AIMS Public Health最新文献

Background: Underinsured patients with advanced head and neck cancer experience worse outcomes compared to their well-insured peers.

Methods: Retrospective logistic regression analysis testing associations between demographic, geospatial, transportation, disease, and treatment factors in 50 government insured or uninsured patients receiving curative-intent, multidisciplinary cancer care.

Results: Forty percent of patients missed at least one treatment or surveillance appointment within the first year. Thirty-two percent reported using public transportation; 42% relied on caregivers. Patients who used public transportation were 3.3 and 4.6 times more likely to miss treatment (p = 0.001) and surveillance (p = 0.014) visits, respectively. The median one-way travel duration for such routes was 52 minutes (range: 16-232 minutes) and included 0.7 miles of walking. Physical distance to care was not associated with transportation type, missed appointments, or disease recurrence.

Conclusions: Underserved, underinsured patient populations face significant logistical challenges with transportation, which may be mitigated by alternative models of care delivery, such as multidisciplinary clinics.

Beta-thalassemia major (β-TM) is a genetic disorder, prevalent especially in the Mediterranean region, Southeast Asia, and the Indian subcontinent. With improvements in management over the years, β-TM has transitioned from a fatal childhood disease to a chronic condition. However, in Pakistan, there is still a lack of a comprehensive national policy and strategic plan, which has resulted in a growing number of β-TM patients, placing a substantial burden on individuals and the national healthcare system. This scoping review is aimed to understand obstacles faced by β-TM patients in Pakistan. For this review, 26 unique articles were identified by using the PRISMA flow guidelines. PubMed and Google Scholar were used with the MESH term Beta-Thalassemia Major AND Pakistan, and the duration was set between 2012-2022. Then, the reviewers created a spreadsheet using Microsoft Excel to add in the data from the studies selected. Inductive and deductive approaches were used for thematic analysis. Additionally, we critically analyzed the current landscape of β-TM in Pakistan. The main challenges in β-TM care in Pakistan are suboptimal transfusion services and a poor complication management. Due to the need of chronic blood transfusions, transfusion-transmitted infection (TTI) incidence within this patient population is high. These largely include hepatitis C, hepatitis B, and the Human immunodeficiency virus (HIV). TTIs impact the quality of life of these patients and their overall survival. Furthermore, psychosocial morbidities are also prevalent in β-TM patients, with increased levels of hostility, anxiety, and depressive symptoms, thus emphasizing the critical need for sustained psychological support. Access to quality treatments is constrained, with notable disparities between public and private sector hospitals. Additionally, the financial burden on β-TM patients is considerable, which contributes to economic strain and more hardships on the already suffering families. The review concludes that the absence of a unified national policy exacerbates these challenges, which results in an escalating burden of β-TM nationwide. To address these issues, essential recommendations include the following: the implementation of a standardized protocol for β-TM care, the enhancement of access to quality care, the provision of iron chelation therapy, and safeguarding safe blood transfusion practices. Prevention programs, along with increased public awareness and education about β-TM and carrier screening, are pivotal. Collaborative efforts with international partners and drawing insights from successful strategies in countries with similar β-TM burdens can aid in mitigating the overall impact of β-TM in Pakistan and improving the quality of life of the affected individuals.

The challenges of maintaining an effective and sustainable healthcare workforce include the recruitment and retention of skilled nurses. COVID-19 exacerbated these challenges, but they persist beyond the pandemic. We explored the impact of work-related quality of life and burnout on reported intentions to leave a variety of healthcare professions including nursing. We collected data at five time-points from November 2020 to February 2023 via an online survey. The validated measures used included the Copenhagen Burnout Inventory and Work-Related Quality of Life (WRQoL) scale; with subscales for Job-Career Satisfaction, General Wellbeing, Control at work, Stress at work, Working conditions, and Home-work interface. Our findings showed that 47.6% of nursing respondents (n = 1780) had considered changing their profession throughout the study period, with the 30-39-year age group most likely to express intentions to leave. Regression analysis reveale that for WRQoL, lower general wellbeing and job-career satisfaction scores predicted intentions to leave when controlling for demographic variables (p < 0.001). When burnout was added to the regression model, both work-related and client-related burnout were predictive of intentions to leave (p < 0.001). These findings highlighted that significant numbers of nurses considered leaving their profession during and shortly after the pandemic and the need for interventions to improve nurses' wellbeing and reduce burnout to improve their retention.

Background: The COVID-19 outbreak played a significant psychological impact on nurses, as they coped with intense emotional and cognitive demands, in a context in which the Health System was not prepared to face the emergency. Literature showed that pandemics influenced the nurses' stress and psychosocial health due to poor rest, high work overloads, a lack of control over the patient flows, and a frequent isolation from family. Under these circumstances, nurses experienced severe psychological and mental stressors that generated mental health problems. Recent literature showed that coping strategies, especially those that were positive, promoted mental health in workers and helped them to face stressors.

Objective: The study aimed to investigate the relationship between vicarious traumas and the impact of traumatic events on nurses' mental health. In addition, we analyzed the role of coping strategies in moderating the effect of vicarious traumas on mental health.

Methods: The study was performed in November 2020, during the first wave of the COVID-19 pandemic. A self-reported structured questionnaire was administered via an online method to reduce face-to-face contact. Logistic regressions were conducted to analyze the relationship between both vicarious traumas and the impact of traumatic events impact and mental health. An interaction analysis with the PROCESS macro was performed to analyze the role of coping strategies in moderating the relationship between vicarious traumas and mental health.

Results: A total of 183 nurses answered to the questionnaire. A moderation analysis showed that positive coping strategies such as physical activity, reading/music, and yoga/meditation showed to be protective in reducing the effect of vicarious traumas on the nurses' mental health problems. Conversely, negative coping strategies strengthened that relationship and may compromise their quality of working life.

Conclusion: These findings provide further support for considering positive coping strategies as an important resource to alleviate psychological distress, thus helping the professional to reduce the negative effects of stress.

Introduction: Triage training has positive effects on health professionals, the quality of indicators in emergency departments, and the patients. However, data on the effectiveness of triage training on nurses with two different triage scales is limited.

Objective: This study sought to evaluate the effectiveness of a triage training program in Emergency Departments (EDs), as well as the effect on the accuracy, knowledge, and skills of nurses working in the National Health System of Greece.

Methods: Α quasi-experimental study was carried out, with measurements taken pre-, post-, and three months after implementing the education program. Data were collected between March 2021 and July 2022. Eligible participants for this study included nurses employed in the hospital units of the 4^th Health Region of the National Health System. A total of 117 nurses participated in the study. Skills, knowledge, and accuracy were assessed using the Emergency Severity Index and the Australian Triage Scale.

Results: After completing the training program, there was a noticeable improvement in the nurses' performance. Their triage skills displayed an overall statistically significant increase (p < 0.001) and, more crucially, in the subscales of rapid patient assessment skills, patient categorization skills, and patient allocation skills. Additionally, statistically significant increases were observed for triage knowledge and for both screening scales that measured triage accuracy, namely the Emergency Severity Index (p < 0.001) and the Australian Triage Scale (p < 0.001). In addition, the number of over-triage and under-triage cases decreased.

Conclusions: The education program had a positive impact on the nurses, resulting in a statistically significant increase in their triage skills and knowledge. Moreover, the use of both triage scales resulted in an increase in the triage accuracy. The increase in triage skills, knowledge, and accuracy decreased after three months.

Black Americans (AA) face a confluence of challenges when seeking care including unaffordable costs, negative experiences with providers, racism, and distrust in the healthcare system. This study utilized linear regressions and mediation analysis to explore the interconnectedness of these challenges within a community-based sample of 313 AA women aged 45 and older. Approximately 23% of participants reported affordability problems, while 44% had a negative experience with a provider. In the initial linear regression model excluding perceived racism, higher levels of distrust were observed among women reporting affordability problems (β = 2.66; p = 0.003) or negative experiences with a healthcare provider (β = 3.02; p = <0.001). However, upon including perceived racism in the model, it emerged as a significant predictor of distrust (β = 0.81; p = < 0.001), attenuating the relationships between affordability and distrust (β = 1.74; p = 0.030) and negative experience with a provider and distrust (β = 1.79; p = 0.009). Mediation analysis indicated that perceived racism mediated approximately 35% and 41% of the relationships between affordability and distrust and negative experience with a provider and distrust, respectively. These findings underscore the critical imperative of addressing racism in the efforts to mitigate racial disparities in healthcare. Future research should explore the applicability of these findings to other marginalized populations.

The provocative advice of health policymakers in endorsing private health insurance, as a critical tool for health reforms, is well-reckoned as a deterrent to mounting healthcare expenditure in the wake of the public health insurance quagmire. However, scholarly evidence has condemned the ineffectiveness of private health insurance in containing out-of-pocket expenditure. In this backdrop, we carried out a nuanced investigation of the coverage pattern of private health insurance policies. We examined the one-year billing information of private health insurance holders hospitalized in a multi-specialty teaching hospital. We found that private health insurance fails to provide full coverage, leading to underinsurance though minimal financial protection was extended. Moreover, reimbursement patterns under various cost heads are also discussed. We conclude by emphasizing the need for future research to fill the knowledge gap. We claim methodological novelty in its approach to data collection.

This study aims to explore if the dimensions of anger can be risk factors for the development of social media addiction and an internet gaming disorder, considering that the correlation between anger and these specific subcategories of internet addiction can represent a core intervention in their prevention and treatment. 477 subjects, recruited among the general population, were assessed on-line by the following tools: STAXI-2; BSMAS, and IGDS9-SF. A correlation analyses showed a significantly positive relationship between the total score of the BSMAS and the STAXI-2 scales SANG (p < 0.0001), TANG (p < 0.0001), AX-O (p = 0.003), and AX-I (p < 0.0001), and between the total score of the IGDS9-SF and the STAXI-2 scales SANG (p = 0.002), TANG (p < 0.0001), AX-O (p = 0.001), AX-I (p < 0.0001), and AC-O (p = 0.004). A linear regression model showed how TANG and AX-I were direct predictors of the BSMAS total scores, and how AX-I was a direct predictor of the IGDS9-SF total scores. It appears plausible that there is a significant correlation between the dimensions of anger and the emergence of social media addiction and internet gaming: internet usage may serve as a coping mechanism for emotional or social challenges and as a protective screen to deal with negative emotions.

The accelerating pace of urbanization, coupled with the intensifying impacts of climate change, poses unprecedented challenges to both the environment and human well-being. In this review, we delved into the intricate interaction between climate change and urbanization and the various effects they have on the environment and human well-being, shedding light on the emergent urban climate crisis. Urban areas serve as epicenters for diverse socio-economic activities, yet they also contribute significantly to global greenhouse gas emissions and environmental degradation. Through an interdisciplinary lens, we explored the root causes of the urban climate crisis, examining how rapid urbanization exacerbates climate change and vice versa. By synthesizing current research and case studies, we elucidate the various environmental and social ramifications of this nexus, ranging from urban heat island effects to heightened vulnerability to extreme weather events. Furthermore, we delve into the unequal distribution of climate risks within urban populations, highlighting the disproportionate burden borne by marginalized communities. Finally, the chapter presents strategies and interventions for mitigating and adapting to the urban climate crisis, emphasizing the imperative of holistic and equitable approaches that prioritize both environmental sustainability and human well-being. Overall, this review calls for concerted efforts to unravel the complexities of the urban climate crisis and forge a path toward resilient, sustainable, and equitable urban futures.

Introduction: African American women have a higher prevalence of hypertension than women of other ethnicities. The increasing prevalence of hypertension among this population is alarming.

Methods: This was an 8-week feasibility study. The study population consisted of African American women aged 60 years and older with a self-reported diagnosis of hypertension. Participants identified a peer to participate with or were paired with another participant in the study. Educational sessions on communication, the Dietary Approaches to Stop Hypertension (DASH) diet, and home blood pressure monitoring were provided for participants. Participants were required to measure their blood pressure twice daily using an Omron monitor and communicate with their peers at least twice weekly. Dietary intake was measured pre- and post-intervention using the DASH Quality (DASH-Q) survey, social support was measured using the Medical Outcomes Study (MOS) Social Support Survey, and communication was tracked using communication logs. Feasibility was assessed by enrollment and retention rates.

Results: Pre-intervention, participants had an average DASH-Q score of 33.76 (SD = 13.37). Participants' post-intervention DASH-Q scores increased by 5 points compared to their pre-intervention scores; however, this difference was not significant (t = -1.608, p = 0.059). Additionally, participants who completed the intervention had a 4-point decrease in their systolic blood pressure at week 6. A dependent sample t-test revealed the difference was significant (t = 2.305, p = 0.014). A total of 40 participants were enrolled in the study, and the retention rate was 85%.

Conclusion: Although not statistically significant, improvements in systolic blood pressure and DASH diet adherence were observed. Therefore, the results indicate that the peer (dyadic) support intervention was feasible.