Interactive Journal of Medical Research最新文献

Background: First Nations peoples in Australia experience inequitable mental health outcomes and service access. Digital mental health (DMH) services, which refer to offering mental health services through digital platforms, are considered potential solutions to address such mental health service inequities and improve First Nations Australians' mental health outcomes. However, evidence on the effectiveness of DMH for First Nations Peoples in Australia is yet to be synthesised.

Objective: This systematic scoping review aimed to fill this gap, and to identify the facilitators and barriers that influence the implementation of DMH services in this context.

Methods: A systematic search was conducted across six academic databases to search for studies related to DMH services for First Nations Peoples in Australia. Search terms relating to First Nations Peoples, geographic terminologies of Australia, mental health, and digital mental health services were used. Studies were included if they assessed the effectiveness, or determinants of facilitators and barriers of implementing digital mental health interventions among First Nations people in Australia. Data were extracted based on study design, targeted services, and research findings, then synthesised using a thematic analysis framework.

Results: In total, 22 studies met the inclusion criteria. DMH services were used to provide support, treatment, and psychological assessments for First Nations Australians. Evidence of effectiveness was stronger for non-severe mental health conditions. Determinants of facilitators and barriers of the implementation of DMH services included: (i) organisational and administrative factors; (ii) cultural appropriateness; (iii) accessibility; (iv) integration of DMH services to the existing health system; (v) engagement between clients and service providers; (vi) coverage of different conditions and clients; (vii) acceptability to DMH services; (viii) digital literacy, and (ix) efficiency.

Conclusions: Evidence on the use of digital mental health (DMH) services for First Nations Australians remains heterogeneous in study design and outcome measurement. DMH services appear most effective for managing non-severe mental health conditions. Successful implementation requires multi-level structural support, including policy and organisational commitment, enhanced digital infrastructure, workforce training and engagement, and the design of culturally responsive DMH models to improve uptake and equitable access to mental health care among First Nations Australians.

Clinicaltrial:

Background: Age-related hearing loss (ARHL) is associated with severe negative outcomes, including social isolation, depression, and cognitive decline. Despite this, routine ARHL screening is often neglected in primary care due to low awareness, resource limitations, and inefficiencies. A practical risk assessment tool could effectively address this gap.

Objective: This study aims to develop and validate a user-friendly nomogram for identifying older adults at high risk of ARHL in community settings, thereby facilitating targeted screening and timely interventions.

Methods: This multicenter retrospective cohort study included 34,983 older adults from 3 primary health care centers in Beijing (January 2020 to October 2023). Data from center A (n=18,707) were used for model development, with external validation performed on cohorts from center B (n=11,008) and center C (n=5268). Least absolute shrinkage and selection operator and logistic regression identified the final predictors. Model performance was evaluated using discrimination, calibration, and decision curve analysis, leading to the development of an online nomogram.

Results: In the training cohort (center A), 1177 participants (6.3%) had hearing loss. Six key predictors were identified: age, education, exercise frequency, physical function, dietary habits, and hypertension. The multivariate logistic regression model demonstrated good discrimination in internal validation (area under the curve [AUC] 0.806, 95% CI 0.782-0.831; sensitivity 0.774; specificity 0.820). External validation confirmed its generalizability (AUC 0.720, 95% CI 0.670-0.771 and AUC 0.747, 95% CI 0.712-0.782). Decision curve analysis highlighted a substantial clinical net benefit. A user-friendly online prediction web page was also developed.

Conclusions: We successfully developed and validated a dynamic, online nomogram for predicting ARHL in older adults. Comprising 6 readily available predictors, this model shows potential as a practical, online tool for proactive risk identification in primary care. However, further validation in larger and more diverse populations is essential to confirm its generalizability and real-world clinical utility.

In rural Australia, recent trends reveal an exponential increase in the rates of physical inactivity, central obesity, metabolic syndrome, and cancer in the population. The limited rural health workforce, which is struggling to meet this growing burden, is boosted by digital technologies such as My Health Record, Cardihab, Healthdirect, and MindSpot, all of which offer opportunities for improved diagnostics, monitoring, and management of chronic diseases. However, implementing proven digital health technologies in rural communities has been challenging on numerous fronts. This perspective aims to (1) highlight the rural health gap and propose a way forward in implementing evidence-based digital health technologies in the rural, regional, and remote communities of Australia and (2) guide future rural health policy.

Background: The COVID-19 pandemic disrupted sexual and reproductive health services, including family planning (FP) and contraceptive services. The World Health Organization conducted a multicountry study in India, Nigeria, and Tanzania to determine the impact of the pandemic on the health system's readiness to provide contraception services and trends in contraceptive uptake.

Objective: This study aimed to determine the status, availability, and health facility readiness to provide contraceptive services and to compare trends in contraceptive uptake before and during the pandemic.

Methods: This cross-sectional study was conducted by the Indian Council of Medical Research-National Institute of Research in Reproductive and Child Health (India), the University of Ilorin Teaching Hospital (Nigeria), and the Ifakara Health Institute (Tanzania). A total of 50 primary health facilities (11 in India, 6 in Nigeria, and 33 in Tanzania) were evaluated using a standardized facility assessment questionnaire, completed by the most knowledgeable senior health care provider or administrator at the facility. Monthly data on service utilization and contraceptive availability were collected to capture trends before and during the COVID-19 pandemic. Data were collected from May to August 2022. The study received ethical and scientific approval from the World Health Organization Ethics Review Committee and Research Project Review Panel and national regulatory bodies. Key outcomes included availability of FP guidelines and tools, service disruptions including contraceptive and abortion services, stock-outs, reasons for service disruptions, and mitigation measures to sustain service deliveries. Descriptive analysis was used to summarize the key trends and patterns.

Results: Health facilities in all three countries reported shortages of various contraceptives. Contraceptive services were partially disrupted in 91% facilities in India, 83% facilities in Nigeria, and 43% facilities in Tanzania. Abortion services were partially disrupted in all surveyed facilities offering these services in India and Nigeria and in 26.7% of facilities in Tanzania. Client visits declined in health facilities in 2020 compared to 2019 in India (30%) and Nigeria (11%), with a gradual recovery thereafter. In contrast, Tanzania experienced a 1% decline in client visits in 2020. Readiness measures such as telemedicine, task shifting, community outreach, triaging, and patient redirection were implemented to minimize service disruptions.

Conclusions: This study provides crucial insights into the challenges posed by the COVID-19 pandemic on contraceptive services and the measures taken to alleviate them. The findings can help countries to better prepare to prevent the disruption of FP and contraceptive services in future pandemics or emergencies.

Background: A growing body of evidence has identified that people's physical health could influence self-rated health and quality of life (QoL). However, only focusing on physical health is not adequate for the well-being of older adults. Studies focusing on the impact of psychological well-being on self-rated health and QoL are still rare.

Objective: This study aimed to identify the mediating effect of depression on the association between psychological well-being and self-rated health and QoL to comprehensively understand the relationship between them.

Methods: We used a cross-sectional study design and secondary data analysis from the Chinese Longitudinal Healthy Longevity Survey of 2017 to 2018. Path analysis was applied to examine the research questions.

Results: A large sample of 8839 older adults was included. Among them, more positive affect was found among those who were younger and had more years of schooling, higher household income, greater social security and social insurance, lower depression levels, and higher self-rated health levels. Depression had a partial mediation effect of psychological well-being on self-rated health and QoL, which explained 36% of the total variance (R2=0.36). In addition, psychological well-being had a statistically significant direct effect on self-rated health and QoL (β=0.290; P<.001).

Conclusions: Our results indicate that psychological well-being had both direct and indirect effects on self-rated health and QoL. Depression was an important mediator that regulated the effect pathway in older adults.

Background: Sepsis is a life-threatening condition characterized by organ dysfunction resulting from dysregulated host response to infections. Approximately 48.9 million people worldwide are diagnosed with sepsis annually, leading to 11 million deaths and representing 19.7% of all global deaths. No specific, effective treatments for sepsis, which has a poor prognosis, are available.

Objective: The study aimed to systematically explore the association between genetically predicted modifiable risk factors and sepsis.

Methods: Univariable 2-sample Mendelian randomization (MR) analysis was performed to explore the association between 30 modifiable risk factors (12 lifestyle, 3 educational and psychological, and 15 metabolic factors) and sepsis. Heterogeneity was evaluated using the Cochran Q analysis. Sensitivity analyses were conducted using the MR-Egger regression intercept tests and leave-one-out analyses. Additionally, multivariable MR analyses were performed to adjust for genetic associations between the instruments and obesity.

Results: Genetically predicted smoking (odds ratio [OR] 1.20, 95% CI 1.06-1.36; P=.005), a higher number of cigarettes smoked daily (OR 1.70, 95% CI 1.29-2.23; P<.001), a higher overall health rating (OR 2.19, 95% CI 1.61-2.98; P<.001), BMI (OR 1.50, 95% CI 1.38-1.63; P<.001), waist circumference (OR 1.70, 95% CI 1.53-1.89; P<.001), whole body fat mass (OR 1.50, 95% CI 1.37-1.64; P<.001), trunk fat mass (OR 1.48, 95% CI 1.36-1.62; P<.001), arm fat mass (OR 1.57, 95% CI 1.43-1.71; P<.001), and leg fat mass (OR 1.69, 95% CI 1.51-1.90; P<.001) were associated with increased sepsis risk. However, light physical activity (OR 0.26, 95% CI 0.08-0.83; P=.03), higher education attainment (OR 0.52, 95% CI 0.40-0.67; P<.001), and high-density lipoprotein cholesterol (OR 0.91, 95% CI 0.84-0.98; P=.02) exhibited protective effects against sepsis. Using a multivariate analysis of obesity traits, the waist circumference (OR 2.16, 95% CI 1.18-3.96; P=.01) was an independent risk factor of sepsis.

Conclusions: Our study demonstrated that genetic predictors of lifestyle (smoking and physical activity), educational level, and metabolic factors (waist circumference and high-density lipoprotein cholesterol) exhibited a causal association with sepsis risk. Future research should further investigate the underlying mechanisms of these associations to inform more effective preventive strategies against sepsis.