Asia-Pacific Journal of Public Health最新文献

The purpose of this study was to investigate the effects of the COVID-19 pandemic on the mortality of traumatic brain injury (TBI) patients transported by emergency medical services (EMS). Adult TBI patients who were assessed and transported by EMS between January 2018 and December 2021 were analyzed. The main exposure was during the COVID-19 pandemic period at the time of the event. The primary outcome was in-hospital mortality. A total of 18 988 patients were analyzed. The in-hospital mortality in the COVID-19 era group was 1812 (20.9%), and that in the non-COVID-19 era group was 2040 (19.8%). Multivariate logistic regression analysis revealed a significantly greater probability of in-hospital mortality in the COVID-19-era group; adjusted odds ratio of 1.16. Compared with non-COVID-19 era patients, TBI patients who were assessed and transported during the COVID-19 era were more likely to have higher in-hospital mortality.

This study aimed to explore the perspectives of actors in human immunodeficiency virus (HIV) prevention concerning pre-exposure prophylaxis (PrEP) in Cambodia. Interviews with national-level policymakers and focus groups with service providers (health care workers and community-based organization [CBO] workers) providing care to key populations (KPs) were conducted in 2022. Actors viewed pre-exposure prophylaxis as an effective tool for reducing HIV transmission among KPs and were committed to its implementation. However, they were concerned about KPs' lack of protection against sexually transmitted infections other than HIV and about unintended pregnancies, as well as potential challenges to PrEP adherence and associated side effects. Key barriers to implementation included funding shortages, difficulties in reaching mobile KPs, and the need for further training for service providers. This study revealed the strong commitment to PrEP of actors in HIV prevention in Cambodia, and the need for community-centered approaches to ensure that sexual and reproductive health services best meet KPs' needs.

Informal carers are essential to post-stroke recovery in Malaysia but often encounter significant challenges with minimal support. This qualitative study examined the lived experiences of 10 carers of stroke survivors with moderate to severe dependency in Klang Valley. Guided by Schlossberg's transition theory, in-depth interviews were analyzed using inductive thematic analysis. Five main themes emerged: (1) focus shifted toward the stroke survivors, (2) caregiving repercussions, (3) lack of resources, (4) ways of surviving hardships, and (5) beauty emerging from hardships. Findings highlighted the public health importance of integrating carer support into post-stroke services, particularly in aging societies. Policy measures should include structured carer training, expanded community rehabilitation, workplace flexibility, and stronger linkages between health care, social services, and non-governmental organizations. Addressing these needs can enhance carer wellbeing, improve survivor outcomes and reduce long-term health system burdens.

In Indonesia, weaknesses in the neonatal emergency referral and transport system have been identified as important factors in preventable neonatal deaths. To address this, a bottleneck analysis study was conducted in Surabaya using the modified Tanahashi model to identify bottlenecks in four key domains: supply, demand, quality, and the enabling environment. A mixed-method approach was employed. Qualitative data from interviews and focus groups identified gaps and underlying causes. Tracer indicators were used for targeted quantitative data collection through Health Facility Assessments and secondary data review to measure the gap extent. Primary health care facilities lacked trained staff, and bed shortages delayed transfers. Nonstandardized processes hindered transfer efficiency and affected neonatal care at specialized hospitals. Systemic weaknesses were found in data collection, monitoring, interagency coordination, and policy implementation. The bottleneck analysis framework effectively identified critical gaps and guided strategic prioritization for system improvement. Findings highlight the need for reviewing facility standards, modifying staff training, streamlining referral processes, establishing clear oversight roles for referral and prioritizing systematic monitoring and evaluation. The selected tracer indicators offer a framework for assessing neonatal emergency referral systems in other resource-limited settings, supporting efforts to improve neonatal survival through more effective referral and transport mechanisms.

Educational level is a key determinant of subjective health status. Drawing on conceptual hypotheses regarding how its relationship develops across the life course and differs across cohorts, this study examined long-term patterns in their association using data from the Korea National Health and Nutrition Examination Survey (KNHANES). Integrated data from eight waves (2001-2023) comprising 94,717 adults were analyzed to assess trends in the association between two variables. Inverse probability weighting (IPW) was applied by multiplying the IPW weights with the complex survey design weights. After applying IPW, subjective health status among baby boomers with less than middle school group decreased by 0.28 per decade, while the decline was ≤0.1 among older cohorts. High school and college graduates reported 0.18 and 0.29 points higher subjective health, with slight downward trends over time. The findings support two hypotheses, confirming a persistent association between educational level and subjective health status across time.

Japan launched a municipal financial incentive program in 2018 to promote higher-quality long-term care (LTC). We quantified the association between municipal incentive performance and subsequent incident LTC certification and all-cause mortality among community-dwelling older people. Baseline 2016 data from the Japan Gerontological Evaluation Study (N = 90 896 adults aged ≥65 years in 23 municipalities) were linked to 2018-2020 administrative records. Each municipality received a composite incentive score (0-612). Using multivariable logistic regression with fixed effects, we estimated odds ratios (ORs) per 1 SD score increase, adjusting for demographics, socioeconomic status, and health. Over three years, 10.7% newly required LTC certification and 5.1% died. A 1 SD higher incentive score was associated with lower odds of incident LTC (OR: 0.91) and all-cause mortality (OR: 0.66). These benefits were driven by the "Support Functional Independence/Prevent Progression" domain in less-urban areas, while plan-do-check-act-style activities predominated in cities. Overall, better municipal performance under Japan's financial incentive policy correlated with short-term reductions in LTC utilization and mortality among older residents, supporting continued monitoring and policy refinement.

The prevalence of overweight/obesity (OW/OB-defined by body mass index) in low- and middle-income countries is rising, and the sociodemographic characteristics of the most affected populations are changing. The relationship between education, widely recognized as a gender-related variable, and OW/OB in high-income countries is well understood; however, the impact in South Asian (SA) countries is less clear. This systematic review interrogated the relationship between educational attainment and OW/OB, by searching Ovid MEDLINE, CINAHL, EMBASE, and Web of Science for studies published after 2013, reporting the prevalence of OW/OB by educational attainment in eight SA countries. Data were extracted and the association between education and OW/OB was coded as direct, indirect, null, or U-shaped. A total of 32 studies were included in the review. The mean age was 38.5 years. The prevalence of OW/OB ranged between 4.6% and 64.4%. Females were reported to be at higher risk of OW/OB compared with males. Most of the studies reported women with higher education at greater risk of being OW/OB. SA countries are undergoing substantial transformations in their economic and social frameworks that influence how sex and gender mediate cardiovascular risk factors like OW/OB. Preventive strategies must be tailored to the unique characteristics of the SA population.

Evidence on modern contraceptive use among Orang Asli women is limited. This study aimed to assess the prevalence and factors influencing modern contraceptive use among married or cohabiting Orang Asli women of reproductive age (15-49 years). Data from 3249 Orang Asli women in the 2022 Orang Asli Health Survey (OAHS), a cross-sectional study employing a two-stage stratified random sampling design, were analyzed. Complex sample analysis with logistic regression was applied. The study found that 53.3% of Orang Asli women used modern contraceptives. Key factors significantly associated with contraceptive use included residence in remote areas (aOR=1.88; 95% CI = 1.08, 3.27), age 20-34 years (aOR = 2.43; 95% CI = 1.91, 3.09), and having three or more children (aOR = 2.17; 95% CI = 1.75, 2.70). The prevalence of modern contraceptive use among Orang Asli women exceeded Malaysia's national average and Indigenous populations globally. Improving accessibility and affordability remains critical, particularly for Orang Asli women in urban areas, to reduce disparities.

The Orang Asli, the indigenous community of Peninsular Malaysia, experience significant health disparities. This study assesses the prevalence and factors associated with poor self-rated health (SRH) among adults aged 18 and above using data from the Orang Asli Health Survey 2022. The prevalence of poor SRH was 12.8% (95% CI: [9.74, 16.68]). Factors associated with poor SRH are health-related factors (acute illness [adjusted odds ratio, aOR = 4.61, 95% CI: [3.54, 5.99]], recent hospitalization [aOR = 2.58, 95% CI: [1.78, 3.74]]), sociodemographic (unemployment [aOR = 1.51, 95% CI: [1.30, 1.76]], older age [aOR = 0.43, 95% CI: [0.30, 0.64]], and the Negrito tribes [aOR = 0.61, 95% CI: [0.37, 0.99]]) as well as lifestyle (tobacco use [aOR = 1.26, 95% CI: [1.03, 1.53]]). These findings underscore the importance of integrated health and social interventions sensitive to Orang Asli beliefs to improve health equity.