify the status and issues.Methods: The package inserts of 24 substrate drugs of CYP3A with contraindications for itraconazole, a strong CYP3A inhibitor, were examined, and the descriptions of strong, moderate, and other CYP3A inhibitors were studied.Results: The frequencies of contraindication for strong CYP3A inhibitors were cobicistat (75%), grapefruit juice (0%), ritonavir (92%), voriconazole (67%), clarithromycin (50%), ceritinib (0%), and posaconazole (33%). On the other hand, some CYP3A substrate drugs was contraindicated with moderate CYP3A inhibitors but not with these strong CYP3A inhibitors. Furthermore, 19 CYP3A inhibitors, which were not on the drug list published in 2021, were identified as contraindications for co-administration. Majority of these were protease inhibitors, and some have been discontinued or not available in Japan.Conclusion: The findings of this study imply the necessity of organizing scientific description based on the GL strength classification. Moreover, it is important to disseminate the information and precautions for drug interactions provided in the package inserts to medical practice.

Study of Contraceptive Duration Described in the Information Materials of Prescription Drugs Requiring Contraception / 医薬品情報学

Objective: In the instructions for package inserts (PI) of prescription drugs revised in June 2017, the section “persons with reproductive potential” was established under “precautions concerning patients with specific backgrounds.” The description rules associated with contraceptive duration were modified in these. In this study, we investigated descriptions of contraceptive duration in PI that were prepared based on the revised instructions, interview forms (IF), and other proper use materials (PM).Methods: We collected PI, IF, and PM of prescription drugs containing a new active ingredient approved from April 2017 to March 2022 for which the PI were prepared based on the revised instructions and investigated descriptions of PI, contraceptive duration, and its evidence in each information material.Results: Of the 181 drugs studied, 43.1 and 12.7% required females and males to use contraception during the period of drug consumption, respectively. Among these, the ratio of drugs that had descriptions of contraceptive duration were 15.4 and 0% for females and males at PI, respectively; 51.3 and 39.1% for female sand males at IF, respectively. Anticancer drugstended to describe contraceptive duration in the PM rather than PI or IF. For some drugs, there was no description of contraceptive duration in any of the materials. Contraceptive durations ranged from the period of administration of that drug to over a year for females and approximately one week to six months for males. The reasons for these contraceptive durations were diverse.Conclusion: Contraceptive information in the PI based on revised instructions were not sufficient for use by healthcare workers, even when the IF and PM were confirmed. These results suggest that there is a need for standardizing the descriptions, types of materials to be described, and choice of evidence for contraceptive duration.

Análise da qualidade das evidências científicas sobre a eficácia e segurança nas bulas de anticoagulantes orais diretos comercializados no Brasil / Analysis of the quality of scientific evidence on efficacy and safety in the package leaflets of direct oral anticoagulants marketed in Brazil

Objetivo: Identificar e analisar a qualidade das evidências científicas sobre a eficácia e segurança dos anticoagulantes orais direto (DOAC) disponíveis nos ensaios clínicos referenciados nas bulas dos medicamentos comercializados no Brasil. Método: Trata-se de um descritivo documental dividido em duas etapas, sendo elas: (i) identificação e análise da disponibilidade das referências bibliográficas contidas nas bulas dos DOAC e (ii) análise da qualidade dos estudos contidos nas bulas através da ferramenta da Cochrane Risk of Bias RevMan versão 5.4. Foram analisados setes domínios de importâncias para ensino clínico, sendo que cada domínio foi classificado como alto, incerto ou baixo risco de viés, segundo a avaliação dos colaboradores. Resultados: Foram analisadas 10 bulas destinadas aos profissionais da saúde. Sendo que destas, foram avaliados 25 ensaios clínicos. A análise da qualidade das evidências científicas, referenciadas nas bulas para profissionais dos DOAC, mostrou que os estudos citados apresentaram consistência metodológica. Entretanto, na maioria dos estudos, os domínios foram classificados como viés incerto, ou seja, não foi possível identificar como esses pontos foram abordados nos estudos. Conclusão: Portanto, o presente estudo evidenciou que a qualidade dos ensaios clínicos referenciados nas bulas dos DOAC apresentou incertezas metodológicas em seus ensaios. Sugere-se a necessidade de normativas que estabeleçam atualizações do conteúdo informativo presente nas bulas profissionais e estabeleçam descrição dos métodos de forma clara e coesa (AU).

Objective: Identify and analyze the quality of scientific evidence on the efficacy and safety of direct oral anticoagulants (DOAC) available in clinical trials referenced in the package leaflets of drugs marketed in Brazil. Method: This is a descriptive documentary study divided into two stages: (i) identification and analysis of the availability of the bibliographic references contained in the package leaflets of DOACs and (ii) analysis of the quality of the studies contained in the package leaflets through the Cochrane Risk of Bias RevMan tool version 5.4. Seven domains of importance for clinical teaching were analyzed, and each domain was classified as high, uncertain or low risk of bias, according to the assessment of the collaborators. Results: Ten package leaflets intended for health professionals were analyzed. Of these, 25 clinical trials were evaluated. The analysis of the quality of the scientific evidence referenced in the package leaflets for health professionals showed that the cited studies presented methodological consistency. However, in most studies, the domains were classified as uncertain bias, i.e., it was not possible to identify how these points were addressed in the studies. Conclusion: Therefore, the present study evidenced that the quality of clinical trials referenced in the package leaflets of DOACs presented methodological uncertainties in their trials. It is suggested the need for regulations that establish updates of the information content present in the professional package inserts and establish a description of the methods in a clear and cohesive way (AU).

Ações de enfermagem na prevenção da pneumonia associada à ventilação mecânica: Uma revisão integrativa / Acciones de enfermería en la prevención de la neumonía asociada a la ventilación mecánica: Una revisión integrativa / Nursing actions in the prevention of mechanical ventilation associated pneumonia: An integrative review

OBJETIVO: Objetivou-se identificar medidas de prevenção realizadas pela equipe de enfermagem para prevenir pneumonia associada à ventilação mecânica. MÉTODO: Trata-se de revisão integrativa da literatura norteada pela questão: quais as medidas de prevenção de pneumonia associada à ventilação mecânica utilizadas na assistência de enfermagem ao paciente adulto? A busca foi realizada durante o mês de dezembro de 2020, sem recorte temporal,nas bases: Cumulative Index toNursingandAllied Health Literature; Web of Science; Base de Dados em Enfermagem; Literatura Latino-Americana e do Caribe em Ciências da Saúde. Utilizando os Descritores em Ciências da Saúde: "Pneumonia associada à ventilação mecânica"; "Cuidados de enfermagem"; "Pacote de assistência ao paciente". RESULTADOS:Encontrou-se 1.864 estudos, desses 16 compuseram a amostra final. As medidas mais utilizadas são: elevação da cabeceira do leito, higiene oral e reajuste diário do nível de sedação.CONCLUSÃO:São medidas de baixo custo financeiro e que se mostraram eficazes na prevenção direta(AU)

OBJECTIVE: Objective to identify preventive measures carried out by the nursing team to prevent pneumonia associated with mechanical ventilation. METHOD: This is an integrative review of the literature focused on the question: what are the preventive measures for pneumonia associated with mechanical ventilation used in nursing care of adult patients? The search was carried out during the month of December 2020, in the bases: Cumulative Index to Nursing and Allied Health Literature; Web of Science; Database in Sickness; Latin American and Caribbean Literature in Health Sciences. Using the Describers in Health Sciences: "Pneumonia associated with mechanical ventilation"; "Sick care"; "Pacote of assistance to the patient". RESULTS: 1,864 studies were found, 16 of which were composed in the final sample. The most used measures are: elevation of the head of the bed, oral hygiene and daily readjustment of the level of sedation. CONCLUSION: There are low financial cost measures that will be effective in direct prevention.(AU)

OBJETIVO: Objetivou-se identificar medidas de prevenção realizadas pela equipo de enfermagem para prevenir pneumonia associada à ventilación mecânica. MÉTODO: Trata-se de revisão integrativa da literatura norteada pela questão: ¿cuálessonlas medidas de prevención de neumoníaasociada a laventilaciónmecánica utilizada enlaasistencia de enfermagem ao paciente adulto? Una búsqueda realizada durante o más de diciembre de 2020, nas bases: Cumulative Index toNursingandAllied Health Literature; Web de laCiencia; Base de Dados en Enfermagem; Literatura Latino-Americana e do Caribe em Ciências da Saúde. Utilizando os Descritores em Ciências da Saúde: "Pneumonia associada à ventilação mecânica"; "Cuidados de enfermagem"; "Paquete de asistencia al paciente". RESULTADOS: Encontrou-se 1.864 estudos, desses 16 compuseram a amostra final. Las medidas más utilizadas son: elevação da cabeceira do leito, higiene oral y reajuste diário do nível de sedação. CONCLUSÃO: São medidas de baixo custo financeiro e que se muestraneficaces na prevenção direta.(AU)

Assessment of knowledge Vis-à-vis Food Labels

Background: Public health initiatives focused on improving food at the community level to reduce the risk of nutritionrelated disorders have gained pace in light of the enormous illness burden associated with chronic diseases connected to nutrition. Delivering straightforward, pertinent, and understandable information regarding the nutritional value of food is the goal of Front of Package Labelling (FoPLs), which are intended to assist consumers in choosing healthier foods at the point of purchase. Methodology: It was a cross-sectional study carried out online through a series of webinars using an online survey platform and a feedback-designed questionnaire to ascertain webinar participants' knowledge of front of package labeling. Results: Among the participants, only 75.4% correctly identified the characteristics of packaged foods that increase the risk of obesity. Also, it was found that 84.7% of the participants knew that food labels had to display complete nutritional information. About 93.6 percent of the individuals were aware of public health initiatives that raise awareness of FOPL. Only 38.9% of the individuals were aware that certain food products were free from labelling, in comparison. Conclusion: Front of package labelling (FOPL) regulation goals must be adopted in order to enable consumers to simply, quickly, and accurately identify items containing extra sugars, trans-fats, oils, and sodium. This will help the Government of India comply with WHO recommendations on unhealthy foods.

Preparedness of Healthcare Facilities of Manipur in the Management of Noncommunicable Diseases: A Cross-Sectional Study

Background: India is experiencing a rapid health transition with a rising burden of noncommunicable diseases (NCDs), causing significant morbidity and mortality. Cost?effective interventions for comprehensive NCD management can only be designed after assessing the readiness of various health facilities. Objectives: This study aimed to assess the preparedness of healthcare facilities of Manipur in the management of NCDs and to assess the knowledge of doctors regarding NCDs. Methods: A cross?sectional study was conducted in 21 public healthcare facilities in seven districts of Manipur during October 2021. Readiness of these facilities was assessed through observation and interview of doctors and nurses using a checklist adapted from the WHO Package of Essential NCDs. Knowledge of 153 doctors was also assessed using a self?administered, structured questionnaire. Data were entered in SPSS?26 and expressed using descriptive statistics. Results: General readiness index of primary health centers(PHCs), community health centers(CHCs), district hospitals(DHs), and tertiary care centers(TCCs) was 47%, 66.3%, 73.2%, and 70%, respectively. CHCs were ready in the domains of patient care services (80%), human resources (75%), and advocacy (91.7%). DHs and TCCs were ready in terms of patient care services, human resources, record maintenance, referral system, and advocacy. PHCs were not ready in any of the nine domains. Majority of the doctors (88%) had inadequate knowledge regarding NCDs. Conclusion: PHCs and CHCs were not adequately prepared, but DHs and TCCs were ready to manage NCDs. More than four?fifth of the doctors had inadequate knowledge. Strengthening PHCs and CHCs and training of healthcare workers are needed for integrated NCD management.

Effectiveness of an Intervention Package on Life Skill Education among Children with Speci c Chronic Illness

Life skill education develops young people'#39;s capacity o engage in positive behaviours that nurture their own well-being, set personal goals, and grow successfully as self-suf cient adults. The life skills education of children helps develop a concept of oneself as a person of worth and dignity. In the present study 28 Government high school children of 8 and 9 standard of both genders in the age group 13-15 with asthma and epilepsy were selected for the study. Once the children and parents expressed the interest in taking part in the study, home visit and school visits were conducted to collect information from the parents. In-depth interview and FGD (Focus Group Discussion) were conducted for children, parents and teachers to obtain the information as complete as possible on the participants'#39; past and current illness and its management. The results were classi ed under four themes '#39;perception on children with chronic illnesses'#39;, '#39; rst aid management in the school'#39;, '#39;Safety and security during rst aid management'#39; and '#39;Peer group support'#39;. FGD with parents arrived with three themes were '#39;Perception on children with speci c chronic illness'#39;, '#39;First aid management in the school'#39; and '#39;Peer group support'#39;. In-depth interview with class teacher: 50 percent teachers were ready to give care for children but 50 percent of the teachers stated that they have no time to give special care besides some risky involved in providing care. There was no special system of education for the children with chronic illness.

Efficiency of Nursing Care Package on Expected Outcome in Prevention of Ventilator-Associated Pneumonia among Ventilated Clients in ETCM Hospital Kolar

Pneumonia has accounted for approximately 15 percent of all hospital-associated infections and 27 percent and 24 percent of all infections acquired in the medical intensive-care unit (ICU) and coronary care unit, respectively. It has been the second most common hospital-associated infection after that of the urinary tract. Because of this tremendous risk, in the last two decades, most of the research on hospital-associated pneumonia has focused on ventilator-associated pneumonia. This study was aimed to assess effi ciency of nursing care package on expected outcome regarding prevention of ventilator associated pneumonia among ventilated clients. A quantitative research approach with quasi experimental research design with pre-and post-test with equivalent control group design was used to carry out the study. Ventilated clients from selected hospitals who were fulfi lling the inclusion criteria were selected by using non-probability convenient sampling technique. Total 40 (20 experimental and 20 control group) size sample was included in the study. In experimental group, majority (50%) had mild infection and only 15 percent had no infection in pre-test; in post-test majority (75%) had no infection and only 25 percent had mild infection and no patient had severe infection. It showed that delivery of nursing care package is effective in decreasing ventilator associated pneumonia. In control group, majority (50%) had mild infection and only 10 percent had no infection in pre-test and in post-test majority (40%) had mild infection and 60 percent had severe infection and no patient had severe infection. As nursing care package was not delivered, the infected cases increased. The effi ciency of nursing care package on expected outcome regarding prevention of ventilator-associated pneumonia between experimental groups was statistically signifi cant and in control group it was not signifi cant. The delivered nursing care package on ventilator-associated pneumonia among ventilated clients proved its benefi cial effects in controlling infection level and preventing ventilator-associated pneumonia at intensive care units. This study confi rmed that nursing care package for ventilated clients can prevent infection and cut short long stay in intensive care units.

HPV INFECTION: DOES EDUCATION PACKAGE IMPROVE THE PERCEPTION AND ATTITUDE TOWARDS HPV VACCINE AMONG SCHOOLTEACHERS?

INTRODUCTION: Human papillomavirus (HPV) is a non-enveloped virus that causes infections like 'warts' in the genital region & throat which later develops into cancer in the cervix, vulva, vagina, penis/anus and Oropharyngeal cancer. Virus infections contribute as a cause of 15-20% of all human cancers. As per WHO vaccination schedule, it is essential to vaccinate secondary school students between the age group of 11-18 years/above with 2 doses. Aim of the study is to evaluate the effectiveness of educational package on HPV infection and Vaccine with regard to Pre and Post assessment among schoolteachers and to determine the level of awareness on Human Papilloma virus infection and to assess the attitude towards administering the HPV vaccine among School teachers. METHODS: A cross sectional study was carried out among 177 schoolteachers in Chennai district. The setting was chosen based on feasibility and availability of adequate samples (C0VID restrictions). The target population for the present study was schoolteachers, Chennai. Systematic random sampling technique was used for selecting the samples. A self-administered questionnaire was administered to assess the level of awareness among schoolteachers. Questions formulated under various domains. The data collection was done over a period of 6 months duration. RESULTS: 20.4% of teachers had fair attitude with less awareness towards HPV vaccination, 4.1% of teachers had good attitude with less awareness towards HPV vaccination.79.6% of teachers had fair attitude with good awareness score regarding HPV infection, 95.9% of teachers had good attitude with good awareness regarding the HPV infection. Statistical analysis using Chi-square test represents the post attitude and post awareness score were good and hence the education package was effective. The study shows the signi?cant difference between pre and post knowledge scores.

Quality of clinical studies present in the package inserts of coagulation factors used in the treatment of hemophilia

ABSTRACT Objective To identify and analyze the quality of scientific evidence from clinical efficacy studies present in the package inserts of coagulation factors, used in the treatment of hemophilia A and B. Methods Documentary study developed in two stages. The first stage consisted of identifying the medicine packages inserts electronically registered in the Brazilian Health Regulatory Agency, and analyzing the availability of the bibliographic references cited therein. This analysis was conducted in the PubMed, SciELO, Google Scholar, and Web of Science databases. The second step was the analysis of the methodological quality of the efficacy studies. Two trained researchers used the Cochrane Collaboration Risk of Bias version 5.1.0 tools for methodological quality analysis, and Review Manager 5.4 software to generate the risk of bias graph. Results Of the 17 medicines listed, 7 had referenced package inserts. Of these, 10 studies were eligible for analysis of methodological quality. More than half of the analyzed studies did not control for selection, performance, and detection bias. A total of 100% controlled attrition and reporting biases, and 50% had a high risk of conflict of interest. Conclusion The biases present are significant and may have influenced the overestimation of the effects of the outcomes of each of the studies.

Effect evaluation of supplementary food nutrition package for infants aged 6-24 months in rural areas of Hainan / 中国热带医学

@#Abstract: Objective To analyze the effect of nutrition package on the nutritional status and prevalence of children in rural areas of Hainan Province, and provide scientific basis and suggestions for further improving the nutritional and health status of children in this region. Methods　Four cities and counties were randomly selected as the intervention group, and four cities and counties matched with the intervention group in terms of population, economy, social culture, maternal and child health work foundation of township health centers, physical nutrition and health status were selected as the control group.With the combination of monitoring and prospective cohort study, infants in the intervention group and the control group were studied from June 1, 2020, and they were intervened for 12 months with supplementary food nutrition package. Before and after intervention, the nutrition and health status of infants aged 6-24 months in the intervention group and the control group were investigated to evaluate the nutritional and health effects of supplementary food nutrition package for infants aged 6-24 months in rural Hainan Province. Results　A total of 999 infants were investigated, including 427 in the intervention group and 572 in the control group. After 12 months of nutritional intervention, there was no significant difference in weight-for-age Z-score (WAZ) and height-for-age Z-score (HAZ) and weight-for-height Z-score (WHZ) between the intervention group and the control group (P>0.05). The rate of emaciation of the intervention group was 1.64%, which was significantly lower than 3.67% of the control group (P<0.05). There were no significant differences in the rate of growth retardation (2.81% and 3.32%, respectively) and underweight (0.47% and 1.92%, respectively) between the intervention group and the control group (P>0.05). The rate of respiratory infection and diarrhea in the intervention group were 9.13% and 1.17%, which were significantly lower than corresponding 23.25% and 3.15% in the control group (P<0.05). The hemoglobin of the intervention group and the control group were 117.24 g/L and 114.51 g/L respectively, and the rates of anemia were 11.11% and 22.84% respectively, the differences were statistically significant (P<0.05). Conclusions　The intervention of nutrition package in rural areas of Hainan Province has achieved the expected results, and supplementary food nutrition package has reduced the incidence of malnutrition and respiratory infection and diarrhea in recent two weeks in infants and anemia to a certain extent. We should attach great importance to the supplementary nutrition package for right-age children and promote the growth and health of children in rural areas through supplementary nutrition package, and continuously improve the nutrition and health level of children in Hainan Province.

Primary care services in the UHC: Cost identification study

Background@#In order to financially sustain the participation of the private sector in the UHC, there is a need to find reasonable balance of accountability in the costing of health services. The costing must be based on actual resources used from the perspective of the private health service provider. @*Objective@#The objective of this paper was to determine the cost of primary care services from the framework of the UHC reform in the private sector.@*Method@#This is a multi-method approach to cost-identification in establishing and providing primary care health service in the UHC. The approaches used by the authors included review of published literature, laws and policies from DOH and other regulatory agencies. From this review, they develop the minimum facility requirement for basic primary care facility and primary care facility with ancillary services. They used the actual expenditures of existing primary care clinics, 2021 quotations from equipment and supplies companies, published construction rates and consensus approach to establish the cost. Based on 2021 value of Philippine Peso, they estimated the cost of constructing and operating a primary care facility.@*Results@#The total estimated cost of building a primary health care facility based on the DOH licensing standard was estimated to be around PhP2,490,000. The cost of furniture and equipment as required in the DOH AO was PhP474,685. Thus, the total cost of the construction and equipment for a basic primary care facility setup is PhP2,964,685. We estimated the annual operating cost with the building estimated to depreciate in 20 years and the furniture and equipment in 5 years, the annualized cost for the building is PhP124,500 and for the furniture and equipment PhP94,937. The total annual salary of the staff based on government standards was PhP2,381,962. The maintenance, operating and overhead expenses (MOOE) which included water and electricity, repair and maintenance, waste disposal, supplies and other fees was PhP451,190. The total annual operating cost of a basic primary care facility is PhP3,052,590. This facility can provide basic services such as outpatient consultation and minor surgeries. Using the same approach for the basic facility, the total annual operating cost of a basic primary care facility with ancillary service is PhP11,023,670. This facility can provide outpatient consultation, minor surgeries and primary care services such as health education and preventive care plus the ancillary services like pharmacy, clinical laboratory and x-ray. For patients with diabetes, the total annual cost is PhP8,986. The significant cost driver is the clinical assessment and non-pharmacologic intervention. The researchers found the same cost pattern for the annual cost care of patients with hypertension but with a slightly higher annual total with PhP9,963. Their sensitivity analysis based on inflation, construction, equipment and operating expense may increase these cost estimates by 20% in the next 5 years. @*Conclusion@#Based on their findings, the current per capita support from PHIC Konsulta package is not adequate in the private sector both for wellness and care of patients with chronic condition. PHIC needs to consider adjusting per capita rates and consider case rate payment as it is currently doing for hospital care. Without this proposed adjustment, only those patients in the higher socioeconomic status will be capable of consulting the private sector. This scenario defeats the equity issue that is a primary concern in the UHC.

Study on the content of family doctor health service packages in functional communities / 上海预防医学

ObjectiveBased on a demand survey， to put forward the idea of family doctor service health service packages for people in functional communities， and provide suggestions for the implementation of family doctor health service in such communities. MethodsThrough the stratified cluster sampling survey of a science and innovation bearing functional community， combined with literature research， current situation survey， case analysis and interviews， this paper proposes the service content of the service packages. ResultsOn the basis of demand survey， the mode of "specified action + optional action" should be adopted. Community health service center should first provide basic service， and then expand their services in diagnosis， treatment， and health management in line with local demand， and provide optional multi-level health service packages for scientific and innovative functional community residents， which should be divided into basic health service， value-added health service and high-end health service. ConclusionSorting out the content of health service packages of family doctor service in functional communities can provide the basis for further improving the allocation of medical service resources， further optimizing the design of the financing and compensation mechanism， and further standardizing the contract service of family doctors.

Warning effects of tobacco packaging on teenagers / 上海预防医学

ObjectiveTo evaluate the warning effect of different tobacco packaging on teenagers and provide an objective evidence for improving tobacco packaging in China. MethodsA multi-stage cluster sampling method was used to investigate students from two middle schools and two high schools in Huangpu District， Shanghai with a self-filled questionnaire survey， and a total of 1 238 valid questionnaires were collected. Epidata 3.1 was used to input data and SPSS 20.0 was used for data analysis. ResultsAbout 69% of the respondents supported printing pictures of diseases on tobacco packages in China， and 81.58% thought graphic warnings should cover more than 70% of the tobacco package. The effect of graphic health warning labels was better than that of text-only warning labels （P<0.05）， and the effect of real photos was better than abstract pictures. In addition， labels with real graphic warnings had the highest scores in terms of preventing youth smoking and the degree of support， which was significantly different from abstract graphic warning labels and text-only warning labels （P<0.05）. ConclusionCigarette packs with graphic health warnings have a stronger effect on teenagers than plain text health warnings. Teenagers support the use of graphic warnings. It is recommended to apply graphic health warnings with real photos of diseases on the cigarette packages to maximize the effect of the health warnings.