Journal of preventive medicine and hygiene最新文献

Health is a precious asset, essential for both individuals and communities. The wars that have affected various parts of the world in recent years have had a detrimental impact on health, leading to malnutrition and an increased vulnerability to epidemic diseases among the population, especially the poorest. Hospitals and healthcare facilities themselves have become primary strategic targets in many war zones. The destruction of infrastructure and hospitals, along with challenges in obtaining clean water and access to medicines, has contributed to the resurgence of epidemic diseases in countries where they had been eradicated. Additionally, the difficulty in ensuring vaccination programs for children raises the risk of these diseases spreading to areas typically free from them. The authors reflect on the consequences of wars on the health of populations and the close link between health and peace, presenting the latest data on ongoing epidemics in countries affected by war.

Introduction: We examined the association of blood eosinophil counts at the time of AECOPD hospitalization with the risk of ICU admission as well as the hospital lengths of stay and mortality.

Methods: In the current retrospective study, the association between blood eosinophil counts in COPD patients at the time of AECOPD hospitalization and the risk of subsequent ICU admission as well as mortality was assessed. The chi-squared test and t-test were used to compare categorical and continuous variables. The statistical significance level was set at 0.05. Kaplan-Meier curves for mortality as well as ICU admission up to 40 days after discharge from the index hospitalization were constructed using the determined optimal eosinophil threshold derived above and for the predetermined ≥ 300 vs < 300 cells/μL threshold. All analyses were performed using SPSS version 19.

Results: Antibiotic prescription was significantly associated with increased ICU admission (OR = 1.57; confidence interval [95% CI] = 1.02-2.42. Patients with higher FEV1 had decreased ICU admission (OR = 0.98, 95% CI = 0.97-1.01, p = 0.1) as well as all-cause mortality compared (OR = 0.98, 95% CI= 0.92-1.04, p = 0.58). There were significantly greater mortality rates for patients with higher ESR (OR = 1.02, CI =1.01-1.03, p = 0.01) and CRP (OR = 1.02, 95% CI = 1.01-1.03, p = 0.01). There were significantly lower ICU admission rates for patients with higher FVC (OR = 0.97, 95% CI = 0.95-0.98, p = 0.002).

Conclusions: Blood eosinophil count could help determine the risk of ICU admission as well as mortality in COPD patients at the time of hospitalization.

Background: Equity in health service delivery ensures that resources are distributed based on need, minimizing barriers to access and reducing health disparities. Hospital beds are a critical healthcare resource, essential for providing timely and effective medical care. This study aims to evaluate the equity in the distribution of hospital beds in Lorestan Province, western Iran, using the Gini coefficient and Lorenz curve as analytical tools.

Methods: Data on the number of hospital beds and population statistics for each city in Lorestan were collected from the Lorestan University of Medical Sciences and the Statistical Center of Iran. The equity of hospital bed distribution was assessed using the Gini coefficient and Lorenz curve, with analyses conducted using R statistical software.

Results: Lorestan Province, with a population of 1,678,873, has significant disparities in hospital bed distribution. The Gini coefficient for hospital beds was 0.27, indicating moderate inequality. The Lorenz curve showed a substantial deviation from the equity line, highlighting the imbalance. Khorramabad and Aligudarz exhibited the highest inequality, while Rumeshkan, Kuhdasht, and Poldokhtar had more equitable distributions.

Conclusions: The study reveals notable inequities in hospital bed distribution in Lorestan Province, emphasizing the need for targeted policy interventions. Strategic resource allocation, infrastructure development, and policy reforms are essential to enhance healthcare equity. Continuous monitoring and consideration of additional healthcare resources and socioeconomic factors are recommended for comprehensive future assessments.

Background: Family physicians play a crucial role in healthcare delivery systems worldwide. In Iran, the family physician program has been introduced in only two provinces, with its expansion to other regions currently stalled due to various challenges. This study aims to identify the barriers and challenges hindering the effective implementation of the family physician program in urban areas of Iran.

Methods: This qualitative study utilized purposeful sampling to select health system policymakers, senior administrators, and physicians as participants. Data were collected through semi-structured interviews with 32 participants until saturation was reached. The data were analyzed using grounded theory, involving open, axial, and selective coding to identify key themes and sub-themes.

Results: The primary challenge in implementing the urban family physician program was conflicting interests among stakeholders, identified as the core category. Key contributing factors included payment mechanism complexities, stewardship, structural issues, financial constraints, and cultural elements. Specialist physicians, in particular, resisted the program's implementation, often employing reverse referral as a coping strategy. These challenges collectively hindered the nationwide rollout of the program.

Conclusions: Addressing the barriers to implementing urban family physician policies requires a comprehensive reassessment of stakeholder roles and a restructuring of the payment system. Additionally, proactive efforts to resolve the complex contextual challenges within the healthcare system are essential for the successful implementation of these policies.

The emergence of SARS-CoV-2 has underscored the critical need to enhance the ONE HEALTH approach which recognizes the interconnectedness of human, animal, and environmental health. In this review we report on various animal species that were infected by SARS-CoV-2 virus during the pandemic with the aim to contribute to the One Health approach. The SARS-CoV-2 pandemic has highlighted the devastating consequences of zoonotic diseases such as COVID19 and has reiterated the critical role that the health of wildlife, domestic animals, and the environment plays in human health. The pandemic is a lesson learnt on the urgent need for an enhanced ONE HEALTH approach by developing a robust and interconnected global health strategy to effectively prevent and control zoonotic diseases and protect the health of all species on our planet. These efforts are crucial for a sustainable and resilient future for both human and ecological systems.

Background: Ensuring uninterrupted and free access to health services highlights the critical need for sustainable health financing. Given that tax revenues are essential for achieving universal health coverage, this study, conducted in 2024, aims to identify strategies for generating sustainable financial resources through taxation.

Methods: This qualitative study gathered data through in-depth, semi-structured interviews with 10 experts. Participant selection continued until data saturation was achieved, using purposeful and snowball sampling to ensure maximum diversity. Thematic analysis was employed for data analysis, using Atlas.ti software (version 8).

Findings: The study identified strategies for generating tax-based sustainable financial resources across five main topics: transportation, services, production, individuals, and 11 subtopics. These subtopics include traffic control schemes, highway and road tolls, taxes on urban and intercity transportation systems, fines for traffic violations and vehicle inspection deficiencies, equipment and device imports, corporate sales and revenue, health-damaging products, environmental pollutants, industrial production and petroleum products, businesses and occupations, and long-term exit or migration taxes for health professionals.

Conclusions: Implementing tax policies on the identified items requires strong political support, fostering a shared understanding among stakeholders at various levels of policy-making and implementation, and aligning executive program designs with existing infrastructure. Enhancing regulatory systems and increasing transparency in resource allocation are also essential to improving the implementation of health-related tax policies. Further research should carefully examine the economic and social side effects of these taxes on different sectors of society.

Background: Lung cancer is a significant contributor to mortality worldwide. The aim of this study was to assess the level of lung cancer awareness among the Lebanese general population.

Methods: An online-based questionnaire was completed by 410 participants all over Lebanon. A validated Lung Cancer Awareness Measurement tool was used. Multivariate analysis using Generalized Linear model and post-hoc analysis were performed after assessing validity and reliability of the scale.

Results: Only 13.7% correctly identified age-related lung cancer risk, while 60.7% thought age was unrelated. Warning signs were poorly recalled, with persistent cough being the most remembered (58%), and coughing up blood being highly recognized (87.8%). Participants struggled to recognize persistent shoulder pain (28.7%) and finger/nail changes (29.51%) as possible warning signs of lung cancer. Multivariate analysis showed that governorates, educational level, and occupation significantly affected warning sign-scores. Post-hoc analysis revealed that people residing in Bekaa scored lower warning sign recognition scales compared with participants residing in Beirut, Mount Lebanon, and North. Postgraduates and medical field workers showed higher symptom recognition, with the latter scoring higher recall scales as well. Smoking was the most recalled and recognized risk factor (82% and 95.6%). Females, postgraduates, and medical workers showed higher risk factor recognition. While 75% were willing to seek medical attention for lung cancer suspicion, 58% lacked confidence in identifying warning signs.

Conclusions: Extensive awareness campaigns focusing on age-related misconceptions, warning signs, and risk factors hold immense promise for improved therapeutic outcomes.

Introduction: The introduction of process innovations in healthcare organizations faces challenges in knowledge sharing and incorporating best practices due to a strong professional autonomy, leading to resistance to change. The healthcare paradigm is shifting towards value-based organizations with a patient-centered approach, requiring multidisciplinary care. Change management is crucial, but current approaches are often limited. This study proposes a conceptual framework to support change management in healthcare services redesign.

Methods: The proposed conceptual framework was developed applying Jabareen's multidimensional and multi-method approach. The methodology involved 8 steps consisting in literature review, thematic and content analyses, concepts deconstruction and aggregation, graphical design of the framework, external validation and revision.

Results: The framework integrates 53 evidences from the literature, 3 macro areas of interest and 42 change management models applied to the healthcare context, through 244 implementation actions. Aggregation of concepts led to 15 macro topics applicable to all levels of change and composing the proposed framework. Interviews validated the framework, emphasizing the importance of people-focused approaches and addressing resistance to change. Moreover, steps most and less cited in the literature are highlighted and differences between developed countries and economies in transition or developing countries are explored.

Conclusions: The article proposes a 15-step framework for change in healthcare services redesign. It integrates evidence from literature and change management models, emphasizing stakeholder involvement. A case study in South Africa highlights the importance of awareness, planning, communication, training, and continuous review. Further validation and adaptation are recommended.

Background: Early diagnosis of breast cancer is essential for effective treatment and improved survival rates. A longer gap between the appearance of symptoms and the initiation of therapy results in advanced disease and lower survival.Objectives: to assess factors associated with diagnosis delay among Sudanese women with breast cancer.

Methods: A prospective, descriptive cross-sectional study conducted at Radiation and Isotope Centre of Khartoum (RICK) in Khartoum, Sudan. Relationship between the independent variables and the main outcome of the study was determined by multivariate regression analysis.

Results: A total number of 149 women participated in the study. A total of 58.4% of patients delayed seeking medical advice for more than three months after noticing symptoms. The delay was associated with patient's area of residence and age. Women coming from outside Khartoum had a higher odd of having delayed diagnosis of breast cancer (AOR = 3.283, 95% CI: 1.113 9.687, p = .031). Likewise, older age was another predictor of delayed diagnosis of breast cancer among the study participants (AOR = 101.664, 95% CI: 4.839-2135.883, p = .003).

Conclusions: The present study showed that more than half of the women who participated had experienced delays in seeking medical attention for their breast cancer symptoms. This finding highlighted the impact of limited access to healthcare services as a contributing factor to such delays. These findings show the need for collaborative approaches to address the challenges surrounding breast cancer in Sudan.

Rabies is a zoonotic viral disease transmitted mainly by bites of infected animals, especially dogs, which are responsible for 99% of human cases. Despite being preventable, it remains a neglected disease in low-income countries, with approximately 60,000 deaths per year, mostly concentrated in Africa and Asia. The real worldwide burden of rabies is probably underestimated, as death-reporting systems are inadequate and active surveillance is limited. Rabies prevention implies two main, non-exclusive strategies: (i) dog vaccination, in order to interrupt virus transmission to humans, and (ii) human vaccination i.e. pre-exposure prophylaxis (PrEP) and Post-Esposure Prophylaxis (PEP) through the use of purified cell-culture and embryonated egg-based vaccines (CCEEVs). Rabipur^® is one of the available anti-rabies vaccines and is indicated for active immunization in individuals of all ages. Its efficacy and safety have been amply demonstrated. In rabies-free countries, PrEP is indicated for individuals who face occupational and/or travel-related exposure to the rabies virus in specific settings or over an extended period. Wider use of human rabies vaccination for PrEP and PEP in conjunction with programs to eradicate rabies from animal populations is the challenging goal in order to reduce the burden of disease and achieve zero rabies.