Difficulties Faced by Physicians in the Diagnosis of Endometriosis in the Brazilian Public Health System

Endometriosis is a clinical and recurrent condition characterized by the presence of functional endometrial tissue outside the uterine cavity and myometrium. It is estimated that 6% to 10% of women of reproductive age, 50% to 60% of adolescents and adults with pelvic pain, and up to 50% of women with infertility are pregnant from the condition. However, this proportion tends to be even greater due to the difficulty in diagnosing it: because it presents different symptoms, lack of information from health professionals, and a high-cost diagnostic test. Another aggravating factor is the average time from the onset of symptoms to the medical diagnosis, which even today ranges from five to ten years;this delay has consequences for disease progression, as it prevents early treatment, which is important for improving pain levels and physical and psychological well-being. Aware of these mishaps, it is therefore important to assess the difficulties faced by doctors in the diagnosis of endometriosis in the public health system, in Brazil, the Unified Health System (SUS). With this purpose, a cross sectional was carried out, developed in the virtual environment using traffic in Google forms, with the difficulties quantified in the Likert scale. Participating physicians pointed out a medium difficulty for patients with endometriosis to access the consultation (58%) and moderate difficulty (52%) to perform an ultrasound examination;also signaled great difficulty in performing magnetic resonance imaging (77%) and laparotomy (61%) in these patients. It is hoped that knowledge about the difficulties faced by physicians in the diagnosis of endometriosis in the SUS will give these physicians a voice and corroborate, even if minimally, so that there is more research that provokes the search for these difficulties, in order to improving the quality of life of these women.

Reacting to Epidemics:The Innovative Imperial Public Health System during the Late Northern Song Dynasty

Song China was a period in which China experienced a great increase in its population.Concurrently,the Song dynasty also experienced a rise in the frequency of epidemics and two major wars with the Western Xia and Liao dynasties during the 1000s and 1040s.The consequences of these changes were exacerbated by the increased geographical mobility of certain social groups such as traders and examinees attending civil service examinations.Thus,casualties of wars,epidemics,or disease,especially of people whose families were far away and could not care for them were left without care and“their corpses often lay bare along the roads.”This new social environment created a need for general relief.The Northern Song government(960-1127 CE),especially during the reign of Emperor Huizong,established an innovative public health system to address this issue.The public health system included poorhouses,public hospitals,and pauper’s cemeteries.The first were more of charity organizations,whereas the latter two promoted public health by providing medical services for the poor and burial for those that nobody cared for.In terms of rationale behind these institutions,on the one hand,they constituted an attempt to get the poor and homeless off the streets while providing them relief or burial.On the other hand,it seems that Huizong’s deep concern with medicine propelled him to design and implement a comprehensive public health system oriented to prevent contagion and outbreak of epidemics.This article depicts the background,the organization,and the functions of the system.The article also discusses the conditions and reasons that gave rise to such a unique undertaking by the Northern Song government.

History and Logical Progression of China's Public Health System——From the Perspective of the Protection of the Right to Health

A public health system generally refers to public utilities oriented toward protecting and improving health. It is intended to protect the health of the general public. Since the founding of the People’s Republic of China, China has constructed the largest healthcare system in the world. The 20th National Congress of the Communist Party of China(CPC), stressed that China will improve its public health system. Looking back at the history of China’s public health system from its inception to the reform and development and then improvement, it can be found that its development has always revolved around the theoretical logic of unifying rights and obligations and the practical logic of balancing the protection of the right to health and the regulation of state power. The fundamental goal is to protect the right to health of the people. The increasing health risks in modern society have changed require that efforts be made to construct a crisscrossing legal framework for public health, improve early-warning and emergency response mechanisms for public health emergencies,and integrate the health concept into all policies to further improve the public health system.

Therapeutic Approach in Female Sexual Dysfunctions in an Outpatient Clinic of Sexology in the Public Health System: A Longitudinal and Prospective Study

INTRODUCTION: Sexuality is one of the parameters of quality of life, and it is essential to include care for sexual dysfunctions in primary health care. OBJECTIVE: To evaluate the therapeutic approach in female sexual dysfunction in a public health outpatient clinic. DESIGN: A prospective cohort of women with sexual dysfunctions in an outpatient clinic of sexology in the Public Health System. The Female Sexual Function Index (FSFI) and scored 0 - 10 their sexual satisfaction were applied at the beginning and end of the follow-up. RESULTS: Eighty-nine women were included with a median age of 45 years, 69 (77.5%) had less than 11 years of schooling and 95.5% lived with a partner. The main reasons for referral for follow-up at the outpatient clinic of sexuality were dysfunction of hypoactive sexual desire disorder in 67.4% and pain related to sexual function in 46%. The average number of consultations was five and the main therapeutic interventions were guidance and clarification on sexuality (86.5%), use of topical estrogen (56.2%), and relaxation techniques (37.1%). All FSFI-19 domains had better post-intervention rates (p ≤ 0.005). Considering the domains of the FSFI-19, the medians of desire, arousal, lubrication, orgasm, pleasure and pain were higher in the post-intervention period in relation to the pre-intervention period (p ≤ 0.0001 for all analysis). In addition, the score given by the participant on their sexual satisfaction was higher at the post-intervention time compared to the pre-intervention period (p ≤ 0.0001). CONCLUSION: In public health, even with the care being performed by different professionals in each consultation, we conclude that through simple interventions, it is possible to improve the sexualities of the women attended. Still, offering care in sexuality is fundamental as part of primary health care and the training of medical professionals.

Ancylostoma ceylanicum and other zoonotic canine hookworms:neglected public and animal health risks in the Asia-Pacific region

Zoonotic hookworm infections remain a significant public health problem,causing nearly 500 milion cases globally and approximately four million disability-adjusted life years lost annually.More than one-fth of these cases are attrib-uted to Ancylostoma ceylanicum,an emerging zoonotic health issue in the Asia-Pacific region.This review presents key research gaps regarding the epidemiology,diagnosis,control,prevention and elimination of A.ceylanicum and other canine zoonotic hookworms as neglected health threats.A.ceylanicum is the second most prevalent human hook-worm in the region;it is the most common hookworm among dogs and cats-reservoirs of zoonotic infections.Previous population genetic and phylogenetic analyses revealed that A.ceylanicum has three possible transmis-sion dynamics:zoonotic,animal-only,and human-only pathways.The actual burden of zoonotic ancylostomiasis in most endemic countries remains unknown due to the use of parasitological techniques(e.g.,Kato-Katz thick smear and floatation techniques)that have reduced diagnostic performance and do not allow accurate species identifica-tion in helminth surveys.The emergence of benzimidazole resistance in soil-transmitted helminths(STHs),includ-ing hookworms,is a concern due to the protracted implementation of mass drug administration(MDA).Resistance is conferred by single nucleotide polymorphisms(SNPs)that occur in theβ-tubulin isotype 1 gene.These mutations have been reported in drug-resistant A.caninum but have not been found in A.ceylanicum in the field.A.ceylanicum remains understudied in the Asia-Pacific region.The zoonotic nature of the parasite warrants investigation of its occur-rence in human and animal reservoir hosts to understand the dynamics of zoonotic transmission in different endemic foci.The detection of benzimidazole resistance-associated SNPs in zoonotic hookworms from Asia-Pacific countries has yet to be thoroughly explored.Considering the high level of hookworm endemicity in the region,the circulation of resistant isolates between humans and animals potentially presents a significant One Health threat that can under-mine current MDA and proposed animal deworming-based control efforts.

Comprehensive Analysis of Cancer Incidence and Mortality Trends in Costa Rica: Implications for Public Health

This commentary delves into the evolving landscape of cancer incidence and mortality in Costa Rica, presenting a comprehensive analysis of the data. Key findings reveal a concerning upward trajectory in cancer incidence rates, placing Costa Rica at the forefront within Central America. While prostate cancer and breast cancer dominate, disparities emerge when scrutinizing gender-specific trends. Notably, stomach and cervical cancers show declines, potentially attributed to targeted interventions. However, colorectal and liver cancers witness mortality increases, necessitating strategic responses. Geographical disparities persist across provinces, highlighting the need for equitable healthcare access. In conclusion, this commentary underscores the urgency of addressing the burgeoning cancer burden in Costa Rica, calling for evidence-based interventions and collaborative efforts on a global scale.

Examining Inequality in the Public Health Workforce Distribution in the Centers for Disease Control and Prevention(CDCs) System in China, 2008–2017

Objective Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention.Using the Centers for Disease Control and Prevention(CDCs)system of China as an example,we evaluated inequality in the public health workforce distribution across different regions in China between 2008 and 2017,with the aim of providing information for policymakers to support resource allocation and address growing health inequities.Methods We used three standard public health workforce inequality indices-Gini coefficient,Theil L,and Theil T-and spatial autocorrelation analysis to explore spatial clusters of the workforce in different provinces,visualized with geographical tools.Results The aggregate workforce-to-population ratio decreased from 1.47 to 1.42 per 10,000 population from 2008 to 2017,and was consistently lower than the National Health Commission’s(NHC)recommended critical shortage threshold of 1.75.The workforce distribution inequality indices varied by regional socioeconomic and health system development.Geographic clustering of CDCs workforce distribution was evident,with H–H and L–L clusters in western China and the Guangdong-Fujian region,respectively.Conclusions Our study addressed key issues for government and policymakers in allocation of public health human resources.There is an urgent need for careful identification of analytic questions that will help carry out public health functions in the new era,alongside policy implications for an equitable distribution of the public health workforce focusing on the western region and low–low cluster areas.

Leadership,communication,and science:three pillars essential to public health emergency response and closing the gap in the HIV response among key populations

Globally,there have been multiple public health emergencies in recent decades.High rates of morbidity,occasionally mortality,and economic instability are usually associated with pandemics.One of the epidemics that has significantly increased morbidity and mortality worldwide is the human immunodeficiency virus(HIV)and acquired immune deficiency syndrome(AIDS)pandemic.HIV has a disproportionately negative impact on key populations.Strong leadership,effective communication,and sound science are necessary for public health emergency(PHE)responses to be successful.These three PHE response pllars are also essential for bridging the HIV response gap among key populations in the setting of restrictive laws.In this review,we explored the importance of these three pillars of successful PHEs responses,and how they are essential to closing the gap in the HIV response among key populations.Leaders must make decisions and instil a sense of authority in the populace during PHEs to foster trust and confidence.Leaders should base their choices on scientific evidence.Effective communication during PHEs should be proactive,polite,imaginative,innovative,and constructive.To address gaps in the HIV response among key populations,leaders must create a supportive environment for effective communication and scientific research,communication should be used to raise awareness of HIV and to dispel stigma and discrimination,while science should provide evidence of efficacy and effectiveness of interventions amongkey populations.

Does higher tax rate affect tobacco usage?Unravelling the nexus between tobacco regulatory control and public health concern

Objectives:Bangladesh stands as a prominent global consumer of tobacco,with alarming consequences on public health.The Global Adult Tobacco Survey reported that tobacco consumption claimed over 126000 lives in 2018,contributing to 13.5%of all deaths in the country.This study aims to explore the effectiveness of higher tax rates and tobacco use regulation as control mechanisms in mitigating tobacco consumption and health care cost burden,with a particular emphasis on its implications for public health.Methods:This study is based on the annual time series data over the period 2000-2020.The study employs the ordinary least square method to analyze the quantitative confirming the stationarity of data at level.This research uses different models to investigate individual effects and combined effects on both tobacco consumption and tobacco health care cost burden.Results:The study finds a negative relationship between tobacco tax rate and tobacco consumption.More specifically,the higher tax rate of tobacco(low(β=-0.3495),medium(β=-0.2319),high(β=-0.9033),premium(β=-0.7322),filtered(β=-0.2114),and non-filtered(β=-0.3452)categories)is significant to reduce tobacco use at 1%level of significance.The study finds similar results when it applied tobacco retail price instead of tobacco tax rate as the independent variable.Finally,the study investigates the impact on health care cost through tobacco consumption,tobacco control law,growth rate,export-import,and tobacco production.The results indicate that tobacco consumption,export-import,and tobacco production increases health care cost burden while tobacco use regulatory decreases it.By reducing tobacco consumption,higher taxes and tobacco use regulation contribute to alleviating the burden on the healthcare system,promoting healthier lifestyles,and aligning with global health objectives.Conclusions:Higher tax rate on tobacco products is necessary to increase the retail price so that tobacco users cannot consume tobacco.Specific tax and uniform tax base are needed so that tobacco users cannot switch to lower priced brands.Tobacco control laws need to revised and proper implementation should be ensured as well,to achieve the goal of tobacco free Bangladesh by 2040.Tobacco-related diseases,responsible for a significant proportion of deaths in the country,could witness a considerable decline with the successful implementation of higher tax rates and tobacco use regulation.This study provides insights that not only contribute to the economic discourse but also accentuate the broader public health benefits arising from effective tobacco taxation policies.

Weighing in on monkeypox against the criteria of public health emergency

The monkeypox,a viral zoonotic disease usually found in forest areas of Central and Western Africa,has spread worldwide through new modes of transmission little understood.The WHO on 23 July 2022,declared the virus a Public Health Emergency of International Concern(PHEIC).The declaration has stirred criticism from leading scientists that the criteria for PHEIC as defined by International Health Regulation have not been met and it is non-transparent and contradictory.This paper reviews the criteria of PHEIC and weighs the rationales behind the declaration to increase the clarity of the WHO's decision,justifications,and legitimacy in the ongoing outbreak.

Adolescent health issues:The role of publich health nurses

Adolescent health(AH)is an integral part of public health with the goal of improving the healthy development,safety,and well‑being of adolescents because the behavioral patterns established during this period influence the health status of the adolescents and the risk of developing chronic diseases during adulthood.Adolescence being a time of great physical and psychological change,many social and physical conditions as well as behavioral pattern can impact AH and heighten the risk of illness and diseases.This makes adolescents to be susceptible to various health issues by nature because of their stages of development,which affects their ability to make safe decisions,and the need to rely on significant others for support.Other factors like desire for greater autonomy,pressure to conform to peers,exploration of sexual identity,increased access to and use of technology,violence and sexual abuse,social and cultural norms,family circumstances,emotional and physical environment of the adolescents contribute significantly to adolescents’health issues.Therefore,nurses have significant roles to play to ensure optimal growth and development of the adolescents and to prevent and reduce the impact of changes associated with adolescence on the health and well‑being of the adolescents.This article presents the concept of adolescence,components of AH,health‑related challenges associated with adolescence,and role of public health nurses.

Comments by opponents on the British Medical Association’s guidance on non-therapeutic male circumcision of children seem one-sided and may undermine public health

The British Medical Association(BMA)guidance on non-therapeutic circumcision(NTMC)of male children is limited to ethical,legal and religious issues.Here we evaluate criticisms of the BMA’s guidance by Lempert et al.While their arguments promoting autonomy and consent might be superficially appealing,their claim of high procedural risks and negligible benefits seem one-sided and contrast with high quality evidence of low risk and lifelong benefits.Extensive literature reviews by the American Academy of Pediatrics and the United States Centers for Disease Control and Prevention in developing evidence-based policies,as well as risk-benefit analyses,have found that the medical benefits of infant NTMC greatly exceed the risks,and there is no reduction in sexual function and pleasure.The BMA’s failure to consider the medical benefits of early childhood NTMC may partly explain why this prophylactic intervention is discouraged in the United Kingdom.The consequence is higher prevalence of preventable infections,adverse medical conditions,suffering and net costs to the UK’s National Health Service for treatment of these.Many of the issues and contradictions in the BMA guidance identified by Lempert et al stem from the BMA’s guidance not being sufficiently evidence-based.Indeed,that document called for a review by others of the medical issues surrounding NTMC.While societal factors apply,ultimately,NTMC can only be justified rationally on scientific,evidence-based grounds.Parents are entitled to an accurate presentation of the medical evidence so that they can make an informed decision.Their decision either for or against NTMC should then be respected.

How Attitudes towards Air Pollution May Impact Public Health: A Case Study of Almaty, Kazakhstan

Using an original public opinion survey, we study public attitudes and behaviors toward air pollution in Almaty, Kazakhstan. In the Health Belief Model (HBM) framework previously used to understand an individual’s health decision-making, we evaluate citizens’ awareness of the poor air quality, their perception of risk, and their willingness to devote time and resources to reduce their air pollution exposure. We find that although citizens are aware of the gravity and general harms of air pollution, they significantly underestimate their individual health risks, and, as a result, often engage in daily routines that exacerbate their exposure to pollution. We find that behaviors increasing the risk of pollution exposure are related to the underlying beliefs about personal health risks, self-efficacy, and material and economic limitations. This means that treating pollution as an individual health problem rather than social issue in public discourse may promote behaviors reducing exposure and improving personal and public health outcomes.

Sustainable Community Epidemic Prevention Countermeasures against Public Health Emergencies

How to deal with public health emergencies is an important issue related to the normal life of community residents. However, after the corresponding understanding, it is found that a series of unsustainable epidemic prevention factors have been exposed in the community in the COVID-19, such as blocked access to basic materials, unsafe living environment, and lack of social platforms. In view of these problems, based on Maslow’s hierarchy of needs, the changes in the hierarchy of needs of residents during the epidemic were analyzed, and sustainable community epidemic prevention strategies were proposed from five aspects of material storage, safe environment, social platform, respect opportunity and self-worth realization, so as to provide effective reference for future response to public health emergencies.

An Analysis of the Evolution of Online Public Opinion on Public Health Emergencies by Combining CNN-BiLSTM + Attention and LDA

In this paper, the Foxconn epidemic event in Zhengzhou was taken as an example to analyze the evolution of online public opinion on public health emergencies. In order to improve the performance of online public opinion analysis, based on the life cycle theory and LDA theory, the emotional changes of Internet users in four stages of the Foxconn incident centered on the evolution of inscription were divided. The emotions of netizen speech at different stages are analyzed based on CNN-BiLSTM + Attention model, which uses Convolutional Neural Network (CNN) to extract local features. Bi-directional Long Short-Term Memory (BiLSTM) is used to efficiently extract contextual semantic features and long distance dependencies, and then combined with attention mechanism to add emotional features. Finally, Softmax classifier realizes text emotion prediction. The experimental results show that: compared with TextCNN, BiLSTM, BiLSTM + Attenion, CNN-BiLSTM model, the emotion classification model has better effects in the accuracy rate, accuracy rate, recall rate and F value. By analyzing the emotional distribution and evolution trend of public opinion under “text topic”, the paper accurately deconstructs the development characteristics of public opinion in public health emergencies, in order to provide reference for relevant departments to deal with public opinion in public health emergencies. .

Stand-Alone Patient Reception and Referral System with Health Data Management

The COVID-19 pandemic has exposed vulnerabilities within our healthcare structures. Healthcare facilities are often faced with staff shortages and work overloads, which can have an impact on the collection of health data and constants essential for early diagnosis. In order to minimize the risk of error and optimize data collection, we have developed a robot incorporating artificial intelligence. This robot has been designed to automate and collect health data and constants in a contactless way, while at the same time verifying the conditions for correct measurements, such as the absence of hats and shoes. Furthermore, this health information needs to be transmitted to services for processing. Thus, this article addresses the aspect of reception and collection of health data and constants through various modules: for taking height, temperature and weight, as well as the module for entering patient identification data. The article also deals with orientation, presenting a module for selecting the patient’s destination department. This data is then routed via a wireless network and an application integrated into the doctors’ tablets. This application will enable efficient queue management by classifying patients according to their order of arrival. The system’s infrastructure is easily deployable, taking advantage of the healthcare facility’s local wireless network, and includes encryption mechanisms to reinforce the security of data circulating over the network. In short, this innovative system will offer an autonomous, contactless method for collecting vital constants such as size, mass, and temperature. What’s more, it will facilitate the flow of data, including identification information, across a network, simplifying the implementation of this solution within healthcare facilities.

Impact of River Water Quality on Public Health in Perspective of Asian Rivers:A Case Study of Buriganga River,Bangladesh

Water pollution is one of the current global problems.So many countries are suffering from this problem specifically most South Asian and Southeast Asian countries,and Bangladesh is one of those countries that are suffering from water pollution.Furthermore,the city of Bangladesh,Dhaka is one of the most densely populated cities in the world and overpopulation is showing a negative impact on the water quality now.Most of the rivers are very polluted around Dhaka city because of anthropogenic causes.This study focused on Buriganga river pollution and its impact on public health.This study intended to find out the major cause of Buriganga river pollution and the health status of the community living beside the Buriganga river.Also the study identified all the common diseases which people are suffering from around the Buriganga river area.Then the study compared the results with other southeast Asian countries so that it can make the relationship and can make it easier to understand the current situation of water pollution on public health in East Asia and Southeast Asia regions.During the research work,it was noticed that the Buriganga river is very polluted due to human activities.The transportation system,fishing,and waste canals from industries become the primary reasons behind Buriganga’s current condition.Also irresponsibility of both the environmental department and civil society is the major factor in Buriganga river pollution.The hygienic level was also not in a good condition because so many wastes like plastic materials and other daily use materials were thrown out into the river.That’s why public health conditions around the Buriganga river become vulnerable nowadays.So policies have to be implemented from the right perspective and the institutions have to be strong enough to handle all the issues regarding the Buriganga River.

Study on the demand for public health professional after the COVID-19 epidemic in Zhejiang Province,China:A survey based on human-machine collaboration

To understand the needs of public health institutions in Zhejiang Province,China for public health personnel,and provide basis for training public health personnel.Methods:512 public health institutions in Zhejiang Province were randomly selected from different levels and regions,and the number of ublic health professional and the demand for professional ability were investigated by questionnaire.Results:The preventive medicine personnel in public health institutions in Zhejiang Province are insufficient;There is a certain disjunction or dislocation between the abilities and needs of public health professional;The way of continuing education for public health professional is single and the opportunities are few.Conclusion:Zhejiang Province should appropriately expand the enrollment of preventive medicine majors,especially high-level preventive medicine talents,deepen the education and teaching reform of preventive medicine majors,and strengthen the continuing education and training of public health professional to meet the needs of public health services after the COVID-19 epidemic.

Analysis of CDC’s Role in Public Health Emergencies

Objective:To explore the role of the Centers for Disease Control and Prevention(CDC)in public health emergencies.Methods:The details of 12 public health events that occurred between January 2021 to December 2022 were analyzed to explore the roles of the CDC.Results:There were 160 patients involved in 10 public health events in 2021 and 48 patients involved in 2 public health events in 2022.Besides,the proportion of school public health events in 2022 was 0%,which was lower than in 2021,which was 80%(P<0.05).99.38%of patients during public health events were sent to the hospital promptly in 2022,which was higher than that in 2021,which was 81.25%(P<0.05).Furthermore,the average time taken for the CDC to control public health events in 2022 was 20.11±1.62 hours,and the average time taken to send inspection reports was shorter than that in 2021.The public satisfaction score was also higher in 2022 compared to 2021(P<0.05).Conclusion:The role of the CDC is to control infectious diseases.Therefore,it is important to pinpoint the existing problems in the strategies implemented by the CDC so that more improvements can be made to better prevent infectious diseases.

Study on Public Health Behavior against the Background of COVID-19 Pandemic - Based on Bandura Reciprocal Determinism

Objective To explore the factors influencing public health behaviors in China in the context of COVID-19 pandemic,and to propose suggestions and countermeasures for enhancing public health behaviors.Methods A public health behavior system based on Bandura’s reciprocal determinism was constructed,and public health behavior was analyzed from the perspective of the interaction of health awareness,health behavior and environment.Results and Conclusion The public health behavior was analyzed through the public health behavior system based on Bandura’s reciprocal determinism,and the results and conclusions were draw.The public can be urged to develop better health beliefs and form better health behaviors by strengthening publicity and interventions,improving personal awareness,and increasing government investment.