Adherence to anti-TB treatment in low- and middle-income countries (LMICs), including Afghanistan, is critical for global TB control.

We aimed to determine anti-TB treatment non-adherence prevalence and its predictors in Kandahar, Afghanistan.

We conducted a multi-center cross-sectional study of 579 TB patients in Kandahar, using a systematic random sampling method, and collected their data on sociodemographic attributes, clinical factors, and mental health. The eight-item Tuberculosis Medication Adherence Questionnaire (TBMAQ) was used for labeling TB patients as adherent or non-adherent. We assigned a score of ≤4 (the cut-off) as non-adherence. We performed the multivariable logistic regression to probe significant predictors of non-adherence.

The non-adherence rate in this study was 66.8% (95% CI: 62.9-70.5). Being uneducated (AOR = 1.66, 95 % CI: 1.09-2.53), having a comorbid medical condition (AOR = 2.57, 95 % CI: 1.39-4.74), feeling stigmatized for having TB (AOR = 9.25, 95 % CI: 4.72-18.1), and having a comorbid depression (AOR = 1.77, 95 % CI: 1.16-2.71) were associated with non-adherence.

Anti-TB treatment adherence needs to be prioritized among TB patients overall, particularly in those with a low level of education, comorbidity, perceived TB-related stigma, and comorbid depression with consistent evidence of increased non-adherence.

Indian healthcare system nearly crashed during the pandemic and victims of COVID-19 experienced huge health related economic burden. Thus, we aimed to quantify the direct medical cost associated with COVID-19 management along with the healthcare schemes.

A retrospective study was conducted for the duration of 8 months where the data of COVID-19 patients of one year (2020-2021) was collected from the medical record department. The data of COVID-19 patients of age 18-65 years with confirmed diagnosis based on RT-PCR test were included in the study whereas the data of special population such as pregnant, hemodialysis and patient undergoing surgery were excluded.

Out of 1011 COVID-19 patients, 63.5% were males and 36.5% were female with the mean age of 43.8 ± 14.5 years and with 9.47 days mean length of hospitalization. On direct medical cost analysis, USD 1060.92 was the total median expenses which includes COVID package plus outside COVID package expenses. Similarly, USD 728 and USD 51.1 were the median amount claimed through healthcare schemes and median co-payments respectively. The total median expenses with and without healthcare schemes were found to be USD 1061.37 and USD 1052.94 respectively whereas co-payments with and without schemes were USD 26.005 and USD 1046.64.

Healthcare schemes are the best strategy to overcome the direct medical cost associated with the management of the disease. Quantifying the medical cost could provide an insight to develop effective policy to counteract the financial toxicity among patients.

Asthma represents a significant global health challenge, exhibiting considerable variation in prevalence, incidence, mortality and disability-adjusted life years (DALYs) across regions and countries. This study evaluates global, regional and national trends in asthma burden from 1990 to 2021, analysing associations with temporal, geographical and demographical factors.

Using open data from the Global Burden of Disease (GBD) database (1990-2021), we analysed changes in asthma prevalence, incidence, mortality and DALYs by gender, age and Socio-Demographic Index (SDI) groups. Joinpoint regression analysis calculated the average annual percentage change (AAPC) and annual percentage change (APC).

From 1990 to 2021, the age-standardised prevalence and incidence rates of asthma declined by 40.01% and 29.89%, respectively. While asthma deaths increased slightly, the age-standardised mortality rate (ASMR) declined by 46.01%. The highest prevalence was observed in South Asia, East Asia and high-income North America, while low-SDI regions exhibited elevated mortality and DALYs. The age and sex-specific patterns indicated a higher asthma burden among females. The results of the joinpoint analysis indicated a global age-standardised incidence rate increase between 2005 and 2010 for both males and females. The ASMR exhibited a statistically significant decline from 1990 to 2021.

The global age-standardised rate of asthma burden declined from 1990 to 2021. However, asthma remains a significant public health issue, particularly in regions with lower socioeconomic development. Understanding global and regional trends in asthma can inform future policies and interventions, aiming to promote more equitable prevention, diagnosis and treatment worldwide.

The COVID-19 pandemic has disrupted healthcare, causing challenges in managing chronic diseases like hypertension. Al-Hada Armed Forces Hospital's Pharmaceutical Care Department aims to provide safe, efficient, and effective medication refills for elderly patients pre-and post the pandemic. An improvement project was conducted at Al-Hada Armed Forces tertiary hospital to enhance medication refill processes and adherence among elderly patients with hypertension. Data on medication adherence, including refill cycle times and factors contributing to longer cycles, were collected through the Hospital Information System. The Institute for Healthcare Improvement Model for Improvement guided a study to implement a digital medication refill system. Pre-intervention and post-intervention analyses demonstrated the effectiveness of the digital system in improving medication refill processes for elderly patients with hypertension. We improved the medication refill process, reducing wait times from 40 to 5 minutes by 2022. Our system monitored medication adherence and oversupply, and it also utilized features like delivery services, online medication refills, the Tebtom system and SMS reminders. Tebtom system is an Arabic term that means 'get well soon' in English. The system includes a variety of services, such as obtaining a waiting number for upcoming appointments within 30 minutes, booking appointments, accessing medical reports, laboratory results, radiology requests, and refilling medications. The study showed a significant improvement in refill duration. Medication adherence increased from 35% to 79% with timely reminders, fewer missed doses and increased coverage of medication days. Patient medication oversupply decreased from 50% to 19%, and the system improved communication and refill convenience. A successful quality improvement method has significantly impacted our medication refill system, the effectiveness of message reminders, and patient safety through ensuring compliance with medications and reducing oversupply. During COVID-19, the digital system played a crucial role in maintaining medication access. This project highlights the positive impact of a digital refill system on efficiency and reducing medication oversupply among elderly patients with hypertension before and after the pandemic.

Residents endure psychosocial and work-related situations associated with an increased risk of developing mental health problems. Mental health is often affected during epidemics. Knowledge about the mental health state of residents before and after the onset of the COVID-19 pandemic is scarce.

In this cohort study, demographic features, psychosocial characteristics, and mental health disorders were examined before and after one year of training. The second evaluation assessed burnout syndrome (BS) and individual experiences with the pandemic. Non-parametric tests and logistic regression were used to evaluate differences after 1 year and to analyze the relationship between mental health outcomes and the independent variables. Models were adjusted on a priori supposition of confounding variables.

A total of 49 pediatric residents were included; none were lost to follow-up. Overall, mental health disorders prevalence increased by 30.6%. The prevalence of depressive episodes and generalized anxiety disorder also increased significantly. The prevalence of BS was 57.1%. The main risk factor for developing a mental health disorder was having a family history of mental health disorders.

The increase in the prevalence of mental health disorders after 1 year during the COVID-19 pandemic was more significant than the one observed in pre-pandemic studies. Further research is needed to find strategies to protect mental health among residents, especially during health crises.

Orotracheal intubation can cause complications such as stridor and airway obstruction, which favors weaning failure. The objective of this study was to assess the usefulness of airway ultrasound prior to extubation to predict stridor and extubation failure.

Cross-sectional descriptive study, from March 2023 to June 2024. A total of 50 patients were studied, admitted to the pediatric emergency service of the Children's Hospital of the State of Sonora, under mechanical ventilation ≥ 24 hours and in whom the first extubation attempt. An ultrasound of the airway was performed, calculating the peritube free space and the width of the air column before extubation, and the total number of patients who presented post-extubation stridor and extubation failure were identified.

The mean peritube free space in patients who presented stridor was 3.2 mm (0.3-6.2), with a statistically significant difference (p = 0.012) compared to patients who did not present stridor. The mean width of the air column in patients who presented stridor was 1.21 mm (0.16-4.78 mm), but it did not show a statistically significant difference (p = 0.153) compared to patients who did not present stridor. There were no statistically significant differences in both measurements for the outcome of extubation failure.

Airway ultrasound seems to have a good correlation with the risk of post-extubation stridor.

Approximately 25% of children with asthma experience uncontrolled symptoms, leading to frequent exacerbations, emergency visits, systemic corticosteroid use, unnecessary antibiotic prescription, and increased mortality risk. Poor treatment adherence is a critical factor hindering asthma control. This study aimed to implement and evaluate therapeutic adherence in children with persistent asthma through a technological solution based on short message service (SMS) reminders sent to patients' mobile phones and receiving their responses to optimize disease management and follow-up.

We conducted a quasi-experimental pilot study with 28 children to develop the software RoxySMS for remotely monitoring therapeutic adherence in a tertiary hospital. Participants included caregivers of children aged 5-14 years with persistent asthma requiring daily inhaled corticosteroids alone or with long-acting beta-agonists. Caregivers needed a postpaid mobile phone for SMS communication. Outcome evaluators and data analysts were blinded to the intervention.

The software achieved an average response percentage of 80.8%, with individual responses ranging from 37.9% to 98.9%. On average, 50% of messages were answered immediately (5-87%), 24% within 15-60 min (2-55%), and 26% within 1-24 h (2-84%).

RoxySMS successfully automated message delivery, validating it as a viable and cost-effective tool for monitoring adherence in chronic conditions, such as asthma, particularly in resource-limited settings.

Many service users with neurological conditions do not meet the recommended physical activity requirements. Cultivating early and ongoing access to physical activity and exercise opportunities is vital to improve or maintain function and general health in this vulnerable group.

To evaluate the impact of a pathway that aimed to facilitate access and adherence to physical activity and exercise for service users with neurological conditions.

A London-based NHS healthcare team providing community neurorehabilitation developed a pathway in co-production with public health, local authority, third sector parties and service users to facilitate physical activity and exercise opportunities. First, NHS neurophysiotherapists offered a bespoke programme on exercise, physical activity and education to service users for up to 12 weeks. The pathway continued in local gyms, supported by a fitness instructor, for at least a further 12 weeks. Using a pre-post design, outcomes relating to function, strength and physical activity were recorded at baseline, 6-12 weeks (health care) and 6 weeks later (telephone survey after transition to local gyms). Data analysis was descriptive.

Thirty-five service users (20 men), mean (SD) age 60 (15), with a range of neurological conditions, were eligible and included. Ten participants dropped out: eight (23%) for medical reasons, two (6%) for other reasons. Due to the COVID-19 pandemic, four (11%) service users could not transition when facilities closed in March 2020. Analysis showed potential beneficial effects on function, strength and physical activity for service users as well as reduced waiting times to access the NHS and local gyms.

Outcomes suggested the pathway enabled service users to access and adhere to physical activity and exercise following neurorehabilitation. This evaluation included small numbers but could inform service development and future studies.

This study aimed to investigate how COVID-19 lockdowns in Türkiye influenced parents' actions when their child was ill or injured and how they perceived the impact of the lockdown on the severity of their child's illness and the treatment received.

This descriptive, and cross-sectional mixed method was conducted with 104 parents whose children experienced illness or injury during the pandemic lockdowns between July and September 2022. Data was collected through online survey using snowball sampling method. Descriptive statistics and pearson's chi-square test were used for statistical analysis, while free-text data was subjected to thematic analysis.

Of the parents who sought medical help, 51.7% reported their child being admitted to hospital, and 29.8% noted their child had a chronic health illness. These parents were more likely to report that changes in health services affected their child's treatment compared to those with children without a long-term health issue (45.1% vs. 12.3%, p < 0.001). The experiences of parents seeking help for their sick or injured child during the lockdown were categorized into three main themes: the lockdown's impact on the child, health service accessibility during the lockdown, and parental help-seeking behavior during lockdown.

It is concluded in this study that during COVID-19 lockdowns, pediatric nurses should guide parents regarding when and where to seek medical assistance to mitigate potential complications resulting from reduced parental help-seeking behavior.

To ensure the uninterrupted monitoring and treatment of children with chronic health issues during lockdowns, it is advisable to expand telemedicine practices.

Therapeutic itineraries (TIs) involve the process of choices and the evaluation of care/treatment experiences related to the family, popular and professional subsystems in the course of an illness. The understanding of TIs is fundamental not only in the human experiential sense, but also to subsidize transformations in health care systems. The objective of the study was to describe the therapeutic itineraries of patients with COVID-19 in the city of Manaus, which had the highest mortality rate and and was the epicenter of the disease in Brazil, while considering the severity of the health crisis in the scenario.

A qualitative descriptive study that involved in-depth interviews of 29 patients who recovered from severe COVID-19 in Manaus, Brazil.

The family and popular subsystems were integrated, and the professional subsystem was more prominent, given the conditions of initial ignorance about the disease and the serious repercussions of the epidemic. The TIs covered from the initial assessment of the health condition, available resources, information, access to health services to the worsening, hospitalization and perceived impacts of fear, scientific denial and unpreparedness and collapse of the system.

The reflection regarding objective and subjective behaviors of individuals in the health-disease process should last beyond the temporality of the crisis and mark the (re)construction of a resolutive health system that considers the real problems faced by users in the search for care.