Journal of Community Health最新文献

The Immigration Medical Examination (IME) is a mandatory step in obtaining U.S. permanent residency, yet its high cost and limited accessibility pose significant barriers for low-income immigrants. Addressing these challenges is critical to ensuring equitable healthcare access for underserved populations. To present the benefits and process of integrating IME services into a student-run free clinic serving low-income immigrant populations. A review of IME requirements, cost barriers, and existing student-run clinic models informed the development of an IME program at the Knights Landing One Health Center (KLOHC). The implementation process involved four key steps: assessing community needs, securing qualified personnel, establishing clinic logistics, and implementing a structured training model for student volunteers. A retrospective chart review of patients receiving IME services from May 2022 to May 2024 was conducted to analyze patient demographics, service utilization, and health screening outcomes. KLOHC provided IME services to 204 patients, with 177 adult records analyzed. The majority were Hispanic/Latino (84%) and Spanish-speaking (79%), highlighting the importance of culturally and linguistically competent care. Patient volume steadily increased, with a consistent waitlist of 14-20 individuals per session. Cost reduction was significant, with services provided at no cost for selected cities already served by KLOHC. These cities include Knights Landing, Davis, Winters, Woodland (Yolo County), Yuba City (Sutter County), and Sacramento (Sacramento County). A $250 was charged to non-target community patients, compared to the private sector's $400-$900 range. IME health screenings identified cases of tuberculosis and sexually transmitted infections, enabling timely treatment. The structured student leadership model ensured continuity, training, and sustainability. Integrating IME services into student-run clinics is a feasible and effective strategy to expand access to essential health evaluations for immigrant populations. Funds collected from non-target communities were used to pay for vaccines, x-rays, and transportation for target community members which eased the financial burden of the already expensive immigration process. KLOHC's model demonstrates a cost-effective service for patients, improves healthcare accessibility, and provides hands-on training for future healthcare professionals. This initiative serves as a replicable framework for other student-run clinics nationwide, addressing a critical gap in immigrant healthcare and promoting a more equitable healthcare system.

Evidence on the association between dialysis facility accessibility and mortality in small countries is limited. This study evaluated the association between travel distance and one- and two-year mortality among Israeli end-stage renal disease (ESRD) patients. Data were obtained from the National Renal Replacement Therapy Registry, encompassing all Israeli ESRD patients aged ≥ 45 years who initiated hemodialysis in 2010-2021. Sociodemographic (age, sex, population group), treatment-related (hospital/community treatment, primary renal disease, incident-year cohort), and geographic (residency socioeconomic and peripherality indices) data were collected. Travel distances from the most recent address to the initial treating facility were categorized into three groups based on the 50th and 90th percentiles, excluding outliers (> 100 km). Adjusted Cox regressions assessed associations between travel distances and mortality, with incident-year cohort-specific models evaluating temporal hazard variations. Analyses included 15,606 patients. The long-distance group (> 26.39 km) was characterized by younger age, Arab ethnicity, peripheral residence, and lower socioeconomic status. Compared to the short-distance group (≤ 6.80 km), the hazard ratios (HRs) in the intermediate-distance group (> 6.80 and ≤ 26.39 km) were 1.216 (1.106-1.337) for one-year and 1.181 (1.093-1.275) for two-year mortality. In the long-distance group, the HRs were 1.718 (1.460-2.021) for one-year and 1.554 (1.351-1.787) for two-year mortality (P-for-trend between travel distances <.001). Sensitivity and temporal analyses confirmed consistent associations across incident-year cohorts, alternative cut-offs, and outlier inclusion. The association between travel distance and mortality highlights the need to improve geographic accessibility to healthcare to reduce inequities, especially for life-sustaining chronic treatments such as hemodialysis.

The purpose of this study was to measure the HPV vaccine behaviors and intentions of college-aged men. 493 participants, who identified as "male" or "trans man", from a large university in the Mid-Atlantic were included in this study. An online survey measured several independent variables as well as variables related to HPV and HPV vaccine knowledge, perceptions, and behaviors. Descriptive statistics were used to evaluate each variable after filtering the participants by vaccination status. A binomial logistic regression was used to analyze and predict the effect of each variable on college men's vaccination status. The academic year in which participants completed the survey, home location, and HPV knowledge were significant predictors of HPV vaccination status. Lack of inclusion of males during conversations about the HPV vaccine could be the source of the differences between male and female HPV vaccination behavior and intention.

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.