International Journal of Public Health最新文献

Objectives: To conduct a systematic review to analyze the barriers and facilitators related to accessing essential medicines in low- and middle-income countries (LMICs).

Methods: We searched PubMed, SciELO, LILACS, and Web of Science for studies published between 2002 and 2025. Studies were included if they were peer-reviewed, written in English or Spanish, and reported data on barriers or facilitators across three dimensions: availability, affordability, and adequate use.

Results: From 1010 identified records, 36 studies were included. Most were quantitative (n = 26), followed by qualitative (n = 8) and mixed-methods (n = 2) designs. Barriers (n = 34 studies) were reported more frequently than facilitators (n = 25), particularly for availability and affordability. Key barriers included public sector stock-outs and high prices in the private sector. A key facilitator was the presence of a national essential medicines list.

Conclusion: Our analysis compiles evidence on barriers and facilitators affecting access to essential medicines in LMICs. Policies favoring generic drug procurement and public-private sector disparities highlight the complexity of ensuring equitable access.

[This corrects the article DOI: 10.3389/ijph.2024.1606903.].

Objectives: This study aimed to estimate the proportion of individuals potentially eligible for lung cancer screening in Lausanne, canton of Vaud, Switzerland, and its associations with key sociodemographic and health-related covariates.

Methods: We analyzed self-reported, cross-sectional data from three sources: Lausanne cohort 65+ (2014; n = 1,678; ages 65-70), CoLaus|PsyCoLaus (2014-2017; n = 3,839; ages 50-79), and the Swiss Health Survey (2022, representative of Vaud, ages 50-79). Eligibility was defined by the 2021 United States Preventive Services Task Force criteria. Screening eligibility prevalence was estimated separately in each dataset, and eligible and non-eligible participants were compared using bivariate hypothesis tests.

Results: Eligibility was 18.2% in the Lc65+ cohort, 16.0% in CoLaus, and 14.4% in the Swiss Health Survey. Among eligible individuals, the prevalence of current smoking was 58.7% in Lc65+, 60.1% in the Swiss Health Survey, and 64.9% in CoLaus. Eligible participants tended to have a higher burden of comorbidities and social vulnerabilities, including cardiovascular disease, metabolic syndrome, depression, and lower education or income; statistically significant differences varied by dataset.

Conclusion: In this Swiss population, about one in six adults met lung cancer screening criteria. Findings highlight the need for combining early detection with tobacco cessation, health promotion, and equitable access to care.

Objectives: This paper explores the communication challenges faced by public health institutions in Switzerland during COVID-19 pandemic and identifies key barriers and facilitators of effective communication within and across public health institutions.

Methods: In 2021, we conducted qualitative online semi-structured interviews to collect opinions and experiences of representatives of Swiss public health institutions. Interview transcripts were analyzed using inductive thematic analysis to identify main themes.

Results: Key facilitators of effective communication included flexibility, dedicated resources, new processes, coordination, and experiential knowledge. Inter-institutional communication benefited from clear processes, active listening, mediation, and strong networks. Barriers mirrored these factors, such as role tensions, unclear responsibilities, and limited resources. Discrepancies across cantons and between government levels, especially between the confederation and cantons, often hindered communication.

Conclusion: To strengthen communication in public health crises, we recommend clear protocols, centralized structures, and bridging cultural and linguistic gaps. Ongoing training and diverse perspectives are key to effective communication within and across public health institutions in Switzerland and beyond.

Objectives: Hypertension is a major cardiovascular risk factor in Brazil and globally, requiring effective healthcare system strategies. This study examines how the health system in São Paulo manages hypertension, identifying patterns and connections that influence patient outcomes and resource use.

Methods: Using literature reviews and participatory discussions with experts, we developed a systems map, causal loop diagram, to illustrate dynamic complexity underpinning hypertension management. Thematic analysis of qualitative data informed the model, highlighting key interactions that shape screening, treatment, and long-term care.

Results: The analysis reveals critical dynamics at individual, community, and system levels. Early diagnosis and expanded treatment access improve adherence and reduce complications. However, these improvements also increase the number of patients needing long-term care. This creates a challenge where healthcare gains today can raise future demands if prevention efforts are underfunded.

Conclusion: Understanding these interconnections is crucial for balancing treatment expansion with sustainable prevention strategies. By mapping system-wide challenges, this study offers a framework to help policymakers allocate resources more effectively and strengthen urban health systems. Future research will focus on using simulation modeling to test policy interventions and improve hypertension outcomes.

Objectives: Poor hypertension prevention among people living with HIV (PLHIV) in sub-Saharan Africa may undermine progress in HIV prevention achieved within this population. This review synthesizes data on the prevalence, diagnosis, treatment, control, and challenges related to hypertension prevention among PLHIV in SSA.

Methods: A mixed-method systematic review with meta-analysis was conducted from January to December 2024. Data analysis was performed using random-effects modeling stratified by age and sex, along with thematic analysis. The JBI critical appraisal tool was used to assess study quality.

Results: A total of 31 studies, including 32286 PLHIV (±37 years old), were included. Hypertension affected 25% [95% CI, 21%-28%] of PLHIV, yet only 34% [95% CI, 11%-64%] of cases received treatment, and 19% [95% CI, 3%-34%] had controlled blood pressure, despite BP measurement in 95% [95% CI, 89%-100%] of them.

Conclusion: Hypertension prevention challenges stem from patient-related factors, healthcare providers, and health system gaps. Despite the high prevalence of hypertension among PLHIV, treatment initiation and blood pressure control rates remain low. Strengthening the integration of HIV and hypertension care services is urgently needed.