BMC Public Health最新文献

Background: Deaf and hard-of-hearing (DHH) individuals frequently experience communication barriers in dental settings, resulting in delayed care and increased dental anxiety. Digital tools tailored to their linguistic and cultural needs are limited. This study reports the development and preliminary evaluation of MoDeHe (Mobile Dentist Hearing), a novel mobile application designed to improve communication and support dental management for DHH individuals.

Methods: MoDeHe was fully developed by a multidisciplinary team, incorporating input from DHH consultants and dental professionals. The application consists of two main modules: (i) the Patient Information module, which provides educational sign language (SL) videos on oral health and common dental procedures, and (ii) the Dental Examination module, which includes SL-supported decision trees to facilitate communication during clinical examinations. A pre-post observational study was conducted with 39 DHH participants. Baseline measures included self-reported oral health status and items from the Modified Dental Anxiety Scale. Post-test measures assessed usability, satisfaction, communication preferences, and confidence attending dental care independently.

Results: At baseline, 82.1% of participants had not visited a dentist in over two years and 89.7% perceived their oral health as poor. Communication barriers contributed to cancelled appointments (69.2%) and reliance on interpreters (61.5%). After interacting with MoDeHe, 97.4% reported satisfaction, 66.7% preferred the app as their primary communication facilitator, and 84.6% felt confident visiting the dentist without an interpreter.

Conclusions: MoDeHe is an innovative mobile health (mHealth) solution developed specifically for DHH individuals to enhance communication and accessibility in dental care. Its offline functionality and culturally adapted SL content support scalability in diverse, resource-limited settings. Future studies should assess long-term clinical usability and adaptation to regional SL variations.

Background: North Kivu, in eastern Democratic Republic of the Congo (DRC), was the epicenter of the second largest Ebola Virus Disease (EVD) outbreak in history and has been an active conflict zone for decades. The COVID-19 pandemic further exacerbated an already complex situation. This qualitative study, conducted as part of a broader investigation into Ebola vaccine hesitancy and at the onset of COVID-19 vaccination rollout in the DRC, assessed perceptions, beliefs, and attitudes toward the COVID-19 virus and vaccines among community members and healthcare workers who had experienced the 2018-2020 EVD outbreak, during which a novel vaccine was also administered.

Methods: Between May and June 2021, thirty-three focus group discussions (FGDs) and fifteen key informant interviews were conducted across three health zones that had offered Ebola vaccination (rVSV-ZEBOV) during the 2018-2020 EVD outbreak. Participants included healthcare workers (HCWs) and community members, as well as leaders, administrative officials, and frontline workers who had supported outbreak response and vaccination services.

Results: Across all locations and groups, perceived risk of COVID-19 was low, with many participants doubting its existence and relevance, particularly when compared to other needs and endemic health conditions in their communities. COVID-19 was believed to primarily affect white, affluent individuals in urban areas, and not those residing in hot climates. Vaccine hesitancy was driven by perceived insufficient transparency and communication regarding COVID-19 vaccines, including questions about their composition, potential side effects, and rationale behind prioritizing certain groups. COVID-19 vaccine perceptions also reflected broader concerns, including mistrust of the government and rumors related to past Ebola outbreaks and vaccination efforts. To increase uptake, respondents recommended ensuring COVID-19 vaccination is voluntary and free of charge, working with non-traditional local demand generation and vaccination actors, strengthening local vaccine production capacity, and increasing the impact of interpersonal communication through social media messaging.

Conclusions: These findings add to growing evidence on how prior exposure to another disease of international concern (Ebola) and the associated vaccine, as well as historical context, influence perceptions of novel vaccines. Community engagement and tailored communication to address community concerns and misinformation are essential to building trust. Policymakers and implementers should consider more innovative approaches for developing and implementing vaccination policies in collaboration with local actors.

Background: Tungiasis is a neglected tropical skin disease caused by the sand flea Tunga penetrans. Female fleas burrow into the skin, typically of the feet, producing inflammation, pain, and itching. Although poverty is a major risk factor, not all households or children in the lowest economic bracket are affected, and boys appear disproportionately infected. This study investigated environmental and behavioral characteristics of households and children to explain these variations.

Methods: A total of 3,871 pupils (equal numbers of boys and girls) aged 8-14 years from 44 primary schools in Kwale and Siaya counties, Kenya, were examined for tungiasis. In each school, infected and uninfected pupils were randomly selected for household observations and caregiver interviews. Overall, 273 cases and 548 controls were enrolled, from whom 198 infected and 199 uninfected pupils were selected for in-depth interviews. Mixed-effects logistic regression was used to identify risk factors at individual and household levels. Separate models were run for Kwale and Siaya due to contextual differences, and for boys and girls to explore sex-specific determinants.

Results: At household level, tungiasis was associated with higher odds in Muslim households in Kwale (aOR 2.44, 95% CI 1.28-4.62) and traditionist households in Siaya (aOR 2.27, 95% CI 1.06-4.86) compared to Christian households. Additional risk factors included having a male caregiver (Kwale: aOR 2.31, 95% CI 1.02-5.23), a child with disabilities (Siaya: aOR 7.19, 95% CI 1.64-31.65), and lack of caregiver involvement in schoolwork (Siaya: aOR 1.90, 95% CI 1.13-3.19). For girls, infection odds were higher if parents rarely attended school meetings (aOR 2.11, 95% CI 1.00-4.44) or when mothers were frequently absent (aOR 2.46, 95% CI 1.07-5.64). Caregiver stress scores were positively associated with infection risk across sexes (aOR 1.03, 95% CI 1.00-1.06).

Conclusion: This study identifies novel risk factors for tungiasis beyond poverty, including caregiver characteristics, psychosocial stress, and parenting practices. Effective control interventions should integrate psychosocial support for caregivers and promote positive parenting alongside traditional One Health prevention and treatment strategies.

Trial registration: not applicable.

Purpose: The extent to which existing measures cover the spectrum of neighborhood-level social determinants of health (SDOH) has not yet been assessed. This review compared the content of U.S.-based neighborhood-level SDOH measures and summarized the use of these measures in empirical research.

Methods: We conducted a comprehensive search on PubMed and Google Scholar, identifying review articles published from 1990-2023, and complemented this search by manually examining the original articles on measure development. We identified 85 measures and categorized them into two groups (42 with a specific name and 43 with no name) and used a framework including 14 domains of neighborhood-level adversity to classify the content of each measure.

Findings: Most measures captured the domains of "income/wealth" (96.5% of the 85 measures included a relevant measurement indicator), "employment" (87.1%), "education" (83.5%), "housing" (64.7%), and "demographic/family structure" (60.0%). The most popular measures were the "Social Vulnerability to Environmental Hazards Index" (87.4 citations per year), "Neighborhood Concentrated Disadvantage" (77.6 citations per year), and "Child Opportunity Index 2.0" (53.5 citations per year).

Conclusions: A better understanding of the content coverage and use frequency of U.S.-based neighborhood-level adversity measures will facilitate clinical/health services research to select appropriate measures when assessing the effect of neighborhood-level SDOH on health outcomes.

Background: Much of the burden of non-communicable disease in high-income countries is attributable to harmful engagement with health behaviours. Evidence suggests that these behaviours may be better understood, and more amenable to intervention, if analysed as clusters of behaviours rather than individual behaviours. To date, research on the clustering of health behaviours has focused on the consequences of multi-engagement as opposed to the potential shared antecedent or contemporaneous processes. Moreover, adolescence is a critical period for the development of health behaviours, yet there remain more studies on the clustering of health behaviours in adulthood, when patterns of behaviour are likely already crystallised.

Methods: Drawing from a nationally representative longitudinal dataset of young people living in the Republic of Ireland, latent- class analysis was used to identified clusters of the health behaviours: diet quality, levels of physical activity, screentime, tobacco smoking and underage alcohol consumption, for the first time in this context. We theorised potential social determinants for engagement with the distinct clusters of behaviours and evaluated these theories empirically using multinominal logistic regression.

Results: Our findings indicate that, what are typically termed, 'lifestyle' behaviours (diet, physical activity and screentime) tend to co-occur rather than appear in isolation. These lifestyle behaviours appear to be relatively independent of tobacco smoking and underage alcohol consumption, which we term 'substance use.' We demonstrate that the experience of periodic, but mostly persistent poverty (approx. nine years), is associated with membership of clusters characterised by lifestyle behaviours, while reporting oppositional values is distinctly associated with membership of clusters characterised by substance use.

Conclusions: Our results support the much-established relationship between income poverty and harmful health behaviours related to lifestyle that is evidenced when looking at these behaviours individually and thereby provides further empirical evidence for the theories on 'fundamental causes' of health inequalities and the 'social exclusion framework.' We find an association between oppositional values and substance use behaviours, and furthermore that oppositional values tend to be highest among the income poorest adolescents. We highlight a concurrent influence for substance use in adolescence, which is also relevant for addressing inequalities in health behaviour engagement.