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Assessing the transferability potential of policy practices for older people.
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-28 DOI: 10.1186/s13690-025-01548-w
Mihaela Ghența, Aniela Matei, Franziska Rothe, Marja Aartsen, Iuliana Precupetu

Background: Policies in the fields of health and long-term care are constantly under pressure to ensure the balance between economic stability and an adequate quality of life for all the citizens in need, while policy makers are engaged in finding the most adequate responses to population ageing concerns. Demographic changes create multiple concerns to which policy makers and practitioners need to develop interventions. The aim of this paper is to assess the transferability potential of selected best practices from Norway to Romania in order to increase the social inclusion of older people.

Methods: This approach comprises a mixture of methods. It uses a SWOT analysis to select best practices and a Policy Delphi methodology with experts in relevant fields of social policy for older people (health and long-term care) to assess the transferability potential of those best practices.

Results: The results suggest that the transferability of best practices is closely linked to the national context.

Conclusions: The transferability of best practices from one national context to another is an effective way to advance social policies for older persons, provided that the economic, social, political and cultural circumstances are considered. The results highlight the need for change in the development of policy measures for the selected domains of social policy. To create such change, policy makers should consider the level of development of health and long-term care systems.

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引用次数: 0
Healthy ageing for older adult people with intellectual disability: a scoping review.
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-27 DOI: 10.1186/s13690-025-01528-0
Nadia El Mrayyan, Marianne Holmgren, Gerd Ahlström

Background: The increasing longevity of people with intellectual disability creates a need for a healthy-ageing perspective, translated into evidence-based interventions in this multi-morbidity group. Accordingly, the aim of this scoping review was to identify, summarise and analyse the empirical research on healthy ageing in older adults with intellectual disability.

Methods: This review was based on the PRISMA 2020 guidelines for Scoping Reviews (PRISMA-ScR) and a PICO protocol (Patient/population, Intervention, Comparison/control, and Outcome). Empirical studies in English were included if they concerned older adults with intellectual disability with an average age of at least 45 and were based on a clearly expressed healthy-ageing perspective. An information specialist conducted a search in 11 databases with no geographical or temporal restrictions. Two independent researchers performed study selection, quality assessment and data extraction. Disagreements were resolved in consultation with a third researcher. A textual narrative synthesis was based on PICO domains and the seven research questions.

Results: The 11 studies were all from developed countries and had different designs: qualitative, mixed-method and one systematic review. Only three studies highlighted the term "healthy ageing", most used synonymous terms. Eight studies focused on healthy ageing on the individual level, three on the organisational and societal level. The intervention studies in the systematic review were mainly nonrandomised, concerned interventions varying in intensity and duration, considered different research questions and employed different outcome measures.

Conclusions: The findings highlight a major knowledge gap concerning evidence-based interventions with a healthy-ageing perspective in the case of older adults with intellectual disability. There is an urgent need to initiate healthy-ageing studies in developing countries, where such people are even more vulnerable to stigma and discrimination than those in developed countries. Our findings confirm the need to scale up healthy-ageing interventions in line with the WHO's ambition to develop evidence-based approaches to optimise the functional capacity of all older people, including older adults with intellectual disability, by 2030.

Registration: The study is registered in the International Prospective Register of Systematic Reviews (PROSPERO), CRD42022337211 (13 June 2022).

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引用次数: 0
Usability of technological tools to overcome language barriers in healthcare- a scoping review.
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-25 DOI: 10.1186/s13690-025-01543-1
Annika Kreienbrinck, Saskia Hanft-Robert, Alina Ioana Forray, Asithandile Nozewu, Mike Mösko

Introduction: In many healthcare contexts globally, where the languages of care providers and service users do not match, miscommunication can lead to inaccurate diagnoses and subpar treatment outcomes. The development and use of technological tools to overcome language barriers are increasing, but usability and evaluation of these tools vary widely.

Objectives: This scoping review's objectives are (i) to identify and describe the technological tools used in direct service user-provider communication to overcome language barriers in a healthcare setting, (ii) to identify how the usability of these tools was evaluated, and (iii) to identify the challenges and benefits of using such technological tools.

Methods and analysis: The scoping review followed the JBI methodology. Studies published between January 2019 and July 2024 were identified using a search strategy with variations of the keywords "technological tools," "language barrier," and "health care" in the following six databases and research platforms: PubMed, PsycArticle, Scopus, EBSCOhost, ProQuest, and Web of Science. All literature on individuals using a technological tool to overcome language barriers in a healthcare context was included and exported into the screening assistant software Rayyan. The search was limited to articles written in German or English. The literature was screened twice by three independent reviewers in a blinded fashion, and all relevant data were presented in a descriptive summary.

Results: Based on 16 publications, this scoping review identified 16 technological tools, categorized as fixed-phrase or machine translation apps, to overcome language barriers in a healthcare setting. Usability was assessed in 13 publications applying diverse methods, i.e., surveys, observations, and application data analysis. Technological tools hold potential as a means to address language barriers in healthcare by facilitating communication and supporting diagnostic processes. However, their usability is often constrained by challenges related to translation accuracy, accessibility, and learnability.

Conclusion: Future research and policy efforts should focus on standardizing evaluation methods and diversifying development regionally, linguistically, and interdisciplinary. Rather than broadly promoting these tools, emphasis should be placed on ensuring they are reliable and efficient for their intended use to maximize their effectiveness and relevance in specific healthcare contexts.

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引用次数: 0
Analysis of factors influencing attrition among clinical traditional Chinese medical major graduates: based on a discrete choice experiment.
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-25 DOI: 10.1186/s13690-025-01539-x
Jinying Su, Yichun Gu, Jiaqi Yuan, Botao Tian, Shimeng Liu, Huaxin Yu, Yaqun Wang, Lihang Sun, Yulin Zhang, Da He

Background: Traditional Chinese Medicine (TCM) is essential for promoting health worldwide. Despite governmental support, TCM faces critical challenges, including workforce shortages and high attrition rates, with many clinical TCM graduates pursuing non-clinical careers. This study aims to explore the employment preferences of these graduates and to propose strategies for retaining TCM professionals, optimizing the input-output ratio of TCM education, and supporting the sustainable development of the TCM industry.

Methods: A stratified sampling method was used to select clinical TCM major graduates from 16 universities of Chinese medicine. A Discrete Choice Experiment (DCE) was conducted to investigate the factors influencing the attrition of clinical TCM professionals, including monthly income, work location, housing security, workload, work environment, and promotion opportunities. A mixed logit model was applied to analyze the DCE data.

Results: A total of 273 clinical TCM major graduates were included in the primary DCE analysis. The monthly income was more important than other attributes (RAI = 48.03%). Among non-economic factors, participants expressed the strongest willingness to decrease workload, being willing to forgo 3,370.312 yuan (approximately $500.3) in monthly income to reduce heavy workloads to moderate levels. Other significant factors included work environment (RAI = 13.64%), housing security (RAI = 9.47%), and promotion opportunities (RAI = 5.33%), with work location being the least important (RAI = 3.3%). Subgroup analysis showed that rural graduates were more willing than urban graduates to forgo monthly income for promotion opportunities. Graduates from the central region of China valued work environment and housing security more than those from the eastern and western regions. Postgraduates were more likely than undergraduates to give up monthly income for housing security.

Conclusion: In addition to economic factors, non-economic factors are also critical considerations for clinical TCM major graduates in their employment decisions. A combination of measures, including offering lower workloads, better work environments, housing security, and promotion opportunities, should be adopted to stabilize the employment environment for clinical TCM graduates.

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引用次数: 0
Between intention and action: the paradoxes of female vaccination.
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-25 DOI: 10.1186/s13690-025-01542-2
Libia Santos-Requejo, Obdulia María Torres-González

Background: The article addresses two paradoxes related to the vaccination of women in the context of the COVID-19 pandemic. The first paradox lies in the fact that, though women tend to be more concerned about health issues, they declare less of an intention to vaccinate than do men. The second paradox is that, despite reporting less intention to vaccinate, women actually take up vaccines more than men. This article sets out to study the reasons for these paradoxes.

Methods: We used information from a representative sample of the Spanish population. A dichotomous variable was created ('change' versus 'consistency', in relation to respondents' intention and final decision to get vaccinated), and two logistic regression models were applied: one for the group of women and the other for the group of men.

Results: Several factors have been identified as influencing the change of opinion: such as trust in the health system, conspiracy beliefs about vaccines, positive evaluation of science and technology, level of knowledge, ideology and religion. It is noteworthy that several differences are found between men and women in terms of the factors causing them to change their opinion about vaccination.

Conclusions: The most relevant conclusion is that intention studies in the field of vaccination lose predictive power in the case of women's vaccination. It should also be noted that, with women, there are no factors that conclusively explain their change of opinion. Therefore, if the factors influencing vaccination behaviour are to be discovered, it is necessary to modify the questions included in the questionnaires in order to find the variables that explain women's behaviour.

背景:文章探讨了在 COVID-19 大流行的背景下与妇女接种疫苗有关的两个悖论。第一个悖论在于,尽管女性往往更关注健康问题,但她们宣布接种疫苗的意愿却低于男性。第二个悖论是,尽管女性表示接种疫苗的意愿较低,但实际上接种疫苗的人数却多于男性。本文旨在研究产生这些矛盾的原因:方法:我们使用了具有代表性的西班牙人口样本信息。我们创建了一个二分变量(与受访者接种疫苗的意向和最终决定有关的 "改变 "和 "一致"),并应用了两个逻辑回归模型:一个是女性组,另一个是男性组:结果:有几个因素被认为会影响意见的改变:如对卫生系统的信任、对疫苗的阴谋信念、对科学技术的积极评价、知识水平、意识形态和宗教信仰。值得注意的是,男性和女性在导致他们改变对疫苗接种看法的因素方面存在一些差异:最相关的结论是,疫苗接种领域的意向研究对妇女接种疫苗失去了预测力。还应该指出的是,对于妇女而言,没有任何因素能最终解释她们意见的改变。因此,如果要发现影响疫苗接种行为的因素,就有必要修改问卷中的问题,以便找到能解释妇女行为的变量。
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引用次数: 0
Examining the association of psychosocial and health behaviors with life satisfaction among canadians: a nationally representative study. 研究加拿大人的社会心理和健康行为与生活满意度的关系:一项具有全国代表性的研究。
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-24 DOI: 10.1186/s13690-025-01502-w
Nigatu Regassa Geda, Leah E Cahill, Cindy Feng

Background: Given life satisfaction is a key component or indicator of Quality of Life (QoL), previous studies in Canada have made some attempt to analyze its main determinants at population level. However, our knowledge of the association between psychosocial factors (e.g., sense of belongingness) and health behaviors (e.g., smoking, alcohol intake, and physical activity) and life satisfaction is limited. Understanding the associations between these key variables and life satisfaction is vital for informing interventions and improving well-being. This study aims to address this research gap by examining the relationships between psychosocial factors, health behaviors, and life satisfaction among Canadians aged 12 and above.

Methods: Data from the 2017-2018 Canadian Community Health Survey (CCHS) were utilized for this study, encompassing information from a large sample of 113,000 Canadians aged 12 and above. Generalized Ordered logistic regression models were employed to assess the association of psychosocial and physical health behaviors with life satisfaction.

Results: The study revealed significant associations between psychosocial factors, health behaviors, and life dissatisfaction among Canadians. Respondents living in moderately and severely food insecure households have 2.239 times (95% CI: 1.799-2.786) and 5.093 times (95% CI: 4.097-6.332) higher incidences of experiencing life dissatisfaction, respectively, compared to food-secured households. Respondents with a somewhat weak and very weak sense of belongingness had 2.635 times (95% CI: 2.048-3.391) and 6.740 times (95% CI: 5.210-8.717) higher chances, respectively, of falling into the life dissatisfaction category compared to being satisfied. Higher BMI and obesity were linked to increased life dissatisfaction, while physical activity exhibited a positive relationship with life satisfaction. Smoking was associated with higher levels of life dissatisfaction.

Conclusion: These findings underscore the importance of considering both psychosocial factors and physical health behaviors in understanding life dissatisfaction among Canadians. The results suggest that interventions targeting social factors, such as promoting a sense of belongingness and addressing socioeconomic disparities, alongside efforts to promote healthy lifestyle behaviors, may contribute to improving subjective well-being and life satisfaction.

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引用次数: 0
I don't mind my information going to the Moon, but I don't want any letters from Mars: a qualitative exploration of the challenges with secondary use of health data in Ireland.
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-24 DOI: 10.1186/s13690-025-01524-4
Tina Bedenik, Caitriona Cahir, Kathleen E Bennett

Background: Secondary use of health data is important for public and individual health due to its potential to drive research and healthcare improvement; however, there are challenges to be managed from a socio-ethical, legal and technological perspective. The aim of this qualitative study was to explore knowledge, experiences and perspectives of key stakeholders towards secondary use of health data in Ireland, with a specific focus on the challenges with secondary use.

Methods: The study employed a qualitative cross-sectional approach in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Thirty-five people participated in the study, with seven participants in each of the five focus groups: academics and researchers; healthcare professionals; data controllers, ethics and privacy experts; industry group; and patients and public. Two thirds of the sample were female, and over half of participants were between 35 and 54 years of age. Participants were recruited through purposive and snowballing method. Data was collected through focus group discussions, transcribed and analysed thematically.

Results: The participants across all study groups were supportive of secondary use of health data; however, significant challenges were identified. The four main categories of challenges were related to (1) health data use, (2) ethics, (3) health data ecosystem and (4) social inequalities. Specifically, insufficient collection and low quality of health data, alongside issues regarding access, linking and sharing are a significant barrier to effective secondary use. This is further complicated by complex ethical approval processes and requirements around data protection. The fragmented national Information Technology (IT) and data infrastructure and limited resources further hamper secondary use, and concerns about low health literacy among the public and negative experiences with the healthcare system influence patients' willingness to share data for secondary use.

Conclusions: This study identified the multi-layered and intersecting challenges in the Irish health data ecosystem around secondary use, and highlighted the need for structural improvements, reform of ethical processes, integration of disadvantaged communities, and education and awareness-raising among the public. A careful consideration of these challenges on a national level is required to enable effective secondary use of health data.

背景:健康数据的二次使用对公众和个人健康非常重要,因为它具有推动研究和改善医疗保健的潜力;然而,从社会伦理、法律和技术角度来看,二次使用也面临着挑战。这项定性研究旨在探讨爱尔兰主要利益相关者对二次使用健康数据的认识、经验和观点,特别关注二次使用所面临的挑战:这项研究根据定性研究报告综合标准 (COREQ) 指南,采用了横断面定性研究方法。35 人参与了研究,五个焦点小组中每个小组有 7 名参与者:学者和研究人员;医疗保健专业人员;数据控制者、伦理和隐私专家;行业团体;以及患者和公众。三分之二的样本为女性,一半以上的参与者年龄在 35 至 54 岁之间。参与者是通过有目的和滚雪球的方法招募的。通过焦点小组讨论收集数据,并对数据进行转录和专题分析:所有研究小组的参与者都支持对健康数据进行二次利用,但也发现了一些重大挑战。四大类挑战分别涉及:(1) 健康数据的使用;(2) 道德;(3) 健康数据生态系统;(4) 社会不平等。具体而言,健康数据收集不足、质量不高,以及获取、链接和共享方面的问题是有效二次利用的重大障碍。复杂的伦理审批程序和数据保护要求使问题更加复杂。分散的国家信息技术(IT)和数据基础设施以及有限的资源进一步阻碍了数据的二次利用,而公众对健康知识普及率低的担忧以及对医疗系统的负面体验也影响了患者为二次利用而共享数据的意愿:本研究确定了爱尔兰健康数据生态系统在二次使用方面面临的多层次、相互交织的挑战,并强调了改善结构、改革伦理程序、整合弱势群体以及教育和提高公众意识的必要性。需要在全国范围内认真考虑这些挑战,以实现健康数据的有效二次利用。
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引用次数: 0
Association between serum cotinine concentrations on red blood cell folate concentrations in pregnant women and the mediating role of lymphocytes: an NHANES Study.
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-21 DOI: 10.1186/s13690-025-01533-3
Yang Bao, Cheng Huang, Peng-Qiang Wu, Jie Yan, Shu-Zhen Xiao, Chen Huang, Mao-Hua Wei, Qing-Hong Liu

Background: Folate is essential for DNA synthesis and cell division, particularly during pregnancy, where insufficient levels can lead to adverse outcomes like neural tube defects and preterm birth. Tobacco smoke exposure, indicated by serum cotinine levels, is a known risk factor for reduced folate levels. However, the mechanisms underlying this relationship, especially the role of lymphocytes, are not well understood.

Objectives: This study evaluates the relationship between serum cotinine levels and RBC folate concentrations in pregnant women, explores the mediating role of lymphocyte count, and identifies susceptibility factors that could guide targeted interventions.

Methods: We conducted a cross-sectional analysis using NHANES data from 1999 to 2018, including 1,021 pregnant women. Serum cotinine levels were used as a biomarker for tobacco exposure, while RBC folate levels indicated long-term folate status. Linear regression, restricted cubic spline, and mediation analyses were performed to assess these relationships.

Results: Serum cotinine levels were significantly negatively correlated with RBC folate concentrations (P < 0.001). A nonlinear relationship revealed more pronounced folate depletion at higher cotinine levels. Mediation analysis showed that elevated lymphocyte count mediated 19.3% of the cotinine-folate association. Factors such as smoking history, advanced maternal age, and heavy alcohol consumption exacerbated this negative effect.

Conclusion: Tobacco exposure(as reflected by elevated cotinine levels) significantly reduces folate levels in pregnant women, with lymphocyte count playing a mediating role. These findings underscore the need for targeted public health interventions to mitigate tobacco-related risks during pregnancy.

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引用次数: 0
Financial impacts of the COVID-19 pandemic on immigrant communities in Portland Maine: a qualitative study.
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-21 DOI: 10.1186/s13690-025-01527-1
Eilish W Carpenter, Claude Rwaganje, Michael Kohut, Elizabeth A Jacobs, Kathleen M Fairfield, Gloria D Sclar

Background: The COVID-19 pandemic not only disproportionately impacted the health of immigrants in the US, but led to financial disparities as well. However, few studies to date capture the experience of asylum-seeking and refugee populations.

Methods: We analyzed semi-structured interviews conducted in fall 2021 with immigrants (primarily asylum-seekers and refugees from countries in Central and East Africa) and key informants, and conducted focus group discussions in spring 2023 with employees of a non-profit supporting the financial needs of asylum-seekers and refugees in Portland, ME.

Results: We identified several ways in which the COVID-19 pandemic negatively impacted the financial stability of asylum-seekers and refugees, including: job loss, work permit backlog, lack of sick leave benefits, childcare expenses and related job strain, rising cost of basic goods, issues of housing availability/affordability, and healthcare expenses.

Conclusion: Policy changes that address structural factors and support financial stability among asylum-seekers and refugees and other low-income populations could help mitigate the impact of future public health crises and ultimately improve health equity.

背景:COVID-19 大流行不仅对美国移民的健康造成了极大的影响,而且还导致了经济差异。然而,迄今为止很少有研究能反映寻求庇护者和难民的经历:我们分析了 2021 年秋季对移民(主要是来自中非和东非国家的寻求庇护者和难民)和主要信息提供者进行的半结构化访谈,并在 2023 年春季对支持密歇根州波特兰市寻求庇护者和难民经济需求的非营利组织的员工进行了焦点小组讨论:我们确定了 COVID-19 大流行对寻求庇护者和难民的经济稳定性产生负面影响的几种方式,包括:失业、工作许可积压、缺乏病假福利、育儿支出和相关工作压力、基本商品成本上升、住房可用性/可负担性问题以及医疗保健支出:针对寻求庇护者和难民以及其他低收入人群的结构性因素并支持其经济稳定的政策变化,有助于减轻未来公共卫生危机的影响,并最终改善健康公平状况。
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引用次数: 0
Wealth gradients in healthy aging: evidence from the 2011 and 2013 waves of the China Health and Retirement Longitudinal Study.
IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-02-21 DOI: 10.1186/s13690-025-01526-2
Tiantian Tao, Mengru Zhan, Xin Li, Pingyu Chen

Background: It is crucial to understand how individuals accumulate wealth over their lifespan and explain the relation with the changes in health by age cohort. This study examines wealth-to-health causality as an explanation for the health-wealth gradient.

Methods: Using the 2011 and 2013 waves of individuals aged 45 and above from the China Health and Retirement Longitudinal Study, this study tests for causality by employing various econometric models and statistical strategies, conducting longitudinal and cross-sectional data analyses. The validity of the causal mechanisms is assessed by comparing the fitting results from different models.

Results: The fixed effects model reveals that a 1% increase in wealth results in a statistically significant decrease in the constructed health index by approximately 0.00032 units, at a 1% significance level. Similarly, in the instrumental variables model, the coefficient for wealth is -0.229 and is also significant at the 1% level. The results for other control variables, such as demographic, socioeconomic status, geographical, and childhood health status, remain stable and align with expectations across different models.

Conclusion: This study demonstrates a causal relationship between wealth and health, with permanent income as a key determinant. It highlights the need for poverty alleviation policies that promote long-term wealth accumulation, strengthen social welfare, and consider the indirect health effects of economic and environmental reforms.

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引用次数: 0
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