Inquiry-The Journal of Health Care Organization Provision and Financing最新文献

Regular physical exercise lowers the risk of all-cause mortality and various chronic diseases. New technologies, such as smartphones and social media, have been used successfully as health promotion tools in college populations. The purpose of this study was to conduct a systematic review of studies examining the effectiveness of interventions that used modern technologies, as with social media or text messaging, to promote physical activity or reducing sedentary behavior in college students. The systematic review was conducted on the PubMed and SCOPUS databases, considering studies published from 2012 to 2022. For a total of 19 articles selected, an evidence table was drawn up, and the quality of the studies was assessed using the PRISMA checklist. The interventions differed enormously in design, from the strategies implemented to the types of outcome considered. Fifteen of the 19 studies demonstrated an improvement in participants' physical activity levels, 3 studies found no such improvement, and 1 reported a worsening of baseline activity levels. Interventions to improve college students' physical activity levels through the use of social media and/or text messaging tend to be effective. However, many factors can influence the effectiveness of such interventions. For example, a gender-related difference emerged in student participation, and the interventions proved more effective if they were accompanied by the creation of social groups.

Certificate of need (CON) laws limit the supply of health care services in about two-thirds of U.S. states. The regulations require those who wish to offer new services or expand existing services to first prove to a regulator that the care is needed. While advocates for the regulation have offered several rationales for its continuance, the balance of evidence suggests that the rules protect incumbent providers from competition at the expense of patients, payors, and would-be competitors. In this article, I review the history of CON laws in health care, summarize the large literature evaluating them, and briefly sketch options for reform.JEL Classification: I11, I18, H75.

In the contemporary global context, seafarers persist as the uncelebrated heroes of international trade, despite their substantial contributions. The current estimate places the number of STCW- certified officers at 857 540, reflecting a notable increase of 10.8% since 2015. Nevertheless, there is a growing recognition of the imperative to accord specific attention to seafarers' mental and physical well-being. During their tenures aboard ships, seafarers confront various challenges, including psychological well-being, work-life imbalance, dissatisfaction, diminished performance, and a sense of mistrust toward the organizational framework. The primary objective of this research is to scrutinize the nexus between work-life balance and work effectiveness, exploring the mediating roles of psychological well-being, organizational happiness, and organizational trust. A questionnaire-based survey is meticulously crafted to achieve this, employing a dataset comprising 420 seafarers engaged in diverse vessel types in Turkey, operating under both Turkish and international flags. Methodologically, structural equation modeling and correlation analyses are executed to assess the formulated research hypotheses rigorously. The empirical findings of this research reveal noteworthy mediating roles: psychological well-being exhibits a complete mediation effect, organizational happiness demonstrates a full mediation effect, and organizational trust manifests a partial mediation effect. These outcomes underscore the nuanced interplay between work-life balance and work effectiveness in the seafaring context. The implications of these findings extend significantly to the maritime sector and industry, accentuating the imperative for targeted interventions to enhance the well-being and performance of seafaring professionals.

This study aimed to assess the current status of gestational diabetes mellitus (GDM) diagnosis and management, and the demand for a digital healthcare system, in order to develop an optimal digital-based management model for GDM. An anonymous online survey was conducted targeting pregnant/postpartum women (Group W), internal medicine physicians (Group P), and obstetricians (group O) from September 6, 2022 to December 31, 2022. The survey assessed the women's knowledge of GDM and gathered information about healthcare professionals' (HCPs) current GDM management practices. All groups were asked about their acceptance of and demands for a digital healthcare system for GDM. Statistical comparisons between groups were conducted using the chi-square test or Fisher's exact test where appropriate. A total of 168 participants were in Group W, 185 in Group P, and 256 in Group O. Participants from all groups recognized the need for a digital healthcare system for GDM (Group W: 95.8%, Group P: 85.9%, Group O: 60%). However, HCPs showed less willingness to integrate these systems into their clinics than pregnant/postpartum women. Essential features identified were recording blood glucose levels and insulin, along with automatic data linkage from self-monitoring devices. Group W showed a higher preference for lab test access, search functionality, and fetal weight assessment than groups P and O (all P < .0001), while Groups P and O had a greater preference for recording insulin and maternal body weight compared to Group W (P = .0141 and .0023, respectively). Both pregnant/postpartum women and HCPs acknowledged the benefits of utilizing a digital healthcare system for managing GDM. However, there were differences in perspectives among these groups.

Foreign-born people have been found to be less satisfied with health care than native populations across countries. However, studies on differences in satisfaction with treatment between different foreign-born groups are lacking. This study explores differences in satisfaction with primary health care between the foreign-born population from different regions of origins and the general population of Finland. The study uses survey data on foreign-born population (n = 2708) and general population (n = 6671) living in Finland who report using health services. Satisfaction with experienced respect for privacy during treatment, benefit of treatment and smoothness of treatment are predicted by region of origin using logistic regression. Almost all foreign-born groups were less likely to consider treatment appointments beneficial as compared to the general population. Some foreign-born groups (people from Southeast Asia and South and Central Asia) were more satisfied with smoothness of care compared to general population. People from East Asia were less likely than the general population to consider that their privacy had been respected during the examinations and treatment. While we made the positive finding of high overall satisfaction with treatment, we also found important differences between groups. In particular, appointments were found less useful among the foreign-born population. Perceived unusefulness of treatment might lead to underuse of health care, which might result in accumulation of untreated health problems. The results point toward potential development points in the health care system. Addressing these issues might help decrease health disparities between population groups.

This study aimed to measure the intention to leave and well-being indicators (ie, job satisfaction, burnout, moral distress, risk of depression, and resilience) of health care providers (HCPs) in Saskatchewan, Canada and to explore the association between their intention to leave and well-being indicators and other demographic factors, including gender. A cross-sectional study was conducted among registered nurses (RNs), physicians, and respiratory therapists (RTs) in Saskatchewan between December 2021 and April 2022. An online survey inquired about intentions to leave current positions, well-being indicators, and demographics of HCPs. Logistic regression models explored associations between intention to leave current positions and HCPs' well-being indicators. Adjusted odd ratios (AORs) and 95% confidence intervals (95% CI) are reported. In total, 1497 HCPs participated; 38.6% considered leaving their positions. Controlling by gender, age group, children at home, redeployment, burnout, and resilience levels, the odds of considering leaving their positions decreased by 0.55 (95% CI = 0.43-0.70) per unit of increase in job satisfaction. HCPs experiencing high moral distress were more likely to consider leaving their positions (AOR = 3.97, 95% CI = 2.93-5.39). RNs were more likely to consider leaving their positions than physicians (AOR = 1.68, 95% CI = 1.13-2.50). Age interacted with gender, and burnout interacted with children at home. The job satisfaction, distress levels, and RN designation predicted HCPs' intention to leave. We must recognize the dissimilar effect of age on the intention to leave between women and men and the effect of burnout between those with and without children. Strategies to increase retention of HCPs should consider well-being indicators and focus on reducing morally distressing environments and redeployment.

This study aims to examine the effectiveness of mHealth delivered through LINE application in improving physical activity of older adults. This was a parallel, two-arm, randomized controlled trial, single-blind allocation to experimental and control groups. The sample consisted of 91 individuals (46 experimental and 45 control groups) aged 45 years or older, and had internet access. Intervention group received customized activities focused on raising awareness and knowledge provision for 8 weeks. Out of 91 participants, 82 completed the study (41 in each group). Comparison of Mean Difference values within groups found a significant difference at P < .05 (t = 2.294). The experimental group increased their PA by 7.2 min on average, while the control group decreased to 44.1 min. Subgroup that fully complied with the activity process had a significantly higher percentage of adequate PA at P = .01 level (χ² = 7.853**). Tailoring activity content to older adults' diverse lifestyles via a Mobile Health application can effectively boost PA levels by meeting their needs conveniently and quickly.Clinical trial registration: Thai Clinical Trials Registry (TCTR) TCTR20240422004.

To investigate the status quo and influencing factors of overall frailty and its 3 domains among rural community-dwelling older adults. This is a cross-sectional study. A convenience sample of 195 older adults from 6 villages in Bashang Area of Zhangjiakou City, Hebei Province, China, were recruited from August to September, 2022. The demographic characteristics, the Chinese version of Tilburg Frailty Indicator, Charlson Comorbidity Scale and Hospital Anxiety and Depression Scale were used to investigate frailty and its influencing factors. Univariate analysis and multiple linear regression analysis were employed. The prevalence of overall frailty among the older adults in Bashang Area was 85.13%. Multiple linear regression analysis showed that age, gender, marital status, regular exercise, comorbidity, and anxiety were the influencing factors of overall frailty. While anxiety was the only shared influencing factor for physical frailty, psychological frailty, and social frailty, age, gender, marital status, financial burden, the comorbidity, and regular exercise were factors which influenced 1 or 2 domains of frailty. The prevalence of overall frailty among the older adults in rural areas, Zhangjiakou City is high. It is influenced by many factors. Medical staff and policy makers should work hand in hand to improve frailty among rural community-dwelling older adults in China.

This study examined access to, and use of remote patient monitoring (RPM), medical applications, and wearables in a racially diverse, lower-income population. Data were obtained via a cross-sectional survey of adults from low-income communities in Houston, Los Angeles, and New York between April and August 2023. The survey examined access to, and use of RPM, medical applications, and wearables, among respondents. Binary responses to the following questions were examined using logistic regression models: In the past 12 months, have you (i) used RPM, (ii) used a medical app, and (iii) used an electronic wearable device to monitor or track health or activity? A total of 305 surveys were returned, of which 212 were complete (69.5% completion rate). Demographically, 22% self-identified as Hispanic, 41% as non-Hispanic Black individuals, and 33% as non-Hispanic White individuals. Overall, 69% of respondents reported a pre-tax annual household income of less than $35 000 and 96% indicated they own a smart phone. However, only 3 of 10 reported using RPM, 15% reported using a medical app, and 14% reported using wearables. Race was strongly associated with RPM usage, with Black respondents significantly less likely to have used RPM, compared to their white counterparts (OR: 0.31, P = .002). Education (bachelor's degree or more OR: 4.79, P = .03) and higher income ($35 001 + OR: 4.68, P = .008) were strongly associated with medical app usage. In the wearables model, the same trend was observed with education (bachelor's degree or more OR: 4.45, P = .04), and higher income ($35 001 + OR: 5.49, P = .01). Compared to earlier studies that have reported utilization rates of between 50% and 60%, our finding of much lower utilization in economically disadvantaged populations that are at greater risks for sub-optimal health outcomes gives cause for greater concern. Considering the ongoing proliferation of digital health technological modalities, this further highlights the need to explore and address equity-based barriers to these health tools.

Whether the association between metabolic syndrome (MetS) and functional disability differs depending on sex or age remains unknown. To determine the association between MetS and functional disability in older people separately by sex and age groups. A total of 11 083 participants (4407 men and 6676 women) aged 65 years or over without functional disability were enrolled. MetS was defined according to the revised NCEP ATP III guidelines. Functional disability was defined by a new certification in the long-term care insurance in Japan. Cox proportional hazards models were used to assess the risk of functional disability with adjustment for possible confounding factors. Over the mean observation period of 10.5 years, 1282 men and 2162 women experienced functional disability. For those aged 65 to 74 years, HRs (95% CIs) for functional disability in the MetS group were 1.33 (1.07-1.66) in men and 1.15 (1.000-1.32) in women. For those aged 75 years or older, there was no significant association in men or women. In subjects with a severe care need level, there was a marginal significant association in men aged 65 to 74 years. Among the MetS components that independently increased the risk of functional disability were glucose intolerance and elevated blood pressure (men and women aged 65-74 years), obesity (women aged 65-74 years), and glucose intolerance (women aged 75 years or older). MetS contributed to an increase in a high risk of future functional disability among individuals aged 65 to 74 years. In this age group, improvement of lifestyle, health promotion and interventions for MetS from middle age may prevent future functional disability.