Comparative analysis of the incidence of enteroparasitosis andthe COVID-19 pandemic profile in the city of Bananeiras - PB / Análise comparativa da incidência de enteroparasitoses e doperfil pandêmico da COVID-19 na cidade de Bananeiras - PB

Enteroparasitosis are diseases caused by parasitic agents present in the environment and in the gastrointestinal tract of living beings. In addition, they are still considered neglected diseases, but of great importance for public health, especially when they are related to secondary infections and currently their co-infection profile with COVID-19. The interaction of protozoa and/or helminths with the SARS-CoV-2 virus is timely and its signs and symptoms are confused with other pathogen relationships. In this way, this study aims to correlate the incidence of enteroparasitosis and COVID-19, in the pandemic period from 2020 to April 2022. This is a documentary and exploratory study of secondary data from laboratory tests of patients who were treated and diagnosed with COVID-19 and enteroparasitosis at Hospital Doutor Cloves Bezerra Cavalcante, Municipal Hospital of Bananeiras, Paraíba, Brazil. In the analysis of the database, a significant increase of approximately 48.85% in the incidence of COVID-19 cases from 2020 to 2021 stands out, remaining high until 2022. In contrast, cases of enteroparasites peaked at 48.74% in 2021, followed by an average reduction of 23.12%, with a deviation of 1.49%, in relation to the years 2020 and 2022. It was concluded that COVID-19 is predominantly associated with an increase in secondary infections, highlighting the crucial need to promote health education, improve basic sanitation and guarantee access to health services as essential components in combating the increase in parasitic infections, especially those related to viral pathologies.

As enteroparasitoses são enfermidades originadas por agentes parasitários presentes no meio ambiente e no trato gastrointestinal dos seres vivos. Ademais, ainda são consideradas doenças negligenciadas, porém de grande importância para a saúde pública, em especial, quando estão relacionadas com infecções secundárias e atualmente seu perfil de coinfecção com a COVID-19. A interação de protozoários e/ou helmintos com o vírus SARS-CoV-2 é oportuna e seus sinais e sintomas são confundidos com outras relações de patógenos. Desta maneira, este estudo visa correlacionar a incidência de enteroparasitoses e COVID-19, no período pandêmico de 2020 a abril de 2022. Trata--se de uma pesquisa documental e exploratória, de dados secundários dos exames laboratoriais de pacientes que foram atendidos e diagnosticados com COVID-19 e enteroparasitoses no Hospital Doutor Cloves Bezerra Cavalcante, Hospital Municipal de Bananeiras, Paraíba, Brasil. Na análise da base de dados, destaca-se um aumento significativo de aproximadamente 48,85% na incidência de casos de COVID-19 de 2020 a 2021, mantendo-se elevado até 2022. Em contraste, os casos de enteroparasitas atingiram um pico de 48,74% em 2021, seguido por uma redução média de 23,12%, com um desvio de 1,49%, em relação aos anos de 2020 e 2022. Conclui-se que a COVID-19 está predominantemente associada ao aumento de infecções secundárias, destacando a necessidade crucial de promover a educação em saúde, melhorar o saneamento básico e garantir o acesso aos serviços de saúde como componentes essenciais no combate ao aumento de infecções parasitárias, especialmente aquelas relacionadas a patologias virais.

Refueling a Quiet Fire: Old Truthers and New Discontent in the Wake of COVID-19.

This article investigates the factors that contributed to the proliferation of online COVID skepticism on Twitter across Italian municipalities in 2020. We demonstrate that sociodemographic factors were likely to mitigate the emergence of skepticism, whereas populist political leanings were more likely to foster it. Furthermore, pre-COVID anti-vaccine sentiment, represented by "old truthers" on Twitter, amplified online COVID skepticism in local communities. Additionally, exploiting the spatial variation in restrictive economic policies with severe implications for suspended workers in nonessential economic sectors, we find that COVID skepticism spreads more in municipalities significantly affected by the economic lockdown. Finally, the diffusion of COVID skepticism is positively associated with COVID vaccine hesitancy.

Public sector replacement of privately funded pharmaceutical R&D: cost and efficiency considerations.

AIMS: Economic studies have found that public support of basic medical research provides important long-term benefits. In response to suggestions that private pharmaceutical research and development (R&D) funding could be totally replaced by public funding, we investigate the economic implications of such a substitution in funding roles that maintain the recent pace of pharmaceutical innovation. MATERIALS AND METHODS: Total lifecycle R&D costs were estimated using the latest available R&D expenditures per novel molecule entering clinical trials, likelihood of approval, pre-clinical and post-approval expenditures, using a published survey and a review of publicly available financial accounts from US-listed multinational developers. This estimate was then stratified by the average number of annual FDA approvals to estimate total costs of R&D funding born by the private sector. RESULTS: We find total lifecycle R&D costs were US$2.83 billion per approved medicine. Estimated uncapitalized costs to replace private R&D funding for one year of FDA approvals were $139.6 billion. These additional costs are equivalent to 302% of the entire National Institute for Health 2022 budget of $46.2 billion, and around 25 times NIH's estimated annual $5.6 billion currently dedicated to clinical research trials for pharmaceuticals. Further assessing the policy proposition through a literature review, we found little evidence for improvements in economic efficiency via public funding substitution, while there may be additional challenges including asymmetric information, adverse selection, yardstick competition, hold-up, under-rewarding of incremental innovation and political rent-seeking. LIMITATIONS: Our calculations may undervalue full replacement costs, by excluding non-R&D expenses for manufacturing, distribution, or financing. CONCLUSIONS: The bulk of investment in R&D is underwritten by the private sector. Political discourse portraying the NIH as the central force in bringing a new drug to market may underappreciate the pivotal role of private at-risk capital. Replacing such investment while maintaining the current innovation output in terms of approved therapies would necessitate substantial increases in taxpayer financing.

Mobile Apps for Vaccination Services: Content Analysis and Quality Assessment.

BACKGROUND: Vaccination services are increasingly in demand by the public, and mobile apps are an effective tool to meet that demand. However, the characteristics and quality of these apps are unknown. OBJECTIVE: Commonly used vaccination service apps on the market were surveyed with regard to quality, service content, and user experience to evaluate and guide users. METHODS: The Qimai Data mobile app data analytics platform was used to search for common vaccination service apps by keyword, and the WeChat and Alipay platforms were searched for apps. The apps included in the study were independently evaluated by two reviewers using the Mobile Application Rating Scale, and the service content and user experience of the apps were analyzed. The intragroup correlation coefficient between raters was used to measure interrater reliability. RESULTS: In the app stores of the four major Android platforms and the iOS app store, 1092 and 207 apps were found, respectively; 189 WeChat applets and 30 Alipay applets were also found. A total of 29 apps was ultimately included in this study according to the inclusion criteria, including 21 independent apps, 4 WeChat applets, and 4 Alipay applets. Significant differences were found between independent apps and applets in terms of the quality score (t449.57=-5.301; P<.001) and the subjective quality score (z=-4.753; P<.001). No significant differences were found between iOS and Android platforms in terms of the quality score (t1404=-2.55; P=.80) and the subjective quality score (z=-0.137; P=.89). There was good intragroup consistency among the raters. CONCLUSIONS: In this study, independent apps and nonindependent apps that rely on social and payment platforms for implementation were included in the vaccination services category. The overall quality of these apps was acceptable. Nonindependent running apps were found to have slightly lower scores and showed room for improvement, and scores for the participatory apps were found to be generally low overall.

Municipal solid waste management in Lagos State: Expansion diffusion of awareness.

This study examined the role of waste management authorities in promoting public awareness of municipal solid waste management (MSWM) through the lens of the expansion diffusion theory (EDT). EDT emphasizes the spread of new ideas and practices within a society through various communication channels and distinct individuals within each system. We employed a mixed-method approach using 116 survey responses from Lagos residents and five semi-structured in-depth interviews. Our findings reveal the need for a more structured approach to create public awareness of MSWM, considering the distinct groups of residents in Lagos and their responses to innovation and knowledge diffusion. We propose four pillars on which waste management authorities in developing countries can sustain their MSWM awareness campaigns, as well as an awareness campaign strategy flowchart. Our findings add to the expanding body of research on public awareness and participation in MSWM, emphasizing the critical role that waste management authorities can play in fostering sustainable waste management awareness and practices.

Psychological distress and trajectories of sleep duration among Australian adolescents: a prospective cohort study.

OBJECTIVES: This study investigated the association between indicators of psychological distress and well-being and trajectories of sleep duration among a cohort of Australian adolescents. DESIGN: A prospective cohort of adolescents was followed over 27 weeks (8 November 2019-14 May 2020). Data on sleep duration and psychological distress were collected via smartphones, based on ecological momentary assessments. SETTING: Sydney population catchment, Australia. PARTICIPANTS: Young people aged 13-19 years were recruited via social media (Instagram or Facebook). PRIMARY OUTCOME MEASURE: Self-reported sleep duration in the past 24 hours. Sleep duration was dichotomised into 'less than 8 hours' and 'at least 8 hours', to represent those participants not meeting the recommended minimum amount of daily sleep. RESULTS: Participants with high psychological distress had higher odds of sleeping less than 8 hours (OR 1.51 (95% CI 1.17 to 1.96)), compared with those with low psychological distress. Social media use (OR 1.34 (95% CI 1.01 to 1.79)) and longer periods spent on homework (OR 1.37, (95% CI 1.07 to 1.75)) were also associated with a sleep duration of less than 8 hours. Also, decreasing sleep trajectories were associated with increased psychological distress (ß=0.069, (95% CI -0.010 to 0.149)) and increased homework hours (ß=0.078 (95% CI 0.036 to 0.120)). CONCLUSION: Findings highlight the adverse impact of psychological distress and high levels of social media use on sleep duration among adolescents. Longitudinal studies with longer follow-up periods are warranted to further explore the temporal associations between sleep duration and different health outcomes among varying populations.

Learning from the Montreal Protocol to improve the global governance of antimicrobial resistance.

The Montreal Protocol has played a critical role in promoting global collective action to phase out the use of ozone-depleting substances, ultimately preventing millions of cases of skin cancer, cataracts and other health issues related to ultraviolet radiation exposure. This success entails transferable lessons for coordinated action required to improve the global governance of other challenges. Like ozone depletion, antimicrobial resistance (AMR) is a challenge of the global commons, requiring coordinated actions across human, animal and environmental sectors. We identify equity, flexibility and accountability as three core governance principles that underlie the success of the protocol and employ the 3-i framework to understand how interests, ideas and institutions contributed to the protocol's success. Equity-promoting strategies consisted of an inclusive negotiation process, supporting developing countries with multilateral funding and a progressive compliance model. Flexibility was built into the protocol through the development of country-specific strategies, reorienting incentive structures for industry and facilitating regular amendments in response to emerging scientific evidence. Accountability was promoted by mobilising public advocacy, establishing targets and enforcement mechanisms and conducting independent scientific and technical assessments. Applying our proposed principles presents an opportunity to improve the global governance of AMR. Finally, we acknowledge limitations to our analysis, including our focus on a single environmental treaty, significantly greater funding requirements and multifacetted stakeholder involvement in the case of AMR, differing market and incentives structures in antibiotic development and distribution, and ethical concerns with using trade restrictions as a policy tool.

Misinformation and perception of COVID-19 and risk assessment among people in Pakistan: A pilot study.

BACKGROUND: During the coronavirus pandemic, misinformation was circulated through technology and social media on a large scale. Since people rely on media to keep connected and informed, misinformation can prevent them from staying safe. OBJECTIVES: To examine the quality of information reaching Pakistanis, the effect of information/misinformation on people's perception, and its relationship with risky health behaviours in different demographical groups. METHODS: A community sample of N= 103 Pakistanis was assessed using a mixed-method cross-sectional survey research design to investigate their sources of knowledge/information, perceptions of coronavirus-related facts, and risky health behaviours. RESULTS: Content analysis of the material that participants read/watched indicated the possible effect of media on people's perception of COVID-19. Specific demography (e.g., increasing age) and people's tendency to believe misinformation/information may indicate risky health behaviours pertaining to coronavirus infection. DISCUSSION: Findings showed how the models considered (social cognitive theory, biological warfare conspiracy theory, theory of planned behaviour, protection motivation theory, the health belief model, and biopsychosocial model) may be relevant to examination of the effects of misinformation on different demographic groups. CONCLUSION: The findings and models need to be verified on larger, more representative samples of Pakistanis using a large-scale survey based on the insights obtained from this pilot study.

Predominance of enterotoxigenic Escherichia coli among ESBL/plasmid-mediated AmpC-producing strains isolated from diarrheic foals: a public health concern.

BACKGROUND: The upsurge of diarrheagenic E. coli pathotypes carrying extended-spectrum beta-lactamases (ESBLs)/plasmid-mediated AmpC ß-lactamase (pAmpC) among animals constitutes an emerging threat for humans and animals. This study investigated the burden of ESBL-/pAmpC-producing diarrheagenic E. coli among diarrheic foals and its potential public health implications. Rectal swabs were collected from 80 diarrheic foals. These swabs were processed to isolate and identify ESBL/pAmpC-producing E. coli using a selective culture medium, biochemical tests, phenotypic identification, and molecular identification of ESBL- and pAmpC-encoding genes. Moreover, all ESBL-/pAmpC-producing E. coli isolates were examined for different virulence genes related to diarrheagenic E. coli pathotypes. RESULTS: Out of 80 examined foals, 26 (32.5%) were confirmed as ESBL-/pAmpC-producing E. coli, of which 14 (17.5%) animals carried only ESBL-producing E. coli, whereas 12 (15%) animals possessed ESBL-pAmpC-producing E. coli. The only detected diarrheagenic pathotype was enterotoxigenic, encoded by the heat-stable enterotoxin gene (ST) with a prevalence rate of 80.8% (21/26). The ST gene was further characterized where STa, STb, and STa + STb were found in one, four, and 16 strains, respectively. Moreover, all enterotoxigenic E. coli (ETEC) isolates exhibited a multidrug-resistance pattern. The phylogenetic analysis of 3 obtained partial STb sequences revealed high genetic relatedness to ETEC isolates retrieved from humans, conferring such sequences' public health significance. CONCLUSIONS: These findings highlight that diarrheic foals could serve as a potential reservoir for multidrug-resistant ESBL-/pAmpC-producing enterotoxigenic E. coli.

Dynamics of Feline Sporotrichosis in Espírito Santo, Brazil: Impact of Urbanisation.

INTRODUCTION: Sporotrichosis is a chronic infectious mycosis caused by traumatic implantation of Sporothrix spp., which poses a significant challenge to public health because of its zoonotic nature. It affects humans and other animals, particularly cats. This study investigated epidemiological trends and spatial distribution of feline sporotrichosis in Espírito Santo between 2017 and 2022. METHODS: This study collected diagnostic data on sporotrichosis from the Veterinary Pathology Laboratory and Center for Infectious Diseases in Espírito Santo from 2017 to 2022. Statistical analyses were performed using STATA and spatial analyses were performed using ArcGIS software to create maps and identify hotspots. Kernel density estimation and directional mean statistics were applied to visualise the disease concentration and transmission trends. RESULTS: The results showed a significant increase in feline sporotrichosis cases in Espírito Santo from 2017 to 2022, with hotspots identified in urban and densely populated areas. Anchieta, Aracruz and Vila Velha reported the highest numbers of cases. Spatial analysis indicated a spread towards the central and northern coastal regions. CONCLUSION: This study highlights the growing threat of feline sporotrichosis in Espírito Santo, Brazil, particularly in densely populated urban areas. This underscores the urgent need for comprehensive public health strategies that address urbanisation, human-animal interactions and managing stray cat populations. Effective control measures and enhanced surveillance are crucial to mitigate the spread of this zoonotic disease. Importantly, this study provides valuable insights into the epidemiology of sporotrichosis in Brazil and offers a framework for other regions identified as emerging hotspots that face similar challenges.

Public Perceptions of Enuresis: Insights From Online Communities in South Korea and the United States.

PURPOSE: To establish a foundation for raising awareness and disseminating accurate information about enuresis-one of the most challenging conditions to discuss openly-this paper examines public perceptions of enuresis. METHODS: This paper collected title and text data from posts related to enuresis on the top popular online platforms such Naver Cafe in South Korea and Reddit in the United States (US). The data along with the thematic subcommunities where the posts were uploaded, was analyzed and visualized using word cloud, Latent Dirichlet Allocation (LDA) topic modeling, and pyLDAvis. RESULTS: The findings reveal both similarities and differences in how the patients from the 2 countries addressed enuresis online. In both countries, enuresis symptoms were a daily concern, and individuals used online platforms as a space to talk about their experiences. However, South Koreans were more inclined to describe symptoms within region-based communities or mothers' forums, where they exchanged information and shared experiences before consulting a doctor. In contrast, US patients with medical experience or knowledge frequently discussed treatment processes, lifestyle adjustments, and medication options. CONCLUSION: South Koreans tend to be cautious when selecting and visiting hospitals, often relying on others for advice and preparation before seeking medical attention. Compared to online communities in the US, Korean users are more likely to seek preliminary diagnoses based on nonprofessional opinions. Consequently, it is important to lower the barriers for patients to access professional medical advice to mitigate the potential harm of relying on nonprofessional opinions. Additionally, there is a need to raise awareness so that adults can recognize and address their symptoms in a timely manner.

Dengue outbreak 2023 in Bangladesh: From a local concern to a global public health issue.

Dengue, a viral infection transmitted by mosquitoes, has become a substantial public health issue in Bangladesh. The high population density and subtropical-tropical climate of the nation create conducive environments for the transmission of the virus. The recent increase in dengue cases in Bangladesh prompts an inquiry into the potential for the virus to progress into an epidemic manifestation. Bangladesh is prone to dengue outbreaks due to a multitude of contributing factors. To commence, the virus is endemic to tropical and subtropical regions, and climate change is contributing to the expansion of its range. Additionally, the high population density in Bangladesh amplifies the vulnerability to dengue transmission. Intimate human proximity elevates the probability of contracting mosquito stings and transmitting viruses. The escalating incidence of dengue in Bangladesh is substantiated by the growing count of documented cases. The emergence of severe dengue is a contributing aspect that raises concerns about the potential worldwide consequences of the disease. It could potentially head from Bangladesh to neighboring nations via an infected individual. There exist apprehensions due to the substantial employment of Bangladeshi laborers overseas, compounded by the presence of foreign laborers within Bangladesh. The endeavor to control dengue in Bangladesh continues to face ongoing challenges. This review addresses the complexities of dengue transmission, assesses Bangladesh's readiness for managing epidemics, analyzes risk factors associated with dengue, and suggests preventive measures to mitigate the possibility of worldwide consequences of dengue originating within the nation.

Ideals and Reality of Public Health Nursing in Korea: Influence of U.S. Nurse Advisors, 1945~1961.

South Korea's national healthcare system after liberation often described as transformation from 'sanitation' to 'public health'. The U.S. military government introduced public health nursing as the primary vehicle for communicating the newly introduced concept of public health to the Korean public. This meant that nursing, which had been in a subordinate position within the healthcare system during the Japanese occupation, had to be repositioned within the healthcare system as an independent and leading professional agent of healthcare. At the same time creating positions for public health nurses within the newly envisioned health center system, and convincing the public that nurses were the primary agents of public health activities. Yet, in resource limited setting, the role of public health nurses was significantly scaled back. Initial plans for institutionalized, community-wide health care through home visits shifted to addressing the challenges facing Korean society, including maternal and child health and infectious disease prevention. Ironically, the expansion of health centers during late 1950s diminished the position of public health nurses within local government health systems, who were gradually replaced by male administrative staff. The role of public health nurses was greatly curtailed in the 1960s, but they laid the groundwork for later community nursing and health care efforts. At the same time, public health nurses were assigned with new role of 'visiting' local health centers for observation, education, and management. Public health nursing allows to look beyond the ideological and institutional dimensions to examine how new concepts and practices of "public health" were actually transmitted to communities in post-liberation Korea.

Measuring the Collective Community Capacity of a Network to Address Health Inequities during a Public Health Emergency: Findings from the National COVID-19 Resiliency Network.

OBJECTIVE: This study assesses the collective community capacity of the National COVID-19 Resiliency Network (NCRN), a multisectoral network mitigating the disproportionate impact of COVID-19 on minoritized populations. METHODS: From January to April 2022, we used two concurrent data collection methods: a Collective Community Capacity (C3) survey (n=65) and key informant interviews (KIIs) (n=26). The C3 assessed capacity for creation of a shared vision, engagement in community change, and distributive leadership. KIIs assessed perspectives on network formation and implementation. We used a convergent design and triangulation for interpretation. RESULTS: NCRN has growing collective community capacity. The C3 survey found high capacity for establishing a shared mission and evidence of mutual commitment, trust, and accountability. About three-quarters of respondents strongly agreed that partners addressed social, economic, and cultural barriers related to COVID-19. Interviewees valued NCRN leaders' openness, availability, and willingness to listen. Partners learned from one another, increased their health communication capacity, and supported sustainability. They sought greater opportunities to partner and support decision-making. CONCLUSIONS: NCRN developed a collaborative network with a shared vision of improving health equity during and beyond the COVID-19 pandemic, while identifying areas for improvement in distributive leadership. Findings can support other organizations seeking to build collective community capacity to address equity in public health emergencies.

Identifying skills required of new epidemiologists: a content analysis of Canadian job postings and master's programs.

Introduction: The rise of emerging public health threats has increased the need for qualified epidemiologists in Canada. Our study aimed to identify the knowledge, skills, and abilities (KSAs) required of epidemiologists entering the workforce and determine whether these align with those taught in graduate epidemiology programs. Methods: An inductive content analysis of Canadian job postings from May to December 2023 containing the keyword "epidemiology" and requiring master's degrees in epidemiology or related fields was conducted to identify the KSAs required in the workforce. Inductive content analysis of Master of Science (MSc) program descriptions and core course descriptions was completed to discern skills gained through Canadian graduate epidemiology and public health programs. Results: Based on the 295 job postings analyzed, five KSA categories were identified: communication skills (n = 268, 90.8%), analytical skills (n = 267, 90.5%), soft skills (n = 254, 86.1%), research methodology (n = 217, 73.6%), and knowledge of epidemiological concepts (n = 170, 57.6%). Analysis of 18 MSc programs found that that all of them described analytical skills, research methodology, and epidemiological concepts within their curriculum. Communication skills were described in 94.4% (n = 17) of programs, while soft skills were mentioned in 50.0% (n = 9). However, only 66.7% (n = 12) of programs outlined learning objectives or specified the skills acquired from their programs in their descriptions. Conclusion: There was alignment between the needs of the Canadian epidemiology job market and MSc programs, particularly in analytical skills and research methodology. However, development of soft skills should be emphasized within graduate epidemiology programs to better prepare graduates for the job market. Future research should aim to develop competency statements for epidemiologists in training to ensure consistency across graduate programs and promote career readiness.

Scaling up! Staff e-learning for a national take-home naloxone program.

Background: A staff e-learning course was developed to prepare for scaling up a national take-home naloxone (THN) program in Norway. The aims of the study were to (a) describe participant characteristics for those that completed a THN e-learning course, (b) compare opioid overdose knowledge scores before and after e-learning course completion, and (c) to explore subsequent THN distribution by those trained. Methods: This was a quasi-experimental pre-test, post-test longitudinal cohort study of individuals completing a THN e-learning course from April 2021 to May 2022. Frequency analyses were performed for participant characteristics and subsequent naloxone distributions at 1-week and 1-month follow-up. The opioid overdose knowledge scale (OOKS) was used to measure pre-test-post-test knowledge among participants. Wilcoxon signed-rank test was performed for comparison between pre-test and post-test. Effect size was calculated using Cohen criteria. Results: In total, 371 individuals were included in this study. Most were either nurses or social workers (n = 277, 75%). Participant knowledge increased by medium or large effect for all items measured. At 1-month follow-up, 15% reported naloxone distribution. During the study period, 94 naloxone kits were distributed. Major reasons for not distributing were "clients not interested", "workplace not distributing" and "workplace in process of distributing". Conclusions: Our findings suggest that an e-learning course is equally effective in terms of knowledge transfer as an in-person classroom setting, and may provide engagement in terms of naloxone distribution. However, our findings also emphasize the importance of clear implementation routines, including support from central coordinators to optimize the implementation process.

The impact of EU public procurement regulations on tenders in Spain: a study with adalimumab.

Introduction: Pharmaceutical spending accounts for a significant portion of public healthcare budgets. To manage these costs, EU countries implement various cost-containment policies, including competitive tendering for pharmaceuticals. This study examines the impact of EU public procurement regulations on medication procurement practices. Methods: A search for all published tenders of adalimumab in Spain from 2018 to 2024 in the Spanish Public Sector Procurement Database, a period that coincides with the implementation of European legislation and the emergence of adalimumab biosimilars. All available documentation for each tender was reviewed, including the tender offer, technical specifications, specific administrative clauses, appointments of evaluation commissions, supporting memorandum, and evaluation reports. Results and Discussion: Our findings reveal substantial price reductions following the introduction of adalimumab biosimilars, yet highlight significant variability in tender criteria and practices across different regions. Despite adherence to EU directives, the inconsistent application of economic and non-economic factors and an erratic criteria concerning price undermine the intended balance of quality and cost, complicating procurement processes and potentially affecting the availability of a given treatment for patients.

Dual career policy at federal universities in Brazil: analysis of academic and sporting support.

Internationally, the implementation of holistic programs aimed at academic, financial and retirement preparation support for student-athletes who find themselves in dual careers, such as university students, has been widespread and intensified. However, little is known about the subject in the Brazilian national context, because although there are related studies, they are punctual and related to specific universities. In view of the above, this study aimed to investigate public policy aimed at student-athletes at Brazilian federal universities. This is an exploratory, qualitative, cross-sectional and documentary study, using the websites, internal regulations and public notices of 69 Brazilian federal universities for the year 2023, using the content analysis technique. The results indicate that 72.05% offer some kind of support to DC based on the holistic model, 66.17% of which is academic and 60.29% sports. Among the academic support, the flexibility of assessments (57.35%) and the differentiated treatment of absences (51.47%) were close. The sporting support is centered on partial payment of competition costs (60.29%) and athlete grants are restricted to 20.58% of universities. It can be concluded that Brazil's federal universities have policies that include support actions that integrate the holistic model (academic), with incipient coverage of scholarships (sports), but do not effectively follow the holistic model.

Quality function deployment approach to urban ecological public art design centred on resident needs.

To improve the quality management of urban ecological public art design and the service centered on residents' needs. Our study introduces a new Quality Function Deployment (QFD)decision-making model called Kano-FAHP-QFD, which applies to urban ecological public art design. Specifically, a new QFD framework is proposed, combining the Kano model and Fuzzy AHP (FAHP). This paper well explains the importance of ranking urban residents' needs and the impacts of the new framework in defining the quality management of urban ecological public art design and the satisfaction of urban residents, while using the framework as a set of prioritized strategies in urban renewal to guide the design and planning of urban ecological public art. The author combined these three approaches to more accurately capture and address their respective issues and thus better understand the residents' needs for urban ecological public art design. In essence, this study investigates how urban ecological public art can be designed and planned in urban renewal through a novel QFD algorithm for urban ecological public art design, with application case validation. Thus, the method keeps the satisfaction of urban residents in line with the positioning and strategies of urban ecological public art design, which is dedicated to enhancing urban vitality, promoting urban renaissance, and sustainable development. It also provides new research ideas for the development of urban ecological public art design in the future.

Association between experience of emotional violence and hypertension among Kenyan women.

Women who experience intimate partner violence (IPV) face increased risks of reproductive health issues and psychological distress. There is also a growing scholarly interest in its effect on cardiovascular health. About 30% of Kenyan women experience emotional violence, and 9.37% are hypertensive. Yet, there is the absence of localized studies on the role of emotional violence on hypertension risk. This study aims to address this gap by investigating the association between emotional violence and hypertension risk among women of reproductive age in Kenya. Using data from the 2022 Kenya demographic and health survey, we analysed the data of 5,109 women. The outcome and exposure were hypertension status and emotional violence, respectively. Descriptive analysis and binary logistic regression models were computed in STATA version 18. Results were presented in tables, showing the frequency, percentage, and adjusted odds ratio (AOR) at a 95% confidence interval (CI). The prevalence of hypertension was 9.78% [95% CI 8.73-10.94]. Women who had experienced emotional violence had 69% higher odds of hypertension [AOR 1.69; 95% CI 1.39-2.06]. After adjusting for covariates (i.e., age, place of residence, wealth status, exposure to media, and educational level), individuals who reported experiencing emotional violence exhibited a 51% higher odds of hypertension compared to those who did not [AOR 1.51; 95% CI 1.23-1.85]. There is a significant association between emotional violence and hypertension. The findings underscore a need for policy makers in Kenya to address emotional violence against women not only as a social issue but as a serious health risk factor. As such, the experience of emotional violence should be considered as part of the criteria to enhance hypertension screening among women.