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

Climate change and mental health research has predominantly focused on adults in non-clinical settings; investigations among youth and in clinical settings are lacking. Our objectives were to understand the relationship between adult caregiver and adolescent patient climate-anxiety and to examine caregivers' community-level concerns and their association with adolescent climate anxiety. This cross-sectional study occurred in a single-center pediatric emergency department (ED) and data collection spanned January to December 2024. Exposures included adolescent demographic factors (age group, sex, race and ethnicity, insurance payor) and adolescent and caregiver general anxiety disorder-7 (GAD-7) scores, as well as caregiver perspectives captured on (1) the climate change anxiety scale (CCAS), (2) a domestic and global issues poll, and (3) an environmental community survey. The outcome was adolescent climate anxiety, operationalized using the CCAS. In total, 557 patient-caregiver dyads completed CCAS surveys, with low within-dyad agreement in scores, ICC = 0.224 (95% CI 0.142, 0.274). Both caregivers and adolescents had higher levels of climate anxiety if the caregiver reported concerns about housing, public services, and pollution in their community (P < .05). Moderate-severe generalized anxiety (GAD-7) was the strongest predictor of climate anxiety in both adolescents and caregivers (OR_adj 6.59, 95% CI 3.52-12.30, P < .001). Caregivers viewing climate change as very important had higher odds of moderate-severe CCAS (OR_adj = 4.50 (95% CI 2.03, 9.98), P < .001), with no significant effect of their perception on adolescent CCAS (P = .172). Generalized anxiety and adult caregiver community-level concerns appear to be associated with adolescent climate anxiety in this large pediatric study, but there is no direct relationship between caregiver climate anxiety and the climate anxiety of the adolescent.

Violence during pregnancy is a significant public health concern, which is associated with different psychological consequences-including depression and suicidal ideation. Although several qualitative studies have been conducted, limited data are available on its prevalence during pregnancy and associated depression and suicidal ideation in Bangladesh. This study identifies the prevalence of violence against pregnant women and depression and suicidal ideation among affected individuals in rural Bangladesh. Our study is a secondary analysis of cross-sectional data, collected in a rural southern subdistrict in Bangladesh using the Edinburgh Postnatal Depression Scale (EPDS). The prevalence of domestic violence (DV), lifetime intimate partner violence (IPV), and IPV during pregnancy were 5.9% (n = 21; 95% CI: 3.7-8.9), 5.4% (n = 19; 95% CI: 3.3-8.3), and 9.9% (n = 35; 95% CI: 7.0-13.5), respectively. Among women exposed to DV, 66.7% (n = 14; 95% CI: 42.6-84.3) reported antenatal depression. Similarly, 68.4% (n = 13; 95% CI: 42.7-86.3) of those with a history of lifetime IPV and 42.9% (n = 15; 95% CI: 27.1-60.3) of those experiencing IPV during pregnancy had depressive symptoms. Suicidal ideation was present in 14.3% (n = 3; 95% CI: 4.2-38.7) of DV victims, 5.3% (n = 1; 95% CI: 0.6-33.8) of lifetime IPV victims, and 5.7% (n = 2; 95% CI: 1.3-21.4) of those experiencing IPV during their current pregnancies. The concerning prevalence of violence and associated mental health issues during pregnancy demands urgent targeted interventions, including policy reforms, health education, and community awareness initiatives.

Depression and anxiety are common, disabling conditions that often require sustained psychiatric care. While digital mental health interventions (DMHIs) offer scalable access, few integrate measurement-based care (MBC) to track outcomes such as minimal clinically important difference (MCID) and remission. The purpose of this study was to evaluate the rate and timing of MCID and remission in depression and anxiety among patients with elevated baseline depression and anxiety scores receiving psychiatry services through Rula Health, a MBC-based DMHI that connects patients with psychiatric care. Symptoms were assessed prior to psychiatric visits over a 24-week period and used to evaluate effect sizes, as well as rates of MCID and remission. Kaplan-Meier and Cox proportional hazards models were used to estimate the timing of MCID and remission, and to identify demographic and clinical factors associated with achieving each outcome. A total of 7124 adults with elevated depression symptoms and 7628 with elevated anxiety symptoms at baseline were included. Depression and anxiety symptoms decreased with large effect sizes (d's = -1.17 to -1.62). The median survival time to MCID in depression was 12 weeks and remission 22 weeks. The median survival time to MCID in anxiety was 11 weeks and remission 19 weeks. Several demographic and clinical characteristics were associated with time to MCID and remission. MBC-based digital psychiatry services can support sustained, clinically meaningful change. Faster improvement among patients with varying clinical and demographic characteristics highlights Rula Health's ability to address a range of patient needs.

Although significant progress has been made in reducing malaria transmission in Zimbabwe, the path to elimination remains challenging. The disease remains a persistent threat, particularly in resource-constrained areas such as Mberengwa, necessitating an urgent need to understand the demographic, behavioural, socioeconomic, and structural factors influencing long-lasting insecticide-treated net use and case severity. This study investigated these factors using individual malaria case data to inform the development of locally tailored strategies for malaria elimination. Individual malaria case data from 2019 to 2024 were collected from the District Health Information System Tracker-2 database for this study. Data were triangulated with line list and health facility register data to verify records and complete the missing data. The resulting 662 cases were analysed using stratified descriptive analysis, multivariate logistic regression, and Random Forest classification models. There is an overall gradual decline in the annual Test Positivity Rate, despite seasonal peaks. A critical finding was the disparity between long-lasting insecticide-treated net ownership (95%) and use (7.7%), suggesting that ownership does not translate to protective use. In the multivariate logistic regression, none of the tested variables were significant determinants of Long-Lasting Insecticide Net use. However, random forest modelling identified age, time to seek care, religious group, distance to health facilities, and education level as the top 5 influential factors. For malaria case severity, greater distance to a health facility (P < .001) and increasing age (P = .002) were consistently identified as significant factors associated with severity. The Random Forest model demonstrated enhanced performance in discriminating case severity compared to Logistic Regression. The findings of this study highlight that effective malaria elimination requires a combined focus on behavioural change, structural improvements in healthcare access, and data-driven programming supported by advanced analytics. Tailored malaria elimination strategies must address the long-lasting insecticide-treated net use gap and structural barriers.

Nursing staff including registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) are critical to nursing home (NH) operations but account for approximately 27% of net revenues. Understanding how nursing staff wages affect financial performance is particularly important as policy efforts seek to expand NH minimum staffing hours. Drawing from efficiency wage theory, which posits that employers may pay above-market wages to enhance worker productivity and retention, this study examined the relationship between nursing staff wages and NH financial performance. We used secondary datasets, including Payroll-Based Journal data and Medicare cost reports (N = 37 933 facility-year observations, 2020-2022). The dependent variable was operating margin, while the independent variables were facility-level RN, LPN, and CNA wages. An instrumental variable (IV) approach was used to address potential endogeneity in RN wages, with county-level average wages (excluding the index facility) serving as the instrument. The first stage modeled RN wages as a function of the instrument, and the second stage estimated the effect of predicted wages on operating margin. Ordinary least squares models were used for LPN and CNA wages, for which endogeneity was not detected. A $1 increase in RN wages was associated with a 0.70 percentage-point decrease in operating margin (P = .01, 95% CI [-1.27, -0.14]). For LPNs, a $1 increase was associated with a 0.17-point decrease (P < .001, 95% CI [-0.20, -0.13]), and for CNAs, a 0.31-point decrease (P < .001, 95% CI [-0.37, -0.26]). These findings underscore the tension between workforce investment and financial sustainability in an industry that operates in a resource-constrained environment. Policy interventions such as wage subsidies or higher Medicaid reimbursements may be necessary to balance staffing investments with financial viability.

Long COVID increases healthcare utilization, yet differences in healthcare spending patterns between individuals with and without long COVID remain poorly characterized, especially at the national level. To evaluate differences in healthcare expenditures among U.S. adults with and without long COVID using nationally representative data. This cross-sectional study analyzed data from the 2022 Medical Expenditure Panel Survey (MEPS), including 16 762 unweighted adults (weighted population: 239 915 159). Healthcare spending outcomes included total expenditures and specific categories including office-based care, outpatient services, emergency room visits, hospital admissions, home healthcare, and prescription medications. A survey-weighted generalized linear model (GLM) with a log link and gamma distribution was used to estimate adjusted differences in expenditures between groups. Individuals with long COVID had significantly higher total healthcare expenditures (mean $11 567; SD $25 334) compared to those without long COVID ($7448; SD $21 734, P < .01). After adjusting for demographic characteristics, insurance status, chronic conditions, and other potential confounders, individuals with long COVID incurred 40% higher total expenditures (β = 1.40, P = .01). Expenditures were significantly elevated for office-based visits (35% higher; β = 1.35, P = .02) and outpatient services (118% higher; β = 2.18, P < .01). No significant differences were found in emergency room, hospital admissions, or dental care expenditures. Long COVID imposes a substantial financial burden on individuals and healthcare systems, primarily through increased outpatient and office-based service utilization. Understanding these spending patterns can help inform policy decisions, optimize healthcare resource allocation, and guide targeted interventions to manage long COVID more effectively.

Using AI-powered mobile applications for mental health screening can help reduce maternal mental health disparities among Black mothers who are pregnant or parenting in the United States. A maternal health education question and answer mobile application chatbot has the potential to intervene in the maternal depression cascade, specifically screening. Extant research demonstrates the usability of mobile applications addressing mental health. However, limited scholarship explores the intersection between AI-powered mobile application chatbots and maternal mental health. This study uses a multimethod analysis to evaluate the usability of an AI-powered mobile application to address maternal mental health among Black women. Data sources, including mobile application engagement, mental health disorder scales, and secondary qualitative analysis from focus group discussions (n = 5), will be assessed through a multimethod approach. The study team previously collected data across the United States for this clinical intervention in 2022. Findings indicate that the mobile application demonstrated promise in the application's usability to screen for maternal health depression indicators. This was achieved using the mobile application's intent classification functionality that classified users' questions that contained targeted search terms (e.g., postpartum depression) or specific inquiries about mental health and appropriate follow-up from the study team to provide mental health resources. Critical interconnected themes were assessed and reflected high confidence, acceptance, and usability of the mobile application in addressing maternal mental health inquiries. Findings contribute to evidence about the usability of AI-powered mobile applications informed by Black mothers in appropriate screening for maternal depression indicators and inquiries. This study provides insight into closing the gap in maternal health disparities in depression outcomes for Black mothers.Trial Registration: ClinicalTrials.gov NCT06053515; https://clinicaltrials.gov/study/NCT06053515.

Although group participation benefits older adults' health, its effects may vary by group type. The Japanese Health and Welfare Co-operative (Hew Co-op) organises peer-led group participation called 'Han Kai' meetings to promote health literacy, but the impact of Han Kai participation on health indicators remains unexplored. This study aimed to examine whether the frequency and duration of Han Kai participation were associated with risk of functional disability. This was a prospective cohort study conducted in Japan between 2018 and 2022. The participants were Han Kai members aged ≥ 65 years who did not receive a Long-Term Care certification. The exposure variables were the frequency of participation in Han Kai per year and the years of participation in 2018. The main outcome was a risk assessment scale score for predicting incident functional disabilities in 2022. Multivariate linear regression was conducted to adjust for covariates. In the study, 2359 older adults participated. Overall, the frequency of Han Kai participation was not significantly associated with disability risk scores. However, participants with ≥10 years of involvement had significantly lower scores (β = -1.95, 95% CI: -3.64 to -0.26, P = .024). Among those aged ≥ 75 years, both frequency and duration showed a significant inverse association with risk scores, with a dose-response relationship. Sustained participation in peer-led group meetings such as Han Kai may help mitigate functional decline, particularly among the oldest age groups. These findings support policies that promote long-term community engagement as part of healthy ageing strategies.

This study attempts to examine how cancer drug lags in South Korea, along with submission-to-approval and approval-to-reimbursement decision time spans, have evolved over the last decade, from 2013 to 2022. For the same set of cancer drugs, the drug lags observed in South Korea were compared with those of United States, European Union, and Japan. Multivariate linear regression and multivariate Cox regression analyses were performed to conduct quantitative analyses. Compared with the 3 other advanced medicine agencies, South Korea (Ministry of Food and Drug Safety [MFDS]) displays an average delay of 1 to 2 years in submission and approval over the sample period. However, the average review processing time is much shorter than the submission and approval lags, and the MFDS fares even better than the European Union (European Medicines Agency [EMA]) in terms of reviewing efficiency. Notable progress has been made in addressing delays in the reimbursement decision process, roughly cut in half over the period, whereas other lags are rather elongated. The multivariate regression results confirm that the variations in approval delays in South Korea are largely associated with submission delays. The fact that South Korea fares poorly in submission and ensuing approval lags compared to other nations and regions with advanced medicine agencies mirrors the reality that South Korea is still not yet being considered as one of the most preferred testing grounds for innovative cancer drugs. The findings highlight that the goal of regulators should be geared towards ensuring more equitable access to oncology drugs in a timely manner for the Korean population.

This study aimed to identify unique social connection factors associated with cognitive impairment among older adults. Longitudinal data from the 2010 to 2020 Health and Retirement Study were used. Discrete-time survival models were applied to examine the impact of the social factors like loneliness, depression, positive and negative support from family and friends, volunteerism, attending sports or social clubs, charity work, and computer use on cognitive impairment. The sample included 15 548 adults aged 50 and older, with 11.4% living in poverty. Key factors associated with cognitive impairment were loneliness, depression, charity work, participation in sports or social clubs, computer use, positive family support, and negative family support. In adults living in poverty, depression and computer use were most strongly linked to cognitive impairment. These results underscore the need for interventions and educational programs that help older adults maintain or improve cognitive function through enhanced social connections.