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

In Nepal, community pharmacies serve as the primary source of medical care. The aim of the current study was to evaluate the effect of an educational intervention on knowledge and practice of dispensing, prescription handling and patient counseling among community pharmacists working in 3 districts (Kathmandu, Lalitpur and Bhaktapur) of Nepal. A quasi-experimental pre-post interventional study was conducted in 123 community pharmacies located in Kathmandu, Bhaktapur, and Lalitpur districts of Nepal. The research questionnaire was developed according to national and international good pharmacy practice guidelines. A structured questionnaire with mainly closed-ended and a few open-ended questions, exploring the knowledge and practice of community pharmacists in the 3 areas mentioned previously was prepared. Demographic information was also collected. The pre-tested questionnaires were completed by the community pharmacy in charge from the selected pharmacy. This data was considered as the pre-intervention data. Education sessions on good pharmacy practice were provided to all selected community pharmacists by expert pharmacists. Three weeks following the educational intervention, post-intervention data was collected at the same pharmacies. The percentage of pharmacies chosen were Kathmandu (48.8%), Lalitpur (30.9%), and Bhaktapur (20.3%). Seventy-four percent of respondents were Diploma in Pharmacy, 21.1% were bachelor's in pharmacy. The major problems faced by the pharmacists during dispensing were inadequate instructions (30.1%), followed by missing duration of therapy (24.4%) and unavailable drugs (22.0%). Other problems included dosage form errors (15.4%), illegible prescriptions (13.0%), dosing errors (13.0%), and drug interactions (13.0%). The educational intervention had a positive impact on both knowledge and practice scores among pharmacists, irrespective of their qualification level. The intervention also significantly improved pharmacists' knowledge and practice scores regardless of gender. The educational intervention improved both knowledge and practice scores in counseling, prescription handling and dispensing. Similar studies in other districts and provinces are required.

Although the association between Health Literacy and Mental Health has been explored in previous research, their interplay within digital technology contexts-especially among the aged-remains insufficiently studied. This study aims to explore the association between ICTs usage and the Mental Health of older adults in China and examine the moderating role of Health Literacy in this relationship. This study is a secondary data analysis based on a cross-sectional survey: 2021 Psychological and Behavioral Investigation of Chinese Residents. Descriptive statistical analysis and hierarchical multiple regression analysis were applied. In zero-order correlation analyses, the relationship between ICTs usage and Mental Health was not significant. After controlling for Health Literacy, ICTs usage had a significant negative association with Mental Health (B = -0.129, β = -.16, P < .001). Health Literacy had a positive relationship with Mental Health (B = 0.027, β = .243, P < .001). Further moderation effect analysis showed that introducing the interaction term did not increase the model's explanatory power (ΔR² = .000). Although no moderating effect was found between ICTs usage and Mental Health, Health Literacy may act as a suppressor variable to offset the negative impact of digital technology. Future Mental Health management for the aged should focus on reducing harmful ICTs usage and enhancing Health Literacy levels.

Drug use has emerged as a significant global health concern, contributing to the burden of liver diseases, particularly hepatocellular carcinoma (HCC) and cirrhosis. This study aims to assess the global burden of drug use-related HCC and cirrhosis from 1990 to 2021, using data from the Global Burden of Disease (GBD) study, and to predict future trends up to 2045. Data on drug use-related cirrhosis and HCC were collected from the GBD 2021 database. Joinpoint regression analysis to evaluate temporal trends. Health inequalities were assessed via the slope index of inequality (SII) and the concentration index (CI). Future burden was projected via Bayesian Age-Period-Cohort (BAPC) models. From 1990 to 2021, global mortality and disability-adjusted life-years (DALYs) attributable to drug use-related HCC and cirrhosis increased gradually. The age-standardized death rate (ASDR) for drug use-related HCC increased by 1.96%, whereas the age-standardized DALY rate for HCC increased, with an average annual percentage change (AAPC) of 1.36%. In contrast, the DALY rate for drug use-related cirrhosis declined annually by -0.12%. High socio-demographic index (SDI) regions, particularly high-income North America, presented the highest burden of drug use-related HCC and cirrhosis. The burden of cirrhosis attributable to drug use increased in low-middle-SDI regions. The global burden of liver cancer due to drug use has become more concentrated in high-SDI regions. Future projections indicate that deaths from drug use-related HCC and cirrhosis will continue to increase, with HCC deaths expected to increase by 150.15% and cirrhosis deaths increasing by 43.03% by 2045. The burden of drug use-related cirrhosis and HCC has increased and is projected to continue increasing. This trend highlights the urgent need for targeted public health interventions, improved access to healthcare, and effective drug use prevention strategies, particularly in high-SDI regions.

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.

We investigate whether the membership of a non-profit hospital's CEO on its board of directors is associated with CEO pay and several measures of hospital performance, including price, operating margin, quality, and service to low-income patients. Although the consequences of CEO board membership for for-profit firms have been studied extensively, the consequences for non-profits in general, and non-profit hospitals in particular, have received less attention. Because most hospitals are non-profit and non-profit hospital prices have increased rapidly over the past 20 years, this gap is important. We use regression models to estimate the association between various measures of hospital performance and CEO board membership, holding constant fixed effects denoting the hospital's county of location, hospital board size, and other hospital characteristics. We find a strong positive association between CEO board membership and non-profit hospital prices, operating margins, and CEO pay, with a weaker positive (negative) association between CEO board membership and quality (service to low-income patients). We conclude that non-profit hospitals' CEO board membership is likely associated with increases in agency costs due to a lack of separation between management and control.

Axillary surgery in breast cancer has evolved from radical dissections to selective de-escalations. Identifying patients who may safely omit sentinel lymph node biopsy (SLNB) can further reduce the surgical burden, post operative complications and financial toxicity associated with breast cancer surgical care. The MD Anderson "Nomogram To Predict Positive Sentinel Lymph Nodes After Neoadjuvant Chemotherapy" is widely available and free of charge to assess SLNB positivity post neoadjuvant chemotherapy (NACT). This study externally validates its accuracy in a sample of Pakistani women and assesses its implications for cost effective breast cancer care in a resource limited setting. Retrospective chart review of 150 women who underwent axillary sentinel lymph node biopsy post NACT at Shaukat Khanum Memorial Cancer Hospital from January 2023 to August 2024. Predicted node probability and observed positivity on histopathology were recorded. Calibration (Hosmer-Lemeshow test) and discrimination (C-index) were calculated. 98% were ductal carcinomas; tumor sub-types showed luminal A (42.7%), luminal B (4.7%), her2neu (H2N) enriched (14%) and triple negative (TNBC; 38.7%). 18% (n = 27) nodes were positive on final pathology closely aligning with the nomogram's predicted probability of 17.1 ± 10.3%. Calibration showed good model fit (P = .89) while C-index (0.64) indicated moderate discrimination. 12.6% of women would avoid costs of SLNB if omitted in the 0% to 5% bracket and 31.3% of women in the 0% to 10% bracket. TNBC demonstrated lowest positivity of 6.89% (P = .01). The MD Anderson Clinical Calculator for predicting positive sentinel lymph nodes post NACT may have a role in tailoring decisions for axillary de-escalation especially in patients with a low probability score between 0% and 10% with decrease in costs of breast cancer care in LMICs. Future studies incorporating safety of axillary surgery omission using the calculator and its economic impact are warranted.

Australians living in rural communities are more likely to experience Domestic violence (DV) than those living in urban areas. Service providers (SP) who provide support to victims of DV in these rural settings encounter some structural barriers at a systems and organizational level that may be useful in improving outreach services. However, few studies have explored SP perspectives surrounding these issues. This study aimed to explore service providers' perspectives on delivering support for DV victims in rural New South Wales (NSW), Australia. This qualitative study utilized structured interviews that were audio recorded and evaluated, using inductive thematic analysis. Ten people from the Central West region of NSW, providing support across DV services, legal services, community centers, medical centers, and the police, were interviewed. Half of the interviewees held roles in organizations that provided DV-specific services. Some service providers noted clients presented with other issues first, before disclosing their experiences with DV. Interviewees described key obstacles, including cultural attitudes, comorbid mental health and substance use disorders, and logistical impediments to leaving relationships and accessing services as barriers for victims. They identified the personal toll of their work and a lack of funding for specialized and multidisciplinary services as challenges to providing effective service delivery. Facilitators such as building trust through community services, using technology for remote support, and community support groups were effective. SP cited DV education in schools as an important avenue for primary prevention. This study highlights the significant barriers and facilitators identified by rural DV service providers in the Central West region of NSW, Australia. Despite the personal toll on providers, supportive networks helped mitigate burnout. The study advocates for increased funding, coordinated multidisciplinary services, and educational programs to address structural and cultural issues in rural DV service delivery at both the systems and organizational levels.

The Cure Violence approach applies public health epidemic control strategies to reduce violence in highly impacted communities and countries. This paper conducts a systematic review to identify studies analyzing the effectiveness of the Cure Violence approach and provides an overview of their findings. A protocol was developed using the PRISMA guidelines. For this study, we examined findings related only to shootings and killings because these are the outcomes to which the Cure Violence approach is applied. We utilized PubMed database, Google Scholar, and the Cure Violence Global organizational files to look for relevant studies. The review identified 13 papers analyzing 27 program sites and offering 83 findings on the impact of the approach on either shootings or killings. Overall, 68.7% of the findings indicated a reduction in shootings or killings, with 32.5% demonstrating statistically significant decreases. Findings varied geographically, with Baltimore accounting for the highest proportion of sites reporting either an increase in shootings or killings or non-significant results. Outside of Baltimore, 95.8% of sites demonstrated reductions in violence, with 54.2% achieving statistical significance. Notable findings include a 52% reduction in killings in Chicago, a 63% reduction in shootings in New York City, and a 74% reduction in killings in Cali, Colombia. The context surrounding the Baltimore findings underscores the importance of contextual factors in determining program effectiveness. Key components influencing program effectiveness include targeting individuals and groups at highest risk, employing credible messengers to reach individuals and groups at highest risk, real-time violence interruption and conflict mediation, sustained case management, structured monitoring systems with rapid response mechanisms, continuous monitoring of impact on shootings and killings, and sufficient, sustained financial investment. Recommendations to researchers are presented regarding the importance of including contextual factors in future research and understanding the importance of their role in guiding communities in improving the effectiveness of violence prevention programs.

This study examined sociodemographic and health-related determinants of self-reported unmet health service needs to better understand the factors contributing to inequities among adults aged 50 and older during the COVID-19 pandemic in Latvia. Data from the longitudinal SHARE study-Corona Surveys 1 and 2, and Wave 8-were analysed using logistic regression. A total of 647 cases from Latvia (62.9% women) were included, with a mean age of 68.6 years (±9.6). During the pandemic, 29.5% of adults aged 50 and older encountered barriers to accessing healthcare services. Gender-stratified analysis revealed that older adults from urban areas, men with higher education, and women with chronic conditions and activity limitations were at significantly higher risk of experiencing unmet health service needs. The study reveals significant disparities in health service needs among older adults in Latvia during the COVID-19 pandemic, emphasising the need for targeted interventions to reduce inequalities and improve access for vulnerable populations in public health crises.

Adverse childhood experiences (ACEs) are linked to lasting health and socioeconomic challenges; however, less is known about how primary care providers' own trauma histories impact their provision of trauma-informed care (TIC). This cross-sectional survey study assessed the relationship between primary care providers' personal trauma history (ACE scores), personal reaction to trauma (burnout, compassion fatigue, and vicarious victimization), and TIC practice. A total of 167 primary care providers were recruited between March 2024 and August 2024 and completed a 38-item online survey. Measures included the Trauma Informed Care-Provider Assessment Tool (TIC-PAT), the Professional Quality of Life Scale (ProQLS), the ACEs Study Questionnaire, and demographics. Descriptive statistics and multiple linear regression analysis was conducted. Respondents were an average of 59.73 years old, white (88.89%) and medical doctors (90.48%). Average ACE score of respondents was 1.4 (SD = 1.47). Analysis revealed that providers with higher ACEs scores were significantly more likely to implement TIC (B = 0.11, P = .02). However, no significant association was found between personal reaction to trauma and TIC provision. Findings suggest that primary care providers with personal trauma histories may be more attuned to the effects of trauma, leading to greater TIC implementation. The study highlights the importance of TIC training for all providers-particularly for those with lower ACE scores-while also recognizing that providers with higher ACE scores may benefit from training to manage personal trauma and enhance their clinical practice.