Public health challenges最新文献

Introduction: Vaccinations are vital for global health; however, since the onset of the COVID-19 pandemic in 2020, there has been a notable decline in maternal vaccine acceptance in Wales, UK. It is a key part of a midwife's role to promote vaccine uptake in pregnancy. Therefore, gaining an understanding of midwives' perceptions of the issue is crucial for identifying factors influencing vaccine uptake in Wales.

Methods: A quantitative, cross-sectional descriptive survey was conducted amongst 143 registered midwives working in Wales using the Capability, Opportunity, Motivation-Behaviour (COM-B) approach to identify factors affecting vaccine uptake.

Results: Midwives lacked training and confidence to promote vaccines, and some noted language barriers as a problem to providing equitable care. Other problems included lack of access to vaccination appointments and inconsistencies in vaccine promotion depending on care provider. Midwives perceived vaccine hesitancy to be high, with 71% saying they thought vaccine hesitancy was common amongst pregnant women and 40% saying they thought it was common amongst their colleagues.

Conclusion: A national approach is required to ensure effective vaccination training amongst midwives in Wales, as well as improved availability of language diverse resources. Additional qualitative research is needed in Wales and the United Kingdom to further understand vaccine hesitancy and barriers to promoting vaccine uptake in pregnancy.

Introduction: This study aims to investigate the association between young children receiving hospital treatment for burn injuries and their parents' education levels.

Method: A retrospective register study collected data using diagnostic codes (T20-T25 and T29) for children seeking emergency medical care for burn injuries between 2018 and 2022. T20-T25 and T29 refer to burn injuries, where each number specifies the affected body region. An additional selection was made using ICD code chapters S and T for overall injury-related hospital care. The inclusion criteria for this study were children aged 0-6 years who had received emergency or specialised care at Queen Silvia Children's Hospital. The education levels of parents, as well as those of children who received care at the hospital, were grouped and aggregated at the area level. Parental education level data were obtained from Gothenburg's public statistical database to determine education levels in the city's areas. The mean of these two variables was calculated, and a simple linear regression was conducted. Data were aggregated and analysed at the intermediate area level rather than the individual level.

Results: The results showed an association between children's burn injuries and parents' education levels; however, parental education level and overall injury-related hospital care were not associated with eachother.

Conclusions: This study demonstrated an association between burn injuries and parental education levels, which needs consideration in clinical practice and future research. Future efforts should explore targeted health literacy and parental support interventions in low-education areas.

This scoping review identifies the challenges in elderly caregiving across the Indian subcontinent by analyzing 21 studies selected from an initial pool of 5349 records. Key issues identified include limited access to healthcare services, high rates of multimorbidity, significant caregiver burden, and difficulties in adopting new health technologies. Additionally, the review highlights the inadequacies in healthcare infrastructure, the impact of socioeconomic factors, and financial barriers to the healthcare of the elderly in the Indian subcontinent. Urban-rural disparities, cultural norms, and the high prevalence of both chronic and infectious diseases also complicate caregiving. The study calls for comprehensive strategies to improve healthcare infrastructure, enhance financial support, strengthen government policies, and promote caregiver training and technology adoption. Addressing these challenges is crucial for improving the quality of life and healthcare for the elderly in the Indian subcontinent.

Anemia remains a persistent public health challenge in India, disproportionately affecting women and undermining maternal and reproductive health outcomes. Despite nationwide efforts, the burden of anemia continues to vary widely across regions, reflecting complex socio-demographic determinants. This study aims to identify region-specific risk factors for anemia among non-pregnant women in East and West Uttar Pradesh (UP), India, using data from the National Family Health Survey (NFHS-5). A secondary data analysis was conducted to explore socio-demographic correlates of anemia among non-pregnant females in East and West UP. Binary and ordinal logistic regression models were employed to analyze various explanatory variables. For variables not meeting the proportional odds assumptions, ordinal variables were binary categorized. Significant regional differences in the correlates of anemia were identified. In West UP, higher odds of anemia were associated with rural residency, alcoholism (odds ratio [OR] = 1.153; p < 0.01), heart disease (OR = 1.155; p < 0.01), younger age, economic disadvantage, illiteracy (OR = 1.335; p < 0.01), and underweight status (OR = 1.523; p = 0.012). In East UP, higher odds of anemia were associated with illiteracy (OR = 1.095; p = 0.010), having a child aged ≤48 months (OR = 1.296; p < 0.01), breastfeeding (OR = 1.067; p < 0.01), alcoholism (OR = 1.155; p < 0.01), hypertension (OR = 1.502; p < 0.01), and underweight status (OR = 1.523; p = 0.012). The study highlights significant differences in the socio-epidemiological correlates of anemia between East and West UP. A universal public health policy is insufficient to address these disparities. Instead, a "Precision Public Policy" tailored to the specific needs of each region is necessary to improve implementation and outcomes.

Background: Project Extension for Community Health Care Outcomes (Project ECHO) is recognized as an effective and affordable way to improve healthcare professionals' knowledge. Project ECHO rapidly expanded in Tanzania from 1 hub to 4 hubs and 12 to nearly 200 spokes in just 3 years. Despite its success, participation among healthcare workers remains low. The study aimed to determine the institutional factors influencing nurses' participation in Project ECHO sessions.

Methods: This cross-sectional study was conducted among 450 nurses from 42 selected primary health facilities in Dar es Salaam, Tanzania. A standardized questionnaire was used to collect data from the study participants. We evaluated the association between sociodemographic variables and institutional factors with Project ECHO participation through descriptive analyses and multivariable logistic regression.

Results: Overall, 64% of the study participants had not attended a single ECHO clinic in the past year. The availability of information and communications technology experts to provide technical backstopping to staff (AOR: 0.45, 95% CI: 0.27-0.76, p value = 0.003) and the availability of designated rooms equipped with appropriate equipment (AOR: 20.95, 95% CI: 4.44-98.82, p value < 0.001) were associated with participation.

Conclusion: The study identifies several factors influencing nurse participation in Project ECHO. These include internet access, incentives, and well-equipped computer labs, all highly valued. Additionally, the availability of information, communication, and technologies (ICT) experts and effective training significantly contribute to positive experiences. To improve participation, addressing the challenges posed by inflexible scheduling and resource limitations is essential.

Objectives: There is a notable rise in patient-initiated imaging requests, with one possible reason being the increased availability of online health information. This study specifically examines the impact of patient-initiated radiological exams on radiologists. Exploring their perspectives on how GPs acquiescing to patients' medical imaging requests impacts healthcare resources and skew patients' expectations of the capabilities of radiological studies. The findings of this study are crucial for understanding the evolving dynamics of radiology practice and its challenges.

Method: A comprehensive cross-sectional opinion survey was administered to radiologists in private multi-specialty medical centers across Australia between November 2023 and February 2024. The survey included structured and open-ended questions distributed via an intranet platform within the same company and reached a wide range of radiologists. A total of 37 survey responses were received from the 100 surveys sent to radiologists, resulting in a response rate of 37%. Of these, 10 provided incomplete responses, leaving 27 for analysis.

Results: Nearly half of the participants (48%) had over 20 years of experience. The majority of radiologists self-reported X-rays (27%), ultrasounds (25%), and computed tomography (CT) scans (24%) as the most commonly requested non-indicated imaging studies. Radiologists attributed these requests to patients' exposure to online medical information and their desire for reassurance. Approximately 24% of radiological studies were deemed unnecessary due to a lack of correlation between clinical history and the imaging or procedure requested to address the clinical issue, with 30% of radiologists reporting feeling pressured by GPs and patients to expedite report completion. Proposed strategies included patient education, communication, and the establishment of clear guidelines.

Conclusions: The study highlights the potential for a growing burden of patient-initiated imaging on radiologists. This burden is further compounded by patients' unrealistic expectations and lack of understanding of diagnostic imaging's limitations, as considered by those surveyed. Radiologists have stressed the crucial role of the broader healthcare context in collaborating with such requests. Patient education was emphasisX-ed to reduce unnecessary imaging and manage patient expectations.

Practice implications: Educating patients about the limitations and appropriate use of diagnostic imaging can help reduce unwarranted requests and manage patient expectations. The study emphasises the need for clear, evidence-based guidelines to assist GPs in addressing patient demands for unnecessary imaging studies. Another contribution from the study is the necessity for improved communication strategies among radiologists, GPs, and patients to ensure a collaborative approach t

Background and aims: In sub-Saharan Africa (SSA), less than 10% of men, compared to 50%-80% of women, are affected by sexually transmitted infections (STIs). Untreated STIs can lead to severe reproductive health complications, including infertility, pelvic inflammatory disease, and increased susceptibility to HIV. Understanding the determinants of healthcare-seeking behaviour for STIs is crucial for informing policies and interventions aimed at improving access to timely and appropriate care. This study examined the healthcare-seeking behaviours of adolescent girls and young women (AGYW) with STIs in SSA.

Methods: Our study utilised data from the Demographic and Health Surveys of 20 countries in SSA. We used a forest plot to present the results on the prevalence of healthcare seeking for STIs among AGYW in SSA. Additionally, we examined the predictors of healthcare seeking for STIs using a multilevel binary logistic regression analysis.

Results: The results showed that 54.31% (95% confidence interval [CI]: 53.48-55.14) of AGYW in SSA sought healthcare for STIs. This ranged from as low as 26.98% (95% CI: 23.44-30.52) in Ethiopia to as high as 82.50% (95% CI: 78.38-86.62) in Liberia. AGYW aged 20-24 (adjusted odds ratio [aOR] = 1.49, 95% CI: 1.31-1.71), those who were cohabiting (aOR = 1.40, 95% CI: 1.10-1.79), those with secondary [aOR = 1.49, 95% CI: 1.20-1.85] or higher education [aOR = 1.68, 95% CI: 1.08-2.61], those who were working at the time of the survey [aOR = 1.23, 95% CI: 1.07-1.40], those who were covered by health insurance [aOR = 1.45, 95% CI: 1.09-1.93], and those in richest wealth quintiles [aOR = 2.18, 95% CI: 1.62-2.92] were more likely to seek healthcare for STIs.

Conclusion: Our study has shown that the proportion of AGYW who sought healthcare for their STIs is relatively low, with country-level variations. Several factors were found to be associated with healthcare seeking for STIs. Focused interventions are required to enhance access to healthcare treatments for STIs among the vulnerable sub-populations.

Aims: This study aims to determine the prevalence of mild cognitive impairment and major neurocognitive disorder among adults aged greater than or equal to 60 in Kaniyambadi block, Vellore, and the factors associated with cognitive impairment.

Settings and design: A community based cross sectional study was conducted on 360 adults greater than or equal to the age of 60 residing in Kaniyambadi block, Vellore.

Methods and material: A semi-structured interviewer-based questionnaire was administered to the participant. Their subjective and objective cognitive abilities were assessed along with their ability to perform their activities of daily living. The participants were also screened for depression.

Statistical analysis used: Univariate analysis was done using measures of central tendencies and proportions. Bivariate analysis was done using Chi square test, and logistic regression was also performed.

Results: The prevalence of mild cognitive impairment among adults aged more than or equal to 60 residing in Kaniyambadi block was 20% (95% CI 15.9-24.5). The prevalence of major neurocognitive disorder in the same population was 4.4% (95% CI 2.5-7.1), and the prevalence of depression was 18.9% (95% CI 14.9-23.3). Age greater than or equal to 70 (AOR 2.24 [1.38-3.64]), no formal education (AOR 2.62 [1.52-4.48]), and depression (AOR 3.64 [1.90-6.99]) were found to be statistically significantly associated with cognitive impairment.

Conclusions: The overall prevalence of mild cognitive impairment and major neurocognitive disorder in Kaniyambadi block was found to be similar to the prevalence in other parts of the nation. Adults aged more than 70 and those with no formal education are associated with a greater risk of developing cognitive impairment. As depression is also associated with cognitive impairment, it is imperative to screen the elderly with depression and other psychiatric illnesses for cognitive impairment.

Key messages: Cognitive impairment is an emerging public health problem that is affecting many elderly people in the population. Early identification and cognitive rehabilitation of those affected with mild cognitive impairment can help slow the progress to major neurocognitive decline.

Background: In Afghanistan, providing care for reproductive tract infections (RTIs) is challenging, among other factors, due to the extreme scarcity of reliable data. To address this gap, the present study investigates symptoms, potential risk factors, knowledge, and care-seeking behavior in the largest sample of women to date.

Methods: From September 16, 2022 to November 26, 2022, a structured questionnaire was administered to women presenting at multi-specialist clinics in the major cities of Afghanistan. Signs and symptoms of RTIs were investigated, together with reproductive history, hygiene practices, and sociodemographic characteristics. Logistic regression, adjusted for selected covariates, was used to assess predictors of delays (over 1 month) from symptoms onset to care-seeking, and of a history of RTI.

Results: A total of 601 responses were analyzed (80.2%). Mean age was 31.3 years (standard deviation [SD] 11.5). Signs symptoms related to RTIs were reported by 79.2%, knowledge of RTIs by only 23.0%, and care-seeking delays by up to 39.5%. Care-seeking delays were positively associated with abnormal vaginal discharge (odds ratios [OR] 4.12; 95% confidence intervals (CI) 2.01-8.45), lower abdominal pain (2.62; 1.44-4.77), and fever (1.93; 1.25-2.98) and negatively associated with being sedentary (0.38; 0.22-0.64), hand washing (0.61; 0.40-0.95), and knowledge about RTI, although borderline significant. A history of RTI (reported by 44.1%) was predicted by abnormal vaginal discharge, fever, irregular menstruations, and use of sanitary pads but not by the husbands' history of RTI.

Conclusions: The majority of women presenting at clinics in Afghanistan reported symptoms related to RTIs, delayed care-seeking, and lack of knowledge about RTI. Healthcare providers should inform the population about RTIs and their standard care pathway, while adopting a multi-dimensional approach accounting for the cultural background of the women.

Millions of individuals worldwide suffer from hepatitis B, a serious, potentially fatal liver infection brought on by the hepatitis B virus (HBV). Although vaccines are available for HBV, infections continue to persist in Ghana. This study reports the prevalence of HBV infections in outpatients and pregnant women attending antenatal care at the Seventh-day Adventist (SDA) Hospital in Gbawe, Ghana. This retrospective cohort study involved the review of de-identified medical records of outpatients and pregnant women who visited the hospital between 2022 and 2024. Data on their HBV infection status, sex and age were analysed using R version 4.4.1. A total of 531 outpatients and 768 pregnant women visited the hospital during the study period. The prevalence of HBV infection was 7.5% in outpatients and 3.9% in pregnant women. It was observed that outpatients were more likely to be hepatitis B surface antigen (HBsAg) positive (OR = 2.0, 95%CI = 1.24-3.28, p = 0.005). It was also seen that HBV prevalence increased from 2022 to 2023 and decreased in 2024. There is a need for more educational campaigns to raise awareness of HBV infections, especially in pregnant women due to the risk of mother-to-child transmission. Furthermore, vaccinations need to be made affordable and easily accessible to the general population to ensure maximum coverage within the country.