Frontiers in Public Health最新文献

Background: An evaluation system for comprehensively measuring medical insurance fund operational performance under China's Diagnosis Related Groups (DRG) payment reform holds critical theoretical and practical significance, especially for enhancing the efficiency of medical insurance fund utilization and the quality of healthcare services. However, few studies undertake performance evaluations of medical insurance funds under DRG payments, especially those incorporating the Analytic Hierarchy Process (AHP)-Entropy Weight Method (EWM)- Fuzzy Comprehensive Evaluation (FCE) method model.

Methods: This study utilizes operational data from medical insurance funds across eight cities in S Province, China, from 2020 to 2022. It develops an innovative performance evaluation system for medical insurance funds utilizing the AHP-EWM-FCE evaluation method. Finally, it explores the key influencing factors by applying the Tobit regression model.

Results: As the reform of DRG payment methods has advanced, the operational performance scores related to the management, fundraising, utilization, and satisfaction of DRG medical insurance funds have consistently improved. Notably, the comprehensive indexes of QD and JN cities exhibit significant comparative advantages, resulting in higher performance evaluation scores for their medical insurance funds. Additionally, the performance scores assessed by the proposed evaluation system align closely with actual operational outcomes. Regression analysis further indicates that medical service capability is the key determinant influencing the operational performance of medical insurance funds.

Conclusion: This study develops a novel evaluation system for measuring medical insurance funds' operational performance. The insights can help proactively foster the high-quality development of these funds, and modernization of the medical insurance governance system and governance capabilities; stimulate the fund's productivity; and enhance the health and wellbeing of people.

Background: States of exclusion from social relations (ESR) refers to severe social isolation in older age that is not always typified by increased loneliness. Relevant deficiencies in the social network of older persons may be gendered and associated with personality and socioeconomic barriers, with direct implications for older persons' welfare. Although the contribution of personality traits and socioeconomic barriers in shaping ESR states in older age are often debated, empirical evidence that addresses their unique contribution is limited. Therefore, the aim of this study was to examine the gender-stratified associations of situational (e.g., marital status, socioeconomic conditions) and dispositional factors (i.e., personality traits) with ESR states and loneliness in older age.

Methods: A cross-sectional and gender-stratified secondary analysis of a sample (N = 36,814) from the Survey on Health, Aging, and Retirement in Europe was conducted using logistic regression models.

Results: The probability of ESR was higher among older men. Certain situational factors (e.g., widowed, never married) significantly increased the probabilities of ESR for both genders, while other (e.g., divorce) had a gender-specific significance. Less extraversion among older women and less conscientiousness among older men was associated with an increased probability of ESR in later life. Within ESR states, older men living alone and older women who are less extraverted were more at-risk of loneliness.

Conclusion: Situational factors are more predictive of ESR states than personality traits, yet a gendered perspective is needed when assessing the risk factors of ESR and loneliness in later life.

Forecasts indicate a substantial increase in the occurrence of eye injuries in future armed conflicts. The Russian invasion of Ukraine, launched in February 2022, caused numerous eye injuries among civilians as well as military personnel, generating a serious epidemiological threat related to vision loss. The main goal of this study was to analyze different eye traumas in the Ukrainian population caused by hostilities, which could allow for a relative estimate of the occurrence of long-term consequences for the health care system, such as loss of vision in a large group of citizens. To assess the scale and types of eye injuries, we analyzed around 500 eye images from 470 patients who were selected because they had sustained eye injuries and were treated at a single hospital. The findings reveal that the most prevalent types of injuries were macular disorders, accounting for 49% of cases, retinal vascular changes at 30.2%, and optic nerve disorders at 22.4%. Additionally, we observed different percentages of eye injuries in the military personnel group compared to civilians. These results highlight the significant impact of eye injuries caused by war operations on the health care system. However, further research and collaborative efforts are needed to fully assess the epidemiological burden and to inform the development of effective treatment and prevention strategies.

Background: College students, as the future strength of national development, have a high level of health literacy in line with the goal of "Healthy China", but the current research found that the health literacy level of college students is uneven and needs to be improved, and there is still a lack of research on the health literacy of students in colleges and universities of traditional Chinese medicine (TCM). Therefore, this study aims to assess the health literacy level of students in TCM colleges and analyze its influencing factors, so as to provide a basis for implementing effective health literacy intervention measures and building healthy schools.

Methods: Using the convenient sampling method, 925 college students in a TCM university in Shandong Province were selected to conduct an online electronic questionnaire survey using "Questionnaire Star" from December 2022 to March 2023. SPSS 22.0 software was used to process and analyze the data. Descriptive statistical analysis was used to analyze the general data of the respondents, chi-square test was used to compare the count data between groups, and Logistic regression model was used to analyze the influencing factors of health literacy.

Results: The health literacy level of TCM college students was 57.30%. Among the three aspects of health literacy, the level from high to low was: healthy lifestyle and behavior literacy (65.41%), health skill literacy (58.70%) and basic knowledge and concept literacy (53.62%). Among the six categories of health literacy, the level of scientific health literacy (79.68%) was the highest, followed by safety and first aid literacy (72.86%), health information literacy (61.62%), basic medical literacy (61.30%), chronic disease prevention literacy (60.11%) and infectious disease prevention literacy (40.86%). The results of multifactorial logistic regression analyses showed that females (AOR: 1.92; 95%CI: 1.40-2.62), college seniors (AOR: 2.02; 95%CI: 1.01-4.05), never smokers (AOR: 2.99; 95%CI: 1.57-5.72), and awareness of the concept of "health literacy" (AOR: 1.54; 95%CI: 1.11-2.13) were protective factors for health literacy, and the health literacy level of students in TCM colleges and universities was statistically significantly positively correlated with their health literacy level (p < 0.050).

Conclusion: Compared with most studies at home and abroad, the overall level of health literacy among students of TCM colleges is high. The healthy lifestyle and behavior literacy of students in TCM colleges is better than knowledge and skill literacy, which is manifested as the separation of knowledge and practice. Gender, grade, smoking or not, being aware of the concept of "health literacy" are the influencing factors of health literacy level of students in TCM colleges.

Introduction: In recent years, relative deprivation related to consumption has sparked intense debate, particularly as the COVID-19 pandemic caused incalculable economic losses worldwide. However, the relationship between relative deprivation related to consumption and mental health remains largely unexplored. This study investigates how both vertical (household-level) and horizontal (household-to-household) relative deprivation related to consumption affect mental health, with a focus on hedonic consumption, and identifies underlying channels and moderating factors.

Methods: We analyze data from the China Family Panel Studies (CFPS) covering 88,144 observations from 2010 to 2018. Hedonic consumption is measured through expenditure on items such as jewelry, antiques, and entertainment, while consumption inequality is assessed using the Kakwani index. Mental health is evaluated using the CES-D and Kessler 6 scales. Ordinary least squares (OLS) and two-stage least squares (2SLS) methods are employed.

Results: Our findings show that reductions in hedonic consumption negatively impact mental health, with involuntary and sudden declines resulting in more pronounced deterioration. Furthermore, greater consumption inequality exacerbates mental health issues, and perceived unfair treatment amplifies this effect. Additionally, self-perception and trust levels are identified as key channels through which these effects. Furthermore, cultural variations and social capital are moderating roles to diminish the adverse mental health.

Conclusion: This study advances our understanding of how relative deprivation related to consumption affects mental health and offers valuable insights for policymakers and practitioners aiming to address these challenges.

Introduction: In India, large inequities in health exist by geography, gender, socio-economic class, religion and caste. Universal health coverage (UHC) is envisioned to address these gaps. The deficiencies in our healthcare system cannot be solely bridged by additional investment, increasing manpower, adoption of technology or establishing regulatory Institutes. While UHC offers promise, its nation-wide implementation must be carefully planned and monitored.

Objectives: (1) To review published literature appraising the concepts of UHC such as coverage of health services and financial protection in the Indian healthcare system, (2) To review the deficiencies of the healthcare system in India and explore solutions within the framework of UHC.

Methods: The relevant articles for review were retrieved from PubMed and Google scholar databases using pertinent text terms. This scoping review includes 12 citations and 3 other published reports which address the determinants of UHC and its impact on the healthcare system in India.

Results: UHC aims to address the concept of health in all its dimensions and not merely as a response to illness. This Program's objectives include reducing the gap between the need and utilization of healthcare, improving its quality and providing financial protection. In India, the public health sector suffers from shortfalls in management, manpower issues and poor accountability, whereas the private health sector is unregulated and contributes to the increasing health expenditure. UHC will improve access to health care and prevent financial impoverishment, which will be advantageous to the rural people and urban poor including workers of the unorganized sector.

Conclusion: UHC enables health systems to efficiently deliver a wide range of healthcare services to the population, as well as adopt sustainable financing mechanisms. Given the current Covid-19 pandemic and the need to address future pandemics, we need to build resilient health systems as well as hasten the implementation of UHC.

Objective: Various guidelines emphasize the cognitive and emotional benefits of physical activity. However, it is not yet clear what kind of exercise intensity is suitable for individuals with subthreshold depression. Therefore, this study aims to examine the effects of high intensity interval training (HIIT) and moderate intensity continuous training (MICT) on the working memory and emotional state.

Methods: Forty-nine female students with subthreshold depression (mean age 16.3 ± 0.5 yrs) completed 20-min group of sit (SIT), MICT, and HIIT on separate days in a counterbalanced order. The modified n-back task was employed to evaluate working memory. Emotional state was assessed using the Feeling Scale (FS) and Felt Arousal Scale (FAS).

Results: Regarding working memory, for accuracy, SIT (82.41 ± 13.79%), MICT (81.79 ± 13.19%) and HIIT (82.06 ± 11.36%) have no significant difference (all p > 0.05). However, for reaction time, MICT (459.86 ± 131.47 ms) is significantly faster than HIIT (491.16 ± 115.68 ms) (p = 0.046), and there is no significant difference between MICT and SIT (462.71 ± 120.64 ms) (p > 0.05). Concerning emotional state, for arousal, FAS scores significantly increased after both HIIT (2.39 ± 1.30 to 3.76 ± 1.12, p < 0.001) and MICT (2.55 ± 0.88 to 3.94 ± 1.08, p < 0.001) compared to pre-exercise, and the increase caused by them was significantly higher than that of SIT (HIIT: p = 0.011; MICT: p < 0.01). For pleasure, the increase in FS score after MICT (-0.27 ± 1.13 to 1.06 ± 1.79) was significantly higher than that of SIT (0.32 ± 1.38 to 0.58 ± 1.53) (p < 0.01).

Conclusion: Acute MICT can enhance working memory and improve the emotional state of adolescent women with subthreshold depression, while HIIT may decrease working memory and pleasure in this particular population.

Background: Influenza vaccination uptake among United States adults aged 65 years or older remains suboptimal and stagnant. This study aims to evaluate the prevalence of influenza vaccination and examine sociodemographic disparities within a nationally representative sample.

Methods: This study is a cross-sectional study. We used the data from the Behavioral Risk Factor Surveillance System spanning the years 2011 to 2022. Logistic regression models were used to assess potential associations between influenza vaccination uptake and sociodemographic characteristics. Concentration indexes were also calculated to measure the socioeconomic inequalities on influenza vaccination uptake.

Results: The study included 1,391,440 adults aged 65 years and older, with 62.87% reporting having received an influenza vaccination. The weighted prevalence of influenza vaccination uptake showed a slight increase, ranging from 59.05% in 2011-2013 to 67.49% in 2020-2022. Higher vaccination rates were observed among non-Hispanic Whites [63.16%; odds ratio (OR) 1.38, (95% CI 1.33-1.42)], individuals with education above high school [63.89%; OR 1.16, (95% CI 1.12-1.19)], and those with an income above $50,000 [65.86%; OR 1.47, (95% CI 1.43-1.50)]. Compared to non-Hispanic Black people with an income below $25,000 and education less than high school, the ORs were significantly higher among non-Hispanic whites [2.12, (95% CI 1.97-2.28)], non-Hispanic Black people [1.30, (95% CI 1.18-1.44)], and Hispanics [1.40, (95% CI 1.24-1.59)] earning above $50,000 and education above high school. Those who received an influenza vaccination tended to be concentrated in the high-income group and high-education group.

Conclusion: There are substantial racial and socioeconomic disparities in influenza vaccination uptake among individuals aged 65 years or older. Health policy maybe urgently needed to reduce these avoidable inequalities.

Introduction: The treatment cost expenditure for family members with illness is a significant factor exacerbating poverty. Using nationally representative data concerning the migrant population, this study analyzes the impact of the economic burden from family members' illness on poverty among young migrant workers.

Methods: Firstly, we construct a multidimensional poverty index system based on five dimensions: income, education, employment, health, and livelihood,and used the A-F method for calculation. Moreover, diverging from existing studies that objectively measure the economic burden of disease, we explore an evaluation method based on subjective perceptions.

Results: The incidence of multidimensional poverty among young migrant workers is relatively high, at 30.93%. The economic burden imposed by family members' illnesses significantly exacerbates their risk of poverty, particularly within the 26-35 age bracket. Furthermore, compared to their male counterparts, female young migrant workers are more susceptible to the adverse effects of the economic burden of disease.

Discussion: In China, migrant workers confront numerous challenges in both their professional and personal lives, with the economic burden on their families further exacerbating their predicament. Consequently, policymakers should prioritize enhancing health insurance coverage and expanding the reach of social welfare programs to alleviate poverty and the pressures faced by young migrant workers who are the primary breadwinners.