Global health journal (Amsterdam, Netherlands)最新文献

Objectives

This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance (CBHI) scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms. There is growing concern about the financial sustainability of CBHI schemes in developing countries. However, few empirical studies have identified potential contributors, including ex-ante and ex-post moral hazards.

Methods

We implement a household fixed-effect panel data regression model, drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia.

Results

The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals. However, CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms. Particularly, on average, we estimate about 4‒6 h delay for malaria symptoms, a little above 4 h for tetanus, and 10‒11 h for tuberculosis among the insured households.

Conclusions

While there is evidence that CBHI improve the utilization of outpatient or primary care services, our study suggests that insured members may wait longer before visiting health facilities. This delay could be partly due to moral hazard problems, as insured households, particularly those from rural areas, may consider the opportunity costs associated with visiting health facilities for minor symptoms. Overall, it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

In sub-Saharan Africa (SSA), 63% of new human immunodeficiency virus (HIV) infections in 2021 were among women, particularly adolescent girls, and young women. There is a high incidence of HIV among pregnant and lactating women (PLW) in SSA. It is estimated that the risk of HIV-acquisition during pregnancy and the postpartum period more than doubles. In this article, we discuss the safety and effectiveness of drugs used for oral HIV pre-exposure prophylaxis (PrEP), considerations for initiating PrEP in PLW, the barriers to initiating and adhering to PrEP among them and suggest recommendations to address these barriers. Tenofovir/emtricitabine, the most widely used combination in SSA, is safe, clinically effective, and cost-effective among PLW. Any PLW who requests PrEP and has no medical contraindications should receive it. PrEP users who are pregnant or lactating may experience barriers to starting and adhering for a variety of reasons, including personal, pill-related, and healthcare facility-related issues. To address the barriers, we recommend an increased provision of information on PrEP to the women and the communities, increasing and/or facilitating access to PrEP among the PLW, and developing strategies to increase adherence.

The medical metaverse and digital twin are set to revolutionise healthcare. Like all emerging technologies their benefits must be weighed against their ethical and social, impacts. If we consider the advances of medical technology as an expression of our values, such as the pursuit of knowledge, cures and healing, an ethical study allows us to align our values and steer the technology towards an agreed goal. However, to appreciate the long-term consequents of a technology, those consequences must be considered in the context of a society already shaped by that technology. This paper identifies the technologies currently shaping society and considers the ethical, and social consequences of the medical metaverse and digital twin in that future society.

Urban agriculture is gaining recognition for its potential contributions to environmental resilience and climate change adaptation, providing advantages such as urban greening, reduced heat island effects, and decreased air pollution. Moreover, it indirectly supports communities during weather events and natural disasters, ensuring food security and fostering community cohesion. However, concerns about planetary health risks persist in highly urbanized and climate-affected areas. Employing electronic databases such as Web of Science and PubMed and adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we identified 55 relevant papers to comprehend the planetary health risks associated with urban agriculture. The literature review identified five distinct health risks related to urban agriculture: (1) trace metal risks in urban farms; (2) health risks associated with wastewater irrigation; (3) zoonotic risks; (4) other health risks; and (5) social and economic risks. The study highlights that urban agriculture, while emphasizing environmental benefits, particularly raises concerns about trace metal bioaccumulation in soil and vegetables, posing health risks for populations. Other well studied risks included wastewater irrigation and backyard livestock farming. The main limitations in the available literature were in studying infectious diseases and antibiotic resistance associated with urban agriculture.

Significant technological trends are impacting health care, from consumerisation, datafication, circular economy, and platformization of services. Web 3.0, or the Internet of Value, enables direct peer-to-peer value exchange, opening up new business models that will impact health care. Among the many technologies that will also be part of the healthcare transformation is artificial intelligence, which shocked the world with the debut of ChatGPT in 2022. This opinion piece will explore how AI underpins the health transformation and, far from being an enemy of health, is the critical friend health care has been waiting for.

The advent of immersive technologies such as the metaverse, extended reality, artificial intelligence, and blockchain offers novel possibilities to transform healthcare services. These innovations coincide with clinicians' aspirations to deliver more comprehensive, patient-centered care tailored to individuals' singular needs and preferences. Integration of these emerging tools may confer opportunities for providers to engage patients through new modalities and expand their role. However, responsible implementation necessitates deliberation of ethical implications and steadfast adherence to foundational principles of compassion and interpersonal connection underpinning the profession. While the metaverse introduces new channels for social prescribing, this perspective advocates that its ultimate purpose should be strengthening, not supplanting, human relationships. We propose an ethical framework centered on respect for patients' dignity to guide integration of metaverse platforms into medical practice. This framework serves both to harness their potential benefits and mitigate risks of dehumanization or uncompassionate care. Our analysis maps the developing topology of metaverse-enabled care while upholding moral imperatives for medicine to promote healing relationships and human flourishing.

Background

Alcohol and illicit drugs (AID) continue to be a major global health concern. Although preventable, AID is linked to millions of deaths annually worldwide. The situation is particularly grave for young people, with AID being a major direct risk factor for disability-adjusted youth life-years lost and death. It further contributes to assaults, road crashes, accidental poisoning, and suicide, leading to long-term issues and public health concerns.

Objective

This study aimed at disclosing current AID prevalence data for Argentinian, Bulgarian, Chilean and Romanian youth. It shed light on the predictors of AID in young people from those countries.

Method

The study used an online survey to gather data from people aged 18 to 25 (n = 1,297). The survey was underpinned by the theory of planned behaviour (TPB). Predictors were investigated separately for drinking alcohol and using illicit drugs.

Results

Our data revealed that across the four target countries, 49% to 90% of the participants drank alcohol, and 8% to 35% used illicit drugs in the past three months. Between 20% and 91% of them intended to drink, and between 8% and 31% intended to use illicit drugs in the following three months. Our TPB model predicted statistically significant (P < 0.001) amounts of variance in drinking alcohol (between 61% and 72%) and using illicit drugs (between 20.3% and 74.4%). Intention was consistent in significantly predicting both behaviours. Evidence around the predictive validity of self-efficacy, age and gender was mixed across the investigated countries.

Conclusion

This research provided an update on the scarce AID epidemiological data. It also supplied evidence about what theoretically-informed measures might be useful targets of interventions in the case of Argentina, Bulgaria, Chile and Romania. This new knowledge of understanding substance abuse determinants and prevalence may help researchers and practitioners better meet young people's health prevention needs.

Background

Pen-pal clubs (PPC) are used worldwide for students to learn about different cultures and other skillsets without the need for travel. Many medical students are interested in global health opportunities abroad but costs, scheduling, and other barriers allow few to participate in such experiences. It is important that medical students have nuanced global medical perspectives and can contribute to the global medical community.

Objective

The purpose of this study is to demonstrate that an international medical student PPC improves medical students’ perspectives of cultural competency and global health engagement.

Methods

In 2021, a novel medical student PPC was established that began between an American and Japanese medical school. Following a shareholders meeting, it was decided that the number of medical schools involved globally be expanded through previous institutional affiliations and online presences. In total, the club connected 50 American medical students and 52 medical students from 17 high- and middle-income countries. The primary form of communication was online; pen-pals were encouraged to communicate monthly using provided topics, although frequency and way of communication was their discretion. In February 2022, American PPC members were emailed a qualitative survey to assess the PPC's impact.

Results

The survey was completed by 42% of American PPC members, 95% of which were 22‒26 years. Participants were preclinical medical students, 60% whom were female and the majority either white (47%) or Asian (43%). Overall, the PPC positively influenced American medical students’ perception of global medicine, medical education, and their cultural competency after joining the PPC compared to prior (P = 0.004).

Conclusion

PPCs encourage medical students to think from a global perspective and foster open-mindedness within varying social and cultural contexts. Having a global communication platform for students during medical school education may be an additional way to train aspiring global leaders.