Clinical Epidemiology and Global Health最新文献_第8页

Does having a family physician influence health seeking behavior and referral pattern in urban India: A cross-sectional analysis 家庭医生是否会影响印度城市居民的就医行为和转诊模式：一项横断面分析

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-11-01 DOI: 10.1016/j.cegh.2025.102212

Maria Sabastin Sagayam , Partha Saha , Ram Ramesh , Angan Sengupta

Problem considered

In absence of a structured referral system, family physicians play a critical role in offering continuous, personalized care. Since consulting a family physician is uncommon even in urban areas, this study examines how family physicians influence health-seeking behavior and referral patterns in urban India.

Methods

A cross-sectional survey has been conducted with 254 participants (21–60 years) in urban Bengaluru, Karnataka, using a structured questionnaire both from slum and non-slum population. Bi-variate and multivariate analysis are conducted to evaluate the association of having a family physician with health-seeking behavior and referral patterns as experienced by the respondents.

Results

Educated, well-off, and non-slum respondents reported having a family physician. Respondents with a family physician reported fewer in-person consultations and lower hospitalization rates compared to those without. However, this relationship lost statistical significance after adjusting for background variables. The likelihood of not availing an online consultation was 70 % lower among respondents without a family physician. During emergency decision-making, those with a family physician relied less on family members (OR = 0.36). Respondents with a family physician experienced three times higher private-to-private referral and 70 % lower public-to-public movement.

Conclusion

The presence of a family physician is associated with distinct patterns in physical and online consultations, hospitalization, and referral practices in urban India. Utilization of family physicians is socio-economically diverse; hence, formally integrating primary caregivers within the system may contribute to more equitable healthcare and reduced reliance on tertiary services, especially among urban poor.

在缺乏结构化转诊系统的情况下，家庭医生在提供持续的个性化护理方面发挥着关键作用。由于即使在城市地区，家庭医生也不常见，因此本研究探讨了家庭医生如何影响印度城市的求医行为和转诊模式。方法在卡纳塔克邦班加罗尔市区对254名参与者（21-60岁）进行了横断面调查，使用了来自贫民窟和非贫民窟人口的结构化问卷。进行了双变量和多变量分析，以评估有一个家庭医生寻求健康的行为和转诊模式的受访者经历的关联。结果受教育、富裕和非贫民窟的受访者报告有家庭医生。与没有家庭医生的受访者相比，有家庭医生的受访者表示，当面咨询的次数更少，住院率也更低。然而，在调整背景变量后，这种关系失去了统计学意义。在没有家庭医生的受访者中，不利用在线咨询的可能性降低了70%。在紧急决策中，有家庭医生的患者对家庭成员的依赖程度较低（OR = 0.36）。有家庭医生的受访者的私人到私人转诊增加了三倍，公共到公共转诊减少了70%。结论：在印度城市，家庭医生的存在与物理和在线咨询、住院和转诊实践的不同模式有关。家庭医生的利用具有社会经济多样性；因此，将初级护理人员正式纳入系统可能有助于更公平的医疗保健和减少对第三服务的依赖，特别是在城市穷人中。

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引用次数: 0

Corrigendum to “Surgical site infection following colorectal surgeries: Incidence, healthcare resource utilisation and risk factors in a major referral hospital in Malaysia” [Clin Epidemiol Global Health 35 (2025) 102167] “结直肠手术后手术部位感染：马来西亚一家大型转诊医院的发病率、医疗资源利用和风险因素”的勘误表[临床流行病学全球卫生35 (2025)102167]

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-11-01 DOI: 10.1016/j.cegh.2025.102215

Kenneth Kwing Chin Lee , Jing Sheng Lim , Fitjerald Henry , Mayurran Panirselvam , Cindy Sin Yee Ngiam , Pavithra Malaimany , Julie Angela Aguilar , HyeJin Park , Wei Chern Ang , Wai Yee Choon , Subramaniam Thanimalai , Renukha Sellappans

引用次数: 0

Assessment of knowledge and practice regarding oral lesions among a group of Iraqi dental practitioners – A cross-sectional study 一组伊拉克牙科医生对口腔病变的知识和实践的评估-一项横断面研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-11-01 DOI: 10.1016/j.cegh.2025.102226

Shokhan Ahmad Hussein

Problem considered

Knowledge about oral lesions is important during daily dental practice. This study aims to evaluate dental practitioners' current knowledge and practices regarding oral lesions.

Methods

A cross-sectional study was carried out to assess dental practitioners' knowledge and practices about oral mucosal lesions. All dental practitioners were targeted through a convenience sampling method.

Results

The questionnaire was distributed among 300 participants, and 253 (84.3 %) answered and returned it. Most practitioners displayed updated information about oral lesions (82.2 %) with females having higher odds regarding knowledge (Odds Ratio = 0.47, p < 0.05) and most of the time (80.2 %), they receive patients with oral lesions; however, most practitioners found diagnosing and treating such patients are problematic (75.1 %). It is apparent that effective management of such patients necessitates substantial experience and advanced academic qualifications (P < 0.001). Most practitioners can manage common oral lesions but face numerous difficulties in other less common ones, and most practitioners (93.7 %) do not like to perform biopsies and prefer to refer the patient to a specialist. The primary reasons for avoiding oral lesion patients were the difficulty in accessing the literature and lack of time and interest regarding oral lesions.

Conclusion

While the positive response demonstrated regarding examining oral lesions is promising, it is crucial to address the educational deficits. Fostering a greater interest in oral medicine and pathology among practitioners and providing comprehensive training should be recommended, as it is essential to raise the quality of patient care provided and keep oral health at the forefront of comprehensive healthcare.

关于口腔病变的知识在日常牙科实践中是很重要的。本研究旨在评估牙科医生目前对口腔病变的知识和实践。方法采用横断面调查的方法对口腔黏膜病变的知识和行为进行评估。通过方便的抽样方法对所有牙科从业人员进行调查。结果共发放问卷300份，回复率253份（84.3%）。大多数医生（82.2%）显示口腔病变的最新信息，其中女性在知识方面的优势更高（优势比= 0.47,p < 0.05），而且大多数时候（80.2%），他们接受的是有口腔病变的患者；然而，大多数医生发现诊断和治疗此类患者存在问题（75.1%）。显然，对这类患者的有效管理需要丰富的经验和高级学历（P < 0.001）。大多数从业者可以处理常见的口腔病变，但在其他不常见的口腔病变中面临许多困难，大多数从业者（93.7%）不喜欢进行活组织检查，而倾向于将患者转介给专科医生。回避口腔病变患者的主要原因是难以获得文献，缺乏对口腔病变的时间和兴趣。结论虽然口腔病变检查的积极响应是有希望的，但解决教育缺陷至关重要。应建议在从业人员中培养对口腔医学和病理学的更大兴趣，并提供全面的培训，因为这对于提高所提供的患者护理质量和保持口腔健康处于综合医疗保健的前沿至关重要。

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引用次数: 0

Impact of pharmacist-led patient-centric care on hypothyroid patients with metabolic syndrome: A comprehensive care based interventional study 药师主导的以患者为中心的护理对代谢综合征甲状腺功能减退患者的影响：一项基于综合护理的介入研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-11-01 DOI: 10.1016/j.cegh.2025.102231

Bipin Shaji , Juno Jerold Joel , Raghava Sharma , Uday Venkat Mateti , Anjusha Alex

Background

Thyroid hormones play a pivotal role in regulating metabolism. Patient-centric care is needed for the effective management of hypothyroidism with comorbid cardiometabolic illnesses.

Objectives

To assess the impact of pharmacist-led comprehensive care on hypothyroid Patients with metabolic syndrome.

Methods

A randomized controlled study was conducted in the General Medicine Department of a tertiary care hospital with 200 hypothyroid patients with metabolic syndrome for a duration of 3 years. The study had two groups, a control group (received usual care from the treating physician) and an intervention group (received pharmaceutical care from an academic pharmacist along with the usual care). The provided pharmaceutical care includes patient education, medical and medication reconciliation, medication review, continued monitoring, identification and resolution of drug related problems and follow-up. The study parameters considered were thyroid hormones, metabolic components, symptoms, medication adherence, economic parameters and quality of life. The collected data were statistically analysed with SPSS ver.29.

Results

After providing pharmaceutical care in the intervention group, significant improvements were observed in the medication adherence pattern (p:0.01), which in turn resulted in normalizing thyroid hormones (TSH, T3, T4) and metabolic components. This enhanced clinical outcomes and improved quality of life. The pharmaceutical care provided was beneficial for the patients and cost-effective.

Conclusions

Pharmacist-led interdisciplinary care was effective in managing hypothyroidism and related metabolic complications. Comparable patient focussed care practices should be implemented in general and specialized endocrine clinics to enhance the therapy outcomes and quality of life.

背景甲状腺激素在调节代谢中起着关键作用。以患者为中心的护理是有效管理甲状腺功能减退症合并心脏代谢疾病的必要条件。目的评价药师主导的综合护理对甲状腺功能减退伴代谢综合征患者的影响。方法对某三级医院综合内科200例甲状腺功能减退伴代谢综合征患者进行为期3年的随机对照研究。该研究分为两组，对照组（接受治疗医生的常规护理）和干预组（接受学术药剂师的常规护理）。所提供的药学服务包括患者教育、医疗和药物协调、药物审查、持续监测、查明和解决与药物有关的问题以及后续行动。考虑的研究参数包括甲状腺激素、代谢成分、症状、药物依从性、经济参数和生活质量。用SPSS ver.29对收集的数据进行统计学分析。结果干预组患者给予药学服务后，服药依从性明显改善（p:0.01），甲状腺激素（TSH、T3、T4）及代谢指标正常。这提高了临床结果和生活质量。所提供的药学服务对患者有益，性价比高。结论以药师为主导的综合护理对甲状腺功能减退及相关代谢并发症的治疗是有效的。应在普通和专科内分泌诊所实施类似的以患者为中心的护理实践，以提高治疗效果和生活质量。

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引用次数: 0

Trend analysis of stroke mortality in China from 2002 to 2021 2002 - 2021年中国脑卒中死亡率趋势分析

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-18 DOI: 10.1016/j.cegh.2025.102210

Yu Tian , Pei Jiang

Problem considered

This study aims to analyze trend of stroke mortality in China in recent 20 years in rural and urban area between male and female, to focus on specific regions and population that need to improve treatment and health promotion to reduce mortality.

Methods

We analyze the mortality in urban and rural area from China Health Statistics Yearbook (2003–2022). The trend of crude mortality and age-standardized mortality were analyzed by region, gender and age. Joinpoint 5.3.0.0 was used to analyze the trend.

Results

Crude mortality in urban and rural area showed a fluctuating increase from 2002 to 2021. Mortality in rural area was higher than in urban area, and males’ mortality was higher than females (P < 0.05). The average annual decrease rate of age-standardized mortality in urban area was 1.25 % (P < 0.05), while 0.71 % (P > 0.05) in rural area. Stroke mortality increased with age, especially 60+ years old. Mortality of 85+ years old reached 3447.32/100,000 and 3803.66/100,000 in urban and rural area, respectively. Age-standardized mortality in urban and rural area decreased generally, but it showed an upward trend for 85+ years old, with an average annual increase rate of 1.40 % (P < 0.05) in rural area.

Conclusion

In rural area, male and the elderly, especially 85+ years old, are high-risk population. Comprehensive prevention and control should be continuously strengthened. Health education could develop healthy lifestyles. First aid training could recognize the early syndromes. Establishing Stroke Alliance can integrate medical resources between urban and rural areas.

本研究旨在分析近20年来中国城乡男性和女性脑卒中死亡率的趋势，重点关注需要改善治疗和健康促进以降低死亡率的特定地区和人群。方法对2003-2022年《中国卫生统计年鉴》中城乡人口死亡率进行分析。按地区、性别和年龄分析粗死亡率和年龄标准化死亡率的变化趋势。采用Joinpoint 5.3.0.0进行趋势分析。结果2002 - 2021年城市和农村粗死亡率呈波动上升趋势。农村地区死亡率高于城市地区，男性死亡率高于女性（P < 0.05）。城市地区年龄标准化死亡率年平均下降1.25% (P < 0.05)，农村地区下降0.71% （P < 0.05）。中风死亡率随年龄增长而增加，尤其是60岁以上。85岁以上的死亡率，城市为3447.32/10万，农村为3803.66/10万。城乡年龄标准化死亡率总体呈下降趋势，但在85岁以上人群中呈上升趋势，农村地区平均年增长率为1.40% （P < 0.05）。结论农村地区以男性和老年人为高危人群，尤其是85岁以上人群。要不断加强综合防控。健康教育可以培养健康的生活方式。急救训练可以识别早期症状。建立脑卒中联盟可以整合城乡医疗资源。

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引用次数: 0

Association of inadequate WaSH, housing, and infectious diseases with undernutrition hotspots among children under five: findings from a national survey in Indonesia 卫生、住房和传染病不足与五岁以下儿童营养不良热点之间的关系：印度尼西亚一项全国调查的结果

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-18 DOI: 10.1016/j.cegh.2025.102211

Yoerdy Agusmal Saputra , Mona Lisa , Nailul Hikmi , Septiria Irawati , Achmad Rizki Azhari , Disa Hijratul Muharramah

Background

Undernutrition in Indonesia persists amid regional disparities in household water, sanitation, hygiene (WaSH), housing, and infectious disease burden. This study quantified associations between household environmental conditions, recent infections, and child undernutrition to inform geographically targeted interventions.

Methods

We conducted a secondary cross-sectional analysis of the 2023 Indonesia Health Survey, including 85,118 children aged 0–59 months. Exposures were household access to improved water, safe sanitation, basic hygiene, and adequate housing, plus self-reported diarrhea, ARI, and pneumonia; outcomes were stunting, underweight, and wasting. Multivariable logistic regression accounted for clustering, stratification, and sample weights, and provincial-level spatial overlays in QGIS mapped environmental and epidemiological hotspots.

Results

National prevalences were 24.2% (stunting), 17.7% (underweight), and 9.8% (wasting). After adjustment, absence of basic hygiene increased odds of stunting (aOR 1.37; 1.33–1.42), underweight (aOR 1.42; 1.37–1.48), and wasting (aOR 1.34; 1.28–1.41). Unimproved water was associated with stunting (aOR 1.26; 1.18–1.34) and underweight (aOR 1.12; 1.04–1.20); inadequate housing raised adjusted odds of stunting (aOR 1.09; 1.05–1.15) and underweight (aOR 1.10; 1.05–1.17). Diarrhea predicted all outcomes (stunting aOR 1.21; 1.15–1.28; underweight aOR 1.19; 1.11–1.26; wasting aOR 1.13; 1.04–1.22); ARI and pneumonia were independently associated with underweight (aOR 1.13; 1.09–1.17) and stunting (aOR 1.12; 1.08–1.17), respectively. Spatial mapping highlighted Eastern and Central provinces as concurrent high-risk areas.

Conclusion

Inadequate WaSH, poor housing, and recent infectious disease episodes independently elevate child undernutrition risk; geospatially targeted, multisectoral WaSH, housing, and infection-control interventions in identified hotspots are warranted.

印度尼西亚在家庭用水、环境卫生、个人卫生（WaSH）、住房和传染病负担方面存在区域差异，导致营养不足问题持续存在。本研究量化了家庭环境条件、近期感染和儿童营养不良之间的关系，为地理上有针对性的干预提供信息。方法：我们对2023年印度尼西亚健康调查进行了二次横断面分析，其中包括85,118名0-59个月的儿童。暴露因素包括家庭获得改善的水、安全的环境卫生、基本卫生和适当的住房，以及自我报告的腹泻、急性呼吸道感染和肺炎；结果是发育迟缓、体重不足和消瘦。多变量logistic回归分析了QGIS环境和流行病学热点的聚类、分层、样本权重和省级空间叠加。结果儿童发育迟缓患病率为24.2%，体重不足患病率为17.7%，消瘦患病率为9.8%。调整后，缺乏基本卫生条件增加了发育迟缓（aOR 1.37; 1.33-1.42）、体重不足（aOR 1.42; 1.37 - 1.48）和消瘦（aOR 1.34; 1.28-1.41）的几率。未改善的水与发育迟缓（aOR为1.26;1.18-1.34）和体重不足（aOR为1.12;1.04-1.20）相关；住房不足增加了发育迟缓（aOR 1.09; 1.05-1.15）和体重不足（aOR 1.10; 1.05-1.17）的调整后几率。腹泻预测所有结局（发育迟缓aOR为1.21;1.15-1.28；体重不足aOR为1.19;1.11-1.26；消瘦aOR为1.13;1.04-1.22）；急性呼吸道感染和肺炎分别与体重不足（aOR 1.13; 1.09-1.17）和发育迟缓（aOR 1.12; 1.08-1.17）独立相关。空间制图突出显示，东部和中部省份同时是高风险地区。结论饮水卫生设施不足、住房条件差和近期发生的传染病是儿童营养不良风险的独立升高因素；有必要在确定的热点地区开展有地理空间针对性的多部门讲卫生、住房和感染控制干预措施。

{"title":"Association of inadequate WaSH, housing, and infectious diseases with undernutrition hotspots among children under five: findings from a national survey in Indonesia","authors":"Yoerdy Agusmal Saputra , Mona Lisa , Nailul Hikmi , Septiria Irawati , Achmad Rizki Azhari , Disa Hijratul Muharramah","doi":"10.1016/j.cegh.2025.102211","DOIUrl":"10.1016/j.cegh.2025.102211","url":null,"abstract":"<div><h3>Background</h3><div>Undernutrition in Indonesia persists amid regional disparities in household water, sanitation, hygiene (WaSH), housing, and infectious disease burden. This study quantified associations between household environmental conditions, recent infections, and child undernutrition to inform geographically targeted interventions.</div></div><div><h3>Methods</h3><div>We conducted a secondary cross-sectional analysis of the 2023 Indonesia Health Survey, including 85,118 children aged 0–59 months. Exposures were household access to improved water, safe sanitation, basic hygiene, and adequate housing, plus self-reported diarrhea, ARI, and pneumonia; outcomes were stunting, underweight, and wasting. Multivariable logistic regression accounted for clustering, stratification, and sample weights, and provincial-level spatial overlays in QGIS mapped environmental and epidemiological hotspots.</div></div><div><h3>Results</h3><div>National prevalences were 24.2% (stunting), 17.7% (underweight), and 9.8% (wasting). After adjustment, absence of basic hygiene increased odds of stunting (aOR 1.37; 1.33–1.42), underweight (aOR 1.42; 1.37–1.48), and wasting (aOR 1.34; 1.28–1.41). Unimproved water was associated with stunting (aOR 1.26; 1.18–1.34) and underweight (aOR 1.12; 1.04–1.20); inadequate housing raised adjusted odds of stunting (aOR 1.09; 1.05–1.15) and underweight (aOR 1.10; 1.05–1.17). Diarrhea predicted all outcomes (stunting aOR 1.21; 1.15–1.28; underweight aOR 1.19; 1.11–1.26; wasting aOR 1.13; 1.04–1.22); ARI and pneumonia were independently associated with underweight (aOR 1.13; 1.09–1.17) and stunting (aOR 1.12; 1.08–1.17), respectively. Spatial mapping highlighted Eastern and Central provinces as concurrent high-risk areas.</div></div><div><h3>Conclusion</h3><div>Inadequate WaSH, poor housing, and recent infectious disease episodes independently elevate child undernutrition risk; geospatially targeted, multisectoral WaSH, housing, and infection-control interventions in identified hotspots are warranted.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"36 ","pages":"Article 102211"},"PeriodicalIF":1.7,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sex-specific associations between body composition, lifestyle habits, and skin autofluorescence-detected advanced glycation end-products in a sample of Japanese young adults 在日本年轻人样本中，身体组成、生活习惯和皮肤自体荧光检测晚期糖基化终产物之间的性别特异性关联

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-17 DOI: 10.1016/j.cegh.2025.102208

Makoto Ohtsuki , Akinobu Nishimura , Kazuki Kanayama , Yusuke Wakasugi , Yuki Aikawa

Problem considered

Advanced glycation end-products (AGEs) are implicated in aging and chronic disease pathogenesis. However, sex-specific associations between AGE accumulation, body composition, and lifestyle factors in healthy adolescents and young adults remain insufficiently explored.

Methods

This cross-sectional study included 153 healthy Japanese individuals aged 10–29 years (58 males, 95 females), recruited from nutrition-related events at universities and high schools in Mie Prefecture. AGE accumulation was measured via skin autofluorescence (SAF). Body composition (BMI, fat mass, muscle mass) was assessed using the InBody 470 bioelectrical impedance analyzer. Lifestyle factors (dietary balance, exercise, sleep) and subjective health perception were evaluated via structured questionnaires. Correlation, chi-square, and multivariate regression analyses were conducted. Bonferroni correction was applied for multiple comparisons in univariate analyses.

Results

Among males, SAF was negatively correlated with muscle mass (r = −0.268, p = 0.042), but the association was not statistically significant after Bonferroni correction. In females, a significant association between imbalanced dietary intake and higher AGE accumulation remained significant after Bonferroni correction (p = 0.005) and was further supported by multivariate regression (β = 0.037, p = 0.042). Logistic regression confirmed imbalanced dietary intake increased the odds of high AGE accumulation (OR = 2.43, 95 % CI: 1.02–5.47, p = 0.045).

Conclusion

While causality cannot be inferred from this cross-sectional study, results underscore the relevance of lifestyle behaviors in AGE accumulation among Japanese youth. Findings may inform sex-sensitive dietary education and health promotion strategies to support healthy aging from early life stages.

晚期糖基化终产物（AGEs）与衰老和慢性疾病发病机制有关。然而，在健康青少年和年轻人中，年龄积累、身体组成和生活方式因素之间的性别特异性关联仍未得到充分探讨。方法本横断面研究包括153名10-29岁的健康日本人（男性58人，女性95人），招募自Mie县大学和高中的营养相关活动。通过皮肤自体荧光（SAF）测定AGE积累。使用InBody 470生物电阻抗分析仪评估身体组成（BMI、脂肪量、肌肉量）。生活方式因素（饮食平衡、运动、睡眠）和主观健康感知通过结构化问卷进行评估。进行了相关分析、卡方分析和多元回归分析。单因素分析中，多重比较采用Bonferroni校正。结果在男性中，SAF与肌肉质量呈负相关（r = - 0.268, p = 0.042），但经Bonferroni校正后相关性无统计学意义。在女性中，经Bonferroni校正（p = 0.005）后，不平衡饮食摄入与较高的AGE积累之间的显著相关性仍然显著，并得到多变量回归的进一步支持（β = 0.037, p = 0.042）。Logistic回归证实饮食摄入不平衡增加了AGE高积累的几率（OR = 2.43, 95% CI: 1.02-5.47, p = 0.045）。结论：虽然不能从横断面研究中推断出因果关系，但结果强调了生活方式行为与日本年轻人年龄积累的相关性。研究结果可能为性别敏感的饮食教育和健康促进策略提供信息，以支持从生命早期开始健康老龄化。

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引用次数: 0

Exploring barriers and strategies for hydroxyurea uptake using the CFIR–ERIC framework: A qualitative study of sickle cell disease in India 利用cfr - eric框架探索羟基脲摄取的障碍和策略：印度镰状细胞病的定性研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-17 DOI: 10.1016/j.cegh.2025.102205

Vandana Mullakkal Venugopalan , Anindita Banerjee , Nithin Rajamani , Ravi Gajbhiye , Manisha Madkaikar , Naveen Khargekar

Problem considered

Hydroxyurea therapy is the cornerstone in treating sickle cell disease (SCD). However, the adherence to hydroxyurea by individuals with SCD is limited, owing to several barriers at multiple levels. Given these challenges, our study sought to elucidate the factors influencing hydroxyurea utilization through interviews with healthcare providers, individuals living with SCD, and their families.

Methods

The study was undertaken in four districts of India with a high prevalence of SCD. Qualitative data was collected from local healthcare providers, individuals with SCD, and their parents. The determinants were categorised using a CFIR-2·0 and strategies to improve uptake of hydroxyurea were developed using CFIR-ERIC matching tools in consultation with stakeholders.

Results

The study covered a total of 132 individuals with SCD and 18 healthcare personnel.

The main barriers to hydroxyurea uptake were: (i) limited awareness and misconceptions about SCD and hydroxyurea among patients and caregivers; (ii) concerns among healthcare providers about side effects and lack of paediatric formulations; (iii) myths, stigma, and reliance on traditional healers; (iv) limited accessibility to healthcare facilities, with high out-of-pocket costs; and (v) overburdened healthcare staff with inadequate time for counselling.

Conclusions

Limited awareness among healthcare providers and individuals with SCD, along with challenges related to the affordability and accessibility of healthcare facilities, as well as the absence of paediatric formulations of hydroxyurea, hindered the uptake of hydroxyurea therapy in individuals with SCD. Strategies to improve the uptake of hydroxyurea therapy include community awareness, continued medical education for healthcare practitioners, providing incentives to treating doctors and involvement of private practitioners for in treatment.

羟脲疗法是治疗镰状细胞病（SCD）的基石。然而，由于多个层面的障碍，SCD患者对羟基脲的依从性是有限的。鉴于这些挑战，我们的研究试图通过对医疗保健提供者、SCD患者及其家人的访谈来阐明影响羟基脲利用的因素。方法本研究在印度四个SCD高发地区进行。定性数据收集自当地医疗保健提供者、SCD患者及其父母。使用cfr -2·0对决定因素进行分类，并在与利益相关者协商后，使用cfr - eric匹配工具制定了改善羟基脲摄取的策略。结果本研究共包括132名SCD患者和18名医护人员。羟基脲摄取的主要障碍是：(i)患者和护理人员对SCD和羟基脲的认识有限和误解；（ii）保健提供者对副作用和缺乏儿科配方的关切；（iii）神话、耻辱和对传统治疗师的依赖；（四）利用保健设施的机会有限，自费费用高；（五）医护人员负担过重，没有足够的时间进行咨询。结论：医疗保健提供者和SCD患者对羟基脲的认识有限，加上医疗设施的可负担性和可及性，以及缺乏儿科配方的羟基脲，阻碍了SCD患者对羟基脲治疗的接受。提高羟基脲疗法接受度的战略包括社区意识、对保健从业人员继续进行医学教育、为治疗医生提供奖励以及让私人医生参与治疗。

{"title":"Exploring barriers and strategies for hydroxyurea uptake using the CFIR–ERIC framework: A qualitative study of sickle cell disease in India","authors":"Vandana Mullakkal Venugopalan , Anindita Banerjee , Nithin Rajamani , Ravi Gajbhiye , Manisha Madkaikar , Naveen Khargekar","doi":"10.1016/j.cegh.2025.102205","DOIUrl":"10.1016/j.cegh.2025.102205","url":null,"abstract":"<div><h3>Problem considered</h3><div>Hydroxyurea therapy is the cornerstone in treating sickle cell disease (SCD). However, the adherence to hydroxyurea by individuals with SCD is limited, owing to several barriers at multiple levels. Given these challenges, our study sought to elucidate the factors influencing hydroxyurea utilization through interviews with healthcare providers, individuals living with SCD, and their families.</div></div><div><h3>Methods</h3><div>The study was undertaken in four districts of India with a high prevalence of SCD. Qualitative data was collected from local healthcare providers, individuals with SCD, and their parents. The determinants were categorised using a CFIR-2·0 and strategies to improve uptake of hydroxyurea were developed using CFIR-ERIC matching tools in consultation with stakeholders.</div></div><div><h3>Results</h3><div>The study covered a total of 132 individuals with SCD and 18 healthcare personnel.</div><div>The main barriers to hydroxyurea uptake were: (i) limited awareness and misconceptions about SCD and hydroxyurea among patients and caregivers; (ii) concerns among healthcare providers about side effects and lack of paediatric formulations; (iii) myths, stigma, and reliance on traditional healers; (iv) limited accessibility to healthcare facilities, with high out-of-pocket costs; and (v) overburdened healthcare staff with inadequate time for counselling.</div></div><div><h3>Conclusions</h3><div>Limited awareness among healthcare providers and individuals with SCD, along with challenges related to the affordability and accessibility of healthcare facilities, as well as the absence of paediatric formulations of hydroxyurea, hindered the uptake of hydroxyurea therapy in individuals with SCD. Strategies to improve the uptake of hydroxyurea therapy include community awareness, continued medical education for healthcare practitioners, providing incentives to treating doctors and involvement of private practitioners for in treatment.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"36 ","pages":"Article 102205"},"PeriodicalIF":1.7,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Air pollution and chronic kidney disease: An emerging challenge 空气污染与慢性肾脏疾病：一个新出现的挑战

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-14 DOI: 10.1016/j.cegh.2025.102204

Bharti Chogtu , Rahul Magazine , Ravindra Prabhu , Vani Lakshmi R

Background

Air pollution is an emerging risk factor for the rising incidence of chronic kidney disease (CKD)

Methods

Using keywords, articles were identified through PubMed search up to August 2025.

Results

Evidence from studies suggest an association between air pollution and renal function decline and elucidate its underlying mechanisms. Vulnerable populations are at increased risk of renal injury and adherence to WHO air pollutant thresholds can potentially reduce adverse consequences.

Conclusion

Growing body of evidence points to air pollution as a risk factor for development of CKD. However, more robust studies need to be conducted to establish a causal relationship.

背景：空气污染是慢性肾脏疾病（CKD）发病率上升的一个新兴危险因素。方法：使用关键词，通过PubMed检索到2025年8月的文章。结果研究表明空气污染与肾功能下降之间存在关联，并阐明了其潜在机制。脆弱人群肾损伤的风险增加，遵守世卫组织空气污染物阈值可潜在地减少不良后果。结论越来越多的证据表明，空气污染是CKD发展的危险因素。然而，需要进行更有力的研究来建立因果关系。

引用次数: 0

Evaluation of post dental extraction wound healing and bone regeneration using topical combined application of osteogenic inducers -a randomized controlled trial 评价局部联合应用成骨诱导剂对拔牙后伤口愈合和骨再生的影响——一项随机对照试验

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2025-10-14 DOI: 10.1016/j.cegh.2025.102202

Shridhar D. Baliga, Rishabh Mandal

Problem considered

The bone loss is indeed substantial during the first three months following extraction and can result in both hard and soft tissue defects impacting the site's potential to regenerate with an acceptable amount of bone. The combination of Dexamethasone, Vitamin C and Beta-Sodium Glycerophosphate as an osteogenic inducer has the potential to trigger bone marrow derived stem cells to transform into osteoblasts, enhancing regeneration of bone.

Methods

36 patients were divided equally into osteogenic group and non-osteogenic group who reported for extraction of mandibular third molar. In the osteogenic group an osteogenic inducer was placed in the extraction socket after the third molar was extracted, whereas in the non-osteogenic group no material was introduced. Patients were recalled at intervals of 1 day, 7 days, 1 and 3 months. Mann-Whitney's test and Generalized Estimating Equation (GEE) models was used.

Results

The osteogenic group showed significantly better wound healing as compared to the non-osteogenic group at the end of 7th day following extraction. Bone regeneration was assessed and the osteogenic group showed faster bone healing when compared to the non-osteogenic group in terms of presence of Lamina Dura, overall bone density and trabecular patterns when assessed after 3 months following extract ion.

Conclusion

Osteogenic inducer used as a graft material showed improved wound and bone healing when placed in the third molar extraction sockets with the added benefits of no additional donor site requirement, reduced postoperative complications and is not technique sensitive.

在拔牙后的前三个月，骨质流失确实是相当严重的，并且可能导致软组织和硬组织的缺陷，影响该部位以可接受的骨量再生的潜力。地塞米松、维生素C和β -甘油磷酸钠作为成骨诱导剂的组合有可能触发骨髓来源的干细胞转化为成骨细胞，增强骨的再生。方法36例下颌第三磨牙拔除患者分为成骨组和非成骨组。成骨组在第三磨牙拔除后在拔牙槽内放置成骨诱导剂，而非成骨组不引入任何材料。每隔1天、7天、1个月和3个月对患者进行回顾。采用Mann-Whitney检验和广义估计方程（GEE）模型。结果拔牙后第7天，成骨组创面愈合明显优于非成骨组。对骨再生进行评估，在提取离子3个月后评估，在硬膜存在、总体骨密度和小梁模式方面，与非成骨组相比，成骨组的骨愈合速度更快。结论成骨诱导剂作为植骨材料应用于第三磨牙拔牙槽位，具有不需要增加供体位置、减少术后并发症、对技术不敏感等优点。

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引用次数: 0