International Journal of Environmental Research and Public Health最新文献

Background: Universal health coverage (UHC) is a global priority, with the goal of ensuring that everyone has access to high-quality healthcare without suffering financial hardship. In Africa, most governments have prioritized UHC over the last two decades. Despite this, the transition to UHC in Africa is seen to be sluggish, with certain countries facing inertia. This study sought to examine the progress of UHC-focused health reform implementation in Africa, investigating the approaches utilized, the challenges faced, and potential solutions.

Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, we scoped the literature to map out the evidence on UHC adoption, roll out, implementation, challenges, and opportunities in the African countries. Literature searches of the Cochrane database of systematic reviews, PUBMED, EBSCO, Eldis, SCOPUS, CINHAL, TRIP, and Google Scholar were conducted in 2023. Using predefined inclusion criteria, we focused on UHC adoption, rollout, implementation, and challenges and opportunities in African countries. Primary qualitative, quantitative, and mixed-methods evidence was included, as well as original analyses of secondary data. We employed thematic analysis to synthesize the evidence.

Results: We found 9633 documents published between May 2005 and December 2023, of which 167 papers were included for analysis. A significant portion of UHC implementation in Africa has focused on establishing social health protection schemes, while others have focused on strengthening primary healthcare systems, and a few have taken integrated approaches. While progress has been made in some areas, considerable obstacles still exist. Financial constraints and supply-side challenges, such as a shortage of healthcare workers, limited infrastructure, and insufficient medical supplies, remain significant barriers to UHC implementation throughout Africa. Some of the promising solutions include boosting public funding for healthcare systems, strengthening public health systems, ensuring equity and inclusion in access to healthcare services, and strengthening governance and community engagement mechanisms.

Conclusion: Successful UHC implementation in Africa will require a multifaceted approach. This includes strengthening public health systems in addition to the health insurance schemes and exploring innovative financing mechanisms. Additionally, addressing the challenges of the informal sector, inequity in healthcare access, and ensuring political commitment and community engagement will be crucial in achieving sustainable and comprehensive healthcare coverage for all African citizens.

This study investigates the process of planning for future inpatient resources (beds, staff and costs) for maternity (pregnancy and childbirth) services. The process of planning is approached from a patient-centered philosophy; hence, how do we discharge a suitably rested healthy mother who is fully capable of caring for the newborn baby back into the community? This demonstrates some of the difficulties in predicting future births and investigates trends in the average length of stay. While it is relatively easy to document longer-term (past) trends in births and the conditions relating to pregnancy and birth, it is exceedingly difficult to predict the future nature of such trends. The issue of optimum average bed occupancy is addressed via the Erlang B equation which links number of beds, average bed occupancy and turn-away. Turn-away is the proportion of times that there is not an immediately available bed for the next arriving inpatient. Data for maternity units show extreme and unexplained variation in turn-away. Economy of scale implied by queuing theory (and the implied role of population density) explains why many well intended community-based schemes fail to gain traction. The paper also addresses some of the erroneous ideas around the dogma that reducing length of stay 'saves' money. Maternity departments are encouraged to understand how their costs are calculated to avoid the trap where it is suggested by others that in reducing the length of stay, they will reduce costs and increase 'efficiency'. Indeed, up to 60% of calculated maternity 'costs' are apportioned from (shared) hospital overheads from supporting departments such as finance, personnel, buildings and grounds, IT, information, etc., along with depreciation charges on the hospital-wide buildings and equipment. These costs, known as 'the fixed costs dilemma', are totally beyond the control of the maternity department and will vary by hospital depending on how these costs are apportioned to the maternity unit. Premature discharge, one of the unfortunate outcomes of turn-away, is demonstrated to shift maternity costs into the pediatric and neonatal departments as 'boomerang babies', and then require the cost of avoidable inpatient care. Examples are given from the English NHS of how misdirected government policy can create unforeseen problems.

Context: Diabetes rates are high in Black and some other ethnic communities, often leading to more severe complications. We conducted a study to identify the prevalence and risk of diabetes among African Caribbean Black (ACB) individuals aged 18-39 and to assess the sensitivity of glycated hemoglobin (HbA1c) compared to an oral glucose tolerance test (OGTT) to diagnose diabetes. Methods: In this mixed-methods study, maximum variation sampling was used to recruit 272 ACB participants from fourteen African and five Caribbean countries from Toronto. Participants' height, weight, waist circumference, HbA1c, OGTT, demographic, and behavioural data were collected. SPSS was used to analyze the quantitative data. This study used descriptive statistics for frequency distribution and cross-tabulation while inferential statistics (regression, ANOVA, factor analysis, etc.) were used for relational analysis. Because of the small sample size, qualitative data were analyzed manually using the charting technique. Results: This study found that 1.5% of participants had diabetes, 9.2% had prediabetes, and 44.9% were at risk of developing diabetes. The mean value of HbA1c, FBS, and 2hPG was 5.5%, 4.8 mmol/L, and 5.7 mmol/L, respectively. The mean BMI was 28.2 kg/m², and the waist circumference was 85.8 cm. This study found a correlation between glucose intolerance and increasing body mass index (BMI) and waist circumference (WC). Dietary habits, physical inactivity, and mental health challenges were risk factors among the participants. HbA1c was found to be a more sensitive and culturally acceptable screening measure than OGTT in diagnosing diabetes. Conclusions: ACB individuals are at high risk of having diabetes, requiring culturally tailored peer-based health promotion strategies to reduce diabetes prevalence and risk. HbA1c is a culturally acceptable and statistically more capable measure than OGTT in identifying individuals with prediabetes. Further longitudinal research is needed.

Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) men's health and social indicators reflect an ongoing legacy of social disruption with profound implications for broader family and community contexts. In response to recognized needs, healing programs have been implemented within Australia. The literature on relevant best practices for Indigenous men's healing was explored to inform the planning and implementation of a local program. A scoping review of electronic databases was undertaken to retrieve information between 2012 and 2022 on social and emotional healing programs for Indigenous men that included a program evaluation. Of the 2123 identified articles, many lacked a program evaluation or were not specific to male participants, with nine meeting the inclusion criteria for the review. Six central elements that supported the programs' reported efficacy were identified: kinship, cultural understanding, a view of healing as being holistic, a strengths-based approach, a male leadership team, and a consistent meeting space. These elements were important for the social and emotional healing of the Indigenous male participants. Based on these findings, there is an increased need for the identified elements to be incorporated into programs for Indigenous men to accompany ongoing efforts in improving the wellbeing of the Indigenous population overall.

Many people with BPD (borderline personality disorder) experience emotional dysregulation and thus engage in NSSI (non-suicidal self-injury), potentially in the pursuit of emotional regulation. However, research is lacking on whether body modifications (piercings, tattoos, etc.) are linked to BPD in a similar way to NSSI. In the current study, we hypothesized (1) that body modifications are associated with BPD symptoms, (2) that emotional regulation and self-expression motivations for body modifications specifically account for variance in BPD symptoms, and (3) that NSSI craving correlates with body modification craving. Participants (N = 199, ages 18-67, located in the USA) were surveyed on BPD symptomatology, NSSI craving, emotional regulation abilities, and the presence of body modifications. The extent of tattooing (number of tattoos and percentage of body surface covered) was not significantly associated with BPD symptomatology, but the number of piercings was. Individuals with higher BPD symptomatology were not more likely to report emotional regulation and self-expression as motivations for obtaining body modifications. NSSI craving scores were significantly positively correlated with body modification craving scores. Body modification may be an alternative method of emotional regulation to NSSI in individuals with BPD, which clinicians may want to consider when treating those with BPD and NSSI.

Today's challenging times highlight the need for workplaces to support employee wellbeing. Workplaces can offer a means to improve employee wellbeing and promote health initiatives. However, small and medium-sized enterprises (SMEs) are less likely than larger organizations to engage with workplace wellbeing initiatives or offer wellbeing provision. This study, conducted in an urban area in central England, explores SME engagement with local government workplace wellbeing provision, and barriers and facilitators to SME engagement, SME implementation of wellbeing provision, and employee uptake. A mixed-methods design was used. Quantitative data were collected via a survey of 103 SMEs and qualitative data from three focus groups with stakeholders involved in promoting SME engagement with wellbeing support (n = 9) and 16 in-depth interviews with SME representatives (n = 8) and employees (n = 8). Quantitative data were analyzed using the chi-squared, Fisher's exact and Mann-Whitney U tests, and multivariable logistic regression. Qualitative data were analyzed using framework analysis. Findings highlighted several interrelated factors acting as barriers and facilitators to SME engagement with wellbeing initiatives, SME-provided wellbeing provision, and employee uptake. The study provides valuable insights for policymakers, public health teams, and SME leaders on improving provision of and engagement with wellbeing programs. Trust, awareness, knowledge, and communication are highlighted as important prerequisites of optimal provision and engagement.

Ototoxicity is a significant adverse effect associated with second-line anti-tuberculosis (TB) medications, particularly in treating extensively drug-resistant TB (XDR-TB). This study investigated the awareness of ototoxic effects among adults with XDR-TB undergoing treatment in South Africa, specifically exploring the role of information counselling on ototoxic symptoms, the timing of counselling, the content covered, and the management pathways available. This cross-sectional, descriptive qualitative study was conducted at Brooklyn Chest Hospital in the Western Cape. Ten adults with XDR-TB were purposively sampled and participated in semi-structured in-depth interviews. Data were thematically analyzed and the results revealed variability in information counselling on ototoxicity, with only 30% of participants receiving comprehensive counselling that specifically addressed ototoxic symptoms. The timing of counselling was inconsistent: while 70% of participants received some information before treatment, the remainder received counselling only after treatment initiation, which may have impacted early symptom recognition. Participants' awareness of ototoxic symptoms was generally limited, with most identifying hearing loss but few recognizing other symptoms such as tinnitus or dizziness. Furthermore, only 20% of participants were provided with clear referral pathways for symptom management. These findings highlight a gap in the depth, timing, and specificity of information counselling on ototoxic effects for XDR-TB in this context. Several interventions can be implemented to address this gap.

Background: Influenza remains a significant public health challenge in low- and middle-income countries (LMICs) like Bangladesh, where vaccine uptake remains low despite the substantial disease burden. Physicians play a vital role in promoting vaccination, yet their intentions and influencing factors are not well understood.

Methods: We conducted a cross-sectional study from June to October 2022 across four tertiary-level hospitals in Bangladesh using a questionnaire grounded in the Theory of Planned Behavior (TPB). Hierarchical logistic regression was employed to identify factors associated with vaccine recommendation intentions.

Results: Among 972 physicians with an average age of 32.1 years, 40.1% intended to recommend and administer the influenza vaccine. Most (85.3%) agreed vaccination reduces risk, 65.5% desired vaccination for self-protection, 63.5% would vaccinate if available at work, and 85.3% anticipated Ministry of Health support. Male (OR = 1.9, 95% CI: 1.5-2.3) and married (OR = 1.5, 95% CI: 1.1-1.9) physicians were more likely to recommend vaccination. Each unit increase in attitude score doubled the likelihood of recommending the vaccine (OR = 2.0, 95% CI: 1.4-3.0).

Conclusions: Physicians' influenza vaccine recommendations in Bangladesh are suboptimal, influenced by gender, marital status, and attitudes. Targeted educational interventions addressing attitudinal barriers and leveraging institutional support could improve recommendation practices.

The study aimed to investigate the reliability, construct, and discriminant validity of the Behavioral Regulation in Exercise Questionnaire 3 (BREQ-3) for evaluating motivational regulations and self-determination for exercise in Brazilian adults aged 50 years or older. The study assessed motivation for exercise, peripheral muscle strength, physical performance, functional capacity, cardiovascular fitness, and frailty phenotype. Two raters independently applied the BREQ-3. The reliability was evaluated using internal consistency, test-retest reliability, and agreement. Construct validity was tested with Spearman's correlation coefficient and discriminant validity with the Kruskal-Wallis test. Eighty individuals participated in the reliability study, and 136 participated in the validation study. Motivational regulation and Self-Determination Index (SDI) internal consistency ranged from 0.55 to 0.82. Test-retest reliability ranged from 0.77 (95% CI 0.64-0.85) to 0.91 (95% CI 0.85-0.94), and inter-rater ranged from 0.80 (95% CI 0.68-0.87) to 0.92 (95% CI 0.88-0.95), except for amotivation, which had poor inter-rater and test-retest reliability. Additionally, moderate to weak correlations between various types of motivation and physical function tests were found (p < 0.05). Frail and pre-frail participants had lower SDI, integrated, and intrinsic motivation regulation than non-frail individuals (p < 0.05). This study confirmed the reliability, construct, and discriminative validity of the Brazilian Portuguese version of the BREQ-3 for evaluating motivational regulations and self-determination for exercise in older adults.

The COVID-19 pandemic led to a rapid shift to remote working, which affected ergonomic conditions and increased the risk of upper body musculoskeletal pain (MSP). This study assessed the prevalence and impact of upper body MSP (affecting the head, neck, shoulders, and back) among academic staff at a University of Technology during the pandemic. Data were collected from 110 participants through an online, descriptive, cross-sectional survey adapted from the Dutch Musculoskeletal Questionnaire, the Standardized Nordic Questionnaire, and the McCaffrey Initial Pain Assessment Tool. The survey examined demographics, ergonomic practices, MSP, and psychological well-being before and during the pandemic. The sample included 59.1% female participants, with most being middle-aged. Persistent MSP was common, with 54.5% reporting neck pain and 59.1% experiencing back pain during the pandemic, alongside a significant decline in wrists in neutral position ergonomics (p = 0.012). Psychological well-being also worsened, as participants reported lower levels of cheerfulness, calmness, and energy than before the pandemic. While 81.9% of 90.9% participants with pre-existing MSP continued to experience pain, a small (9%) but notable proportion saw a decline in MSP during this period. These findings highlight a strong relationship between remote working conditions and MSP, with poor ergonomics and psychological distress contributing significantly to persistent pain. The results emphasise the need for institutions to provide ergonomic support, such as appropriate equipment and workstation adjustments, alongside mental health resources to mitigate the long-term impacts of remote working on physical and mental health.