Frontiers in Public Health最新文献

Background: Diabetic foot is a major public health issue, leading to increased morbidity and mortality among diabetic patients. This study aimed to evaluate the effectiveness of targeted health education interventions on self-efficacy and foot care practices among diabetic women in Jordan.

Methods: A pretest-posttest, quasi-experimental design was used to collect data from 76 diabetic women at a tertiary hospital in northern Jordan. Participants were assigned to three groups: a control group receiving standard care; Intervention Group 1, receiving standard care with weekly text reminders and follow-up calls; and Intervention Group 2, receiving the same components as Intervention Group 1, plus small group education sessions and hands-on foot care training. Generalized Estimating Equations models were used to assess the impact of the interventions on foot care practices and self-efficacy over an 8-week period.

Results: The findings revealed that participants in Intervention Group 2 demonstrated the most significant improvements in both foot care practices and self-efficacy. For foot care practices, Intervention Group 2 had adjusted odds ratios (aORs) of 2.5 (95% CI: 1.3-5.1) and 1.7 (95% CI: 1.2-2.9) when compared to the control group and Intervention Group 1, respectively. Similarly, for self-efficacy, the aORs for Intervention Group 2 were 2.7 (95% CI: 1.4-5.2) relative to the control group, and 1.8 (95% CI: 1.1-3.2) compared to Intervention Group 1.

Conclusion: Our study demonstrates that interactive educational approaches-featuring group discussions, real-time problem-solving, immediate feedback, and family support-can empower diabetic women to take a more active role in managing their foot health. Routine clinical care alone is insufficient to promote proactive foot care behaviors, highlighting the need for healthcare providers to incorporate educational materials tailored to the local cultural context into standard care to enhance patient outcomes.

Introduction: This study investigated potential health status differences among forging, manufacturing, and logistics workers.

Methods: We included 403 participants (age: 41 ± 12 years) from a medium-sized steel company (forge: 64, manufacturing: 299, logistics: 99). Health status was multifactorial assessed: (1) Frequency of musculoskeletal complaints (German Pain Questionnaire). (2) Pain intensity, physical and psychological load [visual analog scales (VAS) 0-100 points]. (3) Occupational moderate-to-vigorous physical activity (MVPA), total MVPA, and sedentary behavior [Global Physical Activity Questionnaire (GPAQ)]. (4) Quality of life [Short Form Health Survey (SF-36)]. Between-group effects were analyzed via one-way ANOVAs with post-hoc Tukey correction.

Results: 308 workers (76.4%) reported at least one musculoskeletal issue. A significant between-group difference was revealed for left shoulder [F(2,40) = 5.40; p = 0.008; ω² = 0.17], occupational MVPA [F(2,368) = 9.49; p < 0.001; ω² = 0.04] and total MVPA [F(2,368) = 6.90; p = 0.001; ω² = 0.03]. Post-hoc tests revealed a difference (p ≤ 0.007) between manufacturing (left shoulder: n = 22; 42.5 ± 24.8; occupational MVPA: n = 219; 6,978 ± 5,137 METs min/week; total MVPA: n = 219; 8,471 ± 5,390 METs min/week) and logistics workers (left shoulder: n = 14; 70.4 ± 26.3 au; occupational MVPA: n = 96; 9,640 ± 4,605 METs min/week; total MVPA: n = 96; 10,856 ± 4,680 METs min/week). No other between-group differences were observed.

Discussion: Variations in health disparities across work conditions were observed. Yet, clear distinctions between work conditions and health outcomes remain a challenge. Effective interventions should be focused on job-specific and personalized health profiles rather than a stratification of work conditions to enhance health, productivity, and workforce sustainability.

While the impact of racism on healthcare interactions has been researched extensively in many parts of the world, substantive studies on healthcare-related racism in Europe, and particularly in Germany, remain scarce. This paper builds on a study that applies Community-Based Participatory Research (CBPR) and aims to explore healthcare users' experiences of racism within German healthcare. Community members were trained as peer researchers and given support as they conducted a total of six focus group discussions that involved a total of 14 study participants: these participants were organized into two subsamples of seven participants each (subsample one: Black, African, Afro-diasporic healthcare users; subsample two: healthcare users perceived or self-describing as Muslim), and each subsample had three focus group discussions. A democratic approach to qualitative data analysis was applied in the form of the DEPICT model. The data analysis developed iteratively, with inductive and deductive steps complementing one another. The study results illustrate how the collaboratively developed concepts of being treated as "other" and being made inaudible can advance our understanding of the forms, dynamics, and effects of racism in healthcare encounters. Because this paper focuses on the process of racialization, it helps illumine the mechanisms of subtle racism, which, as study results suggest, can damage healthcare users, cause a loss of trust in the system, and lead to invisibilization of racism in healthcare. By doing so, it draws attention to areas for change and transformation, to larger power structures that must be challenged in order to ensure responsive and equal healthcare for all healthcare users. The application of CBPR and, particularly, the engagement of racialized healthcare users in the research process offered pathways for analyzing the subtle, otherwise hard-to-detect mechanisms of racism, and for learning from the wisdom of situated knowledges.

Objective: In order to reduce the price and increase the accessibility of innovative medicines, China has implemented the National Drug Price Negotiation (NDPN) since 2016. Anticancer drug is the largest category of NDPN and the number continue to increase. This study evaluated the impact of this policy on the price, utilization rate and affordability of anticancer drugs based on the experiences of Shandong province.

Methods: 25 anticancer drugs were included in this study involved the NDPN in the year 2018 and 2019. Data on prices and utilization of the policy related drugs from 2017 to 2022 were collected from Shandong Province, using an adaptation of the WHO/HAI methodology. Prices were measured as Median Price Ratio (MPR). Usage was measured as Defined Daily Doses (DDDs). Affordability was measured as days of daily per capita disposable income required for the cost of 1 month's treatment. The Mann-Whitney U test was used to estimate the significance of the difference in the change in the MPRs before and after the negotiation.

Results: The data of this study come from 42 key monitoring medical institutions in Shandong Province, including 31 tertiary medical institutions and 11 secondary medical institutions. There has been a significant reduction in the MPR following NDPN, with a median MPR of 0.57 in 2022, and the prices of anticancer medicines were generally lower than IPR. During the period from 2017 to 2022, the total usage of the 25 negotiated medicines continued to rise. With the implementation of negotiation policy, the average number of days of disposable income per capita required for 1 month of medicine costs changed from 104 days to 36 days and 256 days to 80 days for urban and rural residents, respectively. The affordable proportion of anticancer medicines is still not high.

Conclusion: The NDPN policy has reduced the prices of anticancer drugs and greatly improved their affordability. More attention should be paid to improve the affordability to the rural and the poor patients. It is essential to encourage the research and development of high-quality generic drugs to strengthen reasonable market competition, as well as improve the multi-tiered medical security system.

Introduction: The Centers for Disease Control and Prevention (CDC) funded Cancer Prevention and Control Research Network (CPCRN) is a national network which aims to accelerate the adoption and implementation of evidence-based cancer prevention and control strategies and interventions in communities, enhance large-scale efforts to reach underserved populations and reduce their cancer-related health disparities, and develop the capacity of the dissemination and implementation work force specifically in cancer prevention and control.

Methods: Our site has been a part of the CPCRN since its inception in 2002 with the exception of the 2004-2009 funding cycle. As community-based participatory research is a core value of our center, we examined the development and continued engagement of our community partners using a qualitative, inductive approach to identify emergent themes from focus group sessions with current and past investigators.

Results: Several key themes were identified from our analysis including long-term commitment to community partnerships and interconnectedness with other work, authentic approach, valuing our community as experts, and mutual benefits.

Discussion: With our results, we provide evidence of common community-based participatory research (CBPR) principles which have supported the sustained engagement with those racial minorities who are most vulnerable in our community. While future analysis is planned to utilize this same approach with our community partners, this work marks an important step in reflecting upon the approaches which have led to our success and how they can be applied in future collaborations to maximize impact and sustained health improvements.

Objective: Research on the inequality of chronic respiratory disease (CRD) is limited, and the association between CRD and all-cause mortality is not well-established. Investigating the distribution of CRD and its associated mortality risks is essential for improving CRD conditions and developing targeted intervention measures. This study aimed to explore the relationship between inequalities in CRD and all-cause mortality in China.

Methods: This study utilized nationally representative baseline data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020, wave 1-wave 5), including a total of 14,743 subjects. The concentration index was employed to measure socioeconomic-related inequality in CRD, and the concentration index decomposition method was used to describe its influencing factors. Cox proportional hazards regression model was employed to examine the association between CRD and all-cause mortality.

Results: The prevalence of CRD was 11.79% (95% CI: 10.98, 12.66) in China. The concentration index for CRD was -0.050 (95% CI: -0.075, -0.026), indicating a certain degree of inequality in its prevalence. Chronic lung disease (concentration index = -0.046, 95% CI: -0.073, -0.019), asthma (concentration index = -0.102, 95% CI: -0.148, -0.056), and asthma-chronic obstructive pulmonary disease overlap syndrome (concentration index = -0.114, 95% CI: -0.173, -0.055) also exhibited a pro-poor distribution. The decomposition analysis of the concentration index for CRD revealed that age, education level, and economic status played substantial roles in contributing to the observed inequality. Additionally, Cox regression analysis showed that participants with CRD had an increased risk of all-cause mortality (HR = 1.49, 95% CI: 1.34, 1.65).

Conclusion: Inequalities exists in CRDs in China, with the prevalence of these diseases primarily concentrated among economically disadvantaged groups. Additionally, CRD increases the risk of all-cause mortality. Addressing the root causes of economic inequalities and enhancing the educational attainment of individuals with low socioeconomic status can help improve the situation.

Background: Campylobacter is associated with environmental enteric dysfunction (EED) and malnutrition in children. Campylobacter infection could be a linchpin between livestock fecal exposure and health outcomes in low-resource smallholder settings.

Methods: We followed a birth cohort of 106 infants in rural smallholder households in eastern Ethiopia up to 13 months of age. We measured anthropometry, surveyed sociodemographic determinants, and collected stool and urine samples. A short survey was conducted during monthly visits, infant stool samples were collected, and Campylobacter spp. was quantified using genus-specific qPCR. In month 13, we collected stool and urine samples to assay for EED biomarkers. We employed regression analyses to assess the associations of household determinants with Campylobacter colonization, EED, and growth faltering.

Results: The Campylobacter load in infant stools increased with age. The mean length-for-age Z-score (LAZ) decreased from -0.45 at 3-4 months of age to -2.06 at 13 months, while the prevalence of stunting increased from 3 to 51%. The prevalence of EED at 13 months of age was 56%. A higher Campylobacter load was associated with more frequent diarrhea. Prelacteal feeding significantly increased Campylobacter load in the first month of life. Over the whole follow-up period, Campylobacter load was increased by keeping chickens unconfined at home and unsanitary disposal of infant stools while decreased by mothers' handwashing with soap. Longitudinally, Campylobacter load was positively associated with food insecurity, introduction of complementary foods, and raw milk consumption. There were no significant associations between Campylobacter load, EED, and LAZ.

Conclusion: This study found that most determinants associated with increased Campylobacter infection were related to suboptimal feeding practices and hygiene. The findings related to livestock-associated risks were inconclusive. Although stunting, EED, and Campylobacter prevalence rates all increased to high levels by the end of the first year of life, no significant association between them was identified. While additional research is needed to investigate whether findings from this study are replicable in other populations, community efforts to improve infant and young child feeding practices and food hygiene, and water, sanitation, and hygiene (WaSH) at the household level, could reduce (cross-)contamination at the point of exposure.

Background: China has been exploring HIV self-testing (HIVST) among men who have sex with men (MSM) since 2014. Currently, both non-profit and commercial initiatives HIVST services have achieved comprehensive coverage. Investigating the factors influencing the initial adoption of HIVST among MSM in this context can help develop tailored HIVST service strategies of and further promote HIVST adoption among MSM communities.

Methods: We selected 230 participants from a prospective cohort on HIV infection among MSM population in Guangzhou, China, who had no prior experience of HIVST. Among the study participants, 43 who initially adopted HIVST during the follow-up period were designated as the case group, while the rest comprised the control group. Electronic questionnaires were used for baseline and follow-up surveys to collect demographic information, sexual behavior characteristics and HIVST utilization in the past 6 months. Logistic regression models were applied to analyze the factors influencing the initial adoption of HIVST.

Results: Among the study participants, 18.7% (43/230) initially adopted HIVST during the follow-up period. Multivariate logistic regression analysis revealed that individuals who primarily sought sexual partners through offline venues in the past 6 months (aOR = 5.28, 95% CI: 1.01-27.79), had more than one sexual partner in the past 6 months (aOR = 2.76, 95% CI: 1.33-5.74), engaged with more than two casual partners in the past 6 months (aOR = 3.02, 95% CI: 1.35-6.78), or had more than one regular partner (aOR = 3.37, 95% CI: 1.51-7.51) exhibited an increased likelihood of initiating HIVST.

Conclusion: In the context of comprehensive promotion and coverage of HIVST service, the development of personalized, adaptable, and innovative HIVST strategies for MSM with a higher number of sexual partners, particularly those in regular partnerships and those seeking partners offline, may further increase the adoption of HIVST among MSM.