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

The evolving gambling environment, marked by increased accessibility and innovative promotions, has led to rising expenditures globally. Despite this, the relationship between social media use and problem gambling in the Czech Republic remains underexplored. To investigate the association between social media use and problem gambling severity among Czech adults using the Problem Gambling Severity Index (PGSI). Is there a difference in gambling severity based on demographic characteristics? (1); Is there a relationship between social media news consumption and gambling severity? (2); Is there a connection between negative motives for social media use and problematic usage? (3); Is there a link between problematic social media use and gambling severity? (4). Primary research, designed as a cross-sectional study, was conducted in the Czech Republic in November 2024 on a sample of 3093 respondents (48.4% male). All participants were aged 16 years or older. The sample was selected using quota sampling based on multiple identifying quota variables, with minimal differences in the proportions of quota indicators compared to the general population. Non-parametric tests and ordinal logistic regression analyzed relationships between demographics, social media use, and PGSI scores. Higher PGSI scores were found among males, younger participants, those with lower education, and the unemployed or students. Greater social media news consumption correlated with increased gambling severity. Disruptive social media behaviors, such as waking up to check notifications and interrupting activities, were significantly associated with higher PGSI scores. Problematic social media use involving deceit and family conflict substantially heightened the risk of severe gambling problems. These findings highlight the need for targeted prevention initiatives, regulatory policies, and enhanced digital literacy to safeguard vulnerable groups from the risks posed by digital gambling platforms. Addressing both gambling behaviors and problematic social media use is crucial in mitigating potential harms.

Introduction: The Age-Friendly Health Systems initiative (AFHS) was developed to spread principles of high-quality care for older adults using the 4Ms Framework: What Matters, Medications, Mentation and Mobility. In 2020, the Veterans Health Affairs (VA) set a goal to become an AFHS, given nearly half of Veterans are over aged 65.

Methods: This quality improvement study followed the Model for Improvement which guided a series of Plan Do Study Act (PDSA) cycles to implement and spread the AFHS model within the VA, as measured by clinical sites receiving AFHS recognition from the Institute for Healthcare Improvement (IHI). A national AFHS Steering Committee was formed, followed by a 4Ms note template and dashboard. VA ran 3 AFHS Action Communities which included synchronous training sessions and coaching calls in 4Ms care. IHI recognition was tracked over 5 years for VA sites. The Standards for Quality Improvement Reporting Excellence 2.0 guidelines (SQuIRE) were used.

Results: From 2020 to 2025, 455 VA care settings earned Level 1 recognition from IHI at 138/139 (99%) of VA parent facilities. 268/455 (59%) sites have gone on to achieve Level 2 recognition. 66% of Level 1 sites are ambulatory, 7% are acute care, and 24% are nursing homes. Since 2022 when the VA AFHS note template was implemented, 163 000 unique Veterans have been recorded as having been reached with 4Ms care, of whom 71% reside in urban areas, 23% are aged 85 and older, and 59% are aged 65 to 84.

Conclusion: The VA implemented the AFHS initiative at nearly all VA parent facilities over 5 years, spreading the 4Ms model of Age-Friendly care across geographic and care settings. Further study is needed on the clinical impact of and optimal implementation strategies for AFHS. The VA experience offers a promising model for health systems seeking to implement AFHS.

The study focuses on the complex interconnection of race, sexuality, and socioeconomic background in shaping the stories of mothers struggling with addiction disorders as they attempt to recover from traumatic experiences. A sample of 45 mothers was employed in the study. Using case study analysis methodologies, the stories of 6 mothers were used as representative cases based on their individual characteristics, community settings, and institutional experiences. Further, the 6 cases were used to describe the difficulties experienced by participants across 3 major life transitions: (1) childhood (2) initiation to drug use and addiction disorders (3) motherhood. Across these life transitions, participants emphasized the relevance of traumatic experiences and mental health disorders as main reasons for their drug addiction. For each theme highlighted in the narrative of each case, a connection to all other participants was made to summarize the findings in the whole sample. The analysis indicates that while most mothers experienced trauma during their lifetime, mothers who identified as members of racial/ethnic minorities and those who identified as lesbians were more likely to report trauma from prejudice and discrimination. Furthermore, the analysis highlights that mothers who identified as members of racial minorities were more likely to have their children placed in foster care. In the study, mothers' involvement with the criminal legal system contributed to the challenges they experienced while renegotiating their relationships with their children. These mothers' lived experiences and the complexity of the dynamics they described-especially their interactions with the legal system-could potentially help other researchers frame new hypotheses that could be tested by larger empirical studies.

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.

This study aimed to determine the association between physical function and edentulism among older adults. The fifth wave of Indonesian Family Life Survey (IFLS-5) data was used. Physical function was evaluated through physical performance, physical capability, and appendicular skeletal muscle mass (ASM). Edentulous was found in 10.96% of 2554 older adults. Low physical performance (OR 2.02, 95% CI 1.32-3.09; P = .001) was shown to be associated with edentulism in the 60 to 69 age group. In the 70 to 79 age group, both low physical performance (OR 1.62, 95% CI 1.04-2.53; P = .033) and 1 dependency in ADL/IADL (OR 1.75, 95% CI 1.02-2.98; P = .04) were significantly associated with edentulism. Two or more dependencies in ADL/IADL (OR 4.02, 95% CI 1.15-13.99; P = .029) demonstrated significant association with edentulism in older adults ≥80 years. These findings highlighted the importance of maintaining natural teeth and improving oral health during the aging process.

This study aimed to explore the applicability of a dementia prevention lifestyle change program based on the Health Belief Model in the community. A total of 9 participants were included in this study. The participants completed a 10-session program using the KEEP strategy. Assessments, qualitative interviews, and a 4-week follow-up were conducted to evaluate the effectiveness of the program. Lifestyle change motivation significantly improved, particularly perceived benefits (P = .018) and self-efficacy (P = .034). Lifestyle behaviors also significantly improved, including cognitive, social, and health-promoting activities (P = .016, 0.011, and 0.027, respectively). Multifaceted lifestyles showed significant improvements in physical activity and activity participation (P = .008 and 0.011, respectively). Depression significantly decreased (P = .018). The postintervention interviews revealed high participant satisfaction and positive changes in dementia prevention motivation and behaviors. The 4-week follow-up showed that most participants successfully implemented the plans. The dementia prevention lifestyle change program based on the Health Belief Model is effective and applicable in the community, demonstrating significant improvements in various health-related aspects.

Climate variability, particularly global warming, is expected to have a significant impact on the interactions between pathogens, vectors, and animal and human hosts. Trypanosomiasis, a neglected zoonotic disease, is particularly sensitive to changes in climate, as increased temperatures can accelerate vector development and expand geographical range. This disease remains prevalent in Zimbabwe, with the Binga District being disproportionately affected. This study aimed to explore the effects of climate variability on the epidemiology of trypanosomiasis in the Binga District of Zimbabwe from 2008 to 2023. A multi-method approach was used to incorporate secondary data sources and a data-collection guide. Data collection involved a checklist and questionnaire administered using the Kobo Collect Toolbox. Bivariate correlations were employed to investigate the association between climate variability and trypanosomiasis occurrence. Rainfall and temperature data are presented as line graphs and maps at 3-year intervals for the period 2008 to 2023. Spatial analysis was conducted by overlaying climate data with the reported suspected cases of trypanosomiasis. The findings revealed a notable increase in annual case reports, correlating with increasing maximum and fluctuating average temperatures. Specifically, higher annual average temperatures were recorded in 2008 and 2017, coinciding with an increased incidence of trypanosomiasis. These findings underscore the critical role of climate variability in shaping trypanosomiasis trends in the Binga District of Zimbabwe. These findings highlight the importance of effective disease control strategies in response to climate-induced changes.

There is a lack of recent data on the incidence of unintentional injuries and occupational injuries from Pakistan, among youth 15 to 24 years of age. This survey was conducted among vocational school youth in Peshawar, Pakistan (2021-22). Parental consent and assent were obtained for students <18 years of age. After obtaining consent, students were given a hard copy of the self-administered, World Health Organization community survey guide for injuries and violence questionnaire in a classroom session. Incidence Rate Ratios (IRR) were reported for unintentional and occupational injuries There were 547 youth of which [356 (54%)] were males. Majority [535 (97%)] of the students had received formal education before vocational training, while fathers had higher formal education [437(80%)], compared to mothers [326 (60%)]. The median family income of these vocational students was 30 000 Pakistani rupee (PKR) per month. Vocational youth mostly lived in crowded family settings with 239 participants (44%) living with ≥8 family members in the household. In terms of risk behaviors, there was minimal use of tobacco [532 (97.3%)] and minimal alcohol [9 (2%)]. Non-use of helmets was found in [273 (50%)], which was similar to seat belt non-use in [307 (56%)] of participants. Eight percent of students carried a gun for personal protection. Males had 3.24 times higher rates of road traffic injuries, 1.28 times higher rates of occupational injuries, and 1.63 times higher rates of unintentional injuries overall compared to their female counterparts. The 15 to 19 age group had significantly lower incidence of burns and falls compared to the 20 to 24 age group. Factors that increased the risk of unintentional injuries UI_T were tobacco use adjusted IRR = 1.25 (95% CI: 1.05-2.69, P = .049), not using a seat belt adjusted IRR = 1.3 (95% CI: 1.14-1.69, P < .001), lack of formal education prior to vocational training in the youth, adjusted IRR of 4.6 (95% CI: 1.12-18.91, P = .034), lack of father's education adjusted IRR = 4.71 (95% CI: 2.12-10.49, P < .001), lower family income (≤35 000 PKR) adjusted IRR = 2.04 ( 95% CI: 1.04-4.02, P = .039), larger household size (≥8 members), with an adjusted IRR of 3.59 (95% CI: 3.11-5.07, P < .001). In contrast, age ≤19 years showed a higher unadjusted risk (IRR = 2.05, 95% CI: 1-4.2, P = .049), but this association was not significant after adjustment (adjusted IRR = 1.61, 95% CI: 0.8-3.27, P = .184). Marital status and mother's education were not significantly associated with UI_T. This study on vocational youth in Pakistan highlights the critical need for targeted interventions. We recommend prioritizing stricter enforcement of traffic laws, implementing public awareness campaigns specifically for vocational youth, and providing subsidized safety equipment, such as helmets. Furthermore, integrating comprehensive road safety and health education int

Health care price transparency aims to empower patients to make better-informed purchasing decisions. However, the prospective availability of patients' out-of-pocket costs may lead to an increased rate of forgone care. The objective of this study was to examine whether obtaining a prospective out-of-pocket cost estimate is associated with the likelihood of canceling or not arriving at a scheduled outpatient health care appointment. We surveyed adult individuals with scheduled outpatient imaging appointments at a large health care system in Georgia. In this case-control pilot study, we estimated the adjusted association between obtaining an out-of-pocket cost estimate for a scheduled imaging appointment (did not obtain an estimate, did not seek an estimate but received it via an unsolicited phone call from the health care system, and actively sought and obtained an estimate) and not attending the appointment using multivariable logistic regression that controlled for the type of primary health insurance and patient demographics. Actively seeking an out-of-pocket cost estimate was not associated with appointment cancelation or no-show (adjusted odds ratio [aOR] = 0.81, P = .75). Passively receiving an out-of-pocket cost estimate via an unsolicited phone call from the health care system was marginally associated with lower odds of appointment cancelation or no-show (aOR = 0.24; P = .076). This study did not find evidence of an association between prospective exposure of patients to out-of-pocket cost information and the likelihood of health care appointment cancelation or no-show.

The economic contribution of family and friend carers of people with dementia is substantial. Pre-death grief experienced by carers of people living with a rare dementia is complex as carers are faced with unique challenges due to geographical isolation and a lack of access to shared experiences. There is an urgent need for specialised interventions to support carers lacking local support. A micro-costing analysis of a novel online group-based pre-death grief and loss programme ('The Road Less Travelled') tailored for the carers of people with rare dementias was conducted from a provider perspective. Sensitivity analysis was conducted to explore the potential costs of face-to-face delivery of the programme. A budget impact analysis was also conducted to explore the potential costs of roll-out of the programme to carers of people living with a rare dementia across the UK. The total cost of delivering three waves of the grief and loss programme to a total of 20 participant carers was £9848, which equates to a cost of £492 per carer participant. Sensitivity analysis indicated a total cost of £14 673 for face-to-face delivery, equating to £734 per carer participant. Sensitivity analysis indicated a total cost of £14 673 for face-to-face delivery, equating to £734 per carer participant. We estimate from our budget impact analysis that the total costs of a UK wide roll-out to people living with a rare dementia (based on 5% of all people with a dementia) would be £21.77 million. To our knowledge, this is first costing analysis of a pre-death grief and loss programme for carers of people living with a rare dementia. These initial assessments of costs provide a base case for future costing analyses and full economic evaluations which can assess both the cost and benefits to society from supporting people with rare dementias and their carers.