Journal of Public Health Research最新文献

Background: This study examines the relationship between early-life rural residence and executive function (EF) in mid- and late-life and investigates the roles of educational attainment and childhood financial level.

Design and methods: Cross-sectional and longitudinal analyses were conducted using data from the Cognitive Project in Waves 2 and 3 of the Midlife in the United States (MIDUS) study. Structural equation modeling was employed to examine the relationships among these variables.

Results: Educational attainment mediated the rural-EF relationship, and childhood financial status moderated the mediation model. The relationship between rurality and EF decline was fully mediated by education and differentially impacted by childhood financial status.

Conclusions: Educational attainment is a key pathway between childhood rurality and adult EF. While rural individuals are at a disadvantage in educational attainment and score lower on measures of EF in adulthood, childhood financial level appears to be most impactful for individuals who grew up in urban environments.

Background: Over the past three decades, Iran's fertility rate has declined sharply from 6.5 to 1.7, posing a critical demographic and public health challenge, a global trend that highlights the need to tackle multifaceted influences on childbearing intentions, including economic, social, emotional, and attitudinal factors.This study examined the factors influencing childbearing intentions among women.

Design and methods: This cross-sectional study surveyed 450 reproductive-age women in Tabriz, Iran. Data were collected using self-administered questionnaires to assess sociodemographic/obstetric characteristics, attitudes toward fertility/childbearing, subjective norms, marital satisfaction, perceived social support, childbearing/parental anxiety, and hope. Data were analyzed with SPSS v24 via descriptive statistics, chi-square/Fisher's exact tests, independent t-tests, and hierarchical multiple logistic regression to identify predictors of childbearing intention.

Results: Only 34.2% (95% CI: 29.8-38.8) of participants intended to have children. Adjusted logistic regression identified positive associations with childbearing intention for positive attitudes (OR = 1.113, 95% CI: 1.057-1.172), subjective norms (OR = 1.458, 95% CI: 1.292-1.646), social support (OR = 1.093, 95% CI: 1.020-1.172), hope (OR = 1.165, 95% CI: 1.043-1.172), and religious beliefs (OR = 12.789, 95% CI: 1.029-158.990); conversely, negative associations for pregnancy/childbirth anxiety (OR = 0.633, 95% CI: 0.422-0.949), age > 40 years (OR = 0.01, 95% CI: 0.000-0.279), and poor financial status (OR = 0.007, 95% CI: 0.000-0.347).

Conclusion: The findings highlight the multifaceted economic, social, emotional, and attitudinal influences on childbearing intentions among Iranian women. To promote fertility rates, targeted public health strategies are recommended, including counseling for emotional barriers, economic supports like infertility subsidies and family incentives, and community-based education on reproductive health benefits.

Background: Exploring the problems with the current supply chain management of health commodities and vital medicine procurement systems at the local level of government in federal Nepal remained the study's main objective. More precisely, to investigate the theories surrounding the current health commodities supply chain management and the programmatic management elements of the federal government of Nepal's local level medicine procurement systems.

Methodology: In two randomly chosen districts of Nepal's Bagmati and Koshi province namely Kavrepalanchowk and Sankhuwasabha districts, respectively, and at their selected six municipalities and four rural municipalities, 25 semi-structured in-depth interviews were carried out with central, provincial, district, and local health managers and service providers.

Results: The results of verbatim transcriptions and audio video recordings of interviews were examined inductively and subsequently mapped into the four domains of "supply chain management of health commodities and essential drug procurement."Delays in the procurement procedure, mostly at the local level, were the main obstacles to the efficient management of essential drugs. Storage issues can provide difficulties, mostly because of a lack of available storage capacity and the requirement to manage extra emergency related comorbidities.

Conclusion: In Nepal, ensuring access to necessary medications continues to be a difficult task. According to this study, the main reason for the difficulties in supply chain management of health commodities and essential drug procurement at district of Nepal's is procurement delays. Challenges with supply chain management of health commodities and essential drug procurement inventory management systems at various municipalities' levels.

Objective: Prenatal cannabis use has more than doubled in recent years, disproportionately affecting birthing people with lower incomes and mental health conditions. Despite this trend, research remains fragmented, and the voices of birthing people who use cannabis are largely absent. This study aimed to explore multidimensional influences on prenatal cannabis use, centering the lived experiences of those directly affected.

Methods: Researchers conducted a reflective thematic analysis of secondary qualitative data from a community-based program in Wisconsin, where cannabis remains illegal. Nineteen pregnant cannabis users participated in interviews; most were Medicaid recipients, and nearly half reported household incomes below $10,000. Lifecourse theory guided study design and analysis. Synthesized Member Checking was used to enhance credibility.

Results: Five central themes emerged: pregnancy as a turning point in cannabis use; cannabis as emotional regulation; complex ties between cannabis and mental health; relational influences on use; and contextual barriers to informed and supported decision-making. Emotional regulation and mental health were the most cited drivers of cannabis use.

Discussion: Findings highlight the urgent need for holistic prenatal care that addresses both substance use and mental health, and for public health messaging that is unbiased and evidence-based. Addressing prenatal cannabis use requires community-engaged, cross-sector strategies and structural policy reform. Without tackling systemic barriers-such as racial bias in screening and care-efforts to support birthing people who use cannabis will remain insufficient.

Background: Breast cancer and its treatment may contribute to an increased risk of unemployment, influenced by both disease-related factors and socioeconomic determinant. Few longitudinal studies have examined employment outcomes among women diagnosed with cancer. This retrospective study investigated long-term employment among breast cancer survivors (BCS) and assessed disease specific and socioeconomic factors associated with employment.

Design and methods: Registry-based data included working age BCS in Norway 2004-2008 alive at 6 years follow-up (N = 3560). The employment status on each BCS was compared to two matched non-cancer controls (N = 7081) by means of logistic regression analyses with marginal effects. Separate analyses by employment status at the time of diagnosis were conducted.

Results: Among BCS employed at diagnosis, 73.7%, 71.5% and 71.8% of BCS were in employment at 1, 2 and 6 years after diagnosis, respectively. BCS employed at diagnosis had significantly lower probability of being employed at all follow-up time points, compared to controls. BCS outside employment at the time of diagnosis experienced lower probability of employment compared to controls. BCS with secondary or higher education had higher probability of employment compared to BCS with basic education, and BCS living in families with children were more likely to enter employment during follow-up compared to BCS without children.

Conclusions: BCS employed at diagnosis had a subsequent risk of unemployment, and BCS not employed at diagnosis had lower probability of entering employment. Additional risk factors are high age, low education, and being single without children.

Significance for public health: The risk of unemployment after a breast cancer diagnosis was increased. Job loss is costly economically and socially, both for individuals and for society. Early focus on employment particularly among employees with low education and with little family support may alleviate this problem.

Introduction: A significant proportion of under-five diarrhea-related morbidity and mortality can be reduced by timely initiation of treatment. This study assessed determinants of timely treatment-seeking behavior for diarrheal disease among caregivers with under-five children in public hospitals in Sidama region, Ethiopia.

Methods: A facility-based unmatched case-control study was conducted among public hospitals. Data were collected using KOBO Collect with a smartphone and analyzed using SPSS 26.

Results: Three hundred two cases and 302 controls were included. Being urban resident (AOR = 0.251 (95% CI, 0.157, 0.401, p = 0.000)), mothers with no formal education (AOR = 0.397 (95% CI, 0.222, 0.713, p = 0.002)), child age < 24 months (AOR = 0.210 (95% CI, 0.121, 0.364, p = 0.000)), above 120 min walking distance from nearby health facility [AOR = 0.426 (95% CI, 0.211, 0.861, p = 0.017)] were negatively associated. Whereas, reported cost of treatment easy to pay (AOR = 7.988 (95% CI, 3.734, 17.091, p = 0.000)), community-based health insurance (CBHI) membership (AOR = 4.940 (95% CI, 3.124, 7.812, p = 0.000)), and a history of previous diarrhea (AOR = 1.702 (95% CI, 1.021, 2.837, p = 0.041)) were positively associated with timely treatment seeking behavior.

Conclusion: Being urban residents, caregivers' educational status, child age <24 months, and long walking distance from nearby health facility, low-cost of treatment, being a CBHI member, and a child with a history of previous diarrhea were independently associated with timely treatment-seeking. Therefore, it is important to design strategies to improve these factors by involving relevant stakeholders. Future researchers should consider strong designs like prospective cohort involving multiple health facilities to identify causal factors for timely treatment-seeking behavior.

Background: Primary care is essential for improving healthcare access and global health, yet it faces challenges related to limited capacity and slow response times. Digital health interventions (DHI) (DHIs) are increasingly used to address these gaps by promoting healthy behaviours, patient empowerment, and health literacy. However, their implementation is challenged by insufficient regulations and infrastructure, and evaluations often overlook broader sustainability concerns. This scoping review examines how DHIs in primary care are assessed for sustainability across financial, social, and environmental domains.

Methods: The scoping review methodology consisted of three stages: pearl-growing, keywords with operators, and reference list search. MEDLINE (PubMed and Ovid), CINAHL, IEEE Access, ScienceDirect, NICE, and TRIP databases were utilised, and the results were evaluated using qualitative content analysis.

Results: The review highlights four aspects to consider when implementing digital health interventions: Enhancing health promotion and illness prevention through the user's adherence to treatment, while addressing clinical risks. Examine social implications considering wellbeing, access, inclusion, participation, empowerment, and data protection. Consider financial impacts such as resource management, available funding, and appropriate infrastructure. And environmental implications that include product life cycle, resource use, and greenhouse emissions.

Conclusions: It is recommended that guidelines for implementing DHIs in primary care prioritise improving health promotion and preventive care. Emphasising the value of building public trust by promoting well-being, ensuring human rights in data governance, addressing social determinants of health, and improving resource efficiency through interoperability and circular economy principles.

Background: The COVID-19 pandemic posed unique challenges for Asian people living with endometriosis. The purpose of this study was to describe the endometriosis-related coping and self-management strategies used by South, East, and Southeast Asian women living in British Columbia, Canada, during the COVID-19 pandemic and how these contributed to their strength and resilience.

Design and methods: Using photovoice methodology, South, East, and Southeast Asian women residing in a Western Canadian province were invited to generate photographs representing their experiences of living with endometriosis during the COVID-19 pandemic. Photographs were discussed during semi-structured interviews, and data were thematically analyzed.

Results: Women (n = 22) conveyed that during the COVID-19 pandemic: (1) their social support context played a pivotal role in shaping their experiences and ability to cope with and self-manage their endometriosis, which involved (2) taking empowering actions in daily living, accessing healthcare, and acquiring knowledge. (3) Taking empowering actions fostered a sense of inner strength and resilience characterized by advocating for self and others, carrying forward empowering actions to other life domains, and cultivating gratitude and hope for their future.

Conclusions: East, South, and Southeast Asian women demonstrated a resilience approach to living with endometriosis during the COVID-19 pandemic. By drawing on support systems and coping and management strategies, they built resilience mechanisms that promoted well-being and sustainability.

Background: American Indian and Alaska Native communities are disproportionately impacted by the crises of overdose death, self-harm, and other traumas, which lead to inequities in health outcomes. Despite these inequities, American Indian and Alaska Native people have rich and varied traditional practices rooted in resiliency that promote health but have often been overlooked, excluded, or dismissed entirely in Western medicine.

Methods: This paper describes Cultural Guideposts of Health, a crisis response evaluation framework for California's diverse American Indian and Alaska Native communities. In an adaptation of Yamane and Helm's 2022 Culture-as-Health paradigm, a Guiding Coalition of Traditional Healers and Knowledge Keepers convened, both in person and online, and collaborated with a team of academic researchers and cultural advisors to develop the Cultural Guideposts of Health Framework. The Guiding Coalition included cultural leaders, youth, individuals with lived experience, health care providers, and community members throughout the state and engaged in an iterative process of Indigenous Conversation to develop a culturally adaptive and responsive crisis response model for use across diverse Tribal and urban American Indian and Alaska Native communities.

Results: Discussion topics included Indigenous definitions of health, healing, and wellness and culture as health within domains of Indigenous Spirituality, Indigenous Cultural Practices, Indigenous World View, and Place-Based Sacred sites.

Conclusion: The final product was a toolkit which includes a framework for evaluating crisis response and other evidence-based interventions that is adaptable across geography, organizational structures, service delivery models, and distinct Tribal contexts. Future directions include pilot testing and exploration of the framework's utility as an evaluation tool.