Journal of Community Health最新文献

Despite global advancements, pregnant women living with HIV in Nepal remain at risk for vertical transmission. This study examined demographic and clinical characteristics, antiretroviral therapy (ART) retention, and transmission outcomes among this population. A retrospective cohort analysis was conducted using data from Nepal's national electronic HIV register, including 322 women who became pregnant between 2020 and 2023. We analyzed sociodemographic profiles, clinical status at diagnosis, ART initiation timing, retention rates at 6, 12, and 24 months, and infant HIV status. The mean age was 26.9 years; over half (56.2%) were aged 25-39 years. Nearly 40% were illiterate, 87.6% unemployed, and 66.8% reported unsafe sexual behavior as the mode of HIV transmission. Over half (58.1%) were diagnosed prior to pregnancy, and 75.5% were in WHO Stage 1. ART began on the same day in 34.8% and within a week in 40.1%, with 56.8% already on ART during pregnancy. Retention was high: 96.9% at 6 months, 94.8% at 12 months, and 96.0% at 24 months. Vertical transmission occurred in 4.3% of pregnancies. Higher transmission rates were observed among younger mothers (6.9%), Dalit women (11.5%), those in advanced HIV stages (11.1%), with delayed ART initiation (8.6%), high viral loads (13.3%), and home deliveries (17.6%). In Nepal, approximately 1 in 23 infants born to women living with HIV still acquire the infection. Strengthening early diagnosis, improving ART uptake, and addressing disparities in care especially among high-risk groups are essential to eliminating vertical transmission and improving maternal and child health outcomes.

The escalating cost of medications has rendered them increasingly unaffordable, particularly for uninsured and underinsured individuals. Free clinics often serve as vital safety nets for these medically vulnerable populations, offering low-cost or free healthcare and medications. However, these programs often grapple with issues of scalability and sustainability due to limited resources. This study examines the implementation of a novel pharmaceutical program at the Rhode Island Free Clinic, designed to establish a sustainable, charitably-sourced medication program for around 2,000 uninsured patients. Anonymous surveys of 99 patients conducted before and after the program's introduction revealed a marked improvement in medication access. The proportion of patients who found obtaining medications "very difficult" declined from 36% pre-intervention to 9% post-intervention. This initiative distinguishes itself through strategic partnerships with existing programs, fostering a patient-centered approach that prioritizes medication accessibility while minimizing the operational burden on any single organization. While challenges remain, initiatives like this represent a crucial step toward bridging gaps in the current landscape of American healthcare, ultimately contributing to healthier communities, reduced medical expenditure, and a more equitable healthcare system.

Firearm-related suicides and unintentional injuries occur at higher rates in rural U.S. communities than in urban areas. While safe storage programs may help reduce these injuries, little is known about how to effectively engage rural, farming populations. This study aimed to identify factors influencing firearm safety programming and messaging among parents in rural households. Focus groups were conducted in 2024 with rural Iowa parents recruited via FFA club advisors and through the University of Iowa mass e-mail system. Inclusion criteria included: (1) residence in Iowa with active farming or ranching operations, (2) at least one child aged 10-19 living in the home, and (3) at least one firearm in the household. Discussions followed a moderator guide to identify primary themes, with sub-themes emerging organically. Transcripts were analyzed using Dedoose software. Three researchers independently coded the data and resolved discrepancies through consensus. Thirty-two participants identified trusted messengers as law enforcement, Department of Natural Resources personnel, and community members affected by firearm violence. Teachers, healthcare professionals, and celebrities were viewed as less credible. Participants emphasized age-specific messaging using realistic examples and visuals and suggested integrating firearm safety into existing programs like school curricula, 4-H, FFA and local safety courses. Views on distributing safety devices like locks and safes were mixed. Tailoring firearm safety interventions to reflect the values and preferences of rural communities may improve engagement and effectiveness. Strategies led by trusted local messengers may be particularly impactful.

Breast cancer screening rates are lower for Hispanic females (Latinas) than their non-Hispanic White counterparts. This discrepancy is partly due to health disparities, such as limited access to care, inability to take time off work, lack of health insurance, and cultural and emotional barriers. In response to a health department request, the Carol Milgard Breast Center conducted a qualitative assessment, as part of a community grant pilot award from Fred Hutchinson Cancer Center, to better understand the barriers and facilitators influencing Latinas' participation in mammography screening. The objective was to identify key characteristics of an intervention aimed at encouraging mammogram uptake among Latinas. Forty women were recruited and consented to participate in structured interviews, which included questions on their perceptions of mammography. The interviews explored structural barriers (e.g., lack of insurance), cultural issues (e.g., prioritizing family over individual health), and emotional concerns (e.g., fear of embarrassment). By detailing lessons learned and community identified outreach strategies, this work advances the evidence base on community engagement with Latinas for cancer education and outreach. Findings underscore the need for linguistically and culturally tailored resources, trusted messengers, and outreach approaches that meet Latinas where they are. The identified strategies can inform interventions to improve mammography uptake in similar communities and guide larger-scale implementation efforts.

This quasi-experimental study examined the biopsychosocial (BPS) vulnerabilities of non-vaccinated elderly individuals, evaluated the effectiveness of community health workers (CHWs) in improving influenza vaccine uptake, and assessed the impact of a CHW-administered community-based health intervention (CBHI) on health-related quality of life (HRQoL). Pre- and post-intervention data were collected from participants enrolled in the "Get Well, Live Well" (GWLW) program. As part of this CBHI, hospital-employed CHWs applied various interventions to improve influenza vaccine awareness, accessibility, and timely administration. The BPS risk screener and EQ5D-3L were used to assess the individuals' initial biopsychosocial vulnerabilities and pre/post-program HRQoL respectively through face-to-face and telephone interviews. Influenza vaccination rates were computed and data were analyzed utilizing Chi-square and non-parametric tests, along with logistic regression analysis (α = 0.05). The final sample (n = 229) had a mean age of 73.15 ± 5.6 years and comprised 68.1% women and 87.8% Chinese. Non-vaccinated individuals were found to be younger and exhibited significantly greater social health risk and poorer self-rated health than their vaccinated counterparts. Multivariate analysis revealed that age was the primary predictor of non-vaccination (OR = 0.94; 95% CI = 0.90-0.99). The CHW-administered GWLW program doubled influenza vaccination rates (30.1-60.7%) and significantly improved the summary index, self-rated health, and prevalence of no pain/discomfort among the elderly. CBHIs, administered by hospital-employed non-medical CHWs, proved effective in improving influenza vaccination rates and elevating HRQoL. Future influenza vaccination efforts should prioritize socio-interpersonal interventions for the younger elderly.

Violent injury imposes substantial economic, health, and social burdens on survivors, yet little is known about awareness and access to state-run Crime Victims Compensation (CVC) programs among those most affected. This study examined CVC awareness, application patterns, and barriers among violently injured patients at an urban Level I trauma center. We conducted a prospective cohort study of adults (≥ 18 years) admitted between February 1, 2024 and February 1, 2025 for injuries due to firearm assault, pedestrian-motor vehicle collision, physical assault, or reckless injury. Data from the electronic medical record, participant surveys, and the Wisconsin Department of Justice CVC database were analyzed to identify factors associated with CVC application and outcomes. Of 2,200 trauma patients screened, 141 were enrolled. Participants were predominantly male (74%) and Black (68%), with 62% residing in neighborhoods in the highest deciles of socioeconomic disadvantage. Only 9% were aware of the CVC program prior to enrollment, yet 50% applied for funds. Applicants were more likely to be younger, Black, employed, and survivors of gunshot wounds. Among applicants, 55% were approved and 30% denied; delinquent child support accounted for 67% of denials, and discomfort engaging with law enforcement for 14%. Most participants (93%) anticipated injury-related costs (median $1,500). CVC awareness among violently injured patients remains extremely low. Integrating CVC education and assistance into hospital workflows and reforming punitive eligibility criteria are essential to promote equitable financial recovery and community reintegration after violent injury.

The World Health Organization (WHO) has declared public health emergency of international concern (PHEIC) for the multinational outbreak of mpox in 2024, due to clade I Monkeypox virus (MPXV). Our team conducted a questionnaire-based cross-sectional study to investigate the knowledge and attitudes of 902 health science students (who were studying dentistry, physiotherapy, pharmacy, or nursing) in India and Bangladesh. The mean knowledge and attitude scores were 14.4 ± 3.6 and 7.7 ± 1.9, respectively. Despite high (> 85%) awareness of Mpox outbreaks and cognizance of the declaration of PHEIC, noteworthy misconceptions were also noticed: 55.9% thought that MPXV infection could be treated with antibiotics, and there was an increased case fatality estimation. Approximately 91% of students preferred post-infection isolation and relied on vaccination. Nearly three-fourths of them were concerned about the pandemic potential of MPXV. Based on the multivariable models, we found that students ≥ 26 years of age (β = 2.23; 95% CI 0.97-3.50) and those with prior information-seeking behavior through Google, ChatGPT, etc. (β = 1.46; 0.97-1.96) independently predicted higher knowledge. These patterns were also observed for attitudes (β = 0.84, 0.23-1.45). Interns/residents showed better scores, while third-year students displayed lower knowledge (β = -1.42; -2.75 to - 0.09). These findings show that there is scope for readiness, but there are gaps in therapeutic and risk management. This study underscores the need for incremental activities to augment digital and curricular literacy for combating public health emergencies in low-resource academic milieu.

South Asian immigrants in Southeast Queens County, New York City face healthcare, housing, and digital access challenges shaped by English proficiency. Despite community growth, data remains limited. This assessment examines English proficiency as a social determinant of health. A mixed-methods study was conducted across nine ZIP codes in Southeast Queens County, New York City. From August 1-October 31, 2023, the quantitative phase included a multilingual survey (English, Bengali, Hindi) that reached 395 South Asian participants, covering demographics, living conditions, food security, safety, mental health, and digital literacy. The qualitative phase (December 2023-March 2024), guided by IDEO's Human-Centered Design, included five interviews and a focus group. Analysis revealed significant disparities between Limited English Proficiency (LEP, n = 288) and non-LEP (n = 107) individuals. LEP respondents reported more housing issues, especially pest infestations (91.1% vs. 82.4%, p = 0.042), and lower homeownership (19.1% vs. 34.6%, p = 0.031). Computer literacy was lower among LEP individuals (50.6% vs. 80.8%, p < 0.001), though internet access was high in both groups (87.0% for LEP vs. 91.4% for non-LEP, p = 0.24). Housing instability persisted, with a greater share of LEP participants renting (70.6% vs. 56.4%, p = 0.031). This assessment highlights how language proficiency shapes social determinants of health for South Asian immigrants in Southeast Queens County, New York City. LEP individuals faced more housing, food, safety, and digital literacy challenges, underscoring the need for language-accessible, culturally tailored services.

Non-adherence to antiretroviral therapy (ART) remains a major barrier to achieving viral suppression and HIV epidemic control, particularly in sub-Saharan Africa. Despite significant ART coverage in Tanzania, a substantial proportion of people living with HIV (PLHIV) fail to achieve optimal adherence, leading to drug resistance, treatment failure, and increased morbidity. This study determined the prevalence and factors associated with ART non-adherence among PLHIV. A cross-sectional study was conducted among 309 PLHIV receiving ART at Mwananyamala Hospital. Participants were selected through simple random sampling. Data were collected using structured questionnaires and medical record reviews, and analysed using SPSS version 26. Descriptive statistics determined prevalence, while bivariate and multivariate logistic regression identified associated factors. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values < 0.05 were used to determine statistical significance. The prevalence of ART non-adherence was 35.3%. Participants aged ≥ 45 years were more likely to be non-adherent (AOR = 2.52, 95% CI: 0.98,6.52, p = 0.046). Longer ART duration (> 5 years) was also significantly associated with non-adherence (AOR = 1.75, 95% CI: 0.97,3.15, p = 0.041). Forgetfulness emerged as another determinant (AOR = 1.28, 95% CI: 0.36,2.87, p = 0.017). Other factors such as stigma, social support, and alcohol use had no significant association with non-adherence. Over one-third of PLHIV at Mwananyamala Hospital were non-adherent to ART. Targeted interventions addressing treatment fatigue, forgetfulness, and long-term adherence support are essential to sustain viral suppression and prevent treatment failure in Tanzania.

In Australia, adolescent suicidal and non-suicidal self-injury (NSSI) behaviours have been steadily increasing over that past two decades. However, existing research on the geographic distribution of these behaviours in Australia largely focuses on adults, suicides, or uses pre-COVID-19 data. This study aimed to map and describe the geographic regions where ambulance attendances for adolescent suicidal and NSSI behaviours are occurring. Data from the National Ambulance Surveillance System were used to analyse three-year averages and per capita rates of ambulance attendances for adolescents (12-17 years) across local government areas in New South Wales (NSW), Victoria, and Tasmania from 2021 to 2023. The three-year annual average of ambulance attendances for adolescent suicidal behaviour and NSSI were 6,504 in NSW (35.94 per 10,000), 4,017 in Victoria (25.61 per 10,000), and 444 in Tasmania (44.86 per 10,000). Nearly 90% of attendances required transport to hospital, and over 50% occurred outside traditional service hours. Results identified that Major Cities and high socioeconomic status (SES) local government areas (LGAs), were significantly less likely to have higher rates of ambulance attendances for adolescent suicidal and NSSI behaviours. This study highlights substantial variability across three eastern states of Australia where adolescent suicidal and NSSI behaviours are occurring, demonstrating the need for accessible after-hours mental health support, and that regional and lower SES LGA's are disproportionately impacted. Given the concerning state of adolescent mental health in Australia, this study highlights the need for targeted, data-informed responses to reduce the current reliance on emergency care.