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Objectives: This study aimed to identify the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among fully vaccinated air travelers participating in an island-confined quarantine system (Phuket Sandbox Program). It also compared the differential risk of SARS-CoV-2 infection across different coronavirus disease 2019 (COVID-19) vaccines and the difference in time-to-detection periods between asymptomatic and symptomatic cases. Methods: This retrospective cohort study determined the cumulative incidence of SARS-CoV-2 infection among 63 052 air travelers who participated in a quarantine program from July 1, 2021 to October 31, 2021. Using Poisson regression with robust standard errors, we estimated the relative risk of SARS-CoV-2 infection across different brands and types of COVID-19 vaccines, adjusting for relevant covariates. We visualized the time-to-detection periods for SARS-CoV-2 infection using Kaplan-Meier failure curves and compared these curves for asymptomatic and symptomatic travelers using the log-rank test. Results: The overall incidence of SARS-CoV-2 infection was 0.3%. Individuals vaccinated with Ad26.COV2.S, Gam-COVID-Vac, CoronaVac, and replicating viral vector vaccines faced a significantly higher risk of infection than those who received the BNT162b2 and mRNA vaccines. The time-to-detection periods for asymptomatic and symptomatic cases did not differ significantly. Conclusions: Despite the relatively low risk of SARS-CoV-2 infection, a risk of breakthrough cases remained with certain vaccines. Given the high proportion of asymptomatic cases, quarantine and intermittent testing should be implemented. The mandatory quarantine system proved effective in managing positive cases without necessitating a complete shutdown of travel. Implementing an island quarantine could be a viable strategy for reintroducing travel and tourism during a future COVID-19 outbreak or a new pandemic.

Objectives: No comprehensive analysis has yet been published regarding global trends in childhood sexual abuse (CSA) and bullying victimization (BV). The present study offers a longitudinal perspective on their prevalence worldwide. Methods: CSA and BV rates were extracted from the Global Burden of Disease study, spanning the years 1990 to 2019 across 204 countries. Trends by gender, region, and human development index (HDI) were examined. Results: For both boys and girls, and in both high-HDI and low-HDI countries, CSA rates did not significantly change from 1990 to 2019 (p>0.05). However, BV rates increased significantly in high-HDI and low-HDI countries for both genders (p

The August 2024 floods in Bangladesh have precipitated a major public health crisis, significantly elevating the risk of waterborne and vector-borne diseases and exacerbating existing health vulnerabilities. This disaster has impacted over 5 million people, causing widespread environmental disruption, population displacement, and strained healthcare resources. The flooding of latrines, sewage systems, and agricultural land has led to the contamination of drinking water sources, increasing the risk of cholera, enterotoxigenic Escherichia coli diarrhoea, shigellosis, and hepatitis. Additionally, stagnant floodwaters have created breeding grounds for mosquitoes, thereby increasing the threat of malaria and dengue fever. The disruption of healthcare services has further compounded the crisis, delaying emergency responses and impeding access to care. The psychological impact on affected communities is profound, with mental health issues such as anxiety, depression, and post-traumatic stress disorder emerging as significant concerns. This perspective provides an analysis of these public health threats, supported by data on the impact of floods and a discussion of the underlying risk factors. This underscores the need for immediate and long-term public health interventions, including restoring clean water access, enhancing disease surveillance, repairing healthcare infrastructure, and addressing mental health needs. The response to this disaster must be rapid and comprehensive, with lessons learned to inform preparedness efforts to better manage similar events in the future.

Statistical testing in medicine is a controversial and commonly misunderstood topic. Despite decades of efforts by renowned associations and international experts, fallacies such as nullism, the magnitude fallacy, and dichotomania are still widespread within clinical and epidemiological research. This can lead to serious health errors (e.g., misidentification of adverse reactions). In this regard, our work sheds light on another common interpretive and cognitive error: the fallacy of high significance, understood as the mistaken tendency to prioritize findings that lead to low p-values. Indeed, there are target hypotheses (e.g., a hazard ratio of 0.10) for which a high p-value is an optimal and desirable outcome. Accordingly, we propose a novel method that goes beyond mere null hypothesis testing by assessing the statistical surprise of the experimental result compared to the prediction of several target assumptions. Additionally, we formalize the concept of interval hypotheses based on prior information about costs, risks, and benefits for the stakeholders (NORD-h protocol). The incompatibility graph (or surprisal graph) is adopted in this context. Finally, we discuss the epistemic necessity for a descriptive, (quasi) unconditional approach in statistics, which is essential to draw valid conclusions about the consistency of data with all relevant possibilities, including study limitations. Given these considerations, this new protocol has the potential to significantly impact the production of reliable evidence in public health.

Objectives: This study aimed to identify trends in avoidable mortality (AVM) in 16 provincial and metropolitan regions of Korea and determine the factors influencing AVM. Methods: First, the avoidable mortality rate (AVMR) was calculated using the Statistics Korea cause-of-death and population data by age and region from 2013 to 2022. Second, a health determinants model was built, and we identified the factors influencing AVM using generalized estimating equations analysis. Results: Although the AVMR per 100 000 people displayed a steadily decreasing trend from 2013 to 2020, it began to increase in 2021. Meanwhile, Jeonnam, Jeonbuk, Gyeongnam, Gyeongbuk, Chungnam, Chungbuk, and Gangwon Provinces showed a higher AVMR than the national average. The analysis revealed that each 1-unit increase in the older adult population, smoking, perceived stress, or non-local medical utilization was associated with an increase in the AVMR. Conversely, 1-unit increases in the male-to-female ratio, marriage rate, positive self-rated health, local medical utilization, doctor population, influenza vaccination rate, cancer screening rate, or financial independence were associated with decrease in the AVMR. Conclusions: This study established that the AVMR, which had been continuously decreasing across the 16 regions, shifted to an increasing trend in 2021. We also identified several factors influencing AVM. Further studies are needed to confirm the reasons for this shift in the AVMR and explore the factors that influence AVM across Korea’s 16 provincial and metropolitan regions.

This report presents a case of pseudoephedrine-induced non-pigmented bullous fixed drug eruption (NBFDE) manifesting as recurrent palmoplantar exfoliation in a scuba diver. It emphasizes the importance of considering drug allergies in the differential diagnosis when divers present with peeling hands and soles. A 38-year-old female scuba diver experiencing recurrent palmoplantar exfoliation underwent a clinical evaluation, patch testing, an interferon-gamma enzyme-linked immunospot (ELISpot) assay, and graded drug challenges with pseudoephedrine and phenylephrine. Patch testing yielded negative results; however, the ELISpot assay indicated a strong immune response to pseudoephedrine. A graded challenge involving pseudoephedrine successfully reproduced the symptoms, confirming a diagnosis of pseudoephedrine-induced NBFDE. Subsequently, a challenge with phenylephrine elicited a milder reaction, suggesting it as a potential alternative medication for the patient. This case highlights NBFDE as a potential cause of skin peeling in scuba divers who are allergic to pseudoephedrine. It emphasizes the importance of considering drug allergies when diagnosing palmoplantar exfoliation in divers and underscores the need for a thorough evaluation of medication use in this group. Alternative medications and management strategies should be considered for divers with a pseudoephedrine allergy to prevent ear barotrauma while minimizing the risk of adverse skin reactions.

Asymptomatic rubella virus infection can cause delays in the diagnosis of rubella in pregnant women, leading to the development of congenital rubella syndrome (CRS). The clinical manifestations of congenital rubella syndrome are called the rubella triad, which includes heart problems, eye problems, and hearing disorders. Sensorineural hearing loss is the most common type of hearing loss in children with rubella infection. This study aimed to determine the characteristics of hearing loss in CRS patients. This study used a retrospective descriptive research design, utilizing secondary data from the medical records of patients with CRS who underwent hearing examinations at the Ear, Nose, Throat (ENT) Polyclinic of Prof. dr. I.G.N.G. Ngoerah Hospital Denpasar, Indonesia. The study found that the most common age group among suspected CRS patients was 6 - 12 months (51.42%), the majority of these patients were male (62.86%), the most frequent clinical signs and symptoms in suspected CRS patients were congenital heart disease (CHD) as a major criterion (60%), and microcephaly as a minor criterion (77.14%). Based on the CRS case criteria, none of the suspected CRS patients were diagnosed with confirmed CRS, with most cases being classified as clinical CRS (65.71%). The hearing loss in suspected CRS patients was entirely sensorineural type with the majority of cases being bilaterally and to a very severe degree (53.57%)

One of the eating behavior disorders in preschool children is picky eater, a behavior that is picky about food so that children experience limited consumption of a variety of foods. This impacts the nutritional status of children, which can affect their health. Therefore, this study aims to determine the relationship between children's eating behavior disorders (picky eaters) and the nutritional status of preschool children at Kindergarten Gotong Royong Surabaya, Indonesia. This was an observational analytical research with a cross-sectional research design. The sampling method used purposive sampling technique. Data were collected by filling out the CEBQ (Child Eating Behavior Questionnaire) questionnaire and anthropometric measurements of body weight and height, as well as measuring nutritional status using the indicators BB/TB (0-6 months) and BMI/U (>60 months). All data were processed using IBM SPSS v25.0 software with the Spearman rank correlation test. The results of the study showed that 53.6% of preschool children at KB-TK Gotong Royong Surabaya had eating behavior disorders (picky eaters), 46.4% of the children were non-picky eaters, 41.0% had poor nutritional status, and 43.6% had normal nutrition who were mostly non-picky eaters. The bivariate analysis results of the correlation test obtained a p-value of 0.001 (α>0.05). These data showed a relationship between picky eating disorders and the nutritional status of preschool children at Kindergarten Gotong Royong Surabaya.

Millions of poor Indonesians still need access to Indonesia's National Health Protection (NHP). The study investigated barriers making NHP inaccessible for the poor in Waingapu, Sumba Timur, Indonesia. We used a qualitative approach to identify the contributing factors to why NHP was inaccessible for some populations. A total of 30 residents of Waingapu who attended healthcare in two hospitals and five Community Health Centers were recruited using convenience technic. Twenty residents participated in the semi-structured interview, while ten engaged in casual conversations. We also interviewed three heads of community groups and three health cadres for comparative information. Questions have been developed to guide the interviews and casual conversation. The interviews were audio-taped and transcribed while intensive note-taking was performed during the informal discussion or the conversation was narrated immediately after the talks ended. The information was inductive, analyzed, and coded to produce common information among the participants. The data analysis revealed the factors that contributed to the failure of the resident to enroll in the NHP, such as lack of information about the registration, poor socialization of the program, the ignorance of village officers, unaffordability, and confusion about the parties responsible for the registration. The study concluded that poor people were still vulnerable to access free coverage and healthcare from the NHP. The stakeholders of the NHP, especially the local management of NHP and local government, need to urgently and effectively educate the commoners about the mechanism, benefits, and contribution to the NHP to ensure equity and equality in accessing quality healthcare.

Cardiorespiratory anatomy is fundamental knowledge for doctors. However, knowledge retention in medical students decreases over time. Retention is a reflection of memory ability and is affected by many factors, such as COVID-19 infection. COVID-19 is a disease caused by Sars-CoV-2 and has been declared as a pandemic since March 11th 2020. During the pandemic, cardiorespiratory anatomy tests were held in the 1st semester and 4th semester. The objective of this research was to measure the retention difference between students who had suffered from COVID-19 in that period and the ones without a history of COVID-19. This research was a cross-sectional descriptive analytics observational study involving 59 medical students at Universitas Airlangga, Indonesia. It was known that 19 students had suffered from COVID-19, while the other 40 had not. The average score of overall students experienced a significant decrease from 1st semester to 4th semester (p=0.000), both for students who had (p=0.023) and had not suffered from COVID-19 (p=0.001). However, the 1st semester and 4th semester cardiorespiratory anatomy scores of students with a history of COVID-19 were lower than students without a history of COVID-19. Besides scores, the cardiorespiratory anatomy knowledge retention of students who had suffered from COVID-19 (M=86.72%) was also lower than students who had not (M=86.95%). Nevertheless, the retention difference between those two groups of students was not significant (p=0.703).

Delayed diagnosis of cholestasis in neonates remains a problem. Cholestatic jaundice is a pathological condition that requires immediate treatment, such as biliary atresia. This study aims to analyze the characteristics of infants with cholestasis who seek treatment at a tertiary hospital. This study was a cross-sectional study to determine the characteristics of infants with cholestasis treated at the tertiary hospital at Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia. Subjects were collected using medical records using the consecutive method from 2019 to 2021. The inclusion criteria in this study were infants aged >2 weeks who suffered from cholestasis. The age of the 111 infants with cholestasis involved was 4.8 ± 2.9 months old. A total of 27 (24.3%) infants visited the hospital at the age of 4 months. Jaundice was present at birth in 23 infants (20.7%), and most infants had jaundice at 1 month of age in 75 infants (67.6%). Most of the infants (75 infants) had jaundice at the age of 1 month but visited the hospital at the age of >4 months. This showed that the late diagnosis of cholestasis in infants was still quite high. This study supports education for early detection of cholestasis in primary healthcare medical personnel, community health workers, and parents.

The prevalence of diarrhea in Madura is higher than in East Java. Mandangin island, an isolated island in Sampang, Madura has limited access to healthcare and knowledge. It will lead to disruptions in the children’s growth and development. This study aimed to evaluate the impact of health education on community knowledge about gastrointestinal disorders and children’s development. This cross-sectional study involved 48 subjects from Mandangin Island, Sampang by total sampling. The subjects received some presentations related to gastrointestinal disease, growth, and development in children using a handbook and audio-visual media. The subjects were required to complete pretest and posttest questionnaires. The pretest and post-test results were processed and analyzed using the statistical software “SPSS” and the Wilcoxon test. Most of the subjects were housewives with a mean age of 28.73 ± 6.22 years old. There was a significant difference between pre-and post-test in gastrointestinal disease, growth, and development in children (46.04 ± 21.71 vs 62.29 ± 13.25, p

A learning environment is anything that can influence changes in attitudes in teaching and learning activities which will further influence the achievement of learning outcomes and student development. A researcher wants to carry out research on student perceptions regarding changes in the online learning environment due to Coronavirus Disease 19 (COVID-19) in the Faculty of Medicine, Universitas Airlangga. The study aimed to describe the perceptions of the students toward five aspects of an online learning environment. This study was a descriptive research using a quantitive approach and the sampling technique used simple random sampling with 167 medical faculty student class 2020. One hundred sixty-seven respondents' data were collected using the specific measurement tool Dundee Ready Education Environment Measure (DREEM) to measure the learning environment with univariate analysis. The results obtained from this research showed that the perception of students at the Faculty of Medicine, Universitas Airlangga towards the online learning environment is quite good with a score of 139.48. The result of this study indicated that the mean DREEM score was 139.48/200 (SD 22.76) is in the good category. Although the learning environment is in a good category, several points need to be improved so the faculty can increase the quality of the medical education.

New research from the World Health Organization (WHO) shows that the incidence of caesarean sections in childbirth continues to increase globally, accounting for more than 1 in 5 (21%) of all births. Although there is a considerable amount of literature on complications following caesarean section, the demand for caesarean section without medical indication and at maternal request is increasing. This study aimed to identify the reasons why mothers choose to have a caesarean section without a medical indication. Mothers may choose to have a caesarean section due to fear of vaginal delivery, concerns about perceived health risks, previous traumatic childbirth experiences, worries about future sexual life, positive attitudes towards the caesarean section, and the decision-making process. It can be concluded that many expectant mothers are not adequately prepared for this process. Tackling this problem requires collaboration between different stakeholders. WHO has recommended guidelines for non-clinical interventions to reduce unnecessary caesarean sections, targeting women, health professionals and health organizations, facilities, or systems.

Laryngopharyngeal reflux is a condition resulting from the retrograde flow of stomach acid through the distal esophagus into the laryngopharyngeal area. The prevalence of laryngo-pharyngeal reflux in the elderly population remains uncertain. Therefore, the symptoms, findings, and therapy for laryngopharyngeal reflux in the elderly require further investigation. To analyze the characteristics and management of laryngopharyngeal reflux in the elderly. A case of laryngopharyngeal reflux in a 70-year-old woman who frequently experiences sudden choking sensations is presented in this report. Other symptoms include hoarseness, a sensation of throat obstruction, and chest burning. We explored literature on laryngopharyngeal reflux in the elderly through PubMed, PMC, and Google Scholar databases to discuss the case. Laryngopharyngeal reflux in the elderly has a lower reflux symptoms index but a higher reflux finding score. Mental health factors significantly influence laryngopharyngeal reflux incidence in the elderly. Therefore, besides pharmaco-logical therapy, additional non-pharmacological therapies need to be considered to ensure effective laryngopharyngeal reflux treatment. Elderly patients diagnosed with laryngopharyngeal reflux have different presentations and management of the disease compared with younger patients.

Malaria remains a major public health concern in Indonesia, particularly due to its high mortality rate among children under five, accounting for approximately two-thirds of all cases. The disease is transmitted by female Anopheles mosquitoes, which carry the Plasmodium parasite. In 2019, malaria caused 409,000 deaths globally, with 229 million cases reported, particularly in remote areas with poor access to healthcare, commonly in low-income countries. This literature review highlighted the environmental risk factors contributing to malaria incidence, based on studies from 24 scientific journals using data from the Sinta and Scopus databases. The study identified key environmental factors, including physical, chemical, biological, and socio-cultural elements, with the most significant risk linked to vector breeding sites. Among the reviewed articles, 62.5% (15 out of 24) found a statistically significant association between the presence of mosquito breeding sites and malaria incidence. Additional risk factors included the use of mosquito nets, housing conditions (specifically wall density), and nighttime outdoor activities. Effective malaria control measures require addressing these environmental factors, as they play a crucial role in the disease’s transmission. Strategies to disrupt the transmission cycle include eliminating mosquito breeding sites, applying larvicides to stagnant water, cleaning vector resting areas, promoting the use of insecticide-treated nets, and implementing Indoor Residual Spraying (IRS). A community-based, integrated approach to environmental management is essential to reducing malaria transmission and controlling its spread in affected regions.

Early marriage is an ongoing phenomenon and is becoming more prevalent. The lack of public knowledge and lack of awareness of early child marriage leaves children deeply traumatized. More than 1 million (1.2 million) women aged 20-24 were married for the first time before the age of 18. The purpose of this study was to provide an overview of the causal characteristics of child marriage in Indonesia. The method used in this study was a systematic review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) rules. The literature search was performed across multiple journal sites or online articles such as Google Scholar, PubMed, and Science Direct by entering the keywords 'Determinants of child marriage AND Indonesia'. There is a prevalent belief among parents and youth is that marrying off young girls preserves family honor. Additionally, poverty and economic instability make child marriage more socially acceptable. Other contributing factors include limited access to education and societal norms that promote marriage after puberty and within the same ethnic group. Despite existing laws regulating the minimum age for marriage, enforcement remains problematic. The review of nine articles indicated that child marriage in Indonesia is influenced by beliefs, limited access to education, culture, environmental factors, and gaps in legal enforcement.

Stunting is one of global nutrition problems, especially in developing countries including Indonesia. The prevalence of stunting in Demak Regency, Indonesia, in 2021 was 4.34%, and in 2022 it was 2.99%. However, stunting problem remains a priority because the impact of stunting can hinder efforts to enhance the health of the society and the development of the quality of human resources. Risk factors for stunting are influenced by behavioral aspects of the environment, like sanitation and drinking water. This study aimed to determine the content of bacteriological factors that contribute to the risk pattern of drinking water consumption in cases of stunting toddlers in Temuroso Village, Working Area of Guntur I Health Center, Demak Regency, Indonesia. This study was a quantitative observational case study. The population included families and toddlers in Temuroso Village, totaling as many as 854 people. The sampling technique was purposive sampling, so the sample size was 182 people for cases and controls. Data analysis used Chi-Square test and linear regression test. The bacteriological content was predominantly negative (66.5%), with the majority of subjects showing no infections (67%). Most participants fell into the high drinking water consumption category (62.1%). Stunting incidence was significantly associated with bacteriological content (p

Abstract Background Trastuzumab, a monoclonal antibody for breast cancer, faces global accessibility challenges, primarily due to high costs. This study examines how changes in medical insurance policies and price adjustments influence Trastuzumab utilization in China, focusing on implementation challenges and their impact on drug accessibility and affordability. Methods This retrospective study investigated Trastuzumab utilization among HER2-positive breast cancer patients at a tertiary hospital from May 2013 to December 2022 in JX, a prefecture-level city in eastern China. Patients were stratified based on their CerbB2 indicator, because those with a 2 + CerbB2 status require further FISH testing to confirm Trastuzumab eligibility. We analyzed the utilization rates of both FISH test and Trastuzumab using logistic regressions, identifying factors that influence their usage. Results 766 patients were included. The utilization rate of Trastuzumab among patients with CerbB2 3+ rose from 40.40 to 77.94% in September 2017 following the expansion of insurance coverage, and further increased to 90.41% after a price reduction in 2020. The FISH test was not covered by health insurance, and it was not available in the local hospital until Trastuzumab became available in JX city. For patients with CerbB2 2+, the proportion undergoing the FISH test increased dramatically from 8.89 to 82.08% after the price reduction in 2020. The mere inclusion into basic medical insurance, regardless of insurance types, significantly increased the utilization of Trastuzumab and the FISH test. However, rural patients in JX city are still facing financial burdens with Trastuzumab's out-of-pocket cost accounting for 62.9% of their annual disposable income in 2020. Conclusions Our findings indicate that insurance coverage and price reduction significantly increased Trastuzumab utilization. However, failure to improve the accessibility of the FISH test can pose challenges in enhancing the uptake of Trastuzumab among eligible patients. With the expiration of Trastuzumab's patent and the development of affordable biosimilars, there are now greater opportunities to enhance treatment access globally. These insights can inform policy makers of implementation guidance about providing financial support for breast cancer patients in other LMICs.

Abstract Introduction In Brazil, a country of continental dimensions, the lack of services in the different regions is a major barrier that prevents patients from accessing Pediatric Palliative Care (PPC). If accessing PPC is already challenging, end-of-life care for these patients may also be difficult. Therefore, this study is based on a recent mapping effort, aimed at reflecting on the end-of-life care for children in Palliative Care in Brazil. Method Descriptive, cross-sectional study, and online survey research, based on a larger study of Palliative Care Network. Results The final sample comprised 90 Pediatric Palliative Care services, which proved to be unevenly distributed across the country. Many services lack a minimum team, 40% face difficulties accessing opioids, and one-third do not provide bereavement care. Discussion There should be more services with better distribution across the country, and a minimum team should be required to provide adequate care for children and adolescents. Strategies to improve symptom control and grief support should be introduced. Conclusions It is concluded that continuing education and the inclusion of relevant topics in health courses are necessary. Additionally, health service managers must expand their focus to address these issues effectively.

Abstract Background It is important to identify and evaluate cardiovascular risk factors at an early stage to address them accordingly. Among the younger population, the metabolic syndrome is less common than in older ages. However, each separate metabolic risk factor still has an additive effect on cardiovascular risk factor burden. Non-metabolic risk factors that occur in the younger population include family history, smoking, psychological distress and socioeconomic vulnerability. In 2021 a voluntary health intervention program was introduced in an urban area in Sweden where a cohort of 40-year-olds was invited for cardiovascular risk identification. The aim of this study was to identify how cardiovascular risk factors tend to aggregate in individuals participating in a voluntary health screening program and how the metabolic risk factors associate with non-metabolic cardiovascular risk factors. Methods This was a cross-sectional study with 1831 participants. Data from questionnaires and baseline measurements were used to calculate the prevalence of metabolic- (blood pressure, lipids, fasting plasma glucose, BMI, waist-hip ratio) and non-metabolic risk factors (family history of CVD, smoking, psychological distress, socioeconomic vulnerability) for CVD. SCORE2 was calculated according to the algorithm provided by the SCORE2 working group and ESC (European Society of Cardiology) Cardiovascular Risk Collaboration. Associations among each of the metabolic risk factors and non-metabolic risk factors were estimated using logistic regression and presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results More than half of the study population had at least one metabolic risk factor, and more than 1/3 was considered to be suffering from psychological distress. Furthermore, obesity or central obesity demonstrated individual associations with all of the non-metabolic risk factors in the study; smoking (1.49; 1.32–2.63), family history of CVD (1.41; 1.14–1.73), socioeconomic vulnerability (1.60; 1.24–2.07), and psychological distress (1.40; 1.14–1.72). According to SCORE2 25% of the men were at moderate risk (2.5–7.5%) of developing a cardiovascular event within 5–10 years, but only 2% of the women. Conclusions Obesity/central obesity should be a prioritized target in health screening programs. The non-metabolic risk factors, socioeconomic vulnerability, and psychological distress should not be ignored and addressed with adequate guidance to create health equity.

Abstract Background Added sugars intake is common among individuals with Parkinson’s disease (PD), yet the link between added sugars intake and PD is not well understood. Our study aims to investigate the association between added sugars intake and PD. Methods This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from1990 to 2020. Added sugars intake was estimated based on a 24-hour dietary recall from participants. Multivariable logistic regression analysis was employed to explore the relationship between added sugars intake and the prevalence of PD. Restricted cubic spline (RCS) was used to explore the nonlinear association between added sugars intake and PD. To further observe whether the conclusions were consistent across different subgroups, we conducted subgroup analyses to investigate the association of added sugars intake with PD in different populations. Results The study included 12,489 participants, of which 100 had PD. When weighted, the data represented 136,959,144 participants. The study revealed a positive association between added sugars intake and the prevalence of PD. In multivariable regression models adjusted for all confounding factors, compared with the lowest quartile of added sugars intake, the third quartile (OR = 2.99; 95% CI: 1.43–6.26) and those consuming more than 25% of their calories from added sugars (OR = 3.34; 95% CI: 1.03–10.86) had the highest risk of PD. The RCS curve showed an L-shaped nonlinear association between added sugars intake and PD. Two-segment linear regression by sex revealed that PD prevalence in women was linearly related to sugar intake (nonlinear P = 0.465), while men exhibited an L-shaped nonlinear relationship (nonlinear P = 0.03). Additionally, subgroup analysis showed that alcohol consumption and diabetes significantly influenced the association between added sugars intake and the prevalence of PD. Conclusion These results highlight a positive association between added sugars intake and the prevalence of PD, particularly among women, heavy drinkers, and individuals with diabetes.

Abstract Introduction Despite the significant contribution of postnatal care (PNC) to maternal and newborn survival, few studies have explored the concept of the quality of PNC received by mothers in Kenya. Therefore, this study aimed to determine the prevalence and factors associated with the quality of PNC in Kenya. Methods Secondary data from the Kenya Demographic and Health Survey (KDHS) of 2022 were analyzed, comprising 11,863 women who were aged 15 to 49 years. The quality of PNC was indicated as receiving all components of PNC in the first two days after childbirth. Multivariable logistic regression was conducted to determine the factors associated with the quality of PNC, using SPSS, version 20. Results Out of the 11,863 women, 39% (95% CI: 37.0-40.9) had received all components of PNC in the first two days after childbirth. Additionally, older women aged 35–49 years (AOR 1.88, 95%CI: 1.07–3.29), those who made decisions to seek health care jointly (AOR 1.48, 95%CI: 1.18–1.85), those who owned a telephone (AOR 1.36, 95%CI: 1.05–1.76), women who received quality antenatal care (AOR 4.62, 95%CI: 3.69–5.76), older women aged 30–34 years at the time of their first childbirth (AOR 2.25, 95%CI: 1.11–4.55), those who gave birth through cesarean section birth (AOR 1.93, 95%CI: 1.49–2.49), those who gave birth at public health facilities (AOR 1.69, 95%CI: 1.01–2.82) and those who received quality intrapartum care (AOR 1.87, 95%CI: 1.43–2.43) when compared with their counterparts were more likely to receive quality PNC. On the other hand, women from other provinces of Kenya i.e., Western (AOR 0.51, 95%CI: 0.33–0.80), and Rift Valley (AOR 0.57, 95%CI: 0.39–0.81), those who gave birth to female children (AOR 0.75, 95%CI: 0.61–0.91) and those who reported to have not been respected at all times during their hospital stay (AOR 0.49, 95%CI: 0.29–0.82) when compared with their counterparts were less likely to receive quality PNC. Conclusion The proportion of mothers receiving quality PNC was found to be low. The study also highlights the need to continue encouraging mothers to attend numerous ANC visits. Moreover, emphasis should be placed on providing quality ANC, intrapartum care, and respectful maternity care by health workers. Targeted interventions to increase access to quality PNC may need to focus on young mothers, mothers living in certain regions of Kenya, and those giving birth to female babies, most especially at private health facilities, and through vaginal birth.

Abstract Background Cost-effectiveness analyses of health technologies have become a part of the decision-making process in healthcare policies. Nevertheless, economic results are not always presented in comprehensible formats for non-technical audiences, such as the general population, healthcare professionals or decision-makers. The purpose of this study was to observe which formats best convey the key message of an economic evaluation, and which are best received by two different audiences. Methods The summary of a hypothetical cost-effectiveness analysis was edited in different formats: infographic, plain language text and video-abstract for the general population; executive summary and policy brief for a specialized population, i.e. clinicians, clinical and non-clinical managers, or methodologists in health-technology assessment. Participants were randomly shown one of the formats, and data on objective and subjective comprehension, and perceived usefulness/acceptability were gathered by means of online questionnaires. Statistical differences between formats within each audience were analysed. Results In the general population (N = 324), objective comprehension was statistically significantly better for infographic than for video-abstract (p = 0.005), and for plain text than for video-abstract (p = 0.024). There were no differences in subjective comprehension, but video-abstract was considered statistically significantly more useful to understand the information than plain text (p = 0.011). In the specialized population (N = 100), no statistically significant differences were observed for objective and subjective comprehension, although policy brief was perceived as statistically significantly more useful than executive summary (p = 0.005). Conclusions A balance between effectivity of conveying the message and attractivity of the format needs to be sought, to facilitate non-technical audiences’ understanding of economic data and, consequently, perceive decision-making processes as more transparent and legitimate. The infographic and policy brief could be robust ways to present economic data to the general public and specialized audience, respectively.

Abstract Background Under the background of similar geography and culture in Lancang-Mekong countries and rapid changes in the regional economy and lifestyle, this study aimed to describe and compare the prevalence, awareness, treatment, and control of hypertension and assess the hypertension care cascade in three provinces of China, Laos, and Cambodia. Methods A cross-sectional study was conducted between 2021 and 2023 in the three provinces of Lancang–Mekong River countries using consistent investigative procedures. We included 11,005 participants aged ≥ 18 years from three provinces, and data were collected through questionnaires, physical examinations, and biochemical tests. We analyzed the cascade of hypertension care and compared the prevalence, awareness, treatment, and control of hypertension. Results The hypertension care cascade indicated that 46.3%, 51.6%, and 63.1% of patients in Yunnan Province (China), Oudomxay Province (Laos), and Ratanakiri Province (Cambodia), respectively, were not diagnosed, and 10.7%, 12.8% and 21.1% of patients, respectively, did not receive treatment. After sex-age standardization, the prevalence rates of hypertension in the three provinces were 33.4%, 34.5%, and 23.6%, respectively. Higher awareness rate in Yunnan Province (53.4%) and Oudomxay Province (46.5%) than in Ratanakiri Province of Cambodia (39.7%). The treatment rate of hypertension in Yunnan Province (42.4%) was higher than that in Oudomxay Province (34.5%), and Ratanakiri Province (16.9%). In addition, less than 20% of the patients in the three provinces had their blood pressure under control. The factors associated with hypertension differed across the three provinces. Conclusions In the three provinces of the Lancang-Mekong River Basin countries, there is a high burden of hypertension and a significant unmet need for hypertension care. Targeted and precise intervention strategies are urgently needed to improve the awareness, treatment, and control of hypertension in low- and middle-income regions. Graphic Abstract

Abstract Background Polytrauma was defined as a severe traumatic injury and believed that it was a sudden and unpredictable incident. Is polytrauma really just a simple accident? In order to comprehensively answer this question, the study sought to determine the frequency and specific risk factors associated with polytrauma recidivism, while also comparing the initial and subsequent injury events among recidivists. Methods A multicenter, retrospective cohort study was conducted at four Advanced Trauma Centers’ emergency surgery or traumatic intensive care units (TICUs) between August 2020 and July 2023. A total of 2490 consecutive trauma patients who met the criteria consecutively were recruited and analyzed in the study. Risk factors for recurrent polytrauma were identified through the use of logistic regression analysis. A nomogram was created using the results from a multivariate logistic regression analysis and the rms package in R. Results In polytrauma, the rate of recidivism was 44.6% (672/1507), then recidivists were predominantly male (80.4%) and frequently within the 45 to 54 year-old age range (51.3%). Recidivists in polytrauma patients overall had a median time to reinjury of 27 months, as measured by the interquartile range (IQR). The polytrauma patients in the recent traumatic event were often more severe than that in the initial event, as patients had higher ISS scores and lower GCS scores (P

Abstract Background Cognitive frailty, intimately tied to adverse outcomes such as falls, early mortality, and hospitalization, represents a dynamic, reversible process. Multicomponent exercise has emerged as one of the most potent means of mitigating cognitive frailty. Aims This research seeks to quantitively amalgamate the effects of multicomponent exercise on various domains: cognitive function, frailty status, and other health-related outcomes in cognitively frail older adults. Methods Our methodology entailed a comprehensive review of literature in databases including PubMed, EMbase, CINAHL, Cochrane Library, Web of Science, Wanfang, Sinomed, VIP, and CNKI from the inception of these databases to December 10, 2023. For our statistical analysis, we utilized RevMan 5.3, Stata 17.0 and R 4.3.2 software. Adherence was maintained to the PRISMA checklist, with the study being registered with PROSPERO (CRD42024499808). Results Our review encapsulated a total of 2,222 participants and 11 trials. The findings intimate that multicomponent exercise enhances cognitive function [MD = 2.52, p = 0.03]), grip strength[SMD = 0.39, p = 0.008] and lower limb muscle strength[MD = 4.30, p

Abstract Background Incarcerated individuals face high rates of mental illness, substance use disorders and communicable diseases including HIV, with increased health complications and mortality in the early post-release period. Multiple re-entry interventions linking justice-involved individuals to community resources via peer navigation have emerged, though limited data exist on the mechanics and personal impact of these approaches. This paper quantifies and evaluates a pilot study of a combined Community Health Worker (CHW)-re-entry intervention for individuals released from jail who use substances and have HIV to inform future large-scale applications. Methods A mixed-methods analysis of a CHW-re-entry intervention utilized in a pilot randomized controlled trial involving people with HIV who have a history of substance (stimulant, opioid or alcohol) use in Dallas, TX was conducted using an explanatory sequential design. Quantitative assessments of the intervention measured interaction types, time spent, and topics discussed and explored associations between the “dose” of intervention and patient outcomes. Qualitative analyses of CHW field notes and end-of-study participant interviews were triangulated with quantitative findings to elucidate the intervention’s impact. Results Of the 17/31 participants assigned to the intervention, 16 interacted with the CHW on at least one occasion, and 6 successfully completed a visit with the re-entry organization. Most CHW interactions occurred by phone (66%) or in person (28%). Frequently discussed topics included substance use, housing, and physical health. On average, participants spent 7.65 h (range 0-37.18, SD = 9.33) engaged with the intervention over 6 months. Intervention dose was associated with improved HIV control, decreased stimulant use, higher rates of recidivism, and improved clinical appointment show rate. Qualitative analyses revealed key intervention components, paralleling benefits of study participation alone: outreach, nonjudgmental approach, motivation and accountability. Conclusions A CHW-re-entry intervention, while resource-intensive, shows preliminary promise in improving HIV and some substance use outcomes. Frequent telephone and in-person contact, with an empathetic yet goal-oriented approach, fostered participant support and motivation to address HIV and substance use. Participants reported that engagement in research provided accountability and a sense of purpose. Future studies should focus on optimizing implementation of CHW-based interventions to enhance impact on vulnerable populations.

Abstract The provision of social care for people in prison in England has historically been lacking. Seeking to address this, the 2014 Care Act clarified that local authorities are responsible for identifying, assessing and meeting prisoners’ social care needs. Against this background, in 2020 we undertook a survey to explore the emerging services for this group. Eighty-six (57%) local authorities responded. A mixed methods approach was taken. Numerical data were analysed through descriptive statistics with comparisons made to the previous survey. An inductive approach to thematic analysis was used to analyse the free text responses. The findings revealed some improvements since the 2015/16 surveys, including the wider introduction of self-referral systems, the success of peer supporters in identifying people in need of social care and greater multi-disciplinary working. However, other issues remained stubbornly persistent, including a dearth of systematic processes to identify those needing social care on release from prison, a lack of timely information sharing and disputes over the sending and receiving authorities’ responsibilities. There were also particular concerns about the shortage of appropriate accommodation for people leaving prison. Perhaps the most striking finding, however, was how little most authorities knew about this population. Building on discussions in previous papers, we explore three ways in which arrangements could be strengthened for this group: the collection of better data, the wider use of release on temporary licence and the greater employment of technology in planning people’s release.

Abstract Background Drug use disorders are highly prevalent among people in prison. Nevertheless, treatment coverage for individuals with drug use disorders in prison remains understudied and unknown. The aim of this study was to estimate treatment coverage among a sample of people with harmful and likely drug dependence before entering prison and to investigate the factors associated with treatment utilization. Methods This was a longitudinal cohort study using baseline survey data linked to registry data on imprisonment and treatment utilization. The study is based on the Norwegian Offender Mental Health and Addiction (NorMA) cohort (n = 733) recruited in 2013–2014 from 57 Norwegian prisons. At baseline, participants reported drug use the year before imprisonment, using the Drug Use Disorder Identification Test (DUDIT). The outcome of interest was DUD treatment, defined as at least one DUD treatment episode from the specialized health services during baseline imprisonment. Results 40% of the sample had DUDIT scores that indicated likely drug dependence (≥ 25) and a need for treatment. Among this group, 64% received DUD treatment while imprisoned. Longer imprisonment (> 12 months; aOR = 8.87, p

Abstract Background The economic sanctions imposed on Iran have had a significant impact on the country’s healthcare system. The sanctions have affected the availability and affordability of cancer diagnosis and treatment services, leading to a range of challenges for patients with cancer. This study aimed to explore these challenges and gain a deeper understanding of the impact of economic sanctions on cancer care in Iran. Methods The research method involved qualitative in-depth interviews with 53 experts, including clinical and basic sciences specialists, who were selected through purposeful sampling. The data were analyzed through qualitative content analysis using MAXQDA 2020. Results A total of 900 codes were identified, categorized into three primary groups—input, process, and output—and further divided into 13 subcategories. Within the input category related to health systems providing cancer care to patients, several critical issues emerged. These included instability in financing mechanisms and regulations, shortages of materials, low-quality imported materials, high material prices, and loss of human resources. Meanwhile, in the process of delivering diagnostic and treatment procedures to cancer patients, concerns centered around delayed and inadequate care, non-adherence to guidelines, limited international collaborations, and reduced provider satisfaction. Finally, during the output phase, the main subcategories extracted were lower effectiveness, increased adverse events, and increased equity gaps. Conclusions Although economic sanctions against Iran have not officially targeted healthcare and access to drugs, they have restricted access to standard equipment and modern technologies, leading to increased delays, misdiagnosis, and diagnostic and therapeutic side effects in cancer patients to the point of death.

Abstract Background As compared to men, older women´s higher rates of depression diagnosis and antidepressant use are widely reported. We aimed to: a) explore whether there is a potential gender bias in the clinical diagnosis of depression and antidepressant prescription in an older population from Stockholm; and 2) analyze if such gender bias differs by patients’ age and socioeconomic status. Methods We used data from the Swedish National Study on Aging and Care in Kungsholmen, SNAC-K (N = 2,941). We compared gender differences in: (a) clinical diagnosis of depression according to the Swedish National Patient Register (ICD-10 codes F32-F34; F412) (“register-based diagnosis”); (b) SNAC-K-based diagnosis of depression, partially gender-blind, using the Comprehensive Psychopathological Rating Scale (CPRS) and the DSM-IV-TR (“SNAC-K based diagnosis); and (c) antidepressant use (ATC code N06A). To analyze the magnitude of the gender bias in the register-based diagnosis of depression and in antidepressant use, and the role of potential moderating factors, prevalence ratios (PR) were calculated using Poisson regression models. Models were run separately by age and social class. Results Women had a 63% higher probability of having a register-based diagnosis of depression (PR = 1.63[1.23–2.15]) and a 79% higher probability of using antidepressants (PR = 1.79[1.34–2.40]). No gender differences were observed in the SNAC-K-based diagnosis of depression. The gender differences in the register-based diagnosis were narrowed, although remained significant, after considering age, depressive symptoms, and health services use (PR = 1.44[1.10–1.88]), as well as the register-based diagnosis in the case of antidepressant use (PR = 1.31[1.04–1.64]). This gender bias was larger among the younger-old and the most advantaged social class. Conclusion A gender-bias was identified in the diagnosis and treatment of depression in older adults within the Swedish healthcare setting, which could imply that health services may be contributing to the medicalization of women’s mental health. Gender-sensitive clinical and public health interventions are essential to reduce gender disparities in mental healthcare, also in old age.

Abstract Background Health system satisfaction is an important but understudied indicator of health system performance. It has far-reaching implications for sustainability but has been widely understudied particularly for non-European settings. Qatar represents a growing international experience of rapid development requiring steadfast system funding and reorganisation. After decades of unprecedented immigration and nearly free health care, Qatar sought to expand the system by 2016, reorganise it by 2022, and accelerate private funding and health system outcomes by 2030. Aim The aim of this study is to conduct a comprehensive assessment of health system satisfaction in Qatar, in anticipation of the 2024–2030 health reforms, with a particular emphasis on detailed policy attribution and the formulation of recommendations. The overarching aim of this study is to contribute to the limited body of international literature on health system satisfaction, particularly in non-European contexts, with a focus on specific populations such as migrants, labourers, and labour camp residents. Methods We analysed the levels of, and individual inequalities in, health system satisfaction in Qatar between 2012 and 2014. Descriptive statistics were employed to assess satisfaction levels, while inequalities were examined using logit analysis. The satisfaction variables encompass the key aspects of health system provision and management, whereas the individual variables are focused on their attributability to Qatar’s specific health policy context, including regionally distinct socio-economic groups. Findings Health system satisfaction levels in Qatar were relatively high in both 2012 and 2014, particularly regarding service provision, though they did not reach exceptionally high levels. Both satisfaction dimensions—provision and management—improved in 2014, with management showing more rapid progress. However, males, Qatari citizens, individuals with chronic disease, labourers, and residents of the largest labour camps were less likely to express satisfaction with the system. Conclusion Qatar’s satisfaction trends and inequalities between 2012 and 2014 emphasise the significance of both dedicated efforts and effective organisational structures in maintaining high levels of health system satisfaction during periods of rapid development. To ensure continued satisfaction, performance, and sustainability throughout the 2024–2030 reforms, it is essential to address unresolved organisational constraints before eroding dedicated efforts through increased private health funding.

Abstract Background Palliative care (PC) has the potential to alleviate suffering and enhance quality of life for patients with serious progressive diseases; however, access to PC remains unequal across different populations. Objective This scoping review aimed to systematically examine the literature on: (1) the primary contributors to inequity in accessing PC; (2) the key barriers to achieving equitable access to PC; (3) the essential recommendations for addressing these issues. Methods The PubMed, Web of Science, and Embase databases were searched for English-language articles published since 2017. Eligibility criteria: Population- people with chronic, progressive, life-threatening, or limiting diseases. Interventions- any PC intervention, including teams, services, programs, or strategies implemented in both hospital and community settings. Outcomes- equity in access to PC. Study Design- any. The PRISMA (extension for scoping reviews) recommendations were followed. Results Fourteen studies were included: half originated from North America (USA, n = 5; Canada, n = 2) and the other half from Europe (UK, n = 4; Spain, n = 1) and Australia (n = 2). Most studies focused on ethnic/racial discrimination (n = 4) or geographical discrepancies (n = 4). The remaining studies addressed PC in low- or middle-income countries (n = 2), gender discrepancies (n = 1), informal caregiving (n = 1), socioeconomic inequities (n = 2), and barriers to accessing PC (n = 1). Barriers to equitable access to PC include difficulties in identifying patients nearing the end of life, the “survival imperative,” the “normalization of dying,” misconceptions, mistrust, limited information about PC and end-of-life care, and a fragmented care system. Conversely, enablers of equitable access to PC encompass proper patient evaluation and workforce education, addressing basic survival needs and social determinants of equity, and promoting intersectoral collaboration, community advocacy, and engagement. Conclusion Achieving equity in PC is a complex endeavor requiring strong commitment and action at both policy and governmental levels. Additionally, it calls for sustained efforts in clinical practice, workforce planning, capacity building, community engagement, and research investment to implement and assess public health approaches to PC. Future research should aim to provide more comprehensive and generalizable insights into the determinants of equitable access, as well as the enablers and barriers to PC and end-of-life care.

Abstract Background It remains unclear how COVID-19 has disproportionately affected the mental health of different vulnerable groups. This study explores how mental health inequalities changed between 2014 (pre-COVID-19) and 2021 (during COVID-19) in the Netherlands across intersectional social strata defined by interplays of educational attainment, income level, gender, and age. Methods Using 2014 and 2021 self-reported cohort data on health and living conditions of the adult population of Eindhoven and surroundings (N = 1,157), a Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) was applied to explore intersectional inequalities in mental health in 2014, 2021, and in mental health changes (2014–2021). We examined this using the Mental Health Inventory-5 across 53 intersectional social strata based on interplays of education, income, gender, and age in 2014. Results There were substantial differences in mental health trajectories across social strata. Between-stratum mental health inequalities were patterned additively, indicating that inequality patterns along one axis (such as income) tended to be consistent across other axes of comparison. Additive trends revealed that women with a low income were at highest risk of poor mental health in 2014 and 2021, and people over 65 were at highest risk of mental health setbacks over time. Nonsignificant educational inequalities were found in 2014 and 2021. Income inequalities persisted, but slightly decreased in 2021 due to stronger mental health setbacks among those with high incomes. Women experienced persisting disadvantages that slightly flattened over time, and the mental health advantages of older age diminished over time. Conclusions Inequalities in mental health add up for those who experience multiple axes of disadvantage, such as women and those with low incomes, but no disproportionate intersectional interaction effects were found. Effort is needed to ensure that mental health support is accessible for all, especially those with low incomes. Given the especially strong mental health declines among those over 65, responses to future crises need to include measures to protect the mental health of the elderly. Future research should investigate intersectional inequalities along other axes of disadvantage, such as ethnicity, employment and family status.

Abstract Background Previous research highlights persistent differential attainment by ethnicity in medical education, wherein the perceived inclusiveness significantly influences ethnic minority students’ and trainees’ outcomes. Biased organizational practices and microaggressions exacerbate the challenges faced by ethnic minorities, leading to lower academic performance and higher dropout rates. Consequently, understanding ethnic minority GP-trainees’ experiences and perspectives regarding relevant educational aspects is crucial for addressing these disparities and cultivating a more inclusive environment within medical education. Research question We aimed to investigate the experiences of minority GP-trainees throughout their educational journey in Dutch GP-specialty training, emphasizing their challenges, sources of support, and suggestions for enhancing their learning environment. Method We conducted semi-structured, in-depth interviews with minority GP trainees, employing purposive convenience sampling to ensure diversity across multiple dimensions. These included gender, age, ethnicity, social background, migration generation, educational stage, encountered challenges, sources of support, and the GP training institute attended. The analysis involved iterative, open and axial coding, followed by generating, reviewing, and defining themes. For a structured analysis of encountered microaggressions, we adopted Sue's Taxonomy of Microaggressions. Results All fourteen ethnic minority interviewees had faced educational barriers stemming from misunderstandings and stereotyping in a predominantly 'white' organization. These barriers impacted various aspects of their education, including professional identity formation, application, admission, assessment procedures, social networks, course content, and expert guidance. Microaggressions permeated throughout their educational journey, hindering their full expression and potential. Their ideal GP-specialty training emphasized uniqueness of all trainees, comprehensive staff engagement in inclusivity, robust diversity, equity, and inclusion (DEI)-policies, individual mentorship, transparent standards, concise language usage in test questions, and bias elimination through mandatory DEI staff training. Conclusion Ethnic minority GP-trainees in the Netherlands face significant challenges like biased assessment and admission, stereotyped course content, inadequate support networks, and microaggressions, putting them at risk for underperformance outcomes. They emphasize the need for inclusive training with robust DEI-policies to eliminate bias.

Abstract Introduction Access to and engagement with primary healthcare can be difficult for marginalized low-income populations residing in inner cities in high-income countries. We designed a study to examine retention in primary care among clients of a novel interdisciplinary primary care clinic in the Downtown Eastside of Vancouver, Canada who did not previously have access to care. Methods Beginning in June 2021, clients of the Hope to Health clinic were offered enrolment in a cohort study which involved a baseline and follow-up surveys every six months, and linking their data to information from the clinic’s electronic medical records. We used Chi-square or Fisher’s Exact test and Wilcoxon rank sum test to compare clients who were lost to follow-up (LTFU) or deceased, with clients who were retained in care at the end of follow-up, Cox proportional hazards modeling was used to examine independent associations with mortality or LTFU. Results Among 425 participants enrolled, the median age was 50 years (IQR 40–59), 286 (67.3%) participants were men and 128 (25.4%) were unstably housed at enrollment. Among 338 participants with at least six months of follow-up after enrolment, 262 participants (67.5%) were retained in care, 20 (5.2%) had moved, 57 (14.7%) were classified as LTFU, and 28 (7.2%) had died with a median of 19.9 months of follow-up time. The risk of death or LTFU was independently associated diagnosed with alcohol use disorder (AUD) (adjusted hazard ratio [AHR] = 2.23 vs. not; 1.38–3.60), frequency of medical doctor visits (AHR = 0.69 per visit per 3 months; 0.60–0.79) and social work visits (AHR = 0.73 per visit per 3 months; 0.59–0.90. Stimulant use disorder or asthma were not significantly associated with retention in care. Conclusion We found that a primary healthcare model of care was successful in retaining over two-thirds of clients in primary healthcare after more than 18 months of follow-up. Additional supports for those diagnosed with alcohol use disorder are needed to retain them in care.

Abstract Background Equitable access to vaccination remains a concern, particularly among population groups made structurally vulnerable. These population groups reflect the diversity of communities that are confronted with structural barriers caused by systemic racism and oppression and result in them experiencing suffer disadvantage and discrimination based on citizenship, race, ethnicity, ancestry, religion, spiritual beliefs, and/or gender identity. In Canada, Ontario public health units (PHUs) engage with faith-based organizations (FBOs) to improve vaccine confidence among populations made structurally vulnerable. This study explores the factors that facilitate and hinder engagement in the implementation of vaccine confidence promoting interventions, and challenges associated with working with FBOs. Methods In-depth interviews were conducted with 18 of the 34 Ontario PHUs who expressed an interest. Braun and Clarke’s “experiential” approach was used to explore the realities of PHUs’ contextual experiences and perspectives. Results The results showed that receptivity and openness of PHUs to learn from FBOs, previous experience working with religious communities and FBOs, ongoing relations based on respect of different beliefs and opinions on the vaccines, leveraging the support of trusted faith leaders among communities and communications strategy adapted and sensitive to the needs of the community was facilitators to community involvement in the prevention and control of COVID-19. On the other hand, factors both internal and external to the PHUs have often posed challenges to collaboration with the FBOs. Internal factors include low operational capacity of PHU like insufficient human and financial resources, weak analytical capacity, ambiguity in the roles and responsibilities of the different actors. Some external challenges issues were related to the provincial level and the Ministry of Health, while others were related to FBOs. For example, faith-based and collective beliefs promoting vaccine hesitancy have resulted in resistance from some religious communities when PHUs have reached out to collaborate. Conclusions Engaging with faith-based communities is an ongoing process that requires time, flexibility, and patience, but it is necessary to improve vaccine confidence and equity access among population groups made structurally vulnerable. Lessons learned from this research can guide the implementation of future vaccination programs.

Abstract Background There are growing global concerns about informal waste pickers and their health issues. This cross-sectional study drew on the structural violence theory to examine the mental health situation of informal waste pickers in Hong Kong and identified the determinants of depression and anxiety in them ranging from individual to societal and governmental levels. Method The data from the largest territory-wide study of informal waste pickers in 2023 was analysed. Descriptive statistics and logistic regressions were used to investigate the association between mental health and socioeconomic variables, including demographic background, governmental measures against informal waste pickers, other negative experiences related to safety and public discrimination, and supportive resources. The symptoms of depression and anxiety were assessed using the Patient Health Questionnaire (PHQ) and General Anxiety Disorder (GAD). Results The results showed that physical strain/illness and chronic illness caused by long-term scavenging works (for depression adjusted OR 3.33, 95% CI [1.75, 6.31]; for anxiety adjusted OR 5.01, 95% CI [2.45, 10.24]), recycling or personal property stolen (for depression adjusted OR 2.04, 95% CI [1.23, 3.36]; for anxiety adjusted OR 2.72, 95% CI [1.62, 4.56]), being treated rudely by citizens (for depression adjusted OR 2.16, 95% CI [1.32, 3.55]); for anxiety (adjusted OR 2.85, 95% CI [1.74, 4.67]) are the critical risk factors of informal waste pickers’ mental health. While higher intention to continue scavenging work if financial conditions permit is the critical protective factor for depression (adjusted OR 0.46, 95% CI [0.24, 0.88]) and anxiety (adjusted OR 0.43, 95% CI [0.22, 0.86]), compared to lower intention to continue scavenging work if financial conditions permit in the multivariate model. Conclusions This study discloses the close relationship between informal waste pickers’ long-term physical strain/illness and mental health and identifies the governmental measures, other negative experiences related to safety issues and public discrimination as risk factors for informal waste pickers’ mental health. Providing outreach, tailored medical services, increasing the unit price of recycling, developing specific recycling zones and establishing membership-based organisations help alleviate the challenges of precarious employment and enhance the well-being of the informal waste pickers.

Abstract Background Latin America and the Caribbean (LAC) is among the most unequal regions in the world in terms of wealth and household income. Such inequalities have been shown to influence different outcomes during the COVID-19 pandemic, including the disruption of routine health services. The aim of this paper is to examine socioeconomic inequalities in household experiences of healthcare disruption in LAC countries from mid-2020 to late 2021. Methods We used household-level data from the COVID-19 High Frequency Phone Surveys (HFPS), conducted in 14 LAC countries in one round in 2020 and 24 countries in two rounds in 2021. Ordinary least square and Logit multivariate regressions were conducted to examine the correlation between reported healthcare disruptions with household characteristics for 2020 and 2021. Since household income levels were not directly collected in the HPFS, we created an index of inequality and estimated the relative index of inequality. Results When analyzing 2020–2021 together, reported healthcare disruptions were lower if the respondent was employed or did not report lack of food in the last month; if the household had more people aged 65 or older or more rooms to sleep in. When analyzed separately in 2020 and 2021, having more people aged 65 or older or not experiencing food insecurity remained stable factors for lower odds of disruption in both years. In addition, being employed was associated with lower odds of disruption in 2020, while being male or having more rooms to sleep in were associated with lower odds of disruption in 2021. Regarding wealth differences in 2021 (it was not possible to compute it for 2020), households with the lowest wealth were 27.3% more likely to report a care disruption than households with the highest wealth. Conclusions The socioeconomic status of households in LAC was a relevant factor in explaining the disruption of healthcare during the COVID19 pandemic, with a clear social gradient where the wealthier a household, the less likely it was to experience disruption of care. Food security, employment, and gender policies should be integral to preparing for and responding to future shocks such as pandemics. Prioritizing the most affected populations, like the elderly during COVID-19, can enhance the health system effectiveness.

Abstract Background China is striving to promote a hierarchical medical system (HMS) to improve the efficiency of health resource utilization and ensure health equity. An innovative payment scheme named the “Diagnosis-Intervention Package” (DIP) has been developed recently and implemented in 71 pilot cities nationwide. Although the impact of payment reform on medical expenditure and provider behavior has been demonstrated, there is little evidence on whether the reform promotes the HMS. Methods This study uses evolutionary game theory to formulate a tripartite evolutionary game model involving the local government (LG), superior medical institutions (SMI), and patients in implementing DIP payment reform. We also analyze the stability of each participant’s strategy and the sensitivity of parameters. Results The results show that for LG, the additional social benefits created for other regions are crucial in influencing the evolution of the game system. SMI are more inclined to support the HMS when the proportion of patient reduction under the DIP payment scheme is low. For patients, the perceived medical quality of primary medical institutions (PMI) is the decisive factor in their strategies. Conclusion The DIP payment scheme is more likely to promote the HMS in regions with an advanced policy framework, abundant medical resources, and high-quality primary medical services. Policymakers need to create effective incentives to boost support for the HMS from each participant. This study provides a feasible methodology for analyzing the impact of payment reforms that can be used in future research.

Abstract Introduction Cancer multi-disciplinary team meetings (MDTM) assemble clinical experts to make diagnostic and treatment recommendations. MDTMs can take place in person, virtually, or in a hybrid format. Virtual and hybrid MDTMs have been in use for over two decades. This systematic scoping review aims to map the evidence on virtual and hybrid MDTM formats over time, providing insights into their quality, and the facilitators and barriers to their effective delivery. Methods The PRISMA scoping review checklist has been followed. A systematic search of PubMed, PsychINFO, and Embase between 1990–2023 identified 9399 records. These were independently screened by two researchers to identify primary research of any design that assessed quality or effectiveness of cancer VMDTMs. Results were narratively synthesised. Results Eight quantitative, two qualitative and three mixed-methods studies were included. All were observational and most were retrospective (n = 8). Varied outcome measures were used to evaluate meeting quality, including treatment recommendations, survival, time from diagnosis, and overall attendance. VMDTMs were superior (N = 6) or sometimes equivalent (N = 4) to face-to-face meetings. Studies identified implementation factors critical to their effective delivery, including internet-stability and chairing. Conclusion The heterogeneous literature suggests VMDTMs offer some benefits over face-to-face meetings. Training and infrastructure are key to prevent risks to patient safety. A definitive comparative evaluation is needed to inform best practice.

Abstract Background Leadership and access to structural empowerment are known to influence the work life experiences of staff and quality of care. Knowledge about relationships between specific factors of structural empowerment, leadership and management, staff well-being and quality of care at both an individual and unit level is scarce. Aim To study the relationship between staff-rated access to empowering structures, leadership and management performance, well-being, and quality of care in hospital settings measured at the individual level and aggregated at the unit level. Methods A cross-sectional correlative design was applied. Questionnaire data from 331 randomized hospital nursing staff working at 38 units in 25 hospitals in Sweden were analyzed using bivariate correlations and general estimation equation (GEE) models. Results Results from the bivariate analysis of relationships confirmed earlier research. In the GEE models, some unexpected results were found and differences between the individual and unit levels. Adding management and leadership as independent factors in the second model showed few relationships of significance to the outcome variables. Conclusion Results confirm the importance of staff access to empowering structures in relation to well-being and quality of care. Differences and similarities were shown when studying these relationships at both the individual and unit level. The findings feature implications for hospital management to promote staff access to empowering structures. The findings provide information on how these structures relate to the individual and the unit; information that could be useful when planning or implementing strategies with the aim to promote staff well-being and care quality. The non-significant results for leadership and management in relation to staff outcomes in the GEE-models, raise questions for further research where a shift from individual to organizational focused performances within the field of leadership is implied.

Abstract Background As researchers and practitioners in the field of global health continue to acknowledge the ongoing impact of colonialism in their work, the call for decolonized research has increased. This has particular relevance in the field of sexual and reproductive health. Despite this recognized need, there is no singularly agreed upon definition of what it means to conduct decolonized research using decolonized methodologies. The aim of this review is to explore the approaches and methodologies used in contemporary sexual and reproductive health research aligned with decolonized systems of thinking. Methods This review was developed and conducted in accordance with the JBI and the Extension for Scoping Reviews (PRISMA-ScR) Checklist. In January 2023, Medline (Ovid), Embase, EMCare, Global Health Database, and Web of Science were systematically searched for relevant studies. Relevant grey literature was also scanned. The screening and data extraction were conducted by four independent reviewers using an iterative approach. The findings were analyzed to uncover shared characteristics between the studies. Results A total of 1775 articles were retrieved through our search strategy, of which 35 were included as discussing sexual health topics, and representing the principles of decolonization. Few of the included articles explicitly self-identified as decolonized literature. Common themes between studies included that most of the data collection was conducted in high-income countries, largely in North America, and the most prevalent sexual health topics were HIV/AIDs, and STIs/STDs. Most studies were qualitative, used community-based methodologies, and included some form of community advisory board. Conclusions This scoping review identifies shared characteristics of both successes and gaps in decolonized research that may inform the methodological processes of future researchers. It emphasizes the need for more decolonized research originating in low- and middle-income countries, as well as decolonization of quantitative research methodologies. The findings also emphasize the importance of community engagement throughout the research process. A shared definition of decolonization is necessary to codify this body of work. Future researchers should focus on clearly communicating their approach in the methodology so that it can be replicated and become part of a shared definition. International Registered Report Identifier (IRRID): DERR1-10.2196/45771

Abstract Background and aim Hospital-at-home (HaH) care is known as a healthcare delivery approach providing acute care services at home as an alternative to traditional hospital care. This study aimed to explore the dimensions and components of HaH care. Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The databases including ScienceDirect, Scopus, PubMed, the Cochrane library, the Web of Science Core Collection, and the Wiley online library were searched for articles on HaH care dimensions and components of from early 2000 to February 19, 2024. The inclusion criteria of the study included articles published in the English language, and and those pertaining to various dimensions and components of HaH care. The quality of the studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and data were analysed using the framework analysis method. Results A total of 4078 articles were retrieved. After screening and quality assessment, 179 articles were included in the review, identifying 88 dimensions and components of HaH care across seven main categories: benefits, challenges and obstacles, facilitators, management-related factors, medical conditions, factors associated with patients and their families, and factors associated with caregivers. The common components included cost savings (n = 30), patient and family satisfaction (n = 23), reduction in re-admissions (n = 13), medication management (n = 12), communication, coordination, and cooperation among healthcare teams, patients, and families (n = 12), preferences of patients and families (n = 12), and education of patients, families, and healthcare teams (n = 10). Conclusion Based on the results, HaH includes many and diverse dimensions and components. So, healthcare policymakers and planners are urged to consider the dimensions and components of HaH care including benefits, challenges and obstacles, facilitators, management-related factors, medical conditions, factors associated with patients and their families, and factors associated with caregivers when developing models and programs to ensure effective outcomes following implementation.

Abstract Background Persons living with dementia and their care partners encounter many challenges within the health and social care system, including lack of information, support, counselling, and access to community services, as well as significant staff turnover in home care services. The objective of this study was to work with multiple stakeholders to formulate relevant and feasible recommendations to improve care for persons living with dementia and their care partners in Quebec, Canada. Methods We conducted deliberative dialogues in the context of a large mixed methods study on the care of persons living with dementia and care partners. First, we organized two deliberative dialogues with care partners to formulate recommendations informed by the quantitative and qualitative results of the large study. These recommendations were further discussed in a third deliberative dialogue focused on the prioritization of relevant and feasible recommendations by clinicians, health project managers, and decision-makers. We performed a thematic analysis of the data using a multi-level framework: structural, organizational, provider, and patient perspectives. Results Participants formulated 14 recommendations. Two structural-level recommendations included fighting ageism and ensuring the same access to services in the whole province. Three organizational-level recommendations involved improving interdisciplinarity collaboration, improving access and follow-up in primary care, and adapting emergency departments. Additionally, two organizational-level recommendations were specific to healthcare crisis management (such as the COVID-19 pandemic): ensuring both the regular communication and the flexibility of implemented rules. Four provider-level recommendations encompassed providing more training on dementia, offering more training on levels of care, reviewing the relationship-based approach in training programs, and revising and optimizing medications. There were three patient-level recommendations including strengthening partnerships with persons living with dementia and care partners, guaranteeing personalized services and care, and reinforcing support for care partners. Conclusion The deliberative dialogues enabled us to formulate relevant recommendations based on research evidence, the lived experience of care partners, and the expertise of clinicians, health project managers and decision-makers. The results revealed several recommendations that will help mitigate the challenges faced by persons living with dementia and care partners in the health and social care system by informing policies and practices.

Abstract Introduction With an upward trend in adoption by industrialized nations, pay-for-performance (P4P) mechanisms are increasingly recognized for fostering quality improvement in healthcare. P4P programs conventionally reward providers with supplemental payments upon achieving predefined performance targets. This study aims to utilize decision modelling to determine the cost-effectiveness and maximum incentive levels of P4P programs. Methods A decision model, grounded in previously published models exploring the cost-effectiveness of implementation programs, was developed. The model evaluates the cost-effectiveness of P4P programs for an exogenous reward size under varied reward mechanisms and also in scenarios with and without a budget or time constraint. Results In instances where P4P programs do not substitute other healthcare programs, their incremental cost-effectiveness ratio (ICER) is deterministically set and ranges from treatment ICER to infinity, irrespective of the reward mechanism. With a budget or time constraint in play, the P4P program is incentivized up to the point where its population cost or ICER aligns with that of the program being replaced. Conclusion The proposed decision model effectively calculates the cost-effectiveness and budget impact of P4P programs, accommodating various reward mechanisms and scenarios, both with and without budget or time constraints.

Abstract Background Lung cancer is one of the leading causes of morbidity and mortality in Brazil. Radiotherapy is an important therapeutic option, but the techniques used remain subjects of discussion. In this study, we compared the costs of conventional radiotherapy (CRT) and stereotactic ablative radiotherapy (SABR) in the treatment of early-stage non-small cell lung cancer (NSCLC). Methods This cost analysis study adopted a micro-costing approach, following the TDABC (Time-Driven Activity-Based Costing) methodology. The study was conducted at a specialized public cancer hospital in São Paulo, Brazil. The analysis involved seven macro-processes related to radiotherapy treatment, identifying resources, costs, and time estimates for each step. Results The cost analysis revealed that SABR treatment for NSCLC is significantly cheaper than CRT. The direct costs of SABR treatment ranged from $2,777.25 to $3,797.49, while CRT ranged from $5,562.65 to $6,052.94. The cost related to CRT treatment constituted more than 80% of the total costs, whereas in SABR, it ranges from 59 to 68%. Planning represented 9% to 10% of the cost in CRT, increasing to 22% to 30% in SABR. Conclusions The results highlight that SABR treatment is a cheaper option for early-stage NSCLC patients when compared to CRT. Furthermore, the increased time required for CRT treatment limits the number of patients who can be treated. These results may influence healthcare policies and the financing of the healthcare system, directly benefiting patients and promoting the efficient allocation of resources.

Abstract Background This study explores patients' perceptions and expectations of smart healthcare services from the perspective of patient experience.The aim is to provide insights for the development of smart healthcare services in hospitals. Methods A cluster sampling method was used to select 10 public county-level hospitals from October to November 2021 in a municipality in southwestern China. Patient expectations and perceptions about smart healthcare services were assessed using SERVQUAL scale, which included 24 items across four dimensions: ability, application, platform, and effectiveness. The perception-expectation gap was calculated, and factors influencing this gap were analyzed. The Importance-Performance Analysis (IPA) model was then applied to evaluate the results. Results A total of 915 patients from outpatient and inpatient departments participated in the study. The average perception score was 3.86, while the average expectation score was 4.44, resulting in a gap of -0.58. Paired sample t-tests revealed significant differences between patients' perceptions and expectations across the 24 items (P

Abstract Introduction In low- and-middle-income-countries (LMICs) like Ghana, universal access to quality healthcare remains a mirage and this undermines achievement of sustainable development goal (SDG) 3. The SafeCare Quality Improvement (QI) programme is an initiative of PharmAccess Foundation, a Netherlands-based non-governmental organisation (NGO). In 2009 SafeCare QI programme was launched in Ghana to help address gaps in healthcare quality standards, leveraging existing local resources. Over 600 private and public healthcare facilities are currently enrolled in the programme and is being adopted for nation-wide rollout by government of Ghana and implementing partners. Objective This paper explored views and experiences of frontline health staff and policy makers on the SafeCare quality improvement programme in Ghana and how local resources were leveraged in its implementation. Methodology Design/setting: The evaluation was conducted in 53 private and public healthcare facilities from seven administrative regions of Ghana across the coastal, middle, and northern geopolitical belts. The regions are Ashanti (n = 12), Bono East (n = 8), Bono (n = 3), Greater Accra (n = 12), Oti (n = 4), Savannah (n = 8) and Western (n = 9). Sampling: Quota and purposive sampling techniques were used to sample the healthcare facilities in accordance with the study eligibility criteria. Total of 45 focus group discussions (FGDs) and 47 individual in-depth interviews (IDIs) were conducted among frontline staff and policy makers from government and private local partner institutions. Analysis: Group and individual interviews were audio recorded, transcribed verbatim and thematic content analysis done using Nvivo (version 12.0) software. Findings Overall, participants perceived the relevance and benefits of the SafeCare programme to be "very satisfactory" while the programme impact, rollout process and success were perceived to be "satisfactory". Quality healthcare standards were perceived to have improved in beneficiary health facilities due to participation in the SafeCare programme. Patient satisfaction, service utilisation and revenue generation in healthcare facilities were also attributed to the SafeCare programme. Proposals were made for harmonisation of existing QI assessment tools to mitigate duplications. Agreed data sharing protocols and interoperability with existing national database were also recommended to promote sustainability. Finally, low staff motivation, high workload, lack of financial and material resources were cited as potential impediments to full compliance with the SafeCare QI standards by healthcare facilities enrolled in the programme. Conclusions SafeCare QI programme has contributed to QI and adherence to patient safety standards in Ghana. Sustainability is however dependent on continuous government commitment as the programme gets adopted as a national QI programme. Overlaps in content of QI assessment tools ought to be addressed to promote efficiency without compromising quality standards. The SafeCare programme demonstrates that health systems in LMICs have the potential to attain acceptable quality healthcare standards when they take advantage of existing local resources, including private-public partnership (PPP) and peer-learning opportunities.