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

Primary health care is the most effective approach to achieving universal health coverage (UHC) and ensuring health security. In this approach, community health workers play a crucial role by delivering a comprehensive array of preventive, promotive, and curative services. Their contributions are vital in addressing health inequities, ensuring that all individuals have access to essential health services. By empowering these workers, we can foster a more equitable health system that meets the diverse needs of communities. African leaders are pursuing a 2 million community health worker agenda, but there are lingering questions about how to set targets of the density of community health workers needed in countries to achieve the sustainable development goals. By examining the implications of empirical estimates and incorporating nuances of working hours of community health workers, we find a wide range of density from 11.2 to 59.5 community health workers per 10 000 population depending on country context and the community health worker's working arrangements. If community health workers are not full-time workers and work between 30% and 65% of their time, the current shortage of community health workers is between 580 000 and 954 500. However, if all the existing community health workers were to be employed full-time, the needs-based shortage of community health workers would shrink significantly to just 210 000. These should be considered ordered guesses and not planning targets for countries. Countries are encouraged to use the available health workforce planning tools to estimate its context-appropriate requirements for community health workers as part of the broader health workforce planning.

Food advertising may influence food preferences and consumption. Due to these advertisements' role in health, the present study has updated the data available on television and radio food advertisements in Iran until 2020. Meanwhile, food advertisements on billboards have been analyzed for the first time. All programs broadcast on two TV and radio channels were downloaded and saved 24 h daily for one week (November 10-16th, 2020). Also, on November 15th billboards located on the busy highways of Tehran were photographed. Validated protocols analyzed the advertisements. A total of 6026 advertisements were analyzed, including 4287 on TV, 1545 on radio, and 194 on billboards. The total duration of TV and radio advertising was 48.6 h. Food products were the most displayed advertisements on TV, radio, and billboards (33.6%). Overall, "condiments" and "desserts" were the most frequently advertised food products among all the studied media (20% and 17%, respectively). The most common advertising appeal included "High quality" on TV and billboards and "Stimulation of profiteering and profit-seeking" on the radio. Advertising violation based on Iran's regulations, Nutrient profile model for the marketing of food and non-alcoholic beverages to children in the WHO Eastern Mediterranean Region, and International Network for Food and Obesity / Non-communicable Diseases (NCDs) Research Monitoring and Action Support (INFORMAS) was reported to be 13%, 74%, and 51%, respectively. Food products ranked the highest among all the advertisements. A clear violation of domestic and international advertising regulations was observed which given the high share of food advertising in the studied media, could endanger public health. This study supports the need for stricter regulations and adherence to international standards to improve nutritional status.

The healthcare supply chain relies on real-time logistics Management Information System (LMIS). Despite Ethiopia's adoption of a digital LMIS in 2009, ongoing evaluation of software, infrastructure, and sustainability remains essential for improving performance from users' and health system's perspectives. The study aimed to evaluate the performance of the facility version of digital LMIS at public health facilities in the Amhara Region, Ethiopia. An institution-based cross-sectional study was used. Out of 102 surveyed facilities, only 37 implemented the digital LMIS. Data was collected using interviewer-administered questionnaires. Out of 37 facilities using digital LMIS, 28 (75.7%) were functional. The average frequency of use across 27 sub-dashlets was 3.13 ± 0.67 out of 4. End users rated the digital LMIS performance as 3.21 ± 0.43 out of 5 (64.2%). Significant differences in LMIS performance related to organizational support were found due to varying end users' experience and internet access (P-value < .05). The digital LMIS performance from end users' perspective was 64.2%, with significant differences in agreement related to health system and organizational support, influenced by internet access and users' experience.

Adolescent pregnancies are associated with several psychosocial challenges. This study explored the psychosocial experiences of pregnant adolescents in a rural District in the Volta Region of Ghana. The participants were 16 pregnant adolescents purposively sampled from 3 communities. Individual in-depth interviews were used for data collection and analyzed using the thematic analysis method. An inductive approach was used to identify emerging central themes from the sub-themes by merging the codes delving deep into the contents and grouping similar statements. Six themes and 14 sub-themes were identified and included (1) meanings attached to the pregnancy/feelings at the first discovery of pregnancy, (2) reaction from parents, friends, neighbors, and sexual partner/boyfriend, (3) participation in social activities in the community, (4) source of support, (5) challenges during pregnancy, and (6) perception of the antecedents to the pregnancy. The factors associated with an adolescent girl getting pregnant were ignorance, promise of marriage, lack of awareness, lack of knowledge on contraceptive use, and nature of interpersonal relationships with friends. Adolescents' reaction to the news of pregnancy was a feeling of dislike and unpleasantness. The adolescent's immediate thoughts of the pregnancy were to terminate the pregnancy. The type of interpersonal relationship with adolescents' parents, friends, and neighbors was strained. The sexual partners were the major sources of financial and resource support. Healthcare providers must use targeted intervention to train, educate, and support adolescents and parents to address psychosocial concerns arising from pregnancies. Future studies should quantify the magnitude of the psychosocial burden of teenage pregnancy. This can lead to developing and testing interventions to prevent or mitigate the liability of teenage pregnancy in the district.

Research suggests that the quality of care provided by family members may be influenced by the quality of relationship they have with the person living with dementia. The study investigated this in the context of assisting with daily activities. The quality of the relationship was assessed using the conceptual framework of relationship continuity/discontinuity which focuses on whether the carer experiences their relationship as continuous or discontinuous with the pre-dementia relationship. Thirty spousal carers completed the Birmingham Relationship Continuity Measure. Participants were also interviewed about how they provide care for their partner's daily activities. Passages consistent with a more person-centered approach were identified, and the total number of these in each transcript was used as the measure of care quality. There was a significant correlation between questionnaire scores and the number of person-centered passages: Those reporting greater continuity more frequently described using a person-centered approach. Findings were consistent with earlier research suggesting associations between the quality of the relationship and the quality of care. The concept of relationship continuity suggests ways in which relationship and care quality are connected, and these suggestions could be used to develop interventions to help family carers provide better care.

The Age-Friendly Health System (AFHS) movement continues to grow in the United States as more health systems implement the 4Ms framework. Despite this growth, there are relatively few studies that evaluate outcomes related to AFHS implementation. This study assessed patient satisfaction with AFHS by analyzing the rate at which patients returned to the clinic for future health care, serving as a measure of quality. A retrospective cohort design using electronic health record (EHR) data obtained from patients 65 years of age and older who received care at a large national network of convenient care clinics in the U.S. (N = 987,197) between January 2021 and March 2024. We assessed the level of AFHS 4Ms care received by these individuals in relation to their subsequent visit back to the clinic through descriptive statistics, a time-to-event analysis using the Kaplan-Meier cumulative incidence approach, and a Cox proportional Hazards model, adjusted for age, race, sex, prior appointments, and number of ICD-10 code diagnoses. Throughout the study period, patients who received complete AFHS 4Ms care exhibited greater rates of returning to the convenient care clinic compared to those who received partial or no 4Ms 4Ms care. Kaplan-Meier curves demonstrated that the cumulative probability of returning to the clinic was higher in patients that received 4Ms over time, compared to patients that did not receive 4Ms. Results from the Cox Proportional Hazards model demonstrated a risk ratio of 3.91 (p < .001) of returning to the clinic, after adjustment. The results indicate that patients are more likely to seek additional care in the future at the same health system when they receive complete 4Ms care, possibly due to increased satisfaction with care. As patient satisfaction is an indicator of quality care, this finding can further inform and spread the AFHS movement.

Undocumented migrants, known for their particularly vulnerable living conditions, were deeply affected by the COVID-19 pandemic. Despite the challenges, some demonstrated resilience, successfully remaining in their host countries. Drawing on insights from the Parchemins study, which examined the experiences of undocumented and newly regularized migrants in Geneva, Switzerland, this paper details on undocumented migrants that faced accumulated difficulties during different moments of data collection amid the pandemic. Based on empirical findings, we observe that only a specific group among undocumented migrants continued to participate in the study post-pandemic. This paper undertakes a comparative analysis of "remainers" and those who dropped out. This indicator serves as a proxy for understanding resilience among the most vulnerable in times of crisis. Through regression models, we identify the factors influencing the likelihood of remaining in the panel as undocumented even in the face of a major crisis that negatively impacted various life domains. Our analysis reveals that the chance of remaining in Geneva amidst the pandemic was influenced by solidarity bonds, prior migration experience, as well as income developments and housing situations.

Worldwide, indulgence in high-risk behaviors such as substance abuse is on the rise in street children. Though substance abuse among street children has been investigated and reported in Pakistan, few studies have explored the relationship between narcotic use and its associated factors. This study was conducted to determine factors associated with narcotic use among street children in Islamabad Capital Territory. An analytical cross-sectional survey of a probability-based sample of 443 (males) street children aged 12 to 18 years, was conducted in Islamabad in March 2022. Using self-reported measures, the relationship between narcotic use and associated factors was determined using multivariate regression analysis. Out of 443 street children, with a mean age of 16.3 ± 1.6 years, 244 (55%) were between 17 and 18 years old. 119 (26.9%) worked as garbage collectors and 76 (17.2%) worked as car washers. The most common substance used was cigarettes in 285 (64.3%), naswaar in 172 (38.8%), hashish in 144 (32.5%), and alcohol in 63 (14.2%) street children. There were 164 (37%) street children who admitted having used narcotics (hashish, heroin, and bhang). On multivariate analysis, age > 16 years (OR: 2.3), sleeping on the streets (OR: 2.4), higher monthly income > Rs.18,000 (OR: 1.6), use of drugs by friends (OR: 5), and involvement in the selling of drugs (OR: 10.3) were independently associated with narcotic use. Substance abuse is a concerning trend among street children in Islamabad. When certain high-risk factors are present, these children are prone to narcotic use.

The Age-Friendly Health System (AFHS) movement has spread widely in recent years, with nearly 5000 healthcare organizations across the country recognized as Age-Friendly. Despite this broad recognition, there is little focus on how AFHS are implemented and the impact of implementation. The objectives of this study were to describe the strategies employed to support AFHS implementation in outpatient settings and to identify the measures used to evaluate implementation and effectiveness. We conducted a systematic review of literature from multiple databases spanning 2015 to March 2024, identified eligible studies using predefined inclusion/exclusion criteria, and extracted key data (eg, study design, study population, implementation strategies, outcomes/measures). We identified ten eligible studies from primary care clinics (N = 8), convenient care clinics (N = 1) and a cancer center (N = 1). The studies employed over 65 implementation strategies and 98 outcomes or measures. The vast majority of measures mapped to components of the 4Ms (Mobility, Mentation, Medication, What Matters), with up to ten measures per M category. Five of ten studies had reporting discrepancies and four did not fully define outcomes. The ten included studies serve as clear examples for the need for more evidence to support AFHS implementation in outpatient settings. Existing research lacks strategy specification and standardization of measures. We present gaps and opportunities to advance from AFHS "recognition" to impact.

This study examined the interplay between physical workload, psychological stress, and the prevalence of work-related musculoskeletal disorders (WMSDs) among construction workers in Indonesia. This cross-sectional study used a purposive sampling technique to gather quantitative data from 409 respondents working in four construction companies through structured questionnaires. Data collection tools included the Copenhagen Psychosocial Questionnaire III (COPSOQ III), the K10 scale for psychosocial distress, and the Nordic Body Map for musculoskeletal symptoms. Independent variables encompassed demographic factors, physical work environment, and psychosocial aspects, while the dependent variable was the presence of work-related musculoskeletal disorders (WMSDs) symptoms over the past 7 days and 12 months. Descriptive statistics and logistic regression analyses were performed using IBM SPSS Statistics Grad Pack 29.0 PREMIUM. The study revealed a high prevalence of WMSDs among workers, with 36.2% reporting symptoms in the past 7 days and 31.5% in the past 12 months. These symptoms primarily affected the neck, shoulders, back, and waist. Both physical and psychosocial factors were found to the risk, with high levels of somatic stress and sleep disorders significantly increasing the likelihood of WMSDs. Psychological distress emerged as a particularly strong predictor to these disorders. The findings underscore the importance of implementing targeted interventions and safety policies to mitigate WMSDs risks and improve occupational health within the construction industry.