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Engaging community members in health-related research and interventions 使社区成员参与与健康有关的研究和干预措施
Pub Date : 2025-06-09 DOI: 10.1016/j.glmedi.2025.100203
Jagdish Khubchandani, Elizabeth England-Kennedy, Michael Wiblishauser, Karen Kopera-Frye, Fern J. Webb
The landscape of public health intervention planning and conducting clinical research has changed a lot in the 21st century with profound alterations occurring since the COVID-19 pandemic. However, the one fundamental, often challenging, but undermined aspect is the involvement of the general public in medical research or community health interventions. This editorial underscores the paramount significance of involving community members in clinical research or public health interventions to enhance their relevance, effectiveness, and sustainability. We introduce a framework based on six essential domains, referred to as the "Six Cs" (i.e. Constituents & Connections; Communication & Cultivation of Trust; Cultural Competency & Conduct Norms; Context, Capacity & Constraints; Creation of Procedures & Protocols; and Commitment to Common Goals). For medical research and community health interventions, this framework emphasizes the need for collaborative, transparent, and culturally sensitive methodologies that can enhance the general public’s engagement. By nurturing authentic partnerships and utilizing community expertise, this framework for community-engaged health research seeks to improve public participation, foster trust, ensure ethical practices, and ultimately realize significant health outcomes for the public and scientific community.
21世纪以来,公共卫生干预规划和开展临床研究的格局发生了很大变化,自COVID-19大流行以来发生了深刻的变化。然而,一个基本的、往往具有挑战性的、但受到破坏的方面是公众参与医学研究或社区卫生干预。这篇社论强调了让社区成员参与临床研究或公共卫生干预以增强其相关性、有效性和可持续性的重要意义。我们介绍了一个基于六个基本领域的框架,称为“六个c”(即成分&;连接;沟通,信任的培养;文化能力;行为准则;背景、容量&;约束;程序的创建&;协议;和对共同目标的承诺)。对于医学研究和社区卫生干预措施,该框架强调需要协作、透明和对文化敏感的方法,以加强公众的参与。通过培养真正的伙伴关系和利用社区专业知识,这一社区参与卫生研究的框架旨在提高公众参与,培养信任,确保道德实践,并最终为公众和科学界实现重大的卫生成果。
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引用次数: 0
Prevalence of female sexual dysfunction in Africa: A systematic review and meta-analysis 非洲女性性功能障碍患病率:系统回顾和荟萃分析
Pub Date : 2025-05-30 DOI: 10.1016/j.glmedi.2025.100202
Andy-Muller Luzolo Nzinga , Véronique Feipel , Jeanne Bertuit
Female Sexual Dysfunction (FSD) is a multifactorial health issue influenced by physiological, psychological, and sociocultural factors. Despite a global prevalence of ,10–63 %, FSD is underrecognized in African contexts due to cultural taboos and limited healthcare access. This review and meta-analysis aim to assess FSD prevalence and risk factors across Africa, guiding culturally sensitive interventions, policies, and future research to improve women's sexual health. Following PRISMA guidelines, a systematic search was conducted in databases including PubMed, Embase, CINAHL, and African Journals Online (AJOL) for studies published between 2000 and 2023. Eligible studies reported FSD prevalence in African women aged 18 years and older. A meta-analysis of pooled prevalence was conducted using a random-effects model, with heterogeneity assessed using I² and Cochran’s Q tests. Thirteen studies involving 11,585 women from five African countries met the inclusion criteria. The pooled prevalence of FSD was 52.1 % (95 % CI: 45.7–58.4 %), with significant heterogeneity (I² = 97.1 %). Regional prevalence rates ranged from 39 % in East Africa to 61 % in West Africa (p = 0.051). The pooled prevalence was 76.2 % for desire disorder; 59.7 %for arousal disorder; 73.7 % for lubrication; 73.1 % for orgasm disorder; 60.6 % for sexual dissatisfaction and 51.6 % for pain/dyspareunia. The diagnostic tool used influenced prevalence estimates, with the Female Sexual Function Index (FSFI) reporting lower rates (44 %) compared to other tools (70 %) (p < 0.001). FSD affects over half of African women, underscoring the need for standardized diagnostic criteria, increased awareness, and culturally appropriate interventions to address this pervasive issue and improve women’s quality of life.
女性性功能障碍是一个受生理、心理和社会文化因素影响的多因素健康问题。尽管全球流行率为10-63 %,但由于文化禁忌和有限的医疗保健机会,在非洲背景下,FSD未得到充分认识。本综述和荟萃分析旨在评估整个非洲的FSD患病率和风险因素,指导文化敏感的干预措施、政策和未来的研究,以改善妇女的性健康。按照PRISMA指南,在PubMed、Embase、CINAHL和非洲在线期刊(AJOL)等数据库中进行了系统检索,检索2000年至2023年间发表的研究。符合条件的研究报告FSD在18岁及以上的非洲妇女中流行。采用随机效应模型对合并患病率进行meta分析,采用I²和Cochran’s Q检验评估异质性。13项研究涉及来自5个非洲国家的11585名妇女,符合纳入标准。FSD的总患病率为52.1 %(95 % CI: 45.7-58.4 %),异质性显著(I²= 97.1 %)。区域患病率从东非的39 %到西非的61 %不等(p = 0.051)。欲望障碍的总患病率为76.2% %;59.7 %为觉醒障碍;73.7 %用于润滑;性高潮障碍73.1 %;性生活不满意占60.6% %,疼痛/性交困难占51.6% %。所使用的诊断工具影响患病率估计,与其他工具(70 %)相比,女性性功能指数(FSFI)报告的发病率(44 %)较低(p <; 0.001)。FSD影响了一半以上的非洲妇女,因此需要标准化的诊断标准、提高认识和文化上适当的干预措施来解决这一普遍问题并改善妇女的生活质量。
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引用次数: 0
Rectus abdominis endometriosis presenting as a menstruation-linked abdominal mass 腹直肌子宫内膜异位症表现为月经相关的腹部肿块
Pub Date : 2025-05-16 DOI: 10.1016/j.glmedi.2025.100201
Derar I.I. Ismerat , Barah K.S. Alsalameh , Majd Oweidat
Rectus abdominis endometriosis (RAE) is a rare form of extra-pelvic endometriosis, often associated with prior surgical or gynecological procedures. We report a case of a woman in her early 30 s who presented with an eight-month history of a painful, cyclical mass in the left lower abdomen. Her history included a cesarean section, medical abortion, and failed IVF. Imaging identified a 2.3 × 1.5 cm hypoechoic nodule within the rectus abdominis muscle. Surgical excision confirmed endometriotic tissue, and the patient had an uneventful recovery. Histopathology revealed ectopic endometrial glands and stroma within the rectus muscle, consistent with RAE. This case highlights the potential for RAE to occur years after gynecological interventions and in atypical locations, suggesting alternative pathogenic mechanisms such as vascular spread or immune dysregulation. In this patient, delayed presentation and lesion location away from the cesarean scar raise the possibility of multifactorial pathogenesis involving both iatrogenic and non-iatrogenic factors, including hormonal stimulation from IVF. Complete surgical excision led to the resolution of symptoms. Clinicians should consider RAE in patients presenting with cyclical abdominal wall masses, even in the absence of recent surgery.
腹直肌子宫内膜异位症(RAE)是一种罕见的盆腔外子宫内膜异位症,通常与先前的外科或妇科手术有关。我们报告一个病例的妇女在她30岁出头 谁提出了一个痛苦的8个月的历史,周期性肿块在左下腹。她的病史包括剖宫产、药物流产和试管受精失败。影像学发现腹直肌内一个2.3 × 1.5 cm的低回声结节。手术切除证实子宫内膜异位症组织,病人有一个平静的恢复。组织病理学显示异位子宫内膜腺体和间质在直肌内,与RAE一致。该病例强调了RAE在妇科干预多年后和非典型部位发生的可能性,提示了其他致病机制,如血管扩散或免疫失调。在该患者中,延迟表现和病变位置远离剖宫产疤痕增加了多因素发病的可能性,包括医源性和非医源性因素,包括体外受精的激素刺激。完全手术切除导致症状缓解。临床医生应考虑周期性腹壁肿块患者的RAE,即使近期没有手术。
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引用次数: 0
Availability and completeness of real-world data in United States community oncology/hematology practices regarding chimeric antigen receptor (CAR T)-cell therapy for relapsed/refractory diffuse large B-cell lymphoma 美国社区肿瘤学/血液学实践中关于嵌合抗原受体(CAR - T)细胞治疗复发/难治性弥漫性大b细胞淋巴瘤的真实数据的可用性和完整性
Pub Date : 2025-05-10 DOI: 10.1016/j.glmedi.2025.100200
David L. Porter , Andrew J. Klink , Alexandrina Balanean , Tammy Schuler , Bindu Kalesan , Richard Scott Swain , Lindsay McAllister , Djibril Liassou , Sarah Lucht , Ajeet Gajra , Bruce Feinberg
This retrospective, observational study evaluated real-world data (RWD) completeness for 65 adults with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) treated with chimeric antigen receptor (CAR) T-cell therapy across 11 community practices in 2019. Eligible patients had ≥ 6 months of follow-up, excluding those who died earlier, had CNS metastases, or participated in clinical trials. Physicians abstracted electronic medical records (EMRs) in 2021 using standardized case report forms (eCRFs), capturing demographics, prior therapies, referral/infusion timelines, toxicities, hospitalizations, and survival. Data underwent quality validation. Baseline demographics were fully documented: 70.8 % of patients had good performance status (Eastern Cooperative Oncology Group [ECOG] 0–1), 73.8 % had elevated lactate dehydrogenase (LDH), and 83.9 % were deemed high-risk. Hospitalization and emergency visit records were 100 % complete, whereas toxicity documentation ranged from 86.2 % to 98.5 %. Patients received a median 3 prior therapy lines; key barriers to CAR T-cell therapy referral included patient choice (45.5 %), center location (36.4 %), and logistics (27.3 %). Rapid disease progression precluded treatment in 81.8 % of nonrecipients. Only 43.1 % had leukapheresis dates recorded, with a 4.5-month median from relapse to infusion. Posttreatment, 75.0 % developed cytokine release syndrome (CRS) and 67.7 % had fever. At median 15.5-month follow-up, 44.6 % relapsed and 47.7 % died. Survival (median progression-free survival, 18.6 months; overall survival, 22.8 months) aligned with trials but revealed disparities in real-world delivery, such as manufacturing delays and incomplete documentation. This study underscores feasibility of robust RWD collection in community settings while highlighting critical gaps—particularly in leukapheresis tracking and postinfusion toxicity reporting—that must be addressed to optimize CAR T-cell therapy management.
这项回顾性观察性研究评估了2019年11个社区实践中65名接受嵌合抗原受体(CAR) t细胞治疗的复发/难治性(R/R)弥漫性大b细胞淋巴瘤(DLBCL)成人的真实世界数据(RWD)完整性。符合条件的患者随访≥ 6个月,排除早期死亡、中枢神经系统转移或参加临床试验的患者。2021年,医生使用标准化病例报告表格(ecrf)提取电子病历(emr),包括人口统计数据、既往治疗、转诊/输液时间表、毒性、住院和生存率。数据进行了质量验证。基线人口统计数据得到充分记录:70.8% %的患者表现良好(东部肿瘤合作组[ECOG] 0-1), 73.8% %的患者乳酸脱氢酶(LDH)升高,83.9% %的患者被认为是高危患者。住院和急诊记录的完完率为100% %,而毒性记录的完完率为86.2 %至98.5% %。患者先前接受的治疗中位数为3条;CAR - t细胞治疗转诊的主要障碍包括患者选择(45.5% %)、中心位置(36.4% %)和后勤(27.3% %)。在81.8% %的未接受治疗的患者中,疾病的快速进展阻碍了治疗。只有43.1 %的患者有白细胞摘除术记录,从复发到输注的中位时间为4.5个月。治疗后,75.0 %出现细胞因子释放综合征(CRS), 67.7% %出现发热。在中位15.5个月的随访中,44.6% %复发,47.7% %死亡。生存期(中位无进展生存期,18.6个月;总生存期(22.8个月)与试验结果一致,但在实际生产中存在差异,如生产延迟和文件不完整。这项研究强调了在社区环境中稳健收集RWD的可行性,同时强调了关键的空白,特别是在白细胞分离跟踪和输注后毒性报告方面,必须解决这些空白,以优化CAR - t细胞治疗管理。
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引用次数: 0
Hepatitis C virus-related liver cancer among Medicaid recipients with schizophrenia, 2002–2012 2002-2012年医疗补助接受者中与丙型肝炎病毒相关的精神分裂症患者肝癌
Pub Date : 2025-04-25 DOI: 10.1016/j.glmedi.2025.100199
Marilyn D. Thomas , Mandana Khalili , Eric Vittinghoff , Francine Cournos , Mark Olfson , Priya Dahiya , Stephen Crystal , Richard Hermida , Christina Mangurian
Nearly half of primary liver cancers are attributed to hepatitis C virus (HCV) infection. People living with schizophrenia have higher HCV prevalence and liver cancer mortality rates than the general population. Among Medicaid beneficiaries with HCV, we compared incident liver cancer diagnosis in recipients living with and without schizophrenia. Using Medicaid claims data, pooled logistic regression and time survival models we estimated adjusted incidence rates of liver cancer diagnosis and risk factors for those living with schizophrenia. During 2002–2012 (N = 104,469), incident liver cancer diagnosis ranged from 845 to 1602 per 100,000 person-years. Recipients living with versus without schizophrenia had lower diagnosis rates over the study period and lower cumulative incidence within common risk factors of liver disease progression (e.g., diabetes). However, rates were higher for those with comorbid human immunodeficiency virus (HIV) infection. Among recipients with schizophrenia, higher odds of liver cancer diagnosis was associated with having comorbid alcohol use disorder (OR=1.23; 95 % confidence interval [CI] =1.70–2.05), diabetes (OR=1.49; CI=1.36–1.64), hypertension (OR=1.49; CI=1.36–1.65), chronic hepatitis B (OR=2.57; CI=2.26–2.91), or ≥ 1 annual primary care visit (OR=1.65; CI=1.46–1.86). Black (versus White) recipients had lower odds of diagnosis (OR=0.77; CI=0.70–0.86). Given higher HCV prevalence and liver cancer mortality in this population, lower diagnosis rates may reflect insufficient liver cancer detection, potentially driving HCV-related excess mortality rates for individuals living with schizophrenia. Addressing metabolic abnormalities and alcohol use is critical to risk reduction in HCV-infected persons living with schizophrenia, especially those living with HCV-HIV coinfection or racially minoritized.
近一半的原发性肝癌是由丙型肝炎病毒(HCV)感染引起的。精神分裂症患者的HCV患病率和肝癌死亡率高于一般人群。在患有丙型肝炎的医疗补助受益人中,我们比较了患有和不患有精神分裂症的受助人的肝癌发病率。使用医疗补助索赔数据、合并逻辑回归和时间生存模型,我们估计了精神分裂症患者肝癌诊断和危险因素的调整发生率。2002-2012年期间(N = 104,469),肝癌诊断发生率为每10万人年845至1602例。在研究期间,患有精神分裂症的患者与没有精神分裂症的患者的诊断率较低,在肝脏疾病进展的常见危险因素(如糖尿病)内的累积发病率也较低。然而,合并症人类免疫缺陷病毒(HIV)感染者的发病率更高。在精神分裂症患者中,肝癌诊断的较高几率与共病性酒精使用障碍相关(OR=1.23;95 %置信区间[CI] = 1.70-2.05),糖尿病(OR=1.49;CI= 1.36-1.64),高血压(OR=1.49;CI= 1.36-1.65),慢性乙型肝炎(OR=2.57;CI= 2.26-2.91),或≥ 1次年度初级保健就诊(or =1.65;CI = 1.46 - -1.86)。黑人(相对于白人)接受者的诊断几率较低(OR=0.77;CI = 0.70 - -0.86)。鉴于这一人群中较高的丙型肝炎患病率和肝癌死亡率,较低的诊断率可能反映出肝癌检测不足,这可能导致精神分裂症患者丙型肝炎相关的高死亡率。解决代谢异常和饮酒问题对于降低丙型肝炎病毒感染的精神分裂症患者的风险至关重要,特别是那些丙型肝炎病毒-艾滋病毒合并感染或少数种族的患者。
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引用次数: 0
Using thematic analysis in qualitative research 在定性研究中运用主题分析
Pub Date : 2025-04-15 DOI: 10.1016/j.glmedi.2025.100198
Sirwan Khalid Ahmed , Ribwar Arsalan Mohammed, Abdulqadir J. Nashwan, Radhwan Hussein Ibrahim, Araz Qadir Abdalla, Barzan Mohammed M. Ameen, Renas Mohammed Khdhir
Thematic analysis (TA) is one of the most widely utilized methods for analyzing qualitative data, offering a structured yet flexible framework for identifying, analyzing, and interpreting patterns of meaning within datasets. This paper provides a comprehensive overview of Braun and Clarke's six-phase thematic analysis framework, which includes (1) familiarization with data, (2) generating initial codes, (3) searching for themes, (4) reviewing themes, (5) defining and naming themes, and (6) writing the report. Additionally, it presents a 16-item checklist to ensure adherence to the established steps of thematic analysis, enhancing the rigor and reliability of the study. Each phase is explored in-depth, highlighting its purpose, key activities, reflexive considerations, challenges, and significance. Emphasis is placed on the iterative and reflexive nature of TA, where researchers actively engage with data and acknowledge their theoretical positioning and biases throughout the process. Challenges such as data overwhelm, coding inconsistencies, and balancing thematic depth and breadth are addressed, alongside practical strategies for overcoming these obstacles. The importance of transparency, reflexivity, and methodological rigor is underscored as central to producing trustworthy and insightful qualitative research. This article serves as both an academic reference and a practical guide for researchers aiming to apply thematic analysis effectively, ensuring that their findings are presented in a coherent, compelling, and analytically sound manner.
主题分析(TA)是应用最广泛的定性数据分析方法之一,它为识别、分析和解释数据集中的意义模式提供了一个结构化但灵活的框架。本文全面概述了Braun和Clarke的六阶段主题分析框架,包括(1)熟悉数据,(2)生成初始代码,(3)搜索主题,(4)审查主题,(5)定义和命名主题,(6)撰写报告。此外,它还提出了一份16项清单,以确保遵守既定的专题分析步骤,提高研究的严谨性和可靠性。每个阶段都进行了深入探讨,突出了其目的、关键活动、反思性考虑、挑战和意义。重点放在技术分析的迭代性和反思性上,研究人员在整个过程中积极参与数据,并承认他们的理论定位和偏见。解决了数据过剩、编码不一致以及平衡主题深度和广度等挑战,并提出了克服这些障碍的实用策略。透明度、反思性和方法严谨性的重要性被强调为产生值得信赖和富有洞察力的定性研究的核心。本文既是学术参考,也是研究人员的实践指南,旨在有效地应用主题分析,确保他们的发现以连贯、引人注目和分析合理的方式呈现。
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引用次数: 0
Bridging the gap: Advancing occupational therapy in cancer recovery for better outcomes 弥合差距:推进癌症康复中的职业治疗以获得更好的结果
Pub Date : 2025-04-11 DOI: 10.1016/j.glmedi.2025.100196
Amanda dos Santos Pereira , Alexander Miller , Amos Olalekan Akinyemi
Cancer is a complex illness that affects millions of individuals worldwide, posing multifaceted challenges to their physical, mental, and social well-being, often hindering engagement in meaningful activities. In recent years, occupational therapy has emerged as a vital component in the comprehensive care of cancer patients, facilitating their recovery and enhancing their quality of life. This commentary explores the intersection of cancer care and occupational therapy, elucidating the role of occupational therapists in addressing the diverse needs of cancer patients across the continuum of care. Drawing on literature published between 2000 and 2025, this commentary synthesizes evidence from peer-reviewed articles, clinical guidelines, and practice-based insights. It emphasizes the importance of advancing occupational therapy interventions in promoting functional independence, managing symptoms, and fostering psychosocial well-being in individuals affected by cancer. Furthermore, it discusses various approaches and techniques employed by occupational therapists in oncology settings, emphasizing the significance of interdisciplinary collaboration to optimizing patient outcomes. By integrating evidence-based insights, this commentary demonstrates the pivotal role of occupational therapy in bridging the gap between cancer treatment and rehabilitation, ultimately contributing to improved recovery and enhanced quality of life for cancer survivors.
癌症是一种复杂的疾病,影响着全世界数百万人,对他们的身体、精神和社会福祉构成多方面的挑战,往往阻碍他们参与有意义的活动。近年来,职业治疗已成为癌症患者综合护理的重要组成部分,促进了他们的康复,提高了他们的生活质量。这篇评论探讨了癌症护理和职业治疗的交集,阐明了职业治疗师在解决癌症患者在连续护理中的不同需求方面的作用。根据2000年至2025年间发表的文献,本评论综合了同行评议文章、临床指南和基于实践的见解的证据。它强调了推进职业治疗干预在促进功能独立性、控制症状和促进癌症患者心理健康方面的重要性。此外,它还讨论了肿瘤环境中职业治疗师采用的各种方法和技术,强调跨学科合作对优化患者预后的重要性。通过整合基于证据的见解,本评论展示了职业治疗在弥合癌症治疗和康复之间的差距方面的关键作用,最终有助于改善癌症幸存者的康复和提高生活质量。
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引用次数: 0
Global COVID-19 vaccination challenges: Inequity of access and vaccine hesitancy 全球COVID-19疫苗接种挑战:获取不公平和疫苗犹豫
Pub Date : 2025-04-09 DOI: 10.1016/j.glmedi.2025.100197
Michael Dagovetz , Kaloyan Momchilov , Liahm Blank , Joshua Khorsandi , Amelia Rizzo , Hicham Khabbache , Aldo Sitibondo , Juan Gómez Salgado , Francesco Chirico , Kavita Batra
The emergence of SARS-CoV-2 in December 2019 led to a global pandemic, exacerbating healthcare inequities and necessitating unprecedented international responses. This commentary examines the progression of the COVID-19 pandemic, emphasizing vaccine development milestones, global disparities in vaccine distribution, and factors contributing to low vaccine uptake. By early 2020, international efforts, including mRNA vaccine development and initiatives such as Operation Warp Speed, demonstrated the rapidity of scientific innovation. However, global vaccine disparities highlighted inequities in healthcare infrastructure and access, particularly in developing nations. Challenges such as cold chain logistics, inadequate healthcare infrastructure, and domination of vaccine supplies by wealthier nations created significant barriers to equitable distribution. Initiatives like COVAX and collaborations with organizations such as the Serum Institute of India sought to address these inequities, underscoring the importance of global partnerships. Despite the proven efficacy of vaccines in preventing severe illness and hospitalization, global vaccination rates remain suboptimal, with only 67 % of the world’s population fully vaccinated by December 2023. Vaccine hesitancy and inequity, driven by systemic healthcare challenges and geopolitical factors, continue to impede efforts to curb the pandemic. This commentary aims to analyze the complex interplay of these factors and evaluate strategies to improve vaccine uptake. By understanding the barriers faced during the COVID-19 pandemic, this also seeks to inform more effective public health interventions and preparedness strategies for future global health crises.
2019年12月SARS-CoV-2的出现导致全球大流行,加剧了医疗不平等,需要采取前所未有的国际应对措施。本评论探讨了COVID-19大流行的进展,强调了疫苗发展的里程碑、疫苗分布的全球差异以及导致疫苗接种率低的因素。到2020年初,包括mRNA疫苗开发和曲速行动等举措在内的国际努力显示了科学创新的速度。然而,全球疫苗差距突出了卫生保健基础设施和获取方面的不平等,特别是在发展中国家。冷链物流、卫生保健基础设施不足以及富裕国家主导疫苗供应等挑战对公平分配造成了重大障碍。covid - 19全球获取疫苗计划等举措以及与印度血清研究所等组织的合作力求解决这些不平等问题,强调了全球伙伴关系的重要性。尽管疫苗在预防严重疾病和住院方面已得到证实,但全球疫苗接种率仍然不理想,到2023年12月,世界人口中只有67% %完全接种疫苗。系统性卫生保健挑战和地缘政治因素造成的疫苗犹豫和不平等继续阻碍遏制大流行的努力。本评论旨在分析这些因素之间复杂的相互作用,并评价提高疫苗摄取的策略。通过了解2019冠状病毒病大流行期间面临的障碍,还旨在为更有效的公共卫生干预措施和应对未来全球卫生危机的防范战略提供信息。
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引用次数: 0
Attitudes of older patients toward artificial intelligence in decision-making in healthcare 老年患者对医疗决策中人工智能的态度
Pub Date : 2025-04-09 DOI: 10.1016/j.glmedi.2025.100193
Moustaq Karim Khan Rony , Tuli Rani Deb , Most. Tahmina Khatun , Latifun Nesa , Jeni Begum , Mahabuba Afrin , Md. Abdun Noor , Mosammat Ruma Akter , Mst. Amena Khatun , Most. Hasina Begum , Mst. Rina Parvin , Fazila Akter

Background

Artificial intelligence (AI) is rapidly transforming healthcare, promising improved diagnostics and efficiency. However, the ethical implications and patient perspectives, particularly among older adults, remain underexplored. This study aimed to explore the ethical considerations and attitudes of older patients toward AI in healthcare decision-making.

Methods

We conducted qualitative research in the geriatric wards of three hospitals in Dhaka, Bangladesh, using the Technology Acceptance Model and a phenomenological approach as the guiding frameworks. Semi-structured interviews were conducted with 21 purposively sampled participants, all aged 60 and above. Data were collected in Bangla, transcribed, translated into English, and analyzed through thematic analysis. Methodological rigor was maintained through member checking, triangulation, and reflexive practices.

Results

Five key themes emerged: (1) Trust and skepticism toward AI’s decision-making capabilities, with concerns about its ability to address nuanced health needs; (2) A strong preference for human interaction over technological efficiency, highlighting the irreplaceable value of empathy; (3) Ethical concerns regarding informed consent, emphasizing the need for transparent and comprehensible AI integration; (4) Apprehension about privacy and data security, reflecting a trust deficit in AI’s handling of sensitive health information; and (5) Mixed perceptions on AI’s role in enhancing or diminishing the quality of care.

Conclusions

This study underscores the need for transparent, patient-centered AI systems that enhance, rather than replace, human elements in care. Addressing ethical concerns about privacy, autonomy, and informed consent is critical to fostering trust and acceptance among older patients.
人工智能(AI)正在迅速改变医疗保健,有望改善诊断和效率。然而,伦理意义和患者观点,特别是在老年人中,仍未得到充分探讨。本研究旨在探讨老年患者对人工智能在医疗保健决策中的伦理考虑和态度。方法采用技术接受模型和现象学方法作为指导框架,在孟加拉国达卡三家医院的老年病房进行定性研究。对21名年龄在60岁及以上的参与者进行了半结构化访谈。数据以孟加拉语收集,转录,翻译成英语,并通过专题分析进行分析。方法的严谨性是通过成员检查、三角测量和反思实践来保持的。结果出现了五个关键主题:(1)对人工智能决策能力的信任和怀疑,以及对其解决细微健康需求的能力的担忧;(2)对人际互动的偏好高于技术效率,凸显了共情的不可替代性价值;(3)关于知情同意的伦理问题,强调需要透明和可理解的人工智能集成;(4)对隐私和数据安全的担忧,反映出人工智能在处理敏感健康信息方面存在信任赤字;(5)对人工智能在提高或降低医疗质量方面的作用的看法不一。本研究强调需要透明、以患者为中心的人工智能系统,以增强而不是取代护理中的人为因素。解决关于隐私、自主权和知情同意的伦理问题对于促进老年患者的信任和接受至关重要。
{"title":"Attitudes of older patients toward artificial intelligence in decision-making in healthcare","authors":"Moustaq Karim Khan Rony ,&nbsp;Tuli Rani Deb ,&nbsp;Most. Tahmina Khatun ,&nbsp;Latifun Nesa ,&nbsp;Jeni Begum ,&nbsp;Mahabuba Afrin ,&nbsp;Md. Abdun Noor ,&nbsp;Mosammat Ruma Akter ,&nbsp;Mst. Amena Khatun ,&nbsp;Most. Hasina Begum ,&nbsp;Mst. Rina Parvin ,&nbsp;Fazila Akter","doi":"10.1016/j.glmedi.2025.100193","DOIUrl":"10.1016/j.glmedi.2025.100193","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is rapidly transforming healthcare, promising improved diagnostics and efficiency. However, the ethical implications and patient perspectives, particularly among older adults, remain underexplored. This study aimed to explore the ethical considerations and attitudes of older patients toward AI in healthcare decision-making.</div></div><div><h3>Methods</h3><div>We conducted qualitative research in the geriatric wards of three hospitals in Dhaka, Bangladesh, using the Technology Acceptance Model and a phenomenological approach as the guiding frameworks. Semi-structured interviews were conducted with 21 purposively sampled participants, all aged 60 and above. Data were collected in Bangla, transcribed, translated into English, and analyzed through thematic analysis. Methodological rigor was maintained through member checking, triangulation, and reflexive practices.</div></div><div><h3>Results</h3><div>Five key themes emerged: (1) Trust and skepticism toward AI’s decision-making capabilities, with concerns about its ability to address nuanced health needs; (2) A strong preference for human interaction over technological efficiency, highlighting the irreplaceable value of empathy; (3) Ethical concerns regarding informed consent, emphasizing the need for transparent and comprehensible AI integration; (4) Apprehension about privacy and data security, reflecting a trust deficit in AI’s handling of sensitive health information; and (5) Mixed perceptions on AI’s role in enhancing or diminishing the quality of care.</div></div><div><h3>Conclusions</h3><div>This study underscores the need for transparent, patient-centered AI systems that enhance, rather than replace, human elements in care. Addressing ethical concerns about privacy, autonomy, and informed consent is critical to fostering trust and acceptance among older patients.</div></div>","PeriodicalId":100804,"journal":{"name":"Journal of Medicine, Surgery, and Public Health","volume":"6 ","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pediatric Frailty: From concept to action – Advancing measurement, biomarkers, and clinical integration 儿科虚弱:从概念到行动--推进测量、生物标记和临床整合
Pub Date : 2025-04-04 DOI: 10.1016/j.glmedi.2025.100195
Rosario Caruso, Arianna Magon
Frailty in pediatric populations is an emerging but increasingly relevant construct that extends beyond physical vulnerability to encompass psychological, social, and developmental dimensions. Although initially conceptualized within gerontology, frailty has gained traction in pediatric healthcare, particularly as it pertains to children living with chronic illnesses, disabilities, or complex care needs. Yet, despite its growing clinical and scientific relevance, pediatric frailty remains an underdeveloped field, with ongoing challenges in its definition, measurement, and integration into practice. This letter outlines the historical evolution of pediatric frailty, identifying four key developmental phases: pre-reflective, reflective, definitional, and research. Initially used synonymously with vulnerability, frailty gradually evolved into an analytical framework supported by statistical modeling, and later became a clinically relevant concept tied to familial and psychological dimensions. The definitional phase saw frailty recognized in pediatric subspecialties, especially oncology and cardiology, with attention to inherited patterns and intergenerational health risks. In the current research phase, efforts have intensified to operationalize frailty through validated scores, biomarkers, and predictive indices tailored to pediatric populations. Notably, frailty is increasingly recognized as a dynamic and multidimensional syndrome that necessitates a broader perspective encompassing family systems and social determinants of health. Despite these advancements, significant gaps persist in the conceptual and methodological foundations of pediatric and familial frailty. There remains a pressing need to develop age-appropriate tools, validate longitudinal trajectories, and incorporate frailty screening into pediatric care pathways. Bridging the gap between conceptual insights and clinical implementation is crucial for enhancing outcomes for vulnerable children and their families. We call on the pediatric clinical communities to prioritize frailty as a core component of child health research and policy. Integrating psychosocial and developmental indicators alongside biological markers will enable early identification and targeted interventions. The evolution of frailty from a theoretical construct to a measurable, actionable clinical entity is within reach—provided future research continues to advance with precision, interdisciplinary collaboration, and patient-centered focus.
在儿科人群中,虚弱是一个新兴的但日益相关的结构,它超越了身体上的脆弱,涵盖了心理、社会和发展方面。虽然虚弱最初是在老年学中概念化的,但在儿科医疗保健中已经获得了牵引力,特别是当它与患有慢性疾病、残疾或复杂护理需求的儿童有关时。然而,尽管其临床和科学相关性越来越大,儿童虚弱仍然是一个不发达的领域,在其定义,测量和整合到实践中面临着持续的挑战。这封信概述了儿童虚弱的历史演变,确定了四个关键的发展阶段:前反思、反思、定义和研究。脆弱最初被用作脆弱性的同义词,后来逐渐演变成一个由统计模型支持的分析框架,后来成为一个与家庭和心理维度相关的临床概念。在定义阶段,在儿科亚专科,特别是肿瘤学和心脏病学中认识到虚弱,并注意遗传模式和代际健康风险。在目前的研究阶段,通过针对儿科人群的有效评分、生物标志物和预测指标,已经加强了对脆弱性的操作。值得注意的是,人们日益认识到,脆弱是一种动态和多方面的综合症,需要从更广泛的角度来看待家庭制度和健康的社会决定因素。尽管取得了这些进展,但在儿童和家庭虚弱的概念和方法基础方面仍然存在重大差距。仍然迫切需要开发适合年龄的工具,验证纵向轨迹,并将虚弱筛查纳入儿科护理途径。弥合概念见解和临床实施之间的差距对于提高弱势儿童及其家庭的成果至关重要。我们呼吁儿科临床界优先考虑脆弱问题,将其作为儿童健康研究和政策的核心组成部分。将社会心理和发育指标与生物标志物结合起来,将有助于早期识别和有针对性的干预。如果未来的研究继续以精确、跨学科合作和以患者为中心的重点推进,虚弱从理论结构到可测量、可操作的临床实体的演变是触手可及的。
{"title":"Pediatric Frailty: From concept to action – Advancing measurement, biomarkers, and clinical integration","authors":"Rosario Caruso,&nbsp;Arianna Magon","doi":"10.1016/j.glmedi.2025.100195","DOIUrl":"10.1016/j.glmedi.2025.100195","url":null,"abstract":"<div><div>Frailty in pediatric populations is an emerging but increasingly relevant construct that extends beyond physical vulnerability to encompass psychological, social, and developmental dimensions. Although initially conceptualized within gerontology, frailty has gained traction in pediatric healthcare, particularly as it pertains to children living with chronic illnesses, disabilities, or complex care needs. Yet, despite its growing clinical and scientific relevance, pediatric frailty remains an underdeveloped field, with ongoing challenges in its definition, measurement, and integration into practice. This letter outlines the historical evolution of pediatric frailty, identifying four key developmental phases: pre-reflective, reflective, definitional, and research. Initially used synonymously with vulnerability, frailty gradually evolved into an analytical framework supported by statistical modeling, and later became a clinically relevant concept tied to familial and psychological dimensions. The definitional phase saw frailty recognized in pediatric subspecialties, especially oncology and cardiology, with attention to inherited patterns and intergenerational health risks. In the current research phase, efforts have intensified to operationalize frailty through validated scores, biomarkers, and predictive indices tailored to pediatric populations. Notably, frailty is increasingly recognized as a dynamic and multidimensional syndrome that necessitates a broader perspective encompassing family systems and social determinants of health. Despite these advancements, significant gaps persist in the conceptual and methodological foundations of pediatric and familial frailty. There remains a pressing need to develop age-appropriate tools, validate longitudinal trajectories, and incorporate frailty screening into pediatric care pathways. Bridging the gap between conceptual insights and clinical implementation is crucial for enhancing outcomes for vulnerable children and their families. We call on the pediatric clinical communities to prioritize frailty as a core component of child health research and policy. Integrating psychosocial and developmental indicators alongside biological markers will enable early identification and targeted interventions. The evolution of frailty from a theoretical construct to a measurable, actionable clinical entity is within reach—provided future research continues to advance with precision, interdisciplinary collaboration, and patient-centered focus.</div></div>","PeriodicalId":100804,"journal":{"name":"Journal of Medicine, Surgery, and Public Health","volume":"6 ","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Medicine, Surgery, and Public Health
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