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BACKGROUND:  Telemedicine expanded rapidly during the COVID-19 pandemic, as key policy changes, financial support, and pandemic fears tipped the balance toward internet-based care. Despite this increased support and benefits to patients and clinicians, telemedicine uptake was variable across clinicians and practices. Little is known regarding physician and institutional characteristics underlying this variability. OBJECTIVE:  This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response. METHODS:  We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse. RESULTS:  Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30% of visits increased from 29.2% (70/239) to 35.7% (85/238). Relative to primary care, odds of substantial telemedicine use (>30%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, census region, or years in practice. CONCLUSIONS:  Prepandemic telemedicine use, high local COVID-19 case counts, and clinician specialty were associated with higher levels of substantial telemedicine use during the early pandemic response. These results suggest that telemedicine uptake in the face of the pandemic may have been heavily influenced by the level of perceived threat and the resources available for implementation. Such understanding has important implications for reducing burnout and preparation for future public health emergencies.

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: There is mounting evidence indicating that the aging process initiates during early life stages, with in utero the individuals environment playing a significant role. Consequently, it is crucial to comprehend the enduring effects of early life circumstances on health in old age. WHAT IS ADDED BY THIS REPORT?: In this study, we conducted a meta-analysis to examine the effects of the Chinese Famine (1959-1961) on the health of older adults. We also explored potential mechanisms underlying these effects. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: The complex interplay between early life circumstances, multiple health-related sectors, and healthy aging necessitates a comprehensive life-course approach and strategic interventions to enhance public health in an aging society.

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Evaluation of the heterogeneous treatment effect (HTE) allows for the assessment of the causal effect of a therapy or intervention while considering heterogeneity in individual factors within a population. Machine learning (ML) methods have previously been employed for HTE evaluation, addressing the limitations associated with modelling complex systems. In this work, three tree-based ML algorithms, causal random forest (CRF), causal Bayesian additive regression trees (CBART), and causal rule ensemble (CRE), are used to analyze the potential causation of benzene exposure to cause childhood acute myeloid leukemia (AML). Data for this analysis is generated by drawing samples from a previously developed model that estimates AML probability given as input demographic information and benzene exposure. Comparison is drawn between the three tree-based algorithms in terms of the predicted average treatment effect (ATE), the regression coefficient of determination, and the computational time of each algorithm. Minimal difference is reported between the three tree-based algorithms in terms of the ATE, as well as the regression coefficient of determination. However, CRF outperforms CBART in terms of algorithm computational time. Moreover, CRF allows for both continuous and binary treatment variables, as opposed to CBART and CRE, making it better suited to environmental health studies, where exposure levels of pollutants shall be considered continuous. Following the comparison of all three algorithms, the influence of adding Gaussian noise to the treatment and outcome variables, as well as outliers, is investigated using CRF. A set of considerations is drawn to guide researchers in using these algorithms. These considerations detail the simulation settings, applications, and results interpretation and aim to provide prompt information in decision-making surrounding the establishment of pollutant exposure thresholds in environmental risk assessments. [ABSTRACT FROM AUTHOR]

Institutional quality (InQ) plays an important role in shaping economic growth (ECG), influencing how economies develop and perform. The literature addresses the nexus between InQ and ECG and the link between health and ECG; findings are often contradictory, creating knowledge gaps. Importantly, research on the interplay between InQ, health, and ECG in Sub-Saharan African (SSA) countries is particularly limited. This study aims to address this gap by evaluating how health impacts ECG, with an emphasis on the mediating role of InQ in the health–growth nexus in SSA. This study examines these interplays across 35 SSA countries from 2012 to 2022. The life expectancy at birth (LEX) and real gross domestic product per capita (GDP) are used as proxies for health outcomes and ECG, respectively. The system generalised method of moments estimator is employed to analyse data. Results show that the LEX has a strong positive effect on economic growth in SSA countries. Furthermore, the InQ indicators (such as control of corruption, government effectiveness, rule of law and political stability, and absence of violence) are positively correlated with ECG. When the LEX interacts with InQ indicators, InQ is identified as a key channel through which LEX influences ECG. The findings confirm that InQ plays a crucial role in the health–growth nexus, with the positive impact of LEX on ECG being more pronounced in countries with higher levels of InQ, while the effect is weaker in countries with lower levels of InQ. The findings of this study have crucial policy implications, highlighting the intricate link among institutional quality, health outcomes, and economic growth. This study's findings provide essential insights for policymakers to design focused strategies that improve InQ and health outcomes to achieve sustained ECG in SSA. [ABSTRACT FROM AUTHOR]

With the rapid progress of industrialization and commercialization, the sales and population intake of ultra-processed foods (UPFs) are constantly increasing globally. High UPFs intake is associated with various health issues. This article provided a brief overview of various health outcomes and explored the possible causes for the health impacts of UPFs consumption from the perspectives of processing and production. The review found that high UPFs intake increased the risks of adult overweight/ obesity, type 2 diabetes, cancer mortality, and anxiety disorders; maternal preeclampsia, gestational hypertension, and gestational diabetes; childhood and adolescent overweight/ obesity. High UPFs intake also affected embryonic development and offspring language development. The possible explanations for the negative health outcomes associated with UPFs were as follows. The convenience and increased accessibility of UPFs affect the dietary structure of the population. The combined exposure to refined carbohydrates and fats added to UPFs increases the desire and motivation for more energy intake. The complex processing process leads to the loss of dietary fibers and micronutrients, affecting human satiety, digestion rate, chewing duration, and producing toxic compounds such as furan, heterocyclic amines, polycyclic aromatic hydrocarbons, and acrolein. The introduction of more types and higher doses of food additives and the migration of exogenous pollutants from packaging materials to food pose potential health and safety risks. At present, there is little research on the relationship between UPFs and human health in China. Based on the known health risks of UPFs, more in-depth research is needed in order to better understand the relationship between UPFs and human health.

Abstract This study investigates the impact of air pollution on health outcomes in Middle Eastern countries, a region facing severe environmental challenges. As such, these are important in an effort to add up to policy-level as well as interventional changes that can be put in practice in the area of public health. Numeration analysis and association with health parameters was carried out by using Analytical tools such as, AIR Data, ARIMA,ANN, SVM and Exponential smoothing. Amongst the models, Support Vector Machine came again on top, with high accuracy yielding Mean Absolute Percentage Error of approximately 1%. Mortality of Air pollution in Qat from the case of Mortality of Air Pollution in Qatar is 959 while Auto regressive Integrated Moving average is 11.096, Exponential Smoothing 9.892 and Artificial Neural Networks are the source of inspiration for the development of this paper 4.61. The above perceptions indicate that there is need to adapt modeling strategies depending on the context and establish that it is possible to implement ML models in public health planning basket. This paper publishes the methodological frameworks for the purpose of modeling and analysis of the EHDs and serves as policy prescription for the policy makers to intending to reduce the effects of air borne pollution on health.

Recently, health-related issues have been attributed to some environmental factors and practices in Sub-Saharan Africa (SSA). These factors have further increased the high mortality rate despite increased spending on health. This study investigates the impact of environmental degradation and renewable energy consumption on the health outcomes of the population in the region. The study used a panel of 45 SSA countries from 2000 to 2019 and employed the generalized method of moments (GMM) and pooled mean group (PMG) regression analysis system. The findings reveal that increased environmental degradation in the form of CO2 emissions exposes people to health hazards, thus reducing their life expectancy. Renewable energy consumption, on the other hand, is a major contributor to the increase in life expectancy. The study recommends adopting the appropriate energy mix to reduce the consumption of non-renewable energy. [ABSTRACT FROM AUTHOR]

Background: The medication regimen for critically ill patients is complex and dynamic, leading to a high incidence of drug-related problems. This study aimed to assess the effectiveness and economic efficiency of pharmaceutical care for these patients. Methods: In this prospective cohort study conducted in a tertiary hospital, adult patients were assigned either to a clinical pharmaceutical care group or a control group based on existing clinical grouping rules. Health outcomes and economic indicators were collected, followed by a cost-effectiveness analysis. Results: The acceptance rate for clinical pharmacist interventions was 89.31%. The pharmaceutical care group exhibited significant reductions in the rate of medication errors (40.65% vs. 61.69%, P < 0.001) and adverse drug events (44.52% vs. 56.45%, P = 0.020). The usage rates for special-grade antibiotics (85.16% vs. 91.13%, P = 0.009) and proton pump inhibitors (77.42% vs. 88.71%, P = 0.002) were also lower in the pharmaceutical care group. Secondary outcomes did not show significant differences in total hospital stay (21 days vs. 22 days, P = 0.092). However, ICU stay was significantly shorter (9 days vs. 11 days, P = 0.003) in the pharmaceutical care group. Cost-effectiveness analysis demonstrated that each 1% reduction in adverse drug events associated with ICU pharmaceutical care saved $226.75 in ICU hospitalization costs and $203.42 in total ICU drug costs. A 1% reduction in the medication error rate saved $128.57 in ICU hospitalization costs and $115.34 in total ICU drug costs. Conclusions: Pharmaceutical care significantly reduces adverse drug events and medication errors, promotes rational use of medications, decreases the length of ICU stay, and lowers treatment costs in critically ill patients, establishing a definitive advantage in terms of cost-effectiveness. [ABSTRACT FROM AUTHOR]

ObjectiveTo compare the development status of health facilities in different regions (non-agricultural and agricultural districts)and different types across four dimensions: organizational management, health environment, health activities, and health outcomes, to explore factors that may affect the current development status and summarize effective experiences, and to provide a foundation for the subsequent comprehensive, standardized, and effective promotion of health facility development and tiered and classified management.MethodsInvestigators conducted a health status survey based on the four dimensions for 50 health facilities in 16 districts of Shanghai, representing three types (including government agencies, enterprises, and communities). Evaluation forms were filled out through on-site observation and document reviews, which were developed in accordance with the Shanghai Health Settings Evaluation Standards (for trial implementation in 2019).ResultsThe average total score of health facilities in Shanghai was (88.42±11.93) points, with an overall excellence rate of 86.0%. The excellence rate of each dimension, from highest to lowest, were healthy environment (84.0%), organizational management (82.0%), health activities (78.0%), and health outcomes (44.0%). Health facilities in agricultural districts scored higher in both total score and average score on the organizational management dimension compared to non-agricultural districts. The excellence rate for the organizational management dimension was also higher in agricultural districts than in non-agricultural districts. There was no statistical significance in the total score, the score of each dimension, the overall excellence rate, and the excellence rate of each dimension among different types of health facilities (P>0.05).ConclusionThe development of health facilities among government agencies, enterprises, and communities in Shanghai has begun to yield positive results. Health facilities in non-agricultural districts should actively draw on the experience of those in agricultural districts, particularly in organizational management, adjust development ideas and planning based on their own realities, so as to continuously improve the levels of development.

We investigated the influence of social determinants of health (SDOH), healthcare services, and health behaviors on mental and physical health outcomes of cancer patients between the first winter and the following post-vaccine summer of the COVID-19 pandemic. A three-wave online survey of individuals diagnosed with incident cancer between January 2019 and January 2020 was conducted between November of 2020 and August of 2021 in northeast Ohio. Descriptive analysis and mixed-effect regression analyses were performed. A total of 322 newly diagnosed cancer patients, with 40 African Americans and 282 Whites (215 from metropolitan areas and 67 nonmetropolitan) responded to the survey questions. In Wave 3 ending in August 2021, the survey respondents reported significantly reduced depression (p =.019) on the Hamilton Depression Rating Scale and improved global health (p =.036) on PROMIS. With age, comorbidity, and other demographic and medical variables controlled in the analyses, the feeling of loneliness (p <.001) and crowded living space (p =.001, p =.015) were the two most prominent factors associated with depression, irritability, and poor global health at baseline, with the lowest p values and persistent effect. Self-efficacy of taking preventive measures was associated with reduced depression (p =.001) and improved global health (p =.029). Increasing access to medicine (p <.01) and satisfaction with telehealth appointments (p <.01) were significantly associated with better global health and reduced irritability. Respondents who had private health insurance reported better health than those that had Medicare coverage only (p <.05). This longitudinal, observational study demonstrated the impact of SDOH on health outcomes of cancer patients. Substandard living conditions resulting in loneliness and crowdedness, quality of medical care (e.g., quality telehealth and access to medicine), and personal behaviors (e.g., self-efficacy) were significantly associated with health outcomes in newly diagnosed cancer patients during the pandemic and should be given adequate consideration for the purpose of improving clinical care. [ABSTRACT FROM AUTHOR]

The IMPRoving Exposure aSSessment Methodologies for Epidemiological Studies on Pesticides (IMPRESS) project (http://www.impress-project.org/) aimed to further the understanding of the performance of pesticide exposure assessment methods (EAMs). To achieve this the IMPRESS project used two approaches to assess EAM performance, using existing and newly collected data from five studies from three different countries and use of published secondary data to undertake three meta-analyses for selected chronic health outcomes. Based on the findings of the IMPRESS project we provide in this paper insights on the overarching research question “How can exposure assessments for pesticides in epidemiological studies be improved”? Exposure assessment is a critical component of pesticide epidemiological studies. EAMs used and epidemiological practices employed need to reflect the changing nature and complexities of pesticide exposure in various occupational settings. To properly assess the association between exposure and selected health outcomes, the choice of EAM should provide a clear exposure contrast within the study population. Acquiring a practical understanding of the pesticide use practices is crucial to determine whether factors such as frequency or intensity of exposure have to be considered in planned analyses. Biomonitoring may be more beneficially applied intensively in a focussed exposure assessment analysis of a particular cohort, which can be used to determine the most relevant exposure factors within that cohort-specific context. Overall, improving pesticide exposure assessment in epidemiological studies requires a multi-disciplinary approach. A next step for the wider scientific community may be to consider the development of a decision tree to aid the selection of suitable EAMs. Such a decision tree would need to consider and be based on multiple parameters including, but not limited to, study type, health endpoint, socio-demographic context, farming system, pesticide used, and application methods.

Volunteering in the advancing years has received abundant attention amongst the ageing population. A mini review of past studies on the key concepts of volunteerism with regard to the research area on the well-being of OAs and the types of evidence available is conducted. Developing and implementing the search strategy for this review occurred in two stages: the search was conducted at the university's digital library and using manual search. A total of 17 articles were included in the final literature review. The current study reviews the effect of volunteering on various health outcomes such as emotional health, physical health, levels of happiness and life satisfaction, purpose in life, and greater feelings of personal control.

Abstract Aims Recent updates of international treatment guidelines for heart failure with reduced ejection fraction (HFrEF) differ regarding the use of angiotensin receptor neprilysin inhibitor (ARNI) as first‐line treatment. The American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) 2022 guidelines gives ARNI a Class IA recommendation for HFrEF patients while the European Society of Cardiology's guidelines are less clear when ARNI could be considered as first line treatment option in de novo patients. This study aimed to model the clinical and budgetary outcomes of implementing these guidelines, comparing conservative ARNI prescription patterns with less conservative in Sweden and in the United Kingdom. Methods and results A health economic model was developed to compare different treatment patterns for HFrEF. Incident cohorts were included on an annual basis and followed over 10 years. The model included treatment specific all‐cause mortality and hospitalization rates, as well as drug acquisition, monitoring, and hospitalization costs. Increasing the use of ARNI could lead to about 7000–12 300 life years gained and 2600–4600 hospitalizations prevented in Sweden. These health benefits come with an additional cost of 112–195 million euros. Similar results were estimated for the United Kingdom, albeit on a larger population. Conclusions Increasing the proportion of patients receiving ARNI instead of angiotensin converting enzyme inhibitors as first‐line treatment of HFrEF will lead to a considerable number of additional life years gained and prevented hospitalizations but with additional cost in terms of health care expenditure in Sweden and in the United Kingdom.

Institutional quality (InQ) plays an important role in shaping economic growth (ECG), influencing how economies develop and perform. The literature addresses the nexus between InQ and ECG and the link between health and ECG; findings are often contradictory, creating knowledge gaps. Importantly, research on the interplay between InQ, health, and ECG in Sub-Saharan African (SSA) countries is particularly limited. This study aims to address this gap by evaluating how health impacts ECG, with an emphasis on the mediating role of InQ in the health–growth nexus in SSA. This study examines these interplays across 35 SSA countries from 2012 to 2022. The life expectancy at birth (LEX) and real gross domestic product per capita (GDP) are used as proxies for health outcomes and ECG, respectively. The system generalised method of moments estimator is employed to analyse data. Results show that the LEX has a strong positive effect on economic growth in SSA countries. Furthermore, the InQ indicators (such as control of corruption, government effectiveness, rule of law and political stability, and absence of violence) are positively correlated with ECG. When the LEX interacts with InQ indicators, InQ is identified as a key channel through which LEX influences ECG. The findings confirm that InQ plays a crucial role in the health–growth nexus, with the positive impact of LEX on ECG being more pronounced in countries with higher levels of InQ, while the effect is weaker in countries with lower levels of InQ. The findings of this study have crucial policy implications, highlighting the intricate link among institutional quality, health outcomes, and economic growth. This study’s findings provide essential insights for policymakers to design focused strategies that improve InQ and health outcomes to achieve sustained ECG in SSA.

The clinical importance of adhering to the regimen in tuberculosis patients has been widely investigated, but most studies were conducted in controlled settings and in limited populations. We aimed to measure the level of real-world adherence during intensive phase and investigate the predictors and the risk of mortality and health outcomes of intensive phase non-adherence in tuberculosis patients. We conducted a nationwide cohort study by linking the Korean National Tuberculosis Surveillance System and the National Health Information Database. We included all incident drug-susceptible tuberculosis patients who initiated the regimens recommended by the World Health Organization from 2013 to 2018. Adherence was measured using the proportion of days covered (poor [<50%], moderate [50%–79%], and high [≥80%]). We used logistic regression model to assess predictors and the Cox proportional hazard model to evaluate the risk of mortality and health outcomes with intensive phase non-adherence. Of 46,818 patients, there were 8% and 11% with poor and moderate adherent groups, respectively. Age ≥45 years, insulin use, and history of renal failure were predictors of non-adherence. Compared with high adherent group, poor and moderate adherent groups were associated with a substantial risk of mortality (poor: hazard ratio, 2.14 [95% confidence interval, 1.95–2.34]; moderate: 1.76 [1.62–1.92]). Similar trends were observed for health outcomes. Stratified analyses showed a higher risk of mortality in patients with medical aid, low income, and history of renal failure, systematic corticosteroids, and immunomodulators. Non-adherence during intensive phase increased mortality risk by twofold, underscoring targeted intervention for high-risk population, including advanced diabetes, and immunocompromised patients. [ABSTRACT FROM AUTHOR]

Aims: Recent updates of international treatment guidelines for heart failure with reduced ejection fraction (HFrEF) differ regarding the use of angiotensin receptor neprilysin inhibitor (ARNI) as first‐line treatment. The American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) 2022 guidelines gives ARNI a Class IA recommendation for HFrEF patients while the European Society of Cardiology's guidelines are less clear when ARNI could be considered as first line treatment option in de novo patients. This study aimed to model the clinical and budgetary outcomes of implementing these guidelines, comparing conservative ARNI prescription patterns with less conservative in Sweden and in the United Kingdom. Methods and results: A health economic model was developed to compare different treatment patterns for HFrEF. Incident cohorts were included on an annual basis and followed over 10 years. The model included treatment specific all‐cause mortality and hospitalization rates, as well as drug acquisition, monitoring, and hospitalization costs. Increasing the use of ARNI could lead to about 7000–12 300 life years gained and 2600–4600 hospitalizations prevented in Sweden. These health benefits come with an additional cost of 112–195 million euros. Similar results were estimated for the United Kingdom, albeit on a larger population. Conclusions: Increasing the proportion of patients receiving ARNI instead of angiotensin converting enzyme inhibitors as first‐line treatment of HFrEF will lead to a considerable number of additional life years gained and prevented hospitalizations but with additional cost in terms of health care expenditure in Sweden and in the United Kingdom. [ABSTRACT FROM AUTHOR]

Neuroscience and biological evidence emphasizes the profound influence of natural light on human health, offering benefits such as reducing fatigue, heightened alertness in healthcare providers, and improving patient outcomes. The objective of this review is to identify scientific studies and research to evaluate and report evidence of indoor lighting conditions' influence on health outcomes, which can be used to develop lighting designs that align circadian rhythms in healthcare settings. A comprehensive search was conducted to identify rigorous empirical studies focused on the link between interior lighting conditions with health outcomes in the healthcare environment. For a comprehensive review of the existing literature, a four-phased methodology was employed including literature search, screening, and selection. Literature appraisals were conducted to determine the relevance and quality of evidence for each study identified. In addition, using a thematic analysis, patterns were identified, analyzed, and interpreted within the literature review. Accordingly, the results were organized into two main groups interventional human subjects and simulation-based studies. Despite evidence that natural light influences human health and happiness, a synthesis of reviewed studies suggests that the evidence for the benefits of artificial lighting in healthcare settings is less conclusive, with potential factors including variations in lighting design, inconsistent implementation of lighting interventions, and differing sample populations across studies. We conclude with an executive summary suggesting that future research should use standardized metrics and methods to focus on bridging the gap between theoretical understanding and practical application in lighting design for healthcare environments. Collaboration among architects, designers, lighting experts, and healthcare professionals can address these factors contributing to building a stronger evidence-based design for the benefits of artificial lighting in healthcare settings. [ABSTRACT FROM AUTHOR]

BACKGROUND: To assess relevant environmental conditions in any work-setting requires a multidisciplinary perspective that is practical, valid, and reliable. This includes the physical, environmental, and psychosocial risk-factors. The Structured Multidisciplinary work Evaluation Tool (SMET) questionnaire simultaneously considers multiple work-related demands. OBJECTIVE: This study translated and culturally adapted the SMET into Persian and evaluated its psychometric properties in Persian industrial workers. METHODS: Cross-sectional translation and cross-cultural adaptation in five standardized phases. A convenience sample (n = 211) recruited from an industrial-occupation setting completed: the SMET; and the Rapid Upper Limb Assessment (RULA), and National Aeronautics and Space Administration Task Load Index (NASA-TLX) criteria; plus light and noise levels were concurrently assessed. Psychometric properties included: validity, with face (from confirmed language clarity, simplicity, and readability), content (via the content validity index, CVI, for equivalency and relevancy), criterion (through Pearson's r correlation with relevant criteria), and construct (through known group validity between participants with/without work-related musculoskeletal disorders, WMSDs); internal consistency (Cronbach's α); and test-retest reliability (intraclass correlation coefficient, ICC2.1). RESULTS: Validity was confirmed with: face through the adaptation; content from suitable CVI values for items (CVI range = 0.78–1.0) and scale-total (CVI = 0.86); criterion from SMET associations with levels for light (r = – 0.42) and noise (r = 0.21), plus RULA (r = 0.42) and NASA-TLX (r = 0.39); and construct through participants with WMSD having significantly higher SMET total-scores (p = 0.01). Internal consistency (α= 0.89) and reliability (ICC2.1 = 0.87) were acceptable and strong. CONCLUSION: This study indicated that the SMET Persian version had acceptable psychometric properties in an industrial occupational setting. Further investigation in longitudinal populations is recommended. [ABSTRACT FROM AUTHOR]

This study examined intimate partner violence patterns using the National Intimate Partner and Sexual Violence Survey, a nationally representative sample collected in 2010. The latent class analysis detected six distinctive patterns: Sexual Violence, Psychological Aggression, Multiple Violence, Coercive Control, Physical and Psychological Violence, and Stalking. Multiple Violence was the most common among males, while Coercive Control was the most common among females. Multiple Violence and Physical and Psychological Violence perpetrators inflicted more negative health consequences than the other types. Intervention and prevention approaches that consider perpetrator types as a part of survivor need assessments will improve services. [ABSTRACT FROM AUTHOR]

This article explores the impact of various crises on the public health of children and adolescents in Europe, including the COVID-19 pandemic, migration, global conflicts, energy shortage, and increased cost of living. These crises have worsened existing health issues and increased inequality among children. The article suggests several measures to mitigate the negative health effects of crises and promote the well-being of children and adolescents, such as preparedness, data collection for evidence-based actions, addressing health inequalities, advocacy, and community empowerment. The authors stress the importance of an integrated and long-term approach, as well as sustained funding, to support children's well-being and address their evolving needs. The article is an open-access publication from the Journal of Pediatrics, in collaboration with the Swiss School of Public Health and the Association of Schools of Public Health of the European Region, and is copyrighted by Frontiers. [Extracted from the article]

Large language models (LLMs) continue to exhibit noteworthy capabilities across a spectrum of areas, including emerging proficiencies across the health care continuum. Successful LLM implementation and adoption depend on digital readiness, modern infrastructure, a trained workforce, privacy, and an ethical regulatory landscape. These factors can vary significantly across health care ecosystems, dictating the choice of a particular LLM implementation pathway. This perspective discusses 3 LLM implementation pathways—training from scratch pathway (TSP), fine-tuned pathway (FTP), and out-of-the-box pathway (OBP)—as potential onboarding points for health systems while facilitating equitable adoption. The choice of a particular pathway is governed by needs as well as affordability. Therefore, the risks, benefits, and economics of these pathways across 4 major cloud service providers (Amazon, Microsoft, Google, and Oracle) are presented. While cost comparisons, such as on-demand and spot pricing across the cloud service providers for the 3 pathways, are presented for completeness, the usefulness of managed services and cloud enterprise tools is elucidated. Managed services can complement the traditional workforce and expertise, while enterprise tools, such as federated learning, can overcome sample size challenges when implementing LLMs using health care data. Of the 3 pathways, TSP is expected to be the most resource-intensive regarding infrastructure and workforce while providing maximum customization, enhanced transparency, and performance. Because TSP trains the LLM using enterprise health care data, it is expected to harness the digital signatures of the population served by the health care system with the potential to impact outcomes. The use of pretrained models in FTP is a limitation. It may impact its performance because the training data used in the pretrained model may have hidden bias and may not necessarily be health care–related. However, FTP provides a balance between customization, cost, and performance. While OBP can be rapidly deployed, it provides minimal customization and transparency without guaranteeing long-term availability. OBP may also present challenges in interfacing seamlessly with downstream applications in health care settings with variations in pricing and use over time. Lack of customization in OBP can significantly limit its ability to impact outcomes. Finally, potential applications of LLMs in health care, including conversational artificial intelligence, chatbots, summarization, and machine translation, are highlighted. While the 3 implementation pathways discussed in this perspective have the potential to facilitate equitable adoption and democratization of LLMs, transitions between them may be necessary as the needs of health systems evolve. Understanding the economics and trade-offs of these onboarding pathways can guide their strategic adoption and demonstrate value while impacting health care outcomes favorably. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity is a global issue for cancer survivors. Wearable activity trackers are promising to address physical inactivity by providing real-time feedback on physical activity and offering opportunities for self-monitoring and goal setting. Meta-analysis has reported the effects of interventions that incorporate wearable activity trackers on improved physical inactivity and related health outcomes (eg, BMI, anxiety and depression, and self-rated health status). However, wearable activity trackers were often used as an adjunct to physical activity interventions, and the effectiveness of wearable activity trackers alone is unknown. Objective: This study aims to determine the association of wearable activity trackers with physical activity and health outcomes in patients with cancer. Methods: Data from 957 cancer survivors from the Health Information National Trends Survey–Surveillance, Epidemiology, and End Results (HINTS-SEER) were analyzed. The outcome variables examined were time spent in moderate to vigorous physical activity, weekly frequency of strength training, BMI, anxiety and depression levels, and self-assessed health status. The primary independent variable was whether cancer survivors had used wearable activity trackers within the past 12 months. Design-based linear regression for continuous outcome variables and ordinal logistic regression for ordinal outcome variables were conducted to determine the associations after controlling for sociodemographic, cancer-related, and health-related factors. All data analyses accounted for the complex survey design and sample weights. Results: Only 29% of cancer survivors reported wearable activity tracker use. Bivariate analyses showed that younger age (P <.001), higher education (P =.04), higher income (P <.001), and an employed status (P <.001) were significantly associated with wearable activity tracker use. Wearable activity tracker use was significantly associated with higher time spent in moderate to vigorous physical activity (adjusted =37.94, 95% CI 8.38-67.5; P =.01), more frequent strength training per week (adjusted odds ratio [OR] 1.50, 95% CI 1.09-2.06; P =.01), and better self-rated health status (adjusted OR 1.58, 95% CI 1.09-2.29; P =.01), but not with BMI or anxiety and depression. Conclusions: This study suggests that the uptake of wearable activity trackers is low and highlights the digital divide among patients with cancer. This study has confirmed the associations of wearable activity tracker use with physical activity and self-rated health, supporting using wearable activity trackers as a promising tool to facilitate physical activity promotion. [ABSTRACT FROM AUTHOR]

Background: Patient and staff experience is a vital factor to consider in the evaluation of remote patient monitoring (RPM) interventions. However, no comprehensive overview of available RPM patient and staff experience–measuring methods and tools exists. Objective: This review aimed at obtaining a comprehensive set of experience constructs and corresponding measuring instruments used in contemporary RPM research and at proposing an initial set of guidelines for improving methodological standardization in this domain. Methods: Full-text papers reporting on instances of patient or staff experience measuring in RPM interventions, written in English, and published after January 1, 2011, were considered for eligibility. By "RPM interventions," we referred to interventions including sensor-based patient monitoring used for clinical decision-making; papers reporting on other kinds of interventions were therefore excluded. Papers describing primary care interventions, involving participants under 18 years of age, or focusing on attitudes or technologies rather than specific interventions were also excluded. We searched 2 electronic databases, Medline (PubMed) and EMBASE, on February 12, 2021.We explored and structured the obtained corpus of data through correspondence analysis, a multivariate statistical technique. Results: In total, 158 papers were included, covering RPM interventions in a variety of domains. From these studies, we reported 546 experience-measuring instances in RPM, covering the use of 160 unique experience-measuring instruments to measure 120 unique experience constructs. We found that the research landscape has seen a sizeable growth in the past decade, that it is affected by a relative lack of focus on the experience of staff, and that the overall corpus of collected experience measures can be organized in 4 main categories (service system related, care related, usage and adherence related, and health outcome related). In the light of the collected findings, we provided a set of 6 actionable recommendations to RPM patient and staff experience evaluators, in terms of both what to measure and how to measure it. Overall, we suggested that RPM researchers and practitioners include experience measuring as part of integrated, interdisciplinary data strategies for continuous RPM evaluation. Conclusions: At present, there is a lack of consensus and standardization in the methods used to measure patient and staff experience in RPM, leading to a critical knowledge gap in our understanding of the impact of RPM interventions. This review offers targeted support for RPM experience evaluators by providing a structured, comprehensive overview of contemporary patient and staff experience measures and a set of practical guidelines for improving research quality and standardization in this domain. [ABSTRACT FROM AUTHOR]

Background: Traditionally, general practitioners (GPs) have initiated the need for, and ordered, radiological tests. With the emergence of consumer-centred care, patients have started to request scans from doctors on their own initiative. Consumeristic health care has shifted the patient–doctor dyadic relationship, with GPs trending towards accommodating patients' requests. Methods: A mixed method analysis was conducted using a survey instrument with open ended questions and concurrent interviews to explore participants' responses from their requests for radiological studies from GPs. Themes emerging from both qualitative and quantitative methodologies were mapped onto the Andersen Newman Model (ANM). Results: Data were analysed for 'predisposing,' 'need' and 'enabling' elements of the ANM model and were correspondingly mapped to patient's requests for radiological referrals according to the elements of the ANM. Participants expressed anxiety about their health, were confident in the types of radiological scans they desired and typically indicated the need for evidence of good health. Their desire for such requested scans was often enabled through prior exposure to health information and the experience of specific symptoms. Requests came with the expectation of validation, and if these requests were denied, participants indicated that they would seek another doctor who would oblige. Conclusions: In our modest study of Australian patients, participants were well informed about their health. Exposure to information seems to create a sense of anxiousness prior to visiting the doctor. Individuals sought visual proof of wellness through imaging, and doctors in return often accommodated patient requests for radiological studies to appease patients' needs and to maintain workflow. With increased availability of online health information, individuals are more educated about managing their health care. Our study investigates patients requesting their own radiological scans rather than relying on their doctors' expertise. We explore participant responses to clinical encounters where they have initiated a radiological study from their general practitioner, and their self-reported responses and outcomes from such requests. [ABSTRACT FROM AUTHOR]

This Viewpoint presents a case study that explored the effects of using a performance-based Memorandum of Understanding (MoU) in public health donor programs to enhance health metrics, program efficiency, and accountability. The MoU between Kebbi State Government in Nigeria and the United States Agency for International Development (USAID) focused on strengthening primary healthcare. It covered Health Systems Strengthening (HSS) indicators, overseen by an Operations Committee (OC) and a high-level Steering Committee (SC). Quarterly and biannual reviews tracked indicators through a dashboard developed by the Integrated Health Program (IHP). Results suggest that the MoU led to better monitoring of primary healthcare (PHC) revitalization, health sector work plan harmonization, and data quality. Dashboard tracking showed improved health facility financing, immunization, antenatal care, and skilled attendants at births. The use of the MoU demonstrated potential for boosting program efficiency, cost-effectiveness, and political commitment for resource mobilization in public health initiatives. Results support recommending MoUs as valuable tools for effective outcome-driven public health funding. [ABSTRACT FROM AUTHOR]

How does the generosity of social insurance coverage affect the demand for healthcare and health outcomes of elderly people? This paper presents an examination of the effects of insurance coverage on long-term care (LTC) utilization and its health consequences using administrative data of the public long-term care insurance (LTCI) system in Japan. In LTCI, a recipient's health score determines their insurance coverage limit, and thresholds of the score generate discontinuous changes in the level of coverage limits. I implement a regression discontinuity design and find that coverage expansion increases recipients' LTC utilization considerably irrespective of their health status. When more generous insurance coverage is available, recipients with low care needs increase day care and rehabilitation services, whereas those with high care needs increase home care services. Moreover, using more LTC has little effect on health outcomes such as the health score and the entry into nursing homes. Together, these results suggest that generous LTCI coverage can induce excessive LTC utilization without having health benefits. [ABSTRACT FROM AUTHOR]

Abstract Background The gender gap remains a major impediment in the path toward equality, and it is especially wide in low-income countries. Gender differences in health-seeking behaviors may be a factor. Family size and childbirth order are two critical factors affecting family resource allocation. This study examines gender differences in healthcare-seeking behaviors among children with visual impairment in rural China across different family structures (birth order and family size). Methods We draw on a dataset containing 19,934 observations constructed by combining data from 252 different school-level surveys spanning two provinces. The surveys were all conducted in 2012 using uniform survey instruments and data collection protocols in randomly selected schools across western provinces in rural China. The sample children range in grades from 4 to 5. Our analysis compares rural girls with rural boys regarding vision health outcome and behavior (vision examination and correction). Results The findings revealed that girls have worse vision than boys. Regarding vision health behaviors, girls have a lower overall vision examination rate than boys. There is no gender difference when the sample student is the only child or the youngest child in the family, but there is still a gender difference when the sample student is the oldest child in the family or the middle child in the birth order. When it comes to vision correction behavior, boys are more likely to own eyeglasses than girls are for groups of students with mild visual impairment, even when the sample student is the only child in the family. However, when the sample student has another brother or sister (the sample student is the youngest, the oldest child in the family, or the middle child in the birth order), the gender difference disappears. Conclusions Gender differences in vision health outcomes are correlated with gender differences in vision health-seeking behaviors among rural children. Depending on the birth order and family size, gender disparities in visual health practices vary. In the future, consideration should be given to providing medical subsidies to reduce the cost of vision health behaviors and to provide information interventions to change gender inequality in households and promote equality in children’s vision health behaviors. Trial registration The trial was approved by the Stanford University Institutional Review Board (Protocol No. ISRCTN03252665). Permission was received from local Boards of Education in each region and the principals of all schools. The principles of the Declaration of Helsinki were followed throughout. Written informed consent was obtained from at least one parent for all child participants.

This study estimates the relative effect of fiscal policy on income inequality and health outcomes in Sub-Saharan Africa (SSA) countries. The study covers the period 2010-2022 using panel data on 12 countries. Estimation is done using the System GMM estimation technique. It is shown that income tax (ICT) exerts a positive and significant effect on MORT. Government health expenditure (GXH) and population growth (POP) negatively but insignificantly influence MORT, while the effect of carbon emission (CO2) is positive, but not statistically significant. The effect of health-oriented development assistance (HODA) on MORT is negative and statistically significant. Additionally, government health expenditure (GXH) exerts a positive but insignificant effect on LFX. The effect of health-oriented development assistance (HODA) on LFX is also positive and statistically significant. Both income tax (ICT); the effect of POP is negative and significant. Finally, the study reveals that a one-period lag in income inequality (INQ) has a negative and significant effect on current INQ. In addition, government health expenditure (GXH), income tax (ICT), and population growth all exert a negative effect on INQ, with ICT being the most significant of all of them. The effect of health-oriented development assistance (HODA) and carbon emission (CO2) is found to be positive, but not statistically significant. Amongst others, the study recommends that countries across SSA formulate policies that will help in slowing down population growth to levels that are manageable and will not pose adverse health challenges in the region. [ABSTRACT FROM AUTHOR]

Vitamin D is a pleiotropic hormone that plays a vital role in regulating bone growth, maintaining calcium and phosphate homeostasis, modulating immune function, and a wide range of other pleiotrophic actions in humans, which have increased the attention for its clinical applications. Despite its importance, vitamin D deficiency is prevalent worldwide and is related to a range of pathophysiological conditions, including an increased risk of osteoporosis and chronic and autoimmune diseases. The recommended daily doses of vitamin D vary depending on genetics, age, sex, and health status, with specific doses recommended for infants, children, adults, and those at increased risk of deficiency or specific health conditions. Maintaining adequate vitamin D levels is essential for optimal health, and together with sun exposure, appropriate supplementation strategies can help achieve this goal. Vitamin D supplementation is commonly used to maintain adequate levels, and the optimal administration strategy, such as a daily dose vs. a bolus, is still being investigated. This review aims to understand vitamin D physiology and the impact of relevant vitamin D polymorphisms and to evaluate the role of a daily dose versus a bolus in maintaining optimal vitamin D levels and clinical health outcomes. It also provides suggested clinical guidelines for clinicians based on the most recent scientific evidence. [ABSTRACT FROM AUTHOR]

Human milk (HM) has been associated with a lower risk of necrotizing enterocolitis (NEC). However, the association of precise HM proportion with the outcome of NEC remains unclear. A total of 77 cases and 154 matched controls were included in this study. The samples were divided into three groups based on the HM proportion of the total enteral intake before NEC onset: ≥70% (HHM), <70% (LHM), and 0% (NHM). The study cohort did not show a significant association between different HM proportions and NEC risk. The adjusted odds ratio (OR) for the highest versus the lowest intake was 0.599. In the prognosis of NEC, different HM proportions significantly affected weight gain, the timing of NEC onset, diagnosis time, hospitalization cost, and the severity of NEC (p < 0.05). Our findings support the beneficial effects of HM on reducing NEC in preterm infants, particularly when a greater proportion of HM of the total enteral intake is included in their feeding. Additionally, the study indicates that preterm infants fed with lower proportions of HM of the total enteral feeding are more prone to experiencing severe cases of NEC. [ABSTRACT FROM AUTHOR]

Reproductive coercion has been the primary focus of research on intimate partner violence against women in regard to reproductive health. While studies have taken a look at whether Intimate Partner Violence makes women more or less inclined to use contraception, not much research has been able to provide a comprehensive analysis of the connection between Intimate Partner Violence and reproductive coercion. This particular direction of research has concentrated its attention on both of these aspects when discussing reproductive coercion. It is significant to analyze these things together because it is important to fully understand the condition of reproductive coercion, reproductive choices, and the consequences that modern women are confronting. As a consequence of the negative effects of reproductive coercion on survivors' mental, physical, and emotional well-being, it is imperative that social workers be able to recognize the signs of Reproductive Coercion and provide effective interventions and advocacy on their behalf. The use of contraception in patriarchal power dynamic societies, the relationship between intimate partner violence and reproductive coercion, and the health outcome for women are all issues that could potentially be explained with the use of feminist theory and the constructionist theory that we proposed. [ABSTRACT FROM AUTHOR]

Abstract Structural racism is the historical and ongoing reinforcement of racism within society due to discriminatory systems and inequitable distribution of key resources. Racism, embedded within institutional structures, processes and values, perpetuates historical injustices and restricts access to structural factors that directly impact health, such as housing, education and employment. Due to the complex and pervasive nature of structural racism, interventions that act at the structural level, rather than the individual level, are necessary to improve racial health equity. This systematic review was conducted to evaluate the effects of structural-level interventions on determinants of health and health outcomes for racialized populations. A total of 29 articles are included in this review, analyzing interventions such as supplemental income programs, minimum wage policies, nutrition safeguard programs, immigration-related policies, and reproductive and family-based policies. Most studies were quasi-experimental or natural experiments. Findings of studies were largely mixed, although there were clear benefits to policies that improve socioeconomic status and opportunities, and demonstrable harms from policies that restrict access to abortion or immigration. Overall, research on the effects of structural-level interventions to address health inequities is lacking, and the evidence base would benefit from well-designed studies on upstream policy interventions that affect the structural determinants of health and health inequities and improve daily living conditions.

Background. Despite a significant share of Nigeria's budget in the health sector, the health status has not improved, as reflected by poor health indicators. Objective. This study investigates the linkages between government expenditure and health outcomes in Nigeria. Methods. The Autoregressive Distributed Lag technique was used to examine the short- and long-run effects of government health expenditure on health outcomes separately. The health outcome was captured by life expectancy at birth and mortality rate. Results. Findings show a negative relationship exists between health expenditure and mortality rate, implying that a rise in health expenditure leads to a decrease in mortality rate, while life expectancy at birth positively responds to the changes in health expenditure. Conclusions. As a policy recommendation from this study, the government should pursue increasing health expenditure and partner with the private sector in the form of Public-Private Partnerships to improve the health sector and outcomes. [ABSTRACT FROM AUTHOR]