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Abstract Deeply rooted in its developmental philosophy of gross national happiness (GNH), Bhutan's healthcare system strives towards achieving a shared goal of universal health coverage (UHC). Despite being primarily financed by the government, the health system faces a plethora of challenges. To overcome these hurdles and achieve UHC goals, expanding the fiscal space for health and improving operational efficiency are crucial. This article aims to address Bhutan's evolving healthcare landscape and advance the achievement of UHC through two policy options. The first policy option focuses on the dual objective of improving health outcomes and promoting financial sustainability by leveraging health taxes, whereas the second option emphasizes reinforcing a systematic health technology assessment (HTA) in the Bhutanese health system. First, drawing lessons from global experiences, the policy brief recommends leveraging health taxes to reduce societal and healthcare costs and enhance financial sustainability in the health sector. Considering Bhutan's high prevalence of tobacco and alcohol consumption, and taking opportunity from the ongoing Goods and Services Tax (GST) reform, continued advocacy on health taxes is essential, and soft earmarking the health taxes may be considered to finance a broader array of public health programmes, particularly focusing on the promotion of healthy lifestyle, health screening and outreach public health activities. Second, the integration of HTA into policymaking and decision‐making processes is essential for effective resource allocation in UHC. Nurturing and strengthening the existing HTA governance structure under the Ministry of Health (MoH) and establishing a dedicated multidisciplinary HTA Committee will ensure informed decision‐making and resource optimization. HTA evidence should inform the revision of health service standards, clinical guidelines development, procurement decisions and healthcare priorities. These policy options can assist the country in improving financial sustainability, enhancing effective resource allocation and utilization and improving healthcare delivery, aligning with its vision of GNH and ultimately accelerating progress towards achieving UHC.

Background: Studies of sexually transmitted infections (STI) apart from HIV are lacking among transgender women in the United States. This paucity of information has limited guidance on testing and prevention [...]

Within the fields of forensic anthropology and forensic medicine in general, the ability to provide accurate estimates of time since death that minimize error, maximize precision, and consider a multitude of variables is a critical component of all forensic and medicolegal investigations that focus on the identification of human remains and the circumstances surrounding death. In comparison with many forensic cases where date of death is typically unknown, we begin with a known postmortem interval and progressively assess, through external testing measures (temperature, skin elasticity and skin color changes) followed by photography and videography, decompositional changes over time. This work seeks to provide well-described cases with documented biological parameters to propose hypotheses for future research. Field team members observe and record any decompositional changes associated with the states of algor, rigor, and livor mortis, as well as progressive changes in skin color and tissue integrity in an environment where variability in climate and ecological factors may vary from case to case. The two cases were followed for 31 (postmortem interval [PMI] 38) and 19 (PMI 27) days in humid subtropical and tropical monsoon Köppen-Geiger classified climatic zones, respectively, where delayed decompositional and putrefactive changes observed are at odds with the anticipated rate and expected suite of biological changes occurring within an indoor permeable setting following clinical death. Within this taphonomic context, we also address the value of describing and documenting postmortem intervals in a closed subpopulation from which some individuals are recognized for exhibiting attenuated decompositional changes. This study emphasizes the importance of addressing understudied and underrepresented regions, climates, and cultural contexts for furthering research into the factors that may contribute to the understanding of the early stages of the PMI period and improve the precision of PMI estimates more broadly.

Abstract Background Alcohol use is a major public health problem in Bhutan. Compliance with regulations at the point of sale is an important strategy in alcohol control. Retail outlets were briefed on sale regulations and provided notification of rules, which they were directed to display on the premises. The extent to which licensed alcohol outlets responded to possible alcohol purchases was assessed through the use of young proxy-purchasers, adults feigning alcohol intoxication and sober adults. A total of 854 visits (pre versus post visits) were made across four district towns. Two towns (Damphu town in Tsirang district and Pema Gatshel town in Pema Gatshel district) received pre- and post-intervention purchase surveys, while the other two neighbouring towns (Khuruthang town in Punakha and Bajo town in Wangdue) were administered only baseline surveys. Method We used a pre- and post-test community intervention design covering all alcohol retailers both on premise (bar, hotel, restaurant, karaoke bars) and off premise (grocery shops). Compliance with alcohol regulations at the point of sale was assessed through the use of young proxy-purchasers, adults feigning alcohol intoxication and sober adults. Results Retailers rarely checked the age and/or identification (ID) of the proxy-purchasers before the intervention. There was a 22.7% (8.6, 37) percent increase in compliance with laws after the intervention. While some strategies are suggested, the strongest and most effective measure to prevent under-age drinking and service to intoxicated individuals is more rigorous enforcement of existing liquor laws. Conclusion Alcohol control requires ongoing government enforcements, supplemented by public awareness and knowledge.

An overview is given of literature containing distribution records of dragonflies and damselflies in Bhutan. Based on this an annotated checklist is presented which contains 92 species. Camacinia gigantea (Brauer, 1867) and Libellago lineata (Burmeister, 1839) are listed as new to Bhutan. [ABSTRACT FROM AUTHOR]

Abstract The sharp rise in anthropogenic activities and climate change has caused the extensive degradation of grasslands worldwide, jeopardizing ecosystem function, and threatening human well‐being. Toxic weeds have been constantly spreading in recent decades; indeed, their occurrence is considered to provide an early sign of land degeneration. Policymakers and scientific researchers often focus on the negative effects of toxic weeds, such as how they inhibit forage growth, kill livestock, and cause economic losses. However, toxic weeds can have several potentially positive ecological impacts on grasslands, such as promoting soil and water conservation, improving nutrient cycling and biodiversity conservation, and protecting pastures from excessive damage by livestock. We reviewed the literature to detail the adaptive mechanisms underlying toxic weeds and to provide new insight into their roles in degraded grassland ecosystems. The findings highlight that the establishment of toxic weeds may provide a self‐protective strategy of degenerated pastures that do not require special interventions. Consequently, policymakers, managers, and other personnel responsible for managing grasslands need to take appropriate actions to assess the long‐term trade‐offs between the development of animal husbandry and the maintenance of ecological services provided by grasslands.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is a growing public health concern globally. In Bhutan, the rates of MDR-TB are high. Data on the risk factors of MDR-TB that can help inform policies are limited in Bhutan. This study aimed to determine the risk factors associated with MDR-TB.MethodsA nationwide unmatched case-control study was conducted that included 79 MDR-TB cases and 118 controls. Data was collected by trained health workers through interviews using a structured questionnaire. Logistic regression analysis was performed to identify the risk factors associated with MDR-TB.ResultsThe mean age of the participants was 32.4 and 33.7 years among the cases and the controls, respectively. In the multivariate analysis, the odds of having MDR-TB was higher among those who slept for less than 9 hours a day (AOR: 2.77, 95%CI: 1.11-6.92), frequently travelled in public transport (AOR: 2.96, 95% CI: 1.36-6.48), and had previous TB treatment (AOR: 5.90, 95%CI: 2.55-13.64). A greater number of rooms was also marginally associated with odds of having MDR-TB.ConclusionsThe findings suggest previous TB treatment, inadequate sleep duration, and travelling by public transport to be the risk factors associated with having MDR-TB in Bhutan. Intensification of early case detection, strengthening directly observed treatment strategy, improving treatment adherence, and increasing awareness can help control the rising MDR-TB epidemic.

Background: A cluster of suspected shigellosis was reported from health center in Pemagatshel district to Royal Center for Disease Control on 14th May 2012. The investigation was done to determine the cause and risk factor for the outbreak so that appropriate control and prevention measures can be implemented. Methods: A descriptive study was used for the outbreak investigation. The food items and drinks served to boarding students were collected from the mess in-charge in order to assess their risk for the outbreak. The kitchen and its premises were inspected to study the likely contamination by rodents and other animals. The water and stool specimens were tested in the laboratory to identify all possible enteric pathogens. Results: 82 boarding students were affected with an overall attack rate of 28% (82/294). Diarrhea was the predominant symptom followed by abdominal pain and headache. The onset date of the cases varied between 11th and 18th May, 2012. Shigella species was isolated from stool specimens that showed resistant to amoxicillin, nalidixic acid, chloramphenicol and sulfamethoxazole. Water specimen collected from source, distribution reservoir and tap water at school were found grossly contaminated. Conclusion: The outbreak was caused by novel strain of Shigella species which was not detected earlier in Bhutan. The promotion and provision of boiled water will greatly reduce the incidence of shigellosis especially in boarding facility.

Scrub typhus in Bhutan was first reported in 2009. We investigated an outbreak of scrub typhus in a remote primary school during August–October 2014. Delay in recognition and treatment resulted in 2 deaths from meningoencephalitis. Scrub typhus warrants urgent public health interventions in Bhutan.

To determine the serotype and genotype of dengue virus (DENV) in Bhutan, we conducted phylogenetic analyses of complete envelope gene sequences. DENV-2 (Cosmopolitan genotype) predominated in 2004, and DENV-3 (genotype III) predominated in 2005-2006; these viruses were imported from India. Primary dengue infections outnumbered secondary infections, suggesting recent emergence. [ABSTRACT FROM AUTHOR]