Dialogues in health最新文献_第2页

Socio-ecological model: Understanding facilitators and barriers to HIV testing and counseling uptake in sub-Saharan Africa – A systematic review 社会生态模型：了解撒哈拉以南非洲地区艾滋病毒检测和咨询的促进因素和障碍-系统综述

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2025-12-23 DOI: 10.1016/j.dialog.2025.100273

Amanda Debuo Der , Elvis Enowbeyang Tarkang

Objective

This systematic review examined the facilitators and barriers to HTC uptake among adults in SSA using the socio-ecological model (SEM).

Methods

A systematic search of Google Scholar, PubMed, Scopus, Sociological Abstracts, PsycINFO and Europe PMC identified 114 HTC uptake studies in SSA from 2010 to 2023 of which 6 met the inclusion criteria. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Individual level facilitators of HTC included high perceived HIV risk, privacy, higher education, and prior testing experience while low HIV knowledge, fear of positive results, stigma, and lack of confidence in self-testing were barriers. Interpersonal facilitators included partner and peer support, and peer normalization of testing, while barriers involved fear of partner reactions, trust concerns, and fear of unintentional disclosure. At the health system-level, facilitators included counseling, positive experiences with providers, and no discrimination while privacy concerns, stigma, and judgmental attitudes of healthcare workers hindered HTC uptake. The community-level barriers included misconceptions and stigma, whereas community-based education improved HTC uptake. At the policy level, cost was a barrier, but availability of self-testing facilitated uptake. The interpersonal factors presented the most significant facilitators (53.3 %), while the policy-level factors were the most significant barriers (57.1 %).

Conclusion

HTC uptake in SSA is shaped by intersecting SEM factors. Understanding these influences are essential for designing effective interventions to improve HTC uptake and linkage to care.

PROSPERO ID: CRD42024583105.

目的利用社会生态模型（SEM）对SSA地区成人摄取HTC的促进因素和障碍进行系统评价。方法系统检索谷歌Scholar、PubMed、Scopus、Sociological Abstracts、PsycINFO和Europe PMC，共检索到2010 - 2023年SSA中114篇HTC摄取研究，其中6篇符合纳入标准。搜索遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目。结果个体层面的促进因素包括HIV风险认知高、隐私、高等教育程度和既往检测经验，而HIV知识低、对阳性结果的恐惧、耻辱感和对自我检测缺乏信心是阻碍因素。人际关系促进因素包括伴侣和同伴的支持，以及同伴对测试的规范化，而障碍包括对伴侣反应的恐惧，信任问题，以及对无意披露的恐惧。在卫生系统层面，促进因素包括咨询，与提供者的积极经验，没有歧视，而隐私问题，污名和卫生保健工作者的判断态度阻碍了HTC的采用。社区层面的障碍包括误解和耻辱感，而社区教育提高了HTC的接受程度。在政策一级，费用是一个障碍，但自检的可用性促进了接受。人际因素是最显著的促进因素（53.3%），政策层面因素是最显著的阻碍因素（57.1%）。结论SSA的htc摄取是由交叉的SEM因素决定的。了解这些影响对于设计有效的干预措施以改善HTC的吸收和与护理的联系至关重要。普洛斯彼罗id: crd42024583105。

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引用次数: 0

Adapting and mitigating: an exploratory Delphi approach to climate change impacts on healthcare institutions in Switzerland 适应和缓解：一个探索性德尔福方法气候变化对瑞士医疗机构的影响

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2025-12-27 DOI: 10.1016/j.dialog.2025.100275

Rafaël Weissbrodt , Pauline Roos , Bozica Krsmanovic , Typhaine Maïko Juvet , Sandrine Corbaz-Kurth , Claude-Alexandre Fournier , Stéphanie Hannart , Valentino Piana

Climate change is increasing morbidity and mortality, exacerbating the imbalance between care needs and available resources. Peer-reviewed literature and international frameworks have emphasized the importance of health system resilience in the face of this growing stressor. Because effective action plans must be tailored to specific national, regional, or local contexts, this study focuses on Switzerland—a Central European country with a high-performing acute care system that is notably energy-intensive and heavily reliant on fossil fuels and imported supplies. Given that temperatures in Switzerland are rising faster than the Northern Hemisphere average, adapting the healthcare system and reducing its energy consumption are critical challenges. The study provides a systematic overview of the anticipated impacts of climate change on the Swiss healthcare institutions and explores their adaptation and mitigation needs. Employing a Delphi approach with ten international climate experts across three phases—semi-structured interviews with thematic analysis, prioritization, and final consensus—we developed a concise conceptual model comprising seven dimensions: (1) Health problems related to climate change, (2) Changing care needs and expectations, (3) Impacts on the functioning of healthcare institutions, (4) Vulnerability of healthcare institutions to the physical impacts of climate change, (5) Contextual factors, (6) Adaptation measures, and (7) Mitigation measures. A typology of items was created for each dimension. Of the 114 final items, 102 were deemed important with strong consensus. The findings complement existing evidence and aim to support healthcare institutions in assessing their external and internal environments to enhance resilience.

气候变化正在增加发病率和死亡率，加剧了护理需求与可用资源之间的不平衡。同行评议文献和国际框架强调了卫生系统在面对这一日益增长的压力源时恢复力的重要性。由于有效的行动计划必须根据具体的国家、地区或地方情况量身定制，因此本研究将重点放在瑞士这个中欧国家。瑞士拥有高效的急症护理系统，但能源密集型且严重依赖化石燃料和进口物资。鉴于瑞士的气温上升速度快于北半球的平均水平，调整医疗保健系统并减少其能源消耗是关键的挑战。该研究系统概述了气候变化对瑞士医疗机构的预期影响，并探讨了其适应和缓解需求。采用德尔菲法与10位国际气候专家分三个阶段进行半结构化访谈，包括主题分析、优先排序和最终共识，我们开发了一个简洁的概念模型，包括七个维度：(1)与气候变化相关的健康问题；(2)不断变化的护理需求和期望；(3)对医疗机构功能的影响；(4)医疗机构对气候变化物理影响的脆弱性；(5)环境因素；(6)适应措施；(7)减缓措施。为每个维度创建了一个项目类型。在114个最终项目中，102个项目被认为是重要的，得到了强烈的共识。研究结果补充了现有证据，旨在支持医疗机构评估其外部和内部环境，以增强复原力。

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引用次数: 0

Use of lethal weapons to kill protesters by Bangladesh police: A discussion analyzing 253 deaths of July 24 revolution 孟加拉国警察使用致命武器杀害抗议者：对7月24日革命253人死亡的分析

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2026-01-08 DOI: 10.1016/j.dialog.2026.100277

Md Abu Bakkar Siddik , Md Syful Islam , Sheikh Muzzammil Hussen , Md. Khalid Syfullah

The use of lethal force by law enforcement against protesters is a critical issue in Bangladesh, where police actions during the July 24 Revolution resulted in more than a thousand recorded deaths. This study analyses the circumstances, demographics, and geographic distribution of these fatalities through a quantitative content analysis of national newspaper reports of 253 deaths, verified through a multi-step validation process to reduce bias. The findings reveal that young adults aged 18 to 29 accounted for 58.1% of victims, underscoring the historical role of youth in political mobilization. Lethal bullets were responsible for 78.66% of deaths, with most fatalities occurring on the spot (77.47%) and predominantly at demonstration sites (75.89%). The chest (46.64%) and head (29.25%) were the most frequently targeted areas, suggesting intentional use of lethal force inconsistent with international norms on proportionality and necessity. These patterns illustrate how the securitization of dissent discursively frames protesters as threats, legitimizing violent repression consistent with broader theories of state violence. In doing so, the findings extend global debates on protest policing by showing how securitization discursively legitimized the lethal targeting of youth protesters in a South Asian context. By situating Bangladesh within South Asian and global debates on protest policing, the study contributes to understanding how state violence undermines democratic participation and public health. The analysis aligns with the World Health Organization's objectives on reducing violence and promoting human rights. While limited by reliance on media reports and cross-sectional data, the findings highlight the need for future research on long-term impacts and for context-specific reforms in accountability, training, and oversight.

执法部门对抗议者使用致命武力是孟加拉国的一个关键问题，在7月24日革命期间，警方的行动导致有记录的一千多人死亡。本研究通过对253例死亡的全国性报纸报道进行定量内容分析，分析了这些死亡的环境、人口统计和地理分布，并通过多步骤验证过程进行验证，以减少偏见。调查结果显示，18岁至29岁的年轻人占受害者的58.1%，强调了青年在政治动员中的历史作用。78.66%的死亡是致命子弹造成的，其中当场死亡最多（77.47%），主要发生在示威场所（75.89%）。胸部（46.64%）和头部（29.25%）是最常见的目标区域，表明故意使用致命武力不符合国际标准的比例和必要性。这些模式说明了异议的证券化如何在话语上将抗议者塑造成威胁，使暴力镇压合法化，与更广泛的国家暴力理论相一致。在此过程中，研究结果通过展示证券化如何在南亚背景下使青年抗议者的致命目标合法化，扩展了关于抗议警察的全球辩论。通过将孟加拉国置于南亚和全球关于抗议警务的辩论中，该研究有助于理解国家暴力如何破坏民主参与和公共卫生。这一分析符合世界卫生组织关于减少暴力和促进人权的目标。虽然受限于对媒体报道和横断面数据的依赖，但研究结果强调，未来有必要对长期影响进行研究，并在问责制、培训和监督方面进行因地制革的改革。

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引用次数: 0

Predicting nurse burnout: A logistic regression approach to workplace and demographic factors 预测护士职业倦怠：工作场所和人口因素的逻辑回归方法

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2025-12-21 DOI: 10.1016/j.dialog.2025.100267

Edona Haxhija , Drita Kruja , Zamira Shabani

Purpose

This study aimed to identify key occupational and demographic factors associated with nurse burnout in a major public hospital in Albania.

Methods

A descriptive cross-sectional survey was conducted among nurses in a regional hospital. Nursing management invited all units to participate. Nurses completed the questionnaire voluntarily and anonymously during breaks. The survey included job satisfaction, burnout risk, working conditions, supervisor and colleague support, workload, shift duration, career opportunities, and demographic variables. Cluster analysis was used to categorize nurses, and exploratory factor analysis examined the structure of job satisfaction factors.

Results

Data from 345 nurses showed that high workload and long shifts significantly increased burnout risk. Strong supervisor support and greater job satisfaction were associated with reduced burnout. Nurses in rural settings had 1.57 times higher odds of burnout compared to urban nurses. Female nurses had 1.25 times greater odds of burnout than male nurses. Advanced education and better career advancement opportunities were linked to lower burnout levels.

Conclusion

Burnout is more prevalent among rural nurses and, to a lesser extent, among female nurses, suggesting the need for context-sensitive and inclusive interventions. Burnout stems from systemic challenges such as excessive workload, insufficient managerial support, and role misalignment. Addressing these issues requires organizational changes including staffing improvements, supportive leadership, and professional development. Future research should apply standardized burnout measures and longitudinal approaches to better understand nurse well-being.

目的本研究旨在确定阿尔巴尼亚一家大型公立医院护士职业倦怠相关的关键职业和人口因素。方法对某地区医院护士进行描述性横断面调查。护理管理部门邀请各单位参与。护士在休息时间自愿匿名完成问卷。调查包括工作满意度、倦怠风险、工作条件、主管和同事支持、工作量、轮班时间、职业机会和人口统计变量。采用聚类分析对护士进行分类，探索性因素分析对护士工作满意度的影响因素进行结构分析。结果345名护士的数据显示，高工作量和长班次显著增加了倦怠风险。强有力的主管支持和更高的工作满意度与减少倦怠有关。农村护士的职业倦怠率是城市护士的1.57倍。女护士的职业倦怠率是男护士的1.25倍。高等教育和更好的职业发展机会与较低的倦怠水平有关。结论职业倦怠在农村护士中更为普遍，在女护士中比例较低，提示需要采取情境敏感和包容性的干预措施。职业倦怠源于系统挑战，如工作量过大、管理支持不足和角色错位。解决这些问题需要组织变革，包括人员配备改进、支持性领导和专业发展。未来的研究应采用标准化的倦怠测量和纵向方法来更好地了解护士的幸福感。

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引用次数: 0

Changing the narrative: Socioeconomic determinants, not gun ownership, drive global homicide rates across 237 countries and territories 改变叙事：在237个国家和地区，推动全球凶杀率的是社会经济决定因素，而不是枪支所有权

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2025-12-23 DOI: 10.1016/j.dialog.2025.100270

Rae-Anne Kastle , Shelby Baxter , Christine Edomwande , An-Lin Cheng , Michael Moncure , Cuthbert Simpkins

Intentional homicide is defined as the unlawful taking of a human life with the intent to cause death or serious injury. Gun ownership is often at the forefront of debates regarding IH, but few have explored this relationship worldwide. Our study seeks to fill this gap by examining the relationship between civilian gun ownership and IH rates globally, while also analyzing various socioeconomic determinants. To investigate this relationship, we conducted a retrospective, cross-national review using publicly available data reported from government websites and public health journals across 237 countries and territories. Spearman Correlation analysis, multivariable linear regression, and ANOVA were conducted with homicide rates as the dependent variable and were repeated after countries were stratified by gross national income. P-values <0·05 were considered significant. Civilian gun ownership did not correlate with IH rates with and without the stratification. The dependent variables that showed the strongest positive correlations with IH rates included Gini Index (r² = 0·55; p < 0·0001) and maternal mortality ratio (r² = 0·52; p < 0·0001). Linear regression showed that the Gini Index (r² = 0·60; p < 0·0001) and poverty rate (r² = 0·44; p = 0·033) can be used to calculate possible IH rates. Gini Index had a positive correlation with IH in lower-income countries. Globally, we found that the Gini Index and poverty rates were strongly associated with IH rates, while there was no correlation between civilian gun ownership. This suggests there are several underlying socioeconomic factors, rather than gun ownership alone, that contribute to IH globally.

故意杀人罪被定义为非法夺取人的生命，意图造成死亡或严重伤害。枪支所有权经常是关于IH的争论的前沿，但很少有人在世界范围内探讨这种关系。我们的研究试图通过研究全球民用枪支所有权与IH率之间的关系来填补这一空白，同时也分析了各种社会经济决定因素。为了调查这种关系，我们利用237个国家和地区的政府网站和公共卫生期刊上报告的公开数据进行了一项回顾性的跨国审查。以杀人率为因变量进行Spearman相关分析、多变量线性回归和方差分析，并在按国民总收入分层后重复进行。p值<；0·05被认为是显著的。无论是否分层，平民枪支拥有率都与IH率无关。与妊高征率呈正相关的因变量包括基尼系数（r2 = 0.55; p < 0.0001）和孕产妇死亡率（r2 = 0.52; p < 0.0001）。线性回归表明，基尼指数（r2 = 0.60; p < 0.0001）和贫困率（r2 = 0.44; p = 0.033）可用于计算可能的IH率。在低收入国家，基尼指数与IH呈正相关。在全球范围内，我们发现基尼指数和贫困率与艾滋病毒感染率密切相关，而平民枪支拥有率之间没有相关性。这表明，在全球范围内，有几个潜在的社会经济因素，而不仅仅是枪支所有权，导致了IH。

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引用次数: 0

Systems thinking in action: Lessons from Jharkhand's journey to reducing maternal mortality 行动中的系统思考：贾坎德邦降低孕产妇死亡率之旅的经验教训

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2025-12-13 DOI: 10.1016/j.dialog.2025.100265

Sanjeev Kumar , Anand Kumar , Amit Kumar Goyal , Ramkrishna Kumar , Pranav Bhushan , Sarwar Khan , Ajit Kumar Singh , Vikas R. Kehsri

引用次数: 0

Cause-variations in neonatal mortality across Europe and Africa; evidence from a 20-year retrospective dataset and clinical practice guidelines 欧洲和非洲新生儿死亡率的原因差异；证据来自20年回顾性数据集和临床实践指南

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2025-12-26 DOI: 10.1016/j.dialog.2025.100272

Frank Adusei-Mensah , Ahmed Ould Boudia , Richard Osei Agjei , Luqman Awoniyi , Ismaila Temitayo Sanusi , Jussi Kauhanen

Background

Global health disparities highlight significant inequities between regions such as Africa and Europe. This present study aims to: (i) compare the trends of the leading causes of neonatal mortalities across Europe and Africa over the past two decades; (ii) analyze the impact of clinical practice guidelines on neonatal mortality trends; and (iii) explore variations in cause-specific neonatal mortality rates between the regions.

Methods

Recent mortality data (2002−2022) were extracted from the WHO database on neonatal mortality for WHO member countries. A comparative non-parametric statistical analysis was conducted on the dataset. Additionally, a scoping review of clinical practice guidelines for both continents was performed, followed by a trend analysis and interrupted time series analysis to explore the impact of these guidelines on neonatal mortality rates.

Results

We observed marked regional differences in the causes of neonatal mortality. In Africa, rates were notably high for conditions including birth asphyxia, prematurity, and infections. Europe showed lower mortality levels with more stable trends. A steady decline in European mortality was significantly associated with a higher volume of published clinical practice guidelines compared to Africa.

Conclusion

Neonatal mortality trends differ significantly between Europe and Africa, with declining rates in Europe and stable or rising rates in Africa. Regional variation in leading causes is evident. The presence of context-specific clinical guidelines is linked to improved outcomes, underscoring the need for tailored, evidence-based interventions.

全球卫生差距突出了非洲和欧洲等区域之间的严重不平等。本研究旨在：(i)比较过去二十年来欧洲和非洲新生儿死亡主要原因的趋势；分析临床实践指南对新生儿死亡率趋势的影响；（三）探讨各区域之间因特定原因造成的新生儿死亡率差异。方法从世卫组织成员国新生儿死亡率数据库中提取2002 - 2022年的近期死亡率数据。对数据集进行了比较非参数统计分析。此外，对两大洲的临床实践指南进行了范围审查，随后进行了趋势分析和中断时间序列分析，以探讨这些指南对新生儿死亡率的影响。结果我们观察到新生儿死亡的原因有明显的地区差异。在非洲，新生儿窒息、早产和感染等疾病的死亡率特别高。欧洲的死亡率较低，趋势更稳定。与非洲相比，欧洲死亡率的稳步下降与出版的临床实践指南数量较多显著相关。结论欧洲和非洲新生儿死亡率趋势差异显著，欧洲新生儿死亡率下降，非洲新生儿死亡率稳定或上升。主要原因的区域差异是明显的。针对具体情况的临床指南的存在与改善结果有关，强调需要有针对性的、基于证据的干预措施。

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引用次数: 0

Antoine Sénanque: When the pen reveals the secrets of the stethoscope 安东尼·萨楠克：当笔揭示听诊器的秘密

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2026-01-27 DOI: 10.1016/j.dialog.2026.100284

El Gaoual Ilham, Taib Berkane, Essarraje Jamal Dine

Purpose

This article investigates the narrative work of neurologist and novelist Antoine Sénanque by situating it at the intersection of medical practice, literary fiction, and social justice. It explores how his novels—Blouse, La Grande Garde, and Guérir quand c'est. impossible—offer a critical perspective on the emotional, ethical, and institutional challenges embedded in contemporary healthcare systems.

Methods

The study employs a qualitative approach combining literary analysis with sociological and narrative medicine frameworks. It draws on the theories of Charon, Fainzang, Pierron, and Bonhomme to examine how Sénanque's fiction articulates the hidden dimensions of the doctor-patient relationship, symbolic violence, and emotional labor in clinical settings.

Results

Findings reveal that Sénanque's narratives expose systemic forms of injustice that are normalized through professional detachment, silencing of emotional expression, and the erasure of patient voices. His fiction critiques institutional expectations that disqualify vulnerability and highlights the ethical significance of narrative presence. By portraying relational breakdowns and moral fatigue, the novels illuminate the symbolic asymmetries that shape the experience of care, particularly for marginalized actors—junior doctors, dying patients, and those excluded from curative logic.

Conclusion

Sénanque's literary corpus functions as a site of narrative resistance and ethical reflection. It underscores the necessity of restoring narrative reciprocity and emotional legitimacy within healthcare. His work suggests that justice in medicine requires not only structural reform but also a cultural shift toward presence, humility, and shared storytelling.

本文通过将神经学家和小说家安托万·萨姆南克的叙事作品置于医学实践、文学小说和社会正义的交叉点来研究他的叙事作品。它探讨了他的小说——《女衬衫》、《大画派》和《古萨伊尔》——是如何诞生的。不可能-提供对嵌入在当代医疗保健系统的情感，道德和制度挑战的关键观点。方法采用文献分析、社会学和叙事医学框架相结合的定性研究方法。它借鉴了Charon， Fainzang， Pierron和Bonhomme的理论来研究ssamanque的小说是如何阐明医患关系，象征性暴力和临床环境中的情绪劳动的隐藏维度的。研究结果表明，ssamunque的叙述揭示了系统性的不公正形式，这些不公正形式通过专业的超然、情感表达的沉默和对患者声音的抹去而正常化。他的小说批评了制度上的期望，这种期望剥夺了脆弱性的资格，并强调了叙事存在的伦理意义。通过描绘关系破裂和道德疲劳，这些小说阐明了塑造护理经验的象征性不对称，特别是对边缘化的演员——初级医生、垂死病人和那些被排除在治疗逻辑之外的人。结论萨楠克的文学语料库是一个叙事抵抗和伦理反思的场所。它强调了在医疗保健中恢复叙事互惠和情感合法性的必要性。他的研究表明，医学上的公正不仅需要结构改革，还需要向在场、谦逊和分享故事的文化转变。

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引用次数: 0

The impact of occupational fatigue on safety and health performance in the porcelain manufacturing industry: An analysis using the ELMERI index 陶瓷制造业职业疲劳对安全健康绩效的影响：基于ELMERI指数的分析

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2026-02-04 DOI: 10.1016/j.dialog.2026.100283

Mostafa Jafarizaveh , Razie Jafarizadeh , Maryam Esmaili , Akram Tabrizi

As a critical social determinant of health, occupational fatigue can be a key indicator for tracking mental health inequalities in working populations. A systematic assessment of fatigue and its impact on safety performance indicators is essential for developing effective preventive strategies in industrial settings. This study aimed to investigate the correlation between occupational fatigue and safety and health performance within an industrial sector in Gonabad, Iran. A descriptive-analytical, cross-sectional study was conducted among industrial workers. Data were collected using a demographic questionnaire, the Swedish Occupational Fatigue Inventory (SOFI) to quantify fatigue, and the ELMERI index to assess safety and health performance levels. Kolmogorov-Smirnov, t-test, Mann-Whitney, and Spearman's rank correlation coefficient tests were used for statistical analysis between variables. The study included participants with a mean work experience of 8.49 (±4.63) years. The mean SOFI score for occupational fatigue was 52.75, indicating a significant burden of fatigue. The mean ELMERI index score was 59.50, reflecting a moderate level of safety and health performance. A significant inverse correlation was found between occupational fatigue and safety performance (r = −0.40, p < 0.05), suggesting that higher levels of fatigue were associated with poorer safety and health outcomes. The findings demonstrate a significant negative relationship between occupational fatigue and safety performance, highlighting the detrimental impact of fatigue on workplace safety. These results underscore the need for implementing fatigue risk management systems and ergonomic interventions in the workplace. Future longitudinal research is recommended to elucidate further the causal mechanisms underlying this relationship.

作为健康的一个关键社会决定因素，职业疲劳可以成为跟踪工作人口心理健康不平等的一个关键指标。系统地评估疲劳及其对安全绩效指标的影响对于在工业环境中制定有效的预防战略至关重要。本研究旨在调查伊朗戈纳巴德一个工业部门的职业疲劳与安全和健康绩效之间的相关性。在产业工人中进行了一项描述性分析的横断面研究。数据收集使用人口调查问卷，瑞典职业疲劳量表（SOFI）来量化疲劳，ELMERI指数来评估安全和健康表现水平。变量间统计分析采用Kolmogorov-Smirnov、t检验、Mann-Whitney、Spearman秩相关系数检验。研究对象的平均工作经验为8.49（±4.63）年。职业疲劳的SOFI平均得分为52.75，疲劳负担显著。平均ELMERI指数得分为59.50，反映了中等水平的安全和健康表现。在职业疲劳和安全表现之间发现了显著的负相关（r = - 0.40, p < 0.05），这表明较高的疲劳水平与较差的安全和健康结果相关。研究结果表明，职业疲劳与安全绩效之间存在显著的负相关关系，突出了疲劳对工作场所安全的有害影响。这些结果强调了在工作场所实施疲劳风险管理系统和人体工程学干预的必要性。建议未来的纵向研究进一步阐明这种关系的因果机制。

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引用次数: 0

Determinants of COVID-19 prevalence in Central Java, Indonesia: An ecological study of socio-demographic, environmental, and healthcare factors 印度尼西亚中爪哇COVID-19流行的决定因素：社会人口、环境和卫生保健因素的生态学研究

Dialogues in health

Pub Date : 2026-06-01 Epub Date: 2025-12-12 DOI: 10.1016/j.dialog.2025.100263

Iqbal Ardiansyah , Agus Subagiyo , Arif widyanto , Army Mitasari

Central Java, Indonesia, experienced a 40.9 % COVID-19 positivity rate in 2022, exceeding the WHO benchmark. This study examines the association between changes in sociodemographic, environmental, and healthcare factors and the rise in COVID-19 prevalence, focusing on regional disparities across Central Java. Variables from public datasets were chosen based on the Social Determinants of Health (SDOH) framework. Data analysis begins with variable identification via Pearson correlation, followed by an Ordinary Least Squares (OLS) regression employing Stepwise Backward Elimination, and subsequent assumption tests including Jarque-Bera, Breusch-Pagan, Moran's I, and multicollinearity checks. Upon identifying spatial autocorrelation and heteroscedasticity, Geographically Weighted Regression (GWR) was applied to address spatial heterogeneity. Ordinary Least Squares (OLS) analysis identified Change in tourist arrival ratio per population, environmental health workforce ratio per land area, and community healthcare workforce ratio per land area as associated factors with change in COVID-19 prevalence. The Geographically Weighted Regression (GWR) model, with a higher R² value of 0.66, better accounted for regional variations, especially in central and eastern regions. The findings indicate that traveler mobility and the spatial distribution of community health workers are linked to increased COVID-19 prevalence, whereas environmental health workers are associated with a protective result, but these are associations at the aggregate (district/city) level and may be influenced by confounding or reverse causation. Structural factors such as unequal access to resources, healthcare, and sanitation, driven by tourism-induced social inequality, contribute to the disproportionate impact of COVID-19 on vulnerable communities, making it essential for policymakers to address these disparities to protect both local populations and visitors. The study recommends regulating risk-based tourist activities, expanding the environmental health workforce, and enhancing spatial monitoring systems to inform evidence-based health policy.

印度尼西亚中爪哇在2022年的COVID-19阳性率为40.9%，超过了世卫组织的基准。本研究考察了社会人口、环境和医疗保健因素的变化与COVID-19患病率上升之间的关系，重点关注中爪哇的区域差异。根据健康的社会决定因素（SDOH）框架从公共数据集中选择变量。数据分析首先通过Pearson相关性进行变量识别，然后采用逐步反向消去法进行普通最小二乘（OLS）回归，然后进行假设检验，包括Jarque-Bera、Breusch-Pagan、Moran's I和多重共线性检验。在识别空间自相关和异方差的基础上，应用地理加权回归（GWR）分析空间异质性。普通最小二乘（OLS）分析发现，人均游客到达率、人均土地面积环境卫生人力比率和人均土地面积社区卫生人力比率的变化与COVID-19流行率变化相关。地理加权回归（GWR）模型的R2值较高，为0.66，较好地反映了区域差异，特别是中东部地区。研究结果表明，旅行者流动性和社区卫生工作者的空间分布与COVID-19患病率增加有关，而环境卫生工作者与保护性结果有关，但这些都是在总体（区/市）层面上的关联，可能受到混杂或反向因果关系的影响。由旅游业引发的社会不平等造成的资源、医疗保健和卫生设施获取不平等等结构性因素，助长了COVID-19对弱势社区的不成比例影响，因此政策制定者必须解决这些差异，以保护当地居民和游客。该研究建议规范基于风险的旅游活动，扩大环境卫生人力，并加强空间监测系统，为基于证据的卫生政策提供信息。

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