Annals of Global Health最新文献

Background: Interest in global health (GH) among pediatric trainees has grown, yet structured GH training remains limited in many programs. Objective: This study evaluates the GH interests, perceived barriers, and curriculum needs of pediatric residents and fellows in a Midwestern training program. Methods: A 23‑question anonymous survey was administered to pediatric trainees between September 2023 and September 2024. The survey assessed demographics, GH interests, barriers to participation, and curriculum gaps. Respondents were categorized by American medical graduates (AMG) vs. international medical graduates (IMG) and junior (PGY1‑2) vs. senior (PGY3‑7) trainees. Statistical analysis was conducted using SAS 9.4. Results: The survey response rate was 60%. Even though only 6% prioritized GH training in program selection, 56% expressed interest in GH electives. Time constraints (34%) and family responsibilities (18%) were primary barriers. IMGs (90%) were more likely than AMGs (65%) to express GH career interest. Communication skills development was identified as the highest educational need overall for all trainees, with junior trainees prioritizing it (59% vs. 32% seniors, p = 0.056) and AMGs vs. IMGs, 53% and 22% of the time (p = 0.15). Conclusions: Our study sheds light on differences in GH interest and trainee characteristics throughout pediatric training from residency through fellowship, considering AMG vs. IMG as a factor. Further, we were able to note how the desire for increased curriculum time in some of the ACGME's core competencies changes throughout the advanced training years, which helps guide further curriculum development. In addition, we uncovered that, despite our program's lack of GH focus, interest in GH remains high, and we call to action for further GH‑focused curriculum exposure in all pediatric training programs, regardless of size and location.

Background: Children born in low‑ and middle‑income countries are 14 times more likely to die before reaching the age of five compared to children in high‑income countries. Pediatric Intensive Care Units (PICUs) with specialized equipment and advanced medications managed by trained clinicians have reduced mortality of children worldwide, yet countries with limited funds and scarce resources strain to meet needs of critically ill children. Objectives: The aim of the study was to identify the disease burden of patients entering the PICU at the Central Hospital in Kigali, Rwanda, and the relationship between patient mortality and allocation of resources. In addition, this study focused on several factors suspected to impact the mortality rate, including the entry point into the health system, delay in admittance, and whether surgery was performed. Method: A retrospective, cross‑sectional review of 30 medical records per year was conducted between January 2016 and December 2022, totaling 177 encounters. Demographic and clinical data were extracted and analyzed to perform descriptive and inferential statistics, including univariable and multivariable logistic regression analyses to identify factors affecting mortality. Findings: The study showed an overall mortality rate of 55% for patients admitted to the PICU. Among patients who died, the most common diagnoses were sepsis, primary respiratory failure, and congenital defects. When holding age and surgery constant, patients with a noted delay in admittance to the PICU had increased odds of mortality than those without a delay. Holding the delay in admittance constant, there was an interaction effect between age and surgery on mortality, with higher odds of mortality in newborns than in children over one month of age when surgery was performed. Conclusions: Careful adherence to emerging pediatric sepsis guidelines, immediate recognition, and appropriate treatment may reduce mortality. Prioritizing policies that reduce delays in treating critically ill children may improve outcomes.

Background: Thailand, a developing country in Southeast Asia, faces significant challenges due to urbanization, population aging, and climate change. This case study focuses on an adaptation strategy implemented in Bangkok to address the impacts of flooding. The study aims to examine the short-, medium-, and long-term effects of flooding exposure on cognitive health among middle-aged and older adults in Thailand and to identify the role of resilient city policy (RCP) in mitigating these impacts. Methods: Data on cognitive health (memory, calculation, and orientation to time) were obtained from the three waves (2017, 2020, and 2022) of the Health, Aging, and Retirement (HART) surveys. Flooding data were retrieved from Thai flood hazard records in the EM-DAT database from 2017 to 2022. Panel data analyses with a fixed effects model were used to estimate the effects of flooding on cognitive health and the moderating effects of RCP. Results: Findings indicate that exposure to flooding negatively impacts memory and orientation to time, with these effects worsening over time. RCP was found to mitigate the negative effects of flooding on memory scores and calculation scores. Additionally, RCP was associated with reduced risks for diabetes and depressive symptoms, indirectly protecting cognitive health. Discussion: Flooding has long-lasting negative effects on certain cognitive health domains, specifically memory and orientation to time. This study suggests that RCP, a multi-component policy aimed at improving structural systems, community preparedness, and healthcare access, shows promise in mitigating the adverse effects of flooding on residents' cognitive health. Further research is needed to link specific policy components to cognitive health outcomes and to understand their roles in protecting cognitive health.

Background: The small island developing states (SIDS) in the Caribbean are particularly vulnerable to the impacts of climate change. Many SIDS' health facilities are in high-risk areas such as coastal zones and are affected by extreme weather events. It is imperative to develop climate-resilient health systems to ensure health service continuity during and after an extreme weather event. One model to achieve this is the Smart Hospital Initiative. Objective: This case study was designed to strengthen the evidence base for decision-making regarding investing in Smart Hospital Initiative facilities as a climate adaptation strategy. Methods: This case study used secondary data derived from the Smart Hospital Initiative implementation (n = 55) focusing on four domains: country population/population served by the facility; pre-post Smart Hospital Initiative facilities' data; disaster and severe weather events' data; and diabetes mellitus (DM) mortality data. To assess the effectiveness of the initiative, an analysis of these data domains across seven countries is presented. Findings: Examining population size and healthcare service resources, healthcare facilities' readiness, climate-related disasters, and a health condition of concern, represents a viable strategy to assess the impact of climate adaptation on health. The Hospital Safety Index data showed that there were statistically significant pre-post retrofitted smart improvements across all 55 retrofitted facilities. The findings revealed that the effectiveness of any adaptation strategy is influenced by local financial and human resources beyond an initial, often external, investment and the capability to maintain the initial retrofitting of health facilities' impact on DM mortality. Conclusions: Climate-smart hospitals are a promising initiative to support the development of climate-resilient health facilities in SIDS. However, successful implementation depends on local capacity to support implementation and maintenance. We propose a framework to assess the utility of implementing climate-smart facilities as an adaptation strategy.

Background: We are early in our understanding of how to effectively implement interventions to mitigate the harm of extreme climate events on human health. We study the actions of the state government in Nuevo Leon, Mexico, which, in 2022, declared a state of emergency due to water shortages resulting from climatic and infrastructural issues. Objective: To document the facilitators and challenges to the rollout of the government's strategy to mitigate water insecurity, using the EquIR Implementation Science framework. Our analysis focused on the activities of the Ministry of Social Policy, which coordinated emergency activities. The government's response included water delivery by tanker trucks, installation of household and community cisterns, and distribution of packaged drinking water. Methods: We used three sources of information: gray and academic literature review, government documents, and 10 key-informant interviews. Findings: Facilitators of government actions were the declaration of an emergency as a policy instrument; multi- and inter-sectoral collaboration; the use of pre-existing social and data infrastructure; technical capacity to identify low-income households without water; and flexibility to convert regular activities to emergency response tasks. Salient challenges included citizen discontent about the lack of water; the absence of a preparedness plan; the scarcity of household equipment to store water; initial inefficiencies with water distribution using tanker trucks; difficulties in installing community cisterns in steep terrain; and staff burnout. A positive externality of the response was the improvement of water distribution in informal settlements. Conclusions: As the need to buffer human health from extreme climate events increases, lessons from Mexico about linking climatic events, social policy, and health outcomes can guide strategies in other locations with increasing drought. This case shows how climatic stressors, infrastructure deficiencies, and the population's coping capacity interact with the government's actions to shape the impacts of a crisis and its mitigation efforts. Successful mitigation strategies may result from strengthening inter-sectoral collaboration and an evidence-based culture of prevention.

Background: Chad is highly vulnerable to climate change, posing significant threats to health systems and population health. Rising temperatures, irregular rainfall, droughts, and resource scarcity exacerbate food insecurity, malnutrition, and vector-borne diseases like malaria. In Ngouri, a rural area in the Lac Region, these climate stressors have led to worsening health outcomes and strained healthcare services. Without adaptation measures, facilities will struggle to maintain essential services amid escalating climate pressures. This case study presents a facility-adapted climate vulnerability and capacity assessment (VCA) for a rural hospital in Chad, identifying key risks and prioritizing solutions to enhance climate resilience. Objectives: This case study describes the development and implementation of a facility-adapted climate VCA in a high-vulnerability, low-resource setting and outlines prioritized solutions for an actionable adaptation plan. Methods: The study employed a participatory mixed-methods design, incorporating five stages: (1) literature review on climate hazards, exposure pathways, and population vulnerabilities; (2) facility audit assessing infrastructure and healthcare delivery gaps; (3) qualitative focus groups to refine risk identification; (4) development of a matrix of solutions with cost estimates and feasibility analysis; and (5) a participatory prioritization process to develop a multi-year facility improvement plan. Findings: The VCA identified climate risks, including elevated malarial mortality and power outages disrupting oxygen supply. A list of 35 solutions was generated, with 22 priority actions selected for implementation. These included anticipatory planning, community sensitization, supplementary feeding programs, and improved waste management. The process highlighted the importance of community engagement, multidisciplinary collaboration, and staff motivation for climate-resilient and sustainable healthcare. Conclusion: The adapted VCA offers a replicable approach to assessing climate-related vulnerabilities and capacities in healthcare facilities. It revealed significant risks to health service delivery and informed the development of locally feasible, sustainable adaptation measures. The framework applied in Ngouri hospital demonstrates relevance for similarly affected contexts, supporting efforts to align health systems with global sustainability goals and to secure quality healthcare under changing climatic conditions.

Background: The prevalence of chronic kidney disease and other non-communicable diseases in Guatemala has been rising. Recently, chronic kidney disease of non-traditional origin (CKDnt) has been identified among occupational cohorts and linked to heavy workloads in hot environments. Objective: To describe a systems-based community participatory approach to occupational safety and health. Methods: Over the last eight years, academic researchers have partnered with a large agribusiness in Southwest Guatemala to address the health, safety, and well-being concerns of workers, especially in relation to CKDnt. This case study presents the Total Worker Health® approach used to develop, implement, and evaluate interventions to address potential causes of CKDnt. The results of these interventions are presented using the Consolidated Framework for Implementation Research and RE-AIM. Findings: A Total Worker Health (TWH) approach addressing both transactional and transformational organizational behavior change to reduce the incidence of reduced kidney function in this workforce can be successfully implemented. Our findings highlight the need for collaborative approaches to the development and implementation of strategies to adapt to climate change in the workplace. The sustainability of interventions needs constant re-evaluation to adapt to changing contexts. Discussion: This case study illustrates a practical, evidence-based TWH approach to address the immediate impacts of heat stress and nephrotoxins on the kidney health of sugarcane workers in Guatemala. It also illustrates the importance of multi-modal interventions implemented and evaluated in a dissemination and implementation science framework informed by the community that is at risk. The principles underlying our approach may have applicability and generalizability to less extreme circumstances, and beyond those with heat-associated kidney disease.

Background: Loneliness is emerging as a key risk factor for child and adolescent mental health. Exacerbated by lack of support, busy routines, continuous adversities, and poor social networks, it is a public health concern. Sleep is essential for healthy development and emotional regulation, critical for modulating risk‑taking, and determines optimal learning and mental health. However, the connection between loneliness and sleep and their impact on mental health and educational outcomes is not well known in low‑ and middle‑income countries (LMICs) like Kenya, where a large portion of the population is young. Objectives: (1) Examine the bidirectional relationship between loneliness and impaired sleep in a Kenyan adolescent cohort. (2) assess the individual and joint contribution of loneliness and sleep impairment relationship in common mental health problems such as anxiety, depression, and anger, while controlling for adverse childhood experiences (ACEs). Methods: A cross‑sectional study with 70 adolescents (ages 11-15) from Nairobi schools. Measures used: Loneliness (NIH Toolbox), Sleep Impairment (PROMIS), Mental Health (PROMIS‑Anger, Anxiety, Depression), ACEs (WHO ACEs‑IQ). Findings: We found a strong association between loneliness and sleep impairment, even after controlling for ACEs (associated with 32.0%-33.9% of variance). Higher ACEs were also associated with increased loneliness and sleep impairment. Notably, after adjusting for the ACE confounder, both sleep impairment and loneliness were significantly associated with adolescent mental disturbances (anxiety, depression, and anger), with sleep impairment explaining greater variance (27.2%-30.4%) than loneliness (11.8%-27.4%) for the anxiety, anger, depression outcomes. Jointly, loneliness and sleep impairment were associated with 28.8%-30.4% of the variance in adolescents' mental health problems. Conclusion: Our article contributes new evidence that sleep health is critical to mental well‑being for adolescents living in high ACEs and LMIC contexts. Providing intervention strategies to reduce loneliness and promote sleep health should be considered to improve adolescent mental health.

Aims: This paper explores the current global health landscape and the transformative potential of empowering Advanced Practice Nurses (APNs) to address global health challenges. It highlights successful models of APN integration from various countries, showcasing their positive impact on patient outcomes and the efficiency of the healthcare system. Introduction: This narrative provides an overview of the current impact of APNs and Nurse Practitioners (NPs) on global health, as well as areas where APNs/NPs can enhance healthcare outcomes. It emphasizes the crucial role that APNs play in addressing healthcare issues and outlines their potential to expand access to quality care through their practice and leadership. Methods: A review of the literature examines current trends and research; this paper highlights critical areas where APNs can make substantial contributions, such as chronic disease management, primary care access, emergency care, and overall health system improvement. Results: It is essential to optimize the utilization of APNs/NPs, standardize APN roles and scope of practice internationally, enhance APN educational programs, and promote interprofessional collaboration. Conclusion: The global healthcare landscape faces unprecedented challenges, including aging populations, increasing burdens from chronic diseases, and persistent health disparities. By empowering APNs, healthcare systems can better address the diverse and evolving health needs of global populations. Impact: APNs and NPs can significantly and multifacetedly impact global health. They are uniquely positioned to provide holistic and patient‑centered care, improve access to services, mitigate provider shortages, enhance quality, and address health disparities. Nursing contribution: APNs/NPs are underutilized in healthcare. They are experts in health promotion and disease prevention, both of which are crucial for improving global population health. APNs/NPs can contribute to achieving the United Nations Sustainable Development Goals (SDGs) related to improved health, greater gender equality, and stronger economies.