Critical Public Health最新文献

Personalised medicine is widely utilised in oncology, and healthcare personnel are its main gatekeepers and implementers. This scoping review provides insights into the knowledge and attitudes of healthcare personnel toward personalised medicine for cancer, barriers and challenges faced, and innovative practices employed for the provision of personalised medicine. Extensive database searches identified 19,972 studies, of which 50 studies were included in the final review. The data was charted by two reviewers and analysed thematically. The knowledge of healthcare personnel of personalised medicine was mixed, with some studies reporting overall good knowledge (n = 2) while some reported poor knowledge among healthcare personnel (n = 4). There was high interest (63-95%) in furthering education and training in personalised medicine (n = 6). The commonly reported barriers and challenges were: limited reimbursement and insurance coverage mechanism (n = 11); insufficient education and training (n = 10); and lack of trained personnel to provide the service (n = 7). The innovations identified emphasised enhancing the skills and capacity of the existing workforce as well as using technologies to assist in timely decision-making. Overall, gaps were identified at the human resource, institutional, and systemic levels, which will need to be addressed to improve the provision of personalised medicine and healthcare personnel's confidence levels.

Concussion in sport is increasingly understood as a public health crisis. A key facet of this crisis concerns the claim that industry-funded research results in conflicts of interest that fundamentally compromise scholarship. This poses a particular problem for policymakers when adjudicating upon who counts as an expert and what to do with the evidence that they provide. In this paper, I explore these matters in relation to the 'Concussion in Sport' report produced by the UK's House of Commons's Digital, Culture, Media and Sport Committee. I ask, first, which stakeholders submit evidence to the Committee and, second, how evidence provided by those stakeholders is marshalled within the report itself. I show that, despite concerns about conflicts of interest, a significant body of interdisciplinary scholarship is submitted to the Committee. The report itself, however, understands academic scholarship as being both deficient and compromised, drawing exclusively upon epidemiological and neuroscientific work. I conclude by suggesting such an approach compromises the committee's own hope for an increasingly expansive notion of expertise.

One Health has gained global prominence in recent years. Alongside its emergence, there have been extensive social science critiques. In this contribution, we make the case for the value of recent theoretical discussions in the field of anthropology - sometimes referred to as an 'ontological turn'. We argue that taking theory seriously benefits One Health as an integrated approach that has interdisciplinary collaborations at its heart, but which encounters challenges when conversations based on different epistemological and ontological positions result in voices talking past each other. In this contribution, we offer two examples of what One Health specialists can gain from anthropologically-informed ontological thinking. Both require questioning ontological premises. Firstly, questioning assumptions about distinctions between animals and humans. Secondly, questioning the universality of biomedical knowledge. In the conclusion, we underline the importance of an ontological openness when it comes to the constitution and position of the actors as well as different bodies of knowledge that are involved in One Health and we show that talking to each other with awareness of different ontological positions is not impossible.

We examined the proportion of the low-income overweight or obese mothers meeting micronutrient recommendations, and whether race, education and body mass index category (BMIc) were associated with micronutrient intake. This analysis included 198 women who completed a validated food frequency questionnaire. Micronutrients were grouped: antioxidant (vitamins A, C, and E, as well as copper, selenium, and zinc), methylation (vitamins B2, B3, B6, B9, and B12, and choline), bone health (vitamins D and K, calcium, magnesium, and phosphorus) and others (vitamin B1, iron, potassium, and sodium). We performed descriptive analysis and generalized linear models. At least two-thirds of women met most antioxidant, methylation, and other micronutrient recommendations. Antioxidant: White reported lower intake of selenium than Black. There were negative associations between education and vitamin E intake and between BMIc and zinc intake. Methylation: White had lower intake of choline than Black, and BMIc was negatively associated with vitamin B12 intake. Bone health: White had lower vitamin K intake than Black. BMIc was negatively associated with magnesium intake. Others: White reported lower potassium and sodium intake than Black. Education was positively associated with iron intake. Nutrition education for the target population might consider tailoring intervention based on race, education, and BMIc.

Residency is a critical factor related to the social determinants of health. This study aimed to evaluate the role of residency in oral health disparities among Kenyan children during the primary dentition period. We recruited participants from three cohorts of children, all aged 3 years, including those living with HIV infection (HIV), exposed to HIV but uninfected (HEU), and their healthy peers (HUU; uninfected and unexposed). We recruited 120 children in each cohort. Logistic regression was used to estimate the associations between oral diseases, HIV status, and residence, adjusting for sex and school type. Most children (47%) were enrolled in private schools, and 49% lived in rural areas. Children in HIV cohort had a significantly higher prevalence (81%) of abnormal oral findings compared with those in HEU (60%) and HUU (54%) cohorts (p < 0.0001). Children living in rural areas (OR = 3.3, 95% CI:1.7-6.3) and urban areas (OR = 2.0, 95% CI:1.1-3.9) were more likely to have abnormal findings than those in peri-urban areas. However, peri-urban residents had the highest prevalence of dental caries (63%), while rural residents had the highest combined prevalence of all dental conditions (83%). Residential area contributed to differences in the burden of oral diseases among HIV and HEU cohorts. Targeted prevention and treatment strategies should be considered by residential location.

Introduction: Racist urban development policies and capitalist municipal management have continued the cycle of poverty experienced by many in the US. Modeling this disadvantage often relies on composite, or "umbrella", socioeconomic variables. We argue that this approach obfuscates the temporal nature of social determinants. We propose organizing downstream consequences of structural racism by exposure duration-historical disenfranchisement and contemporary disadvantage-to assess their differential effect on excess all-cause mortality in an U.S. urban environment during the COVID-19 pandemic.

Methods: ZIP-code tabulation area (ZCTA) 2020 and 2021 demographics were used to create an historical disenfranchisement index, a contemporary disadvantage index, and combined index (our proxy for a "umbrella" variable) for 210 ZCTAs in the Kansas City Metropolitan Area. Indices were dichotomized into "above" and "below" average, as well as a quadrant matrix index categorizing ZCTAs by "above average" in both, one index only, or neither. General linear models assessed the relationship between the indices and excess all-cause mortality. Model fit was compared by AIC.

Results: Across all models, ZCTAs that experienced above average structural racism had significantly greater excess all-cause mortality than those with below average structural racism markers. The quadrant model (AIC = 3441) performed significantly better than the combined index (AIC = 3468.3) with a reduction in AIC of 27.2.

Conclusion: Composite metrics of disadvantage may mask important distinctions in how mechanisms of structural racism are associated with health outcomes. This analysis provides support for place-based, historically sensitive health research.

Many academic and media conversations about COVID-19 vaccination center on lower uptake among racially minoritized individuals due to what is characterized as 'mistrust.' In 'Is trust enough? Anti-Black racism and the perception of Black vaccine hesitancy,' Wilson argues that questioning Black people's trust in the COVID-19 vaccine fails to 'understand Black people as rational, complex beings who are fit to make reasonable decisions guided by complex factors.' In this study, we explore what shapes Black women's COVID-19 vaccination choices using data from 20 qualitative interviews conducted March-April 2022 with a sample of predominantly Black women in Alameda County, CA. Findings provide empirical evidence to support Wilson's argument that a narrow view of 'trust' over-simplifies Black women's comprehensive thinking about health decisions. Participants triangulated COVID-19 information sources and vetted this material with specific consideration of factors highly relevant to Black women's day-to-day lives: evidence of systemic or interpersonal racism in healthcare settings, management of chronic health conditions, and the importance of family. Many participants indicated that it was common for people in their networks to hold different perspectives on vaccination and they normalized these differences of opinions, expressing understanding of the socio-structural factors affecting the impact of the COVID-19 pandemic and vaccination choices.

Awareness months are used as promotion strategies to enhance public health through increasing knowledge and behavioral change, including suicide prevention. However, given epidemiologic evidence and the historical impact of awareness months on health behaviors, the purpose of this paper is to encourage reconsideration of the current timing of suicide prevention month. In the U.S., most suicide deaths occur in May. The original National Suicide Prevention Week was established in May 1974 by the American Association of Suicidology. In the early 2000s, this week was moved to September to align with a global effort by the International Association for Suicide Prevention and the World Health Organization, establishing September 10th as World Suicide Prevention Day and September as National Suicide Prevention Month. This commentary reviews evidence around awareness months/weeks/days and provides a brief history of suicide prevention awareness wee development, inviting a deeper consideration of the timing of National Suicide Prevention Week with epidemiologic trends in suicide attempts and deaths. Specifically, if calendar-anchored campaigns successfully increase awareness and behavior change, then perhaps the placement of National Suicide Prevention Month in September is not maximizing benefit in the U.S. because epidemiologic evidence suggests suicides peak in late spring/early summer, making this a potentially better time to increase awareness campaigns. By aligning the awareness month with the peak of the phenomenon, enhanced suicide prevention awareness could reduce suicide attempts and deaths. Re-scheduling this effort would require nationwide coordinated conversations with stakeholder groups, including non-profit advocacy organizations, loss survivors, researchers, prevention programs, and care agencies.

Introduction: Critical health literacy has attracted much attention as an indicator of success beyond individual behavior change objectives in health promotion and as a tool to assess public health education. Despite its importance, there remains no consensus about how to operationalize critical health literacy. Building on Freire's concepts of critical consciousness and empowerment, we conceptualize critical health literacy as comprising reflection (media literacy and awareness of social determinants) and action (psychological empowerment).

Methods: We developed and validated an 18-item critical health literacy scale among young adult Latinas (N=1,029) aged 18-29 years (mean age=19.6). The scale measures three dimensions: media literacy, awareness of social determinants of health, and psychological empowerment. Face and content validity were established through focus groups and expert panel reviews. We used exploratory factor analysis (EFA) on half the sample to identify the dimensional structure, followed by confirmatory factor analysis (CFA) on the remaining half to assess convergent and discriminant validity.

Results: The EFA and CFA confirmed a five-factor structure with acceptable fit indices (TLI=.96, CFI=.95, RMSEA=.04, SRMR=.03). The scale demonstrated high internal consistency and composite reliability. Convergent and discriminant validity were established for most subscales, with the community control subscale showing weaker but theoretically important psychometric properties.

Discussion: The validated critical health literacy scale provides a reliable tool for assessing understanding of social and commercial determinants of health and the degree to which young people feel empowered to engage in social change. This instrument can evaluate health promotion interventions at multiple levels within a socio-ecological framework and advance research on factors influencing health inequities among populations experiencing health disparities.

In 2021, the Centers for Disease Control and Prevention (CDC) proposed updated clinical practice guidelines for Pre-Exposure Prophylaxis (PrEP), marking a significant shift from risk-based screening to discussing PrEP with all sexually active adults. To ensure widespread adoption of new guidelines, this commentary posits that intentional de-implementation of the previous CDC guidelines is necessary to facilitate the adoption, implementation, and sustainment of new guidelines. Based on a review of the literature, the authors leveraged implementation science frameworks (i.e., CFIR, ERIC taxonomy, and RE-AIM) to map theoretical determinants, corresponding strategies, and outcomes in the context of de-implementing previous CDC guidelines for PrEP and simultaneously implementing the new guidelines. Potential barriers identified included resource constraints, staff capability, and structural characteristics of organizations that may impede de-implementation efforts. Potential facilitators included provider motivation and incentive systems that encourage providers to discuss PrEP with sexually active clients. Strategies like normalizing PrEP education and services, workflow redesign, and task-shifting could tackle workforce challenges. These strategies could aid in phasing out old guidelines, implementing new guidelines, increasing PrEP referrals, and reducing HIV incidence. Phasing out previous PrEP guidelines demands intentional (de-)implementation to enhance universal HIV prevention efforts and advance national plans for Ending the HIV Epidemic.