Global Public Health最新文献

African, Caribbean, and Black (ACB) women are overrepresented among new HIV diagnoses due to social and structural factors. This study seeks to create, implement, and evaluate a community-based peer-led intervention to improve access to HIV prevention and care for ACB women in Canada. This multisite, five-year project, using community-based participatory research, implementation science and evaluation frameworks, will be implemented in five non-iterative phases. Phase 1: Community and partner engagement; Phase 2: Critical health and racial literacy training curriculum and HIV resource development; Phase 3: Implementation research with first cohort of trained HIV Peer Equity Navigators [PENs] in three sites; Phase 4: Training of second cohort of HIV PENs and program implementation of HIV PEN intervention across Ontario; and Phase 5: Evaluation, knowledge sharing and plans for national scale up. We will use a mixed methods approach, including quantitative and qualitative data, such as surveys and qualitative interviews, to analyze and identify implementation scenarios, changes in improving access, and ensuring equity to HIV prevention and care for ACB women in Ontario, Canada. Evidence on the effectiveness of this innovative, peer-led intervention will be used to inform policies and practice related to HIV prevention and care for ACB women in Canada.

Connecting with traditional knowledge and culture promotes the well-being of Indigenous parents and creates healthy environments for child development. Community Elders in a remote northern community in Alberta, Canada, collaborated with researchers to design a pilot Elders Mentoring Program. The programme aims to support young Indigenous mothers(-to-be), bringing back cultural traditions and teachings. Twelve workshops for Indigenous mothers(-to-be) focused on cultural activities and passing down traditional knowledge from Elders. Nine mothers(-to-be) completed a survey about their perinatal and postpartum experiences and care needs. Sharing circles with Elders and individual debriefings with mothers were conducted to understand their experiences in the workshops. Survey responses showed limited childcare services and transportation availability as barriers to accessing perinatal and postpartum support. Four themes emerged from qualitative data analysis: (1) the meaningful role of Elder mentorship for Indigenous mothers(-to-be); (2) Weekly workshops provided a safe space to share and develop relationships; (3) Participation in workshop activities fostered positive coping and improved self-esteem; (4) Elder-led workshops encouraged cultural connection and transference of traditional knowledge to younger generations. Cultural workshops led by Elders enhanced the connection to culture and resilience for Indigenous mothers and expectant mothers in a remote northern community.

From both an academic and a policy angle, menstruation is receiving an unprecedented level of attention. Within the academic literature, there are many different normative arguments being furthered for how menstruation should be understood and framed - variously, that it should be understood as an issue of rights, justice, health or hygiene management. Yet less attention has been paid to the step preceding these normative arguments - how menstruation actually is understood at present within global health policy. In this paper, we argue that, despite this proliferation of academic and policy interest, attention to menstruation is still relatively muted at the level of global health policy. Using Carol Bacchi's 'what's the problem?' approach to critical frame analysis, we show that global health policy on menstruation remains patchy, with little cohesive understanding of it as a policy issue emerging at the international level. Instead, competing constructions of it as an issue emerge, such that there is not one clear way in which menstruation is addressed in international health policy. We sketch the implications of this, arguing that without a collective understanding of the problem, solutions are likely to remain siloed, and cross-sectoral work will be difficult.

Electronic Personal Health Records (EPHRs) are potentially effective tools for improving the continuity and quality of care for migrants and refugees, and specifically for undocumented migrants (UDMs). However, little is known about the intention and preconditions of healthcare providers (HCPs) to use an EPHR for UDM in the Netherlands. Between April 2023 and June 2023, thirteen interviews, using a semi-structured topic guide, were conducted with Dutch HCPs. Open coding and axial coding were used for data coding, organised using the Technology Acceptance Model (TAM). HCPs reported a positive user intention towards using an EPHR for UDMs, coupled with a cautious optimism regarding UDMs' willingness to use an EPHR. Actual usage was dependent on several preconditions: establishing trust among HCPs and UDMs in the EPHR, implementing a highly secure system to protect UDM's sensitive data, giving UDMs control over their EPHR, and using approaches to minimise dual record keeping and developing a user-friendly system. An EPHR shows promise to enhance continuity of care and quality for UDMs in the Netherlands. However, an EPHR should not be a prerequisite for receiving medical care but rather a supportive element in the provision of care.

The current mpox outbreak has challenged previous understanding of the disease, with human-to-human transmission being a significant mode of transmission, particularly among gay, bisexual, and other men who have sex with men (GBMSM). A knowledge gap exists on MSM's mpox experiences in Nigeria's restrictive sociolegal context. This study explored mpox awareness, knowledge, and experiences among MSM in Lagos, Nigeria, through 28 in-depth interviews. We analysed the interview transcripts thematically. Findings showed low awareness and knowledge of mpox among MSM, who prefer seeking healthcare outside public health facilities due to stigma. Intimate contact during sexual intercourse is a likely source of infection among MSM. The Nigerian mpox response does not centre MSM, and centreing them may not be ideal due to potential stigma. MSM seek care through various means, including drugs, herbal remedies, and KP-friendly sexual and reproductive health (SRH) services, but face stressful care-seeking due to limited social support and stigma. The study shows that Nigeria's mpox situation differs from the situation in mpox non-endemic contexts. The homophobic legal and social environment and heterogenous spread require unique disease framing and context-sensitive response. The study concludes that further surveillance is needed to deepen understanding around mpox care seeking among MSM in Nigeria.

Precision oncology (PO) has significantly advanced lung cancer treatment by enabling personalised therapy based on genetic mutations. However, equitable access to molecular testing and targeted therapies remains a challenge, particularly in resource-limited settings such as the Brazilian Public Health System (SUS). To identify the challenges faced by SUS in caring for patients with non-small cell lung cancer (NSCLC) in terms of access to Precision Oncology. Retrospective study with data from e-medical records of NSCLC treated between 2015-2021. 174 patients with NSCLC were included, of which 56% were females and 63% had non-squamous histology - 80% of early-stage patients and 32% of advanced-stage patients missed access to genomic testing, primarily due to short life expectancy or insufficient sample size. Only one participant underwent testing for all recommended biomarkers. Among patients with actionable mutations, 40% did not receive targeted therapy; however, regarding EGFR mutations, only 8% did not get it. Access to targeted therapy was associated with improved survival outcomes. The study highlights critical challenges and missed opportunities in the implementation of precision oncology for NSCLC management within the SUS and underscores the need for strategies to improve access to genomic testing in the public health setting.

This article presents the results of a mapping and analysis of key stakeholders operating in the field of Sexual, Reproductive, and Maternal Health and Rights (SRMHR) who are involved in the entitlement of health rights and access to health services for women, adolescents, LGBTQI+ individuals, migrants, indigenous people, Afro-descendants, and people with disabilities in Latin America and the Caribbean. Our study focuses on Argentina, Colombia, Guatemala, Guyana, Jamaica, Mexico, and Peru. The primary objective was to identify and comprehensively categorise the activities undertaken by them, since their actions shape, and promote or hinder the SRMHR political agenda in the region. The findings of this mapping can be useful in contributing to the development of public policy strategies.

Indigenous data sovereignty is of global concern. The power of data through its multitude of uses can cause harm to Indigenous Peoples, communities, organisations and Nations in Canada and globally. Indigenous research principles play a vital role in guiding researchers, scholars and policy makers in their careers and roles. We define data, data sovereignty principles, ways of practicing Indigenous research principles, and recommendations for applying and actioning Indigenous data sovereignty through culturally safe self-reflection, interpersonal and reciprocal relationships built upon respect, reciprocity, relevance, responsibility and accountability. Research should be co-developed, co-led, and co-disseminated in partnership with Indigenous Peoples, communities, organisations and/or nations to build capacity, support self-determination, and reduce harms produced through the analysis and dissemination of research findings. OCAP® (Ownership, Control, Access & Possession), OCAS (Ownership, Control, Access & Stewardship), Inuit Qaujimajatuqangit principles in conjunction the 4Rs (respect, relevance, reciprocity & responsibility) and cultural competency including self-examination of the 3Ps (power, privilege, and positionality) of researchers, scholars and policy makers can be challenging, but will amplify the voices and understandings of Indigenous research by implementing Indigenous data sovereignty in Canada.

Indigenous ways of knowing, being and doing are based on embodied sovereignty, relationality and countless generations of knowledge sharing. We call for epistemic justice in which Indigenous knowledge systems are recognised and valued in research-related contexts. We draw attention to how colonial knowledge systems silence, delegitimise and devalue specific knowers and ways of knowing, being and doing - through truth telling. This includes (1) the extent to which educational systems, research, practices, decisions, and reported outcomes are whitewashed - a process of structural and systemic discrimination, racism, and exclusion that actively alters or omits Indigenous and non-Euro-Western contributions and perspectives to fit Euro-Western norms and (2) whitewashed and racialised logic in scientific research that claims to be open, collaborative and transparent. Whitewashing not only obscures the history and contributions of Indigenous peoples and communities but also actively reinforces systemic biases and inequities. We assert the need for epistemic justice in public health research. Epistemic justice calls for Indigenous sovereignty and self-determination to be made visible. It may involve on how colonial policies, protocols, and regulations are connected to everyday lived inequities of Indigenous communities, families and individuals. Ultimately, epistemic justice is inherent to Indigenous peoples' health and wellness, self-determination and sovereignty.

Community pharmacies have expanded to include new services such as health screenings and medication reviews. However, developing and implementing new applications tends to be challenging and entails comprehensive planning by multiple stakeholders. This qualitative study explores stakeholders' perspectives of these new services and identifies perceived barriers or facilitators for implementing practice changes. The study held four focus group discussions with 27 stakeholders and was conducted in Al Baha province, Saudi Arabia. Participants described community pharmacy services as traditional and limited to dispensing prescriptions. Several barriers were identified, including a lack of public awareness, public privacy and confidentiality concerns, and inadequate communication and collaboration between community pharmacists and physicians. According to the participants, free training programmes and continuing education for community pharmacists (with a focus on independent and small-chain community pharmacies) and financial support from the government could facilitate extending the roles played by community pharmacists. Another suggestion was that implementing standards for accreditation could create a competitive environment for community pharmacies, granting them well-deserved privileges and enhancing public confidence in the quality and safety of pharmaceutical care. Developing interprofessional policy is also vital, as this would allow community pharmacies to integrate into the health system.