Archives of Public Health最新文献

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.