Journal of Community Health最新文献

Introduction: Although leprosy was declared eliminated in Malaysia in the 1990s, it continues to affect the indigenous Penan community in rural Baram, Sarawak, with prevalence rates of 2.08-35.5 per 10,000-far above the WHO threshold. Previous studies noted delayed diagnoses and geographical clusters among the Penan, but the drivers of ongoing transmission remain unclear.

Objective: This study examined factors contributing to the persistent high incidence of leprosy within the Penan community in Upper Baram, Sarawak.

Methods: Semi-structured qualitative interviews were conducted from January-May 2022 with Penan individuals and healthcare professionals (HCPs), using guides based on the Socioecological Model. Villages with high leprosy incidence and relevant rural health facilities were purposively sampled. Interviews were recorded, transcribed, and thematically analysed.

Results: Thirty-seven participants were interviewed: 22 Penan (aged 19-82) and 15 HCPs (aged 28-62). Three themes emerged: (i) transmission was linked to family-level spread, inter-village movement, and disease characteristics; (ii) community factors included low awareness, nomadic lifestyle, overcrowding, and poor nutrition; (iii) health system barriers included limited access, inadequate diagnostic capacity, fear of slit skin smear procedures, and infrequent active case detection.

Conclusion: Leprosy transmission among the Penan is sustained by cultural, environmental, and healthcare system challenges. Addressing this requires a multifaceted response, including stronger rural health infrastructure, improved diagnostics, regular active case detection, and culturally tailored health education to halt transmission in this underserved community.

To document the characteristics, costs, and services of lodging organizations that support domestic medical travelers and introduce a publicly accessible, geocoded national dataset to inform health services research and policy. We conducted a cross-sectional descriptive study of lodging organizations serving patients and caregivers traveling for medical care across the United States between April 2023 and May 2024. Structured data collection and geospatial mapping were performed. We used chi-square tests to compare characteristics of pediatric-only versus adult- or all-age-serving facilities. Primary data were collected through systematic review of publicly available websites, national directories, and direct outreach to facilities. The analytic sample included 502 U.S.-based lodging organizations meeting eligibility criteria: providing temporary accommodations to patients and caregivers traveling for care. Data were geocoded and analyzed using ArcGIS and R (version 2024.04.2). Among the 502 organizations, 52.4% offered free lodging and 84.7% advertised financial assistance. Pediatric-only facilities (40.8% of the sample) were significantly more likely to offer support services (99.0% vs. 77.1%) and lower-cost accommodations than those serving adults or all ages. Services varied: 53% offered meals, 41% transportation, and 33% domestic activity support (e.g., laundry or kitchens). Organizational affiliation also varied, with 44.4% being independent or hospital-based. A geocoded national map of all facilities was developed and made publicly available at https://www.umaryland.edu/navigator . Lodging organizations form a decentralized but vital support system for patients and caregivers navigating medical travel. This study reveals structural variation in access and highlights equity gaps, particularly for adults and patients with less common diagnoses. Findings support recognition of lodging as a health-related social need and its potential integration into value-based care, Medicaid waivers, and hospital community benefit strategies.

Hepatitis B is a severe liver infection caused by the Hepatitis B virus (HBV), potentially leading to liver cirrhosis, failure, and carcinoma. Transmission occurs through contact with infected bodily fluids, such as blood. Immunization against HBV is the most effective measure to prevent infection. Healthcare employees, particularly those who are under-vaccinated, are at elevated risk due to potential exposure. Although healthcare workers should have access, 24% of the healthcare workforce worldwide remains unvaccinated. Ensuring adequate immunization for this group is essential to maintaining a safe workplace and minimizing the risk of downstream transmission. We aimed to decrease the number of overdue Hepatitis B vaccinations among employees and dependent patients in an Internal Medicine (IM) practice at a large academic medical center At baseline, 3,052 IM patients were under-vaccinated. Our intervention identified 1,000 random patients. An EMR message was sent to the intervention group. The message provided instructions on scheduling an appointment or retrieving documentation from their occupational health records. Four weeks after the initial message, a follow-up message was sent as a reminder. The intervention resulted in a 14% increase in HepB medical record compliance updates. 780 patients interacted at least once with message broadcasts. Our intervention significantly increased Hepatitis B vaccination and documentation for patients within the intervention group. This study identified several barriers, such as a lack of willingness to receive recommended vaccines or update records to reflect accurate vaccination status. Additionally, limitations in record retrieval and difficulties pulling vaccination records from external databases hindered documentation.

The rise in internet use among students is a growing concern about its impact on physical health. This study aimed to assess the prevalence of internet addiction and its association with musculoskeletal pain among medical students in Jordan. A national cross-sectional study was conducted from February to March 2025 across undergraduate medical students in six Jordanian universities, using an online questionnaire that included three sections: demographics, the Internet Addiction Test (IAT), and the Nordic Musculoskeletal Questionnaire-Extended (NMQ-E). Data were analysed using descriptive statistics, chi-square tests, and multivariable logistic regression for the associations between internet addiction and musculoskeletal complaints across nine body regions. Among 1100 students, 65.9% were females. Most students fell within mild (38.7%) or moderate (27.6%) internet addiction levels, while 29.5% were classified as having normal internet use, and 4.1% showed severe addiction. Gender and academic year were not significantly associated with addiction level, though university affiliation was (p = 0.017). Musculoskeletal pain was very common, especially in the neck (67.6%), shoulders (43.5%), and lower back (38.2%). Regression analysis showed that male students had higher odds of experiencing elbow (p = 0.011) and ankle/foot pain (p = 0.049), but lower odds of neck (p < 0.001), shoulder (p < 0.001), and upper back pain (p < 0.001). Internet addiction scores showed no strong link to musculoskeletal symptoms, except for elbow discomfort (p = 0.036). Internet addiction is common among medical students in Jordan, but it shows a limited association with musculoskeletal disorders. Nonetheless, the high prevalence of both conditions highlights the need for integrated strategies that promote healthy digital habits and physical well-being among students.

Evictions are a major social and public health concern in the United States. The development of Natural Language Processing (NLP) technologies allows for analysis of medical record notes to identify eviction cases in healthcare systems. The current study uses medical records data from the largest integrated healthcare system in the United States to develop a surveillance system to estimate incidence rates of NLP-identified evictions (NIEs) and associated patient characteristics. Data on over 8.5 million unique patients in the Veterans Affairs (VA) healthcare system from March 2018-March 2020 were analyzed and NLP was used to identify incidences of eviction. The 2-year incidence rate for NIEs was 2.38% (95% CI = 2.37-2.39%), with an annualized rate of 1.37% (95% CI = 1.36-1.38%). Logistic regression analyses found greater risk for NIEs among patients who were 45-64 years old, were male, non-Hispanic Black, were unmarried, had a high school education or less, had annual household income equal to or below $45,000, lived in an urban area, lived in a high area deprivation index, lived in the West region of the country, and had a history of military sexual trauma. Patients with a history of homelessness (aOR = 6.45; 95% CI = 6.36-6.54), and diagnoses of drug use disorder (aOR = 2.53; 95% CI = 2.49-2.57) or schizophrenia (aOR = 1.88; 95% CI = 1.83-1.93) were also at greater risk for NIEs. These findings suggest evictions are a rare, but important event among veterans, and may inform homeless prevention efforts by identifying veterans from certain backgrounds at greater risk. This study helps demonstrate the utility of using NLP for a surveillance system to identify evictions and track changes over time.

Seasonal influenza represents a significant public health challenge, with high hospitalization and mortality rates among the most vulnerable populations. Despite healthcare recommendations and the availability of safe and effective vaccines, vaccination coverage remains below the targets set by the WHO. This study analyzes the role of socioeconomic factors, knowledge, and individual attitudes in adherence to influenza vaccination in the City of Syracuse, Italy. A cross-sectional study was conducted on 394 adults from the ASP of Siracusa, recruited through General Practitioners. A questionnaire collected sociodemographic data, vaccination information, and assessments of knowledge and attitudes. Statistical analysis was performed using logistic regressions to evaluate the factors associated with vaccination. Multivariate analysis highlighted a significant association between vaccination adherence and socioeconomic and demographic factors. Older age was associated with a higher likelihood of vaccination (OR = 1.04; p = 0.002), while being married or cohabiting was linked to a lower probability of getting vaccinated (OR = 0.33; p = 0.002). Moreover, residents of small towns had a significantly lower probability of vaccination compared to those living in urban areas (OR = 0.04; p < 0.001). Knowledge about the vaccine had a marginal impact on adherence, whereas a favorable attitude did not show a significant association. Adherence to influenza vaccination is influenced by sociodemographic factors, with lower coverage in small municipalities and younger age groups. The active involvement of General Practitioners and targeted strategies for communication and accessibility could improve vaccination coverage.

Human Papillomavirus (HPV) is among the most common sexually transmitted infections (STIs), with almost all sexually active individuals likely to encounter it during their lifetime. It is essential for health science students to have a comprehensive understanding of HPV, as their knowledge, attitudes, and behaviors can greatly impact patient education and decisions about vaccination or their current infection. This study aims to assess the level of awareness and knowledge about HPV among health science students and recognize the factors that influence these levels. We distributed paper questionnaires to 268 students (18-42 years) across different fields of study. Validity and reliability were assessed with 40 participants. After removing unreliable questions, a 36-item questionnaire was finalized. Awareness scores were calculated from responses, and statistical analysis was performed using IBM SPSS-27. This study examined 268 students aged 18 to 42 years, with an average age of 24.4 years (± 4.02). The median age was 24 years. Among the participants, 70.5% were female (189 subjects) and 29.5% were male (79 subjects). Students with PhD degrees in biological sciences had the highest awareness scores, averaging 16 (± 10.34). MSc students in biological sciences followed with awareness scores averaging 15.9 (± 5.83). BSc students in biological sciences had the lowest awareness scores, averaging 11.9 (± 6.43). Statistical analysis indicated that basic characteristics like sex, marital status, or having a partner did not significantly impact awareness levels among the subjects. However, the level of education was identified as a significant factor affecting awareness (p-value = 0.043). The majority of the study participants demonstrated a moderate level of knowledge about HPV. In this study awareness levels vary significantly across educational levels. However, the demographic factors such as gender, marital status, and relationship status did not notably influence the participants' levels of awareness. These findings underscore the need for targeted educational interventions to address this knowledge gap and improve HPV awareness, especially among BSc students in biological sciences.

Colorectal cancer (CRC) is the third most prevalent cancer worldwide, with its incidence rising in the Middle East. In the United Arab Emirates (UAE), higher numbers of younger individuals are being diagnosed, likely due to unhealthy lifestyle habits. This study aims to investigate the relationship between CRC awareness and preventive lifestyle practices among varying risk groups. A cross-sectional study was conducted among the adult UAE population between October and December 2024. Data was collected using a self-administered questionnaire consisting of sociodemographics, CRC risk assessment, screening eligibility, and the Bowel Cancer Awareness Measure (BoCAM). Adherence to cancer-preventive lifestyle behaviors was assessed using the WCRF/AICR Score. 910 participants were surveyed. The median CRC knowledge score was 10 out of 22 (IQR = 6, 13). 57.4% lacked confidence in recognizing CRC symptoms. Higher knowledge scores were significantly associated with female sex, non-Emirati nationality, higher education, employment or studies in healthcare, and a first-degree family history of CRC. Despite having the highest knowledge levels, the higher CRC-risk group exhibited cancer-preventive behaviors comparable to the average and no-risk groups. Risk factor knowledge did not influence adherence to healthy dietary habits but was positively associated with increased physical activity. Few were aware of a CRC screening program (29%) and the recommended screening age (7%). Only 10.1% of screening-eligible participants had undergone CRC screening. Knowledge on CRC in the UAE is relatively low, with a gap between the public's awareness and their lifestyle practices. This calls for targeted educational campaigns and early detection strategies, particularly among higher-risk groups.

Non-Hispanic Black and Hispanic men experience disproportionately high rates of chronic conditions and may use cannabis to manage symptoms. However, cannabis use patterns and correlates in these populations remain underexplored. This study assessed individual and health-related correlates of current (past 30-day) cannabis use among non-Hispanic Black and Hispanic men with chronic illness. Data were drawn from a national sample of 1,982 non-Hispanic Black and Hispanic men aged ≥ 40 with at least one chronic condition. Participants completed measures of cannabis use, health perceptions, and diagnoses of conditions commonly associated with medicinal cannabis use: chronic pain, depression/anxiety, arthritis/rheumatic disease, and cancer. Logistic regression analyses examined associations between cannabis use, chronic conditions, pain, and stress, adjusting for sociodemographics. Participants had a mean age of 56.6 (± 10) years; 58.2% were non-Hispanic Black, and 21.3% reported current cannabis use. Use was significantly more common among those with chronic pain, depression/anxiety, and arthritis (p < 0.001 for all). In adjusted models, greater pain (AOR = 1.11, 95% CI: 1.07-1.16, p < 0.001), higher stress (AOR = 1.06, 1.01-1.10, p < 0.05), and more chronic conditions (AOR = 1.23, 1.10-1.38, p < 0.001) were associated with increased odds of use. Among current users, those reporting both medicinal and recreational use used cannabis more frequently (p < 0.001). Cannabis use was higher among non-Hispanic Black and Hispanic men with chronic conditions who reported greater pain, stress, and poorer physical and mental health. Dual medicinal and recreational use may signal increased cannabis-related health risks. Routine communication and monitoring of cannabis use are recommended to mitigate potential harms.

Recent advancements in childhood cancer treatment have significantly improved survival rates, yet survivors continue to face considerable morbidity and mortality, rendering them a vulnerable population. Tobacco use, linked to heightened cancer risk, is discouraged among survivors for long-term health preservation; however, many persist in its use, mirroring rates among their non-cancer peers. Through 25 in-depth interviews, we explored the interplay of perceived risk and social integration on tobacco use post-treatment among both Latine and non-Latine young adult survivors. Sixty percent of respondents were male, 44% identified as Latine, with ages ranging from 22 to 38 years (mean age 30 years; mean age at diagnosis 9 years), representing diverse cancer types. Despite awareness of tobacco-related health hazards, including general and respiratory health impacts, addiction potential, and financial burdens, survivors consistently cited stress alleviation as a primary motive for tobacco use. Fearof cancer recurrence was seldom cited as a deterrent, rather survivors identified tobacco as a means to foster peer connections, particularly in workplace settings, where smoking norms prevailed. Co-workers influenced initiation, and smoking breaks served as crucial socializing opportunities, endorsed as acceptable coping mechanisms. Notably, generational factors overshadowed cultural influences on tobacco use. These insights underscore the need for targeted interventions, in which clinicians can emphasize alternative stress management strategies over risk-centric messaging, prioritize social skill development, and address workplace environments as high-risk settings.