Journal of Global Health最新文献

Background: The World Health Organization declared that coronavirus disease 2019 (COVID-19) constitutes an international public health emergency, which has strained health resources. In this study, we aimed to understand medical students' willingness to join the workforce fighting against the COVID-19 pandemic and identify factors associated with their decisions.

Methods: We conducted a nationwide cross-sectional study using the Wen-Juan-Xing platform and a pre-designed questionnaire from 23 March to 19 April 2021. We conducted logistic regression analyses to identify the determinants associated with the willingness.

Results: Among the 5022 medical students, the majority (n = 4289, 85.40%) expressed willingness to work on the COVID-19 frontline. Logistic regression indicated that medical students' willingness to work on the COVID-19 frontline in China was associated with gender, region, reason for choosing medicine, having medical workers in the family, students whose family members, relatives or friends experienced COVID-19, and professional attitude. Females (odds ratio (OR) = 1.305; 95% confidence interval (CI) = 1.100-1.549; P = 0.0023), medical students from urban areas (OR = 1.295; 95% CI = 1.089-1.539; P = 0.0034), medical students whose choice of a medical career was their desire (OR = 1.579; 95% CI = 1.290-1.933; P < 0.0001), medical students whose parents or relatives are medical workers (OR = 1.266; 95% CI = 1.066-1.505; P = 0.0073), medical students whose family members, relatives, or friends have never been infected with COVID-19 (OR = 4.567; 95% CI = 3.002-6.947; P < 0.0001), and medical students with undisturbed of professional attitudes (OR = 4.280; 95% CI = 3.241-5.654; P < 0.0001) showed increased willingness to work on the COVID-19 frontline compared with their counterparts.

Conclusions: Medical students demonstrated a strong willingness to contribute to COVID-19 work during the pandemic in China. The findings may provide valuable information for emergency management so that policymakers can maintain sufficient health resources and provide quality health care in similar health emergencies in the future.

Background: Clinical breast exam (CBE) by outreach healthcare workers (HCW) may help downstage breast cancer in resource-limited areas where mammography may not be feasible. We evaluated the effectiveness of a pilot cascade-model training programme for HCWs in remote areas of Pakistan.

Methods: The training programme comprised three phases. In phase one, fellowship-trained breast surgeons at a metropolitan academic centre trained six HCWs to perform CBEs. In phase two, these six HCWs (master trainers) trained 15 additional HCWs, implementing cascade training. In phase three, the consultant breast surgeon conducted a re-evaluation and refresher course for all 21 HCWs at least one year after the original training session. We assessed CBE ability and skills through pre- and post-changes through self-reported confidence and direct observation of procedural skills.

Results: Significant improvements in learners' self-reported confidence and CBE skills were observed in both phases one and two. The median scores in the learners' post-training self-reported confidence and CBE skills (inspection, palpation, and lymph node examination) improved by 20% and 46.2%, respectively, indicating excellent learning outcomes of the cascade training sessions. Phase three showed sustained high scores in self-reported confidence and CBE skills more than one year later.

Conclusions: Mass training of outreach HCWs in remote regions in performing CBE may be possible with a structured multiphase cascade-training model and may be an important step in downstaging symptomatic breast cancer in low-resource settings.

This corrects the article DOI: 10.7189/jogh.14.03029.

Background: The resilience of Peru´s health system was weakened by a political crisis that started in 2016 and was further challenged by the coronavirus 2019 (COVID-19) pandemic. We assessed the indirect impact of the pandemic on the utilisation of essential maternal and child health (MCH) services in Peru at national and subnational levels.

Methods: We assessed the trends in MCH services utilisation and the percentage change from 2018 to 2021, using routine health facility data. We used an interrupted time series analysis to quantify the impact of COVID-19 on the utilisation of health services.

Results: The utilisation of most maternal and child health services dropped dramatically in 2020 after the outbreak. However, we observed a quick recovery in 2021, with service utilisation fairly similar or higher to the pre-pandemic period (2018-2019). The decrease was higher in the utilisation of antenatal care visit one or more (incidence rate ratio (IRR) = 0.79; 95% CI = 0.74-0.83) and antenatal care visits four or more (IRR= 0.76; 95% = 0.74-0.79) in 2020. The IRR showed a drop of 5, 6, 9, and 13% in the utilisation of skilled birth attendances, institutional deliveries, caesarean sections and postnatal care visits within two days of childbirth, respectively in 2020 in comparison to pre-pandemic service utilisation. In 2020 the utilisation decreased in all three natural regions, with the Rainforest being the most affected. In 2021 there was a recovery in all natural regions.

Conclusions: The pandemic decreased the utilisation of essential maternal and child health services in Peru. This highlights the need to preserve the resilience of a health system both at central and local levels, to face more successfully future pandemics.

Background: While countries' coronavirus disease 2019 (COVID-19) emergency contingency and response plans aimed to prevent and control the spread of the virus, they also caused major disruptions to health services. We assessed the effects of COVID-19 on coverage and inequalities in select maternal, newborn, and child health services in Burkina Faso.

Methods: We analysed data from two cross-sectional household surveys conducted in two provinces, one rural and one urban. The first survey of 3375 households was conducted immediately before the pandemic (February to March 2020) and the second survey in the same areas two years after the pandemic (May to June 2022) using a similar methodology. We compared the coverage of maternal, newborn, and child health interventions and care-seeking between the two surveys to assess the effects of the pandemic on maternal, newborn, and child health services.

Results: Our findings did not show significant disruptions in coverage of antenatal service, postnatal care for mothers and babies, child routine vaccination, and care-seeking for sick children during the pandemic. However, there was a dramatic drop of the number of women (23 percentage points) accompanied by their partners for delivery as well as the number of caesarean-section deliveries in urban areas. The shortage of health staff, facility congestion, fear of getting COVID-19 after a caesarean-section admission, and prioritisation of critical health services such as emergency caesarean-section to the detriment of elective cases may explain the decline of caesarean-section rates.

Conclusions: COVID-19 did not cause major reversals in the coverage of maternal, newborn, and child health services in Burkina Faso, except for caesarean sections. We also saw no substantial increases in service coverage. In the absence of a counterfactual, we could not attribute the stagnation to the pandemic. However, the very low proportion of women reporting disruption in care-seeking suggests some resilience of the health systems to mitigate the negative impacts of the pandemic.

Background: Shanghai's high level of ageing has given rise to a considerable number of elderly patients with type 2 diabetes mellitus (T2DM) who are confronted with the challenge of managing multimorbidity. We aimed to determine the prevalence of multimorbidity in elderly T2DM patients in a representative Pudong New Area community and critically evaluate current guidelines' inclusiveness in addressing major comorbidities.

Methods: Through the Shanghai Health Cloud platform, we extracted medical records of residents in the Huamu community (Pudong New Area, Shanghai) to screen elderly patients with at least three outpatient visits or one hospitalisation per year between 2019 and 2022. According to International Classification of Disease, 10th edition codes and personal identification number, we identified the status of T2DM and 12 other common chronic diseases, matched T2DM patients and non-T2DM patients 1:1 by age and gender, and then calculated the prevalence of multimorbidity status and annual prevalence of each comorbidity. We analysed associations between T2DM and specific chronic diseases using logistic regression models.

Results: More than 90% of elderly T2DM patients had at least one additional chronic disease. Multimorbidity was more frequent in women and older patients. Hyperlipidemia, hypertension, and ischaemic heart disease were the most prevalent comorbidities. The diagnosis of T2DM was significantly associated with both cardiovascular-kidney-metabolic and neuropsychiatric diseases. In addition, a higher prevalence and risk of chronic obstructive pulmonary disease (COPD) were consistently detected in elderly patients with T2DM, regardless of age and gender.

Conclusions: Multimorbidity in elderly patients with T2DM needs broader acknowledgement. Current guidelines focus more on cardiovascular-kidney-metabolic and neuropsychiatric diseases with inadequate guidance on COPD management. Hence, the pleiotropic effects of glucose-lowering drugs on COPD should be further investigated to optimise the comprehensive management strategy for this population.

Background: Inclusivity in research priority setting is fundamental to capturing the opinion of all stakeholders in a research area. Globally, experienced healthcare workers often have deep insights that could impactfully shape future research, and a lack of their involvement in formal research and publications could mean that their voices are insufficiently represented. We aimed to modify the well-established Child Health and Nutrition Research Initiative (CHNRI) methodology to address barriers to inclusivity, which are particularly relevant in healthcare that requires highly multidisciplinary care.

Methods: This global research priority-setting exercise for orofacial clefts adapted the CHNRI methodology to include research experts, clinicians from multiple disciplines, and non-technical stakeholders (i.e. patients and parents and non-governmental organisations (NGOs)) on a global basis. A multidisciplinary international steering group proposed and discussed methodological changes to improve inclusivity, including survey edits, subgroups for research questions, a demographics section, translation in French and Spanish, phrasing adaptation, and alternative dissemination techniques.

Results: We received 412 responses and 1420 questions, spanning 78 different countries and 18 different specialties/groups. Challenges remain to improve representation of all groups, with the vast majority of answers (30%) being from surgeons and a comparatively small proportion from patient/parent groups (9%). This also includes managing responses in three languages, effective dissemination, and responses that were not worded as research questions.

Conclusions: This is one of the first CHNRI exercises to involve patients and parents, clinicians, and researchers in its first question submission stage, and the first ever to do so on a global scale. We describe our approach to addressing inclusivity challenges and report related demographic data to serve as a benchmark upon which we hope future CHNRI exercises will improve.

Background: Numerous studies have estimated the impact of outdoor particulate matter (PM) on tuberculosis risk. Nevertheless, whether there is an association between ambient PM and latent tuberculosis infection (LTBI) risk remains uncertain.

Methods: We collected the basic information and LTBI test results of students who underwent freshmen enrolment physical examinations in 68 middle schools from six prefecture-level cities located in eastern China between 2018 and 2021. We also extracted data on air pollutant concentrations and meteorological factors in six cities between 2015 and 2021. We applied the generalised additive model (GAM) to assess the effect of PM on LTBI risk.

Results: We included 198 275 students in the final analysis, of whom 11 721 were diagnosed with LTBI. The LTBI group had higher proportions of males (P < 0.001), individuals of Han nationality (P < 0.001), and body mass index compared to the non-LTBI group (P < 0.001). For each 1-μg/m³ increase in PM₁₀ concentration, the LTBI risk increased by 0.82% (95% confidence interval (CI) = 0.65-1.00), 0.90% (95% CI = 0.73-1.08), and 0.86% (95% CI = 0.69-1.03) when lagged at one, two, and three years, respectively. For PM_2.5, the LTBI risk increased by 0.91% (95% CI = 0.63-1.20), 1.05% (95% CI = 0.75-1.36), and 1.32% (95% CI = 0.96-1.69) when lagged at one, two, and three years, respectively.

Conclusions: Outdoor PM concentration was positively correlated with LTBI risk. Considering that many developing countries are facing the dual challenges of high LTBI rates and serious ambient air pollution, reducing outdoor PM concentration would contribute to alleviating their tuberculosis burden.