METHODS: The development of RaHEM followed the ADDIE framework. A comprehensive analysis was conducted through literature reviews, cross-sectional surveys, and stakeholder interviews. The module's content was designed and developed based on the Modified Health Belief Model and Mayer's Cognitive Theory of Multimedia Learning. Validation was performed by a panel of six experts and ten dog owners through content and face validity indices, respectively.
RESULTS: The module was organized into five core topics, each addressing specific aspects of rabies prevention. Content validity indices for all topics exceeded the acceptable threshold of 0.83, with an overall module CVI of 0.91 for relevance and 0.88 for clarity. Face validity indices also surpassed the 0.83 threshold, with overall module FVI scores of 1.00 for understandability and 0.99 for clarity.
CONCLUSION: The RaHEM MOOC was successfully developed and thoroughly validated, ensuring it met its intended objectives and was suitable for the target audience. This educational module offers a promising approach to enhancing rabies prevention through accessible and engaging online education, potentially contributing to reduced rabies transmission and fatalities. Further studies are recommended to evaluate the module's effectiveness in improving rabies knowledge and attitudes.
MATERIAL AND METHODS: A single centre, cohort study evaluating 335 women who have undergone unilateral mastectomy between January 2017 and March 2020 in Malaysia. Regional anaesthesia were given pre-operatively via ultrasound guided pectoral and intercostal nerves block (PECSII).
RESULTS: Utilization of regional anaesthesia increased from 11% in 2017 to 43% in 2020. Types and duration of surgeries were comparable. Opiod consumption was 3 mg lower in those who had PECS2 block ((27 [24-30] mg), in comparison with those who received general anaesthesia only (30 [26-34] mg), p
METHODS: This is a double-blind randomized clinical trial, involving 26 patients with CRSwNP, who underwent FESS for failed medical therapy. The intervention nostril was packed with ribbon gauze soaked in 500 mg/5 ml TXA. The control nostril was packed with ribbon gauze soaked in Moffett's solution, containing 2 ml 10% cocaine, 1 ml adrenaline 1:1000, and 4 ml 0.9% sodium bicarbonate. Both nostrils were packed for 15 min before FESS. Intraoperative bleeding was recorded in the initial 30 min after commencing the surgery. The recordings were reviewed by two surgeons using Boezaart's scoring system. The scores were taken at 15 and 30 min of surgery. The mean score was then calculated. At the end of the surgery, the intervention nostril was packed with Merocel® soaked in 500 mg/5 ml TXA and the control nostril was packed with Merocel® soaked in normal saline. The amount of bleeding within 24 h post-surgery was evaluated using a bolster gauze.
RESULTS: There was no significant difference in intraoperative bleeding between the intervention (1.54 ± 0.71) and control nostrils (1.69 ± 0.55) with p = 0.172. The amount of bleeding in the postoperative period was significantly reduced in the intervention nostril (1.33 ± 0.55) compared to the control nostril saline (1.81 ± 0.48) with p = 0.001.
CONCLUSIONS: We found that the nasal packing soaked in TXA reduced intraoperative and immediate postoperative bleeding. It is a safe, efficacious and cost-effective alternative to Moffett's solution during FESS and also an alternative to normal saline post-surgery among patients with CRSwNP.
TRIAL REGISTRATION NUMBER: FF-2015-232, 2015.
METHODS: We conducted a systematic review of evidence for provision of opioid agonist treatment (OAT), needle syringe programs (NSPs), HIV testing and antiretroviral therapy (ART), hepatitis C virus (HCV) testing and direct-acting antiviral (DAA) treatment, tuberculosis screening and treatment, hepatitis B virus (HBV) testing, treatment, and vaccination in carceral settings. We searched from peer-reviewed and grey literature databases between 2000 and 2025 and used the most recent data available for each indicator.
FINDINGS: OAT was documented in 59/207 countries (29 %), and NSPs in ten (5 %). HIV testing was documented in 86 countries (42 %) and ART in 79 countries (38 %). HCV testing was confirmed in 55 (27 %), with DAA treatment in 47 (23 %). HBV testing was identified in 51 countries (25 %), treatment in 36 (17 %), and vaccination in 41 (20 %). Tuberculosis screening was documented in 96 countries (46 %) and treatment in 81 (39 %). Fewer than 2 % (approximately 172,000) of the 11.3 million people incarcerated worldwide live in countries that offer OAT, NSPs, and treatment for HIV, HCV, HBV, and tuberculosis in at least one carceral facility. There is not a single country where incarcerated people have access to all such services in every facility. Programme level evidence was rarely available.
INTERPRETATION: The global shortage of services that prevent and treat infectious disease and harms related to injecting drug use in carceral settings is a critical public health issue and, compared with community standards, a breach of human rights. This study underscores the urgent need for international collaboration and policy reform to scale up and stabilise services that address the health needs of incarcerated populations, ultimately improving health outcomes for both incarcerated populations and wider community.
FUNDING: Australian National Health and Medical Research Council.
METHODS: We employ a dynamic Markov model of the effects of vector control on dengue in both vectors and humans over a 15-year period, in six countries: Brazil, Columbia, Malaysia, Mexico, the Philippines, and Thailand. We evaluate the cost (direct medical costs and control programme costs) and cost-effectiveness of sustained vector control, outbreak response and/or medical case management, in the presence of a (hypothetical) highly targeted and low cost immunization strategy using a (non-hypothetical) medium-efficacy vaccine.
RESULTS: Sustained vector control using existing technologies would cost little more than outbreak response, given the associated costs of medical case management. If sustained use of existing or upcoming technologies (of similar price) reduce vector populations by 70-90%, the cost per disability-adjusted life year averted is 2013 US$ 679-1331 (best estimates) relative to no intervention. Sustained vector control could be highly cost-effective even with less effective technologies (50-70% reduction in vector populations) and in the presence of a highly targeted and low cost immunization strategy using a medium-efficacy vaccine.
DISCUSSION: Economic evaluation of the first-ever dengue vaccine is ongoing. However, even under very optimistic assumptions about a highly targeted and low cost immunization strategy, our results suggest that sustained vector control will continue to play an important role in mitigating the impact of environmental change and urbanization on human health. If additional benefits for the control of other Aedes borne diseases, such as Chikungunya, yellow fever and Zika fever are taken into account, the investment case is even stronger. High-burden endemic countries should proceed to map populations to be covered by sustained vector control.