The Portuguese health system has a universal, public, general National Health Service (NHS), tending towards free healthcare access. Created in 1979, this delivery model developed from the integration and complementarity between the different response levels (primary, hospital, continuing, and palliative care). However, over these 40 years, the initially centralized system underwent a decentralization process with the creation of Regional Health Administrations in the five mainland administrative regions. Since then, the entire NHS has settled around this new organization. The most recent step started in 2018 with decentralizing primary health care skills to 190 municipalities. This paper presents the various critical issues involved in the latest gradual decentralization process in health, intending to bring services closer to the citizens, and more focused on their needs. The article identifies and discusses the implications of this experience based on the steps foreseen in the already published legal texts.

Only 15% of the global population has access to occupational safety and health services. In Africa only 5% of employees working from major establishments, have access to occupational health services (OHS). Access to primary health care (PHC) services is addressed in many settings and inclusion of OHS in these facilities might increase efficiency in preventing occupational diseases. A cross-sectional study was conducted in four SADC countries aiming at assessing the availability of OHS at PHC facilities and the organization of OHS. We conducted a literature review to assess the provision and organization of OHS services. In addition to the review, a total of 23 doctors from PHC facilities were interviewed using questionnaires in order to determine the availability of OHS and training. Consultations with heads of ministries were done in four SADC countries. Results showed that in the SADC region, OHS are fragmented and lack a comprehensive approach. In addition, out of 23 PHC facilities only two (13%) provided occupational health and PHC. However, OHS provided at PHC facilities were limited to TB screening and audiometric testing. Our study showed a huge inadequacy of trained occupational health practitioners. This study supports the World Health Organization’s advocacy of integrating OHS at PHC level.

Background: Australia’s healthcare system is complex and fragmented which can create challenges in healthcare, particularly in rural and remote areas. Aboriginal people experience inequalities in healthcare treatment and outcomes. This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in rural and remote Australia. Methods: Semi-structured interviews were conducted with healthcare delivery staff and stakeholders recruited through snowball sampling. The communities were selected for their high proportion of Aboriginal people and geographical representation (coastal, rural, and border). Thematic analysis identified barriers and enablers. Results: Thirty-one interviews were conducted (n =5 coastal, n=13 remote, and n=13 border) and six themes identified: 1) Improved coordination of healthcare services; 2) Better communication between services and patients; 3) Trust in services and cultural safety; 4) Importance of prioritizing health services by Aboriginal people; 5) Importance of reliable, affordable and sustainable services; 6) Distance and transport availability. These themes were often present as both barriers and enablers to healthcare access for Aboriginal people. They were also present across the healthcare system and within all three communities. Conclusions: This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access.

Background: Internal migrants had obstacles in accessing local public health services in China. This study aimed to estimate the utilization of local public health services and its determinants among internal migrants. Methods: Data were from the 2014 and 2015 nationally representative cross-sectional survey of internal migrants in China. Multivariate logistic regressions were used to estimate the relationship between socioeconomic, migration, demographic characteristics and public health services utilization. Results: Internal migrants in more developed eastern regions used less public health services. Those with higher socioeconomic status were more likely to use public health services. The broader and shorter they migrated, the less they used public health services. Compared to migration within the city, migration across provinces is negatively associated with health records (OR=0.88, 95% CI: 0.86-0.90), health education (OR=0.97, 95% CI: 0.94-1.00), and health education on NCDs (OR=0.92, 95% CI: 0.89-0.95) or through Internet channel (OR=0.96, 95% CI: 0.94-0.99). Conclusion: Public health services coverage for internal migrants has seen great improvement due to government subsides. Internal migrants with lower socioeconomic status and across provinces need to be targeted. More attention should be given to the local government in the developed eastern regions in order to narrow the regional gaps.

Although health policy resides mainly with the government, industry can play an important role in building a health ecosystem. From March to May, we administered questionnaires to 1,200 individuals from the general Korean population asking about their perception of health-friendly labels, and if they would purchase such labeled products (foods, pharmaceuticals, etc.) and services (purifying water, preventing air pollution, etc.) at extra cost. The participants placed a high value on the importance of mental, social, spiritual, and physical health factors in terms of company’s products and services with a score of about 8 out of 10 (range, 7.74-8.33). Most respondents (72.4%) said they were interested in adopting health-friendly labels. When a health-friendly label is introduced (such as one by the Business for Social Responsiveness), 65.1% of the respondents said they intended to purchase the product or service, while 6.8% said they did not, and 75.0% said they were willing to pay extra for the health-friendly product or service. Multivariate logistic regression models showed urban residence, high education level, and good social health to be significantly associated with positive attitudes toward health-friendly labels. People with high income, no religion, or normal weight were more likely to say they intend to purchase products and services with health-friendly labels. They also had a more positive attitude toward paying more for such products and services, as did people with good spiritual health. This study provides data that illustrate the importance of health-friendly products and services to the general population and companies.

Access to maternal healthcare services is a challenge in most low and middle-income countries. South Africa is one of the countries striving to improve the accessibility of maternal healthcare services. Although South Africa has put some interventions to improve the accessibility of maternal healthcare services, vulnerable women including women with disabilities are still facing numerous challenges when trying to access maternal healthcare services. The aim of the study was to explore the experiences of women with disabilities in the province of KwaZulu-Natal in South Africa in accessing public maternal healthcare services. Twelve women with disabilities (four with physical impairments, four with hearing impairments and four with visual impairments) were interviewed for this study. Data were transcribed verbatim and analysed utilising the Framework of Assessing Access to Maternal Healthcare Services by Peters et al. 2008. The study found that narrow passages and information in inaccessible formats were a challenge for women with visual impairments. The women with hearing impairments had challenges in communication as most facilities did not have sign language interpreters, negative attitudes of health care workers and being ignored when they asked for help. The women with physical impairments encountered inaccessible buildings, narrow passages, small consultation rooms and equipment which is not adjustable such as beds and scales.

Background: The Covid-19 pandemic abruptly disrupted global healthcare systems, necessitating rapid adaptations. This study evaluates the impact on health systems and services in the aftermath of the first wave in the Indian context. It analyses the disruptions, adaptive measures, and changes made, as well as the challenges faced by healthcare providers and seekers. Valuable insights from this study will enhance the resilience and preparedness of healthcare systems for future challenges. Methods: The eligible studies included primary studies conducted in the Indian context that explore the impact of COVID-19 on health services provision, utilisation, and the well-being of healthcare providers and seekers. Electronic searches were conducted in six databases: PubMed, MEDLINE, Embase, Global Health, CINAHL, and the WHO database on COVID-19. The results were analysed using detailed narrative synthesis. Results: The review includes 38 articles, incorporating a total of 22,502 subjects. There has been a substantial impact on health service provision, particularly in outpatient departments (OPD) (n=19) and elective services (n=16), while emergency services continued at sub-optimal levels (n=20). Various adaptations and changes were implemented in precautionary measures, protocols, staff allocation and training, usage of personal protective equipment (PPE), preoperative, operative, and postoperative measures, as well as physical infrastructure and resources. Depression and stress (n=14), fear of contracting the infection (n=6), stigmatisation (n=5), and financial repercussions (n=5) significantly affected the mental health of healthcare providers, and healthcare seekers also faced significant challenges (n=11). Conclusion: The study reveals COVID-19's substantial impact on health services. The healthcare system responded by quickly adjusting staff management, resource allocation, and infection prevention measures. The study also highlights the mental health challenges faced by healthcare providers and the concerns of healthcare seekers regarding delays and suboptimal care. Looking ahead, the findings underscore the importance of preparedness for future pandemics, including improved healthcare infrastructure, resource optimisation, and comprehensive protocols. Lessons learned from COVID-19 should inform strategies to mitigate disruptions and ensure the well-being of healthcare providers and seekers in future outbreaks.

This review examines from a services perspective strategies for preparedness and response to mental health impacts of three types of climate-related events: 1) acute climate-related events such as hurricanes, floods and wildfires, 2) sub-acute or long-term changes in the environment such as drought and heat stress; and 3) the existential threat of long-lasting changes, including higher temperatures, rising sea levels and a permanently altered and potentially uninhabitable physical environment. Strategies for acute events include development and implementation of guidelines and interventions for monitoring and treating adverse mental health outcomes and strengthening individual and community resilience, training of non-mental health professionals for services delivery, and the mapping of available resources and locations of at-risk populations. Additional strategies for sub-acute changes include advocacy for mitigation policies and programs and adaptation of guidelines and interventions to address the secondary impacts of sub-acute events such as economic loss, threats to livelihood, health and well-being, population and family displacement, environmental degradation and collective violence. Strategies for long-lasting changes include implementation of evidence-based risk communication interventions that address the existential threat of climate change, promoting the mental health benefits of environmental conservation, and promoting positive mental health impacts of climate change.

The ageing transformation of digital health services faces issues of how to distinguish influencing factors, redesign services, and effectively promote measures and policies. In this study, in-depth interviews are conducted and grounded theory applied to open coding, main axis coding, and selective coding to form concepts and categories. Trajectory equifinality modeling clarified the evolution logic of digital transformation. Based on the theory of service ecology, a digital health service ageing model is constructed from the "macro-medium-micro" stages and includes governance, service, and technology transformation paths. The macro stage relies on organizational elements to promote the institutionalization of management and guide the transformation of governance for value realization, including the construction of three categories: mechanism, indemnification, and decision-making. The meso stage relies on service elements to promote service design and realize service transformation suitable for aging design, including the construction of three categories: organization, resources, and processes. The micro stage relies on technical elements to practice experiencing humanization, including the construction of three categories: target, methods, and evaluation. These results deepen the understanding of the main behaviors and roles of macro-organizational, meso-service, and micro-technical elements in digital transformation practice and have positive significance for health administrative agencies to implement action strategies.

(1) Background: There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. (2) Methods: 155 Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. (3) Results: Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. 4) Conclusion: This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live.

Objectives Asylum seekers in Germany represent a highly vulnerable group from a health perspective due to a variety of risk factors. At the same time their access to healthcare is restricted. While the introduction of the Electronic Health Insurance Card (EHIC) for asylum seekers instead of healthcare-vouchers is discussed controversially using politico-economic reasons, there is hardly any empirical evidence on its actual impact on the use of medical services Study design Thus, the aim of this study is to examine the influence of the possession of the EHIC on the use of medical services by asylum seekers as measured by their consultation rate of ambulant physicians (CR). For this purpose, a standardized survey was carried out to 260 asylum seekers in different municipalities of which some have introduced the EHIC for asylum seekers, while others have not. Methods Various CR were differentiated considering possible third variables as well as confounding factors. The period prevalence was compared between the groups "with EHIC" and "without EHIC" using a two-sided t-test. Multivariate analysis was done using a linear OLS regression model. Results Asylum seekers who are in possession of the EHIC are significantly more likely to seek ambulant medical care than those receiving healthcare-vouchers. Their CR, however, does not differ significantly from the age-corrected CR of the autochtonous population. Taking into account relevant covariables, the possession of the EHIC can be viewed as an independent influencing factor on the asylum seekers' use of medical care. Conclusions The results of this study suggest that having to ask for healthcare-vouchers at the social security office could be a relevant barrier for asylum seekers. Nevertheless, the ownership of the EHIC does not seem to lead to an overuse of medical services.

Family support is offered to Australian parents of young children using a mix of targeted and universal child and family health services. A feature of the universal services is the ability for nurses to work in partnership with families and to offer flexibility depending on need. This model of progressive universalism relies on the voluntary engagement of families, including families with complex needs. In this study, the capacity to engage and retain families, including those at risk for child maltreatment and family violence, was examined. Child and Family Health Nurses (n=129) participated in a pragmatic, multilevel mixed-methods study using the McCurdy and Daro (2001) Integrated Theory of Parent Involvement. A questionnaire was used in the first phase of the study to collect the quantitative data. Focus groups were then held with 27 participants recruited from phase one. Both homogeneous and heterogenous practices identified from the questionnaire were the focus of the discussions. Three phases of practice were identified and described: enrolment, retention and conclusion of the nurse-parent relationship and are presented and discussed in this paper. The retention of families with complex needs relies on flexible, advanced, and multidimensional nursing practices.

There is a systematic exclusion of gender-based violence, safe abortion, reproductive cancers, infertility services, comprehensive sexuality education, sexuality services, and STI’s other than HIV in essential health packages in LMICs. To accelerate progress on sexual reproductive health (SRH), the Guttmacher–Lancet Commission proposed the adoption of these interventions into an essential health package of SRH services that should be universally available. In this commentary, we use a healthcare priority-setting processes lens to review the importance of these services for universal health coverage. We isolate inherent challenges in social value judgments for terminal, process and content evidence for their healthcare priority-setting. We then advance promising emerging practical examples from low to middle-income countries on evidence-informed decision-making processes. We recommend capacity development through regional support, generating equity and efficiency evidence and strengthening political and publicly acceptable processes to institutionalise and operationalise evidence-informed decision-making.

This study assessed health inequality trends and the degree of maternal healthcare services utilization in the DRC, using two consecutive Demographic and Health Surveys, 2007 and 2013-2014. First, we assessed the changes in the magnitude of inequality in the utilization of MHCS using logistics and regressions. Second, we analyzed the distribution of inequality in each MHCS utilization variable using the Gini coefficient and the Lorenz curve. Third, we used the Wagstaff two groups concentration indices comparison method to assess health inequality trends. Finally, we fitted the concentration curves to estimate the inequality in the utilization of MHCS to the economic condition of women. Women were less likely to have their first ANC visit within the first trimester, less likely to receive checkups during ANC visits, and less likely to attend more ANC visits when living in eastern DRC compared to western DRC. Women in rural areas were less likely to have their last birth by C-section, and less likely to receive PNC than women in urban areas. Women with middle, richer, and richest wealth indexes were more likely to complete more ANC visits, more likely to deliver by C-section, most likely to receive PNC, and more likely to receive ANC than those with lower wealth indexes. Over time, inequality in the utilization of MHCS decreased for ANC and PNC but increased for the delivery by C-sections. These findings suggest that innovative strategies are still needed to improve the utilization of MHC services among poorer, rural, and underserved women in post-conflict DRC.

Traditional Health Practitioners (THPs) are considered as the entry level of care in African societies and play an important role in the delivery of health services to the population. A phenomenological qualitative study was carried out among pur-posefully selected THPs in Mthatha to understand their roles and the challenges they face in providing maternal health services. The study included a focus group discussion with seven participants, which yielded three themes and seven sub-themes. The content analysis of descriptive data from the focus group discussion revealed threats posed by unregistered and counterfeit THPs to the lives of pregnant women in rural settings. THPs' wide range of services allowed pregnant women to receive prenatal, antenatal, and postnatal care in close proximity. This level of care, however, was characterized by high levels of secrecy and counterfeit practitioners who used human body parts, which jeopardized the practice and made it unpopular. Traditional health practice must be protected through registration of THPs and the establishment of functional referral pathways between THPs and conventional health services.

In August 4 2011, United Nations Environmental Program (UNEP) submitted an unprecedented, scientific, groundbreaking Environmental Assessment Report (EAR) of Ogoniland, to the Nigerian government. This was the outcome of a 14–month intensive evaluation of the extent of pollution. It was intended that UNEP’s recommendations would be implemented to restore the devastated environment, on the one hand, and on the other, counteract the numerous environmental health issues that have for decades, plagued Ogoniland. However, five years post EAR, and, despite the seriousness of the situation, no significant resolution has occurred, both on the part of the government, and on the part of Shell Petroleum Development Company (SPDC) or Shell. To date, millions of Niger Delta residents, particularly those living in the oil-bearing communities, continue to suffer severe consequences. Although, the assessment was conducted in Ogoniland, other communities in the Niger Delta are also affected. This article explores prevailing issues, using Ogoniland (a microcosm of the Niger Delta) as an example. A multidisciplinary approach for sustainable mitigation of environmental health risks in the Niger Delta is paramount, and Environmental Management tools offer valuable strategies. Adopting UNEP’s recommendations for addressing environmental health problems requires implementing the Environmental Management/Environmental Management System (EM/EMS) model.

Along with the advantages associated with access to information and fast communication, screen time from increased digital media consumption has recently been associated with adverse effects on youth well-being. To get a clearer picture of its value for global youth based sustainability initiatives, this study investigates the effects of increased digital media consumption on youth's interests in ecosystem services, sustainability and science as a means for disease prevention. We achieve this, using data on 187821 adolescent students from 50 countries worldwide. Methodologically, we rely on a mixed bivariate ordered probit representation of youth's joint interest in the biosphere (ecosystem services and sustainability) and science as a means for disease prevention, which we then estimate using Markov Chain Monte Carlo (MCMC) Methods. We found that each level increase in adolescent students' reported frequency of news blogs visits and web browsing on broad science adversely affect their interests in ecosystem services, sustainability and science as a means for disease prevention. Although each level increase in youth's frequency of ecological website visits also reduces by 20% (with 95% CI [-0.36; -0.32]) their interests in the biosphere, it is found to increase however by 3% (with 95% CI [0.02; 0.05]) their interest science as a means for disease prevention. Overall, our results highlight heterogeneous effects of digital media consumption on adolescents' well-being in terms of their interests in ecosystem services, sustainability, and science as a means for disease prevention.

Background: The importance of community health psychology in providing complex bio-psycho-social care is well-documented. We present a mixed-method study monitoring the efficacy of health psychology services in the Public Health Focused Model Program for Primary Care Development (2012-2017) in four disadvantaged micro-regions in North-East Hungary. Methods: Study 1 assessed the availability of the services using a sample of 17003 respondents. Study 2 applied a follow-up design to measure the efficacy of the health psychology services in a sample of 132 clients. In Study 3, we conducted focus group interviews to assess clients’ lived experiences. Results: More mental health issues and higher education predicted a higher probability of service use. Follow-up showed that individual and group-based psychological interventions resulted in lower depression and (marginally) higher well-being. Thematic analysis of the focus group interviews indicated that participants deemed topics like psychoeducation, a greater acceptance of psychological support, and heightened awareness of individual and community support important. Conclusions: The results of the monitoring studies demonstrate the important role health psychology services can play in primary health care in disadvantaged regions. Community health psychology can improve well-being, reduce inequality, support the population’s health awareness, and address unmet social needs in disadvantaged regions in Hungary.

Background: Immunization prevents over 4-6 million deaths each year worldwide. Ensuring mother satisfaction is an important means of preventing the death of children caused by communicable diseases. However, in Ethiopia, there is paucity of evidence on maternal satisfaction with immunization services. Thus, this study is aimed at assessing the level of maternal satisfaction with childhood immunization services and associated factors among children’s caregivers. Methods: A facility-based cross-sectional study was conducted among 556 systematically selected children’s caregivers in public health facilities at Gondar Town from May through June, 2022. Data were collected using a pretested structured questionnaire. P≤ 0.25 during the bivariate binary logistic regression analysis was included in the multivariate analysis. From the multivariable analysis, variables with p ≤ 0.05 were declared statistically significant. Results: The prevalence of maternal satisfaction towards childhood immunization services was 69.3%(95%CI: 65.5, 73.1%). Of mothers, 45.3% had adequate knowledge, while 43.9% had favorable attitude. Mothers 19-24 years old [AOR = 5.29; 95%CI:2.58,10.86], mothers who waited less than one hour [AOR = 3.03; 95%CI: 1.92,4.77], mothers less than thirty minutes waiting in health facility[AOR=1.98;95%CI:1.24,3.15], mother feel happy during service[ AOR=4.00; 95%CI: 2.53,6.34], mothers adequate knowledge [AOR=2.91; 95%CI: 1.79, 4.73] and had favorable attitude [AOR=3.64; 95%CI: 2.25, 5.91] were significantly associated with maternal satisfaction during childhood immunization services.Conclusions: The overall level of mothers’ satisfaction with childhood immunization services was considerably lower as compared with other studies. Thus, the town health office and concerned stakeholders need more efforts to improve mothers’ satisfaction with childhood immunization services.

Access to health services compromises therapeutic adherence in patients with HTN, which is a risk factor for cardiovascular disease and premature death. The aim of the research is to determine the influence of access to health services on adherence to antihypertensive treatment during the COVID-19 pandemic. We included a cross-sectional analytical study. A survey was applied to 241 hypertensive patients at the Daniel Alcides Carrión Hospital, Callao-Peru. Data were analyzed using SPSS software. Absolute and relative frequencies were reported and the chi-square test was applied with a statistical significance level of p<0.05. In addition, multiple logistic regression analysis was performed using the Stepwise method. An association was found between non-adherence to treatment and health expenses (ORa: 1.9 CI 95% 1.7-2.2), not receiving care due to lack of a doctor (ORa: 2.8 CI 95% 1.5-3.2), having difficulty with schedules (ORa: 3.7 CI 95% 2. 3-5.5), fear of receiving care at the hospital (ORa: 4.5 CI 95 % 2.7-6.8), trust in health personnel (ORa: 7.5 CI 95% 2.3-10.5) and considering that the physician does not have enough knowledge (ORa: 3.1 CI 95% 2.4-7.8). Therapeutic adherence was associated with physician availability for care, difficulty with schedules, fear of being seen in the hospital, trust in health personnel, and waiting time.

Improving access to sexual health services is critical in light of rising sexually transmitted infections (STIs). We evaluated a Hub and Spoke model for improving access to sexual health services in three general practices in Victoria, Australia. The primary outcome was the impact on HIV and STI (chlamydia, gonorrhoea, syphilis) testing. Segmented linear regression analysis was conducted to examine the trends in the total HIV/STI tests before (from January 2019 to June 2020) and post-implementation (from July 2020 to July 2021). We evaluated the feasibility and acceptability of integrating this model into the general practices using semi-structured individual interviews. There was a statistically significant rise in testing for HIV and STIs in all general practices: post-implementation, there was an increase of an average of 11.2 chlamydia tests per month (p=0.026), 10.5 gonorrhoea tests per month (p=0.001), 4.3 syphilis tests per month (p=0.010), and 5.6 HIV tests per month (p=0.010). Participants reported increases in knowledge level and confidence in offering STI testing and managing more variety of sexual health cases. This study demonstrated the feasibility of implementing a hub and spoke model to enable GPs to deliver sexual health care with support from a sexual health specialist service.

Background: Telemedicine is both effective and can provide efficient care at lower costs. It also enjoys a high acceptance rate among users. The Technology Acceptance Model proposed is based on the two main concepts of ease of use and perceived usefulness and comprises three dimensions: the individual context, the technological context and the implementation or organizational context. There is not a short and validated questionnaire to check the acceptance of telemedicine services amongst health care professionals using a technology acceptance model. Objective To translate and validate a telemedicine acceptance questionnaire based in the technology acceptance model. Methods The study included the following phases: adaptation and translation of the questionnaire into Catalan and psychometric validation which include construct (exploratory factor analysis), consistency (Cronbach’s alpha) and stability (test-retest). Factor analysis was used to describe variability amongst observed variables. Results After removing incomplete responses 144 responses where considered for analysis. The internal consistency measured with the Cronbach’s alpha coefficient was good with an alpha coefficient of 0.84 (95%, CI: 0.79-0.84). The intraclass correlation coefficient was 0.93 (95% CI: 0.852-0.964). The Kaiser-Meyer-Olkin test of sampling was adequate (KMO = 0.818) and the Bartlett test of sphericity was significant (Chi-square 424.188; gl=28; P < .001), indicating that the items were appropriate for a factor analysis. Conclusions The questionnaire validated with this study has robust statistical features that make it a good predictive model of professional’s satisfaction with telemedicine programs.

Introduction: Since its discovery in late 2019, the novel coronavirus (SARSCOVID-2) that causes COVID-19 has spread fast, prompting the World Health Organization (WHO) to designate the disease a worldwide pandemic on March 11, 2020.The epidemic has profoundly altered the preexisting global sexual and reproductive health landscape .The virus’s load has put ordinary services in jeopardy and harmed other health priorities. This encompasses both the provision and the supply of contraceptives, sexual health, new born and maternal health services. This Scoping review therefore mapped the availability evidence on the impact and effects of the COVID-19 disease outbreak on sexual and reproductive health. Methods: The methodological framework by Arksey and O’Malley guided this scoping review. A literature search was conducted from the following databases: Embase, PubMed, CINAHL, Scopus, WOS, and AJOL. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram and the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) checklist were used to document the review process. The Strobe critical review checklist was used to determine the quality of the included studies. Results:19 studies were reviewed, out of which 4 were cross sectional studies, 1 was an observational study, 1 was a descriptive analytical study and the rest were qualitative studies .Majority of the studies showed evidence on the impact of COVID-19 and family planning service, maternal and child services, and three studies reported on COVID-19 and sexual behaviour. Five of the nineteen included studies reported on the impact of COVID-19 and family planning service. Conclusion: This scoping review has granted the assessment of the impact of novel SARS-CoV-2 on Sexual and reproductive health services with regards to sexual behaviour, family planning and maternal, neonatal and child health. From the 18 articles identified and reviewed, the overall responses stipulated a significant reduction in client’s utilization of services due to challenges experiences in service implementation such as stock outs. In addition, low demand for reproductive health services by clients due to restrictions imposed on the movements of people to curb the spread of the virus. It is therefore important that Governments and relevant stakeholders in Maternal and Sexual Reproductive Health prioritize development of policies and practices that protect women from the impacts of the pandemic. Furthermore, regular audits to detect trends in MSRH are necessary to inform on going mitigation efforts.

Background: Health-related knowledge is among the essential factors to enable women to be aware of their rights to seek health services. However, little is known about knowledge of safe abortion care services among women of reproductive age in Ethiopia. The main purpose of the study was to assess knowledge of safe abortion care services and associated factors among women of reproductive age in Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted from April-June 2019 among 432 respondents. Bivariate statistics including correlation coefficients, student t-test, one-way analysis of variance, and linear regressions, and multiple linear regression analyses were used. A significant statistical test was determined at a 95% confidence interval and p-value <0.05. Results: About 65.5% had heard about safe abortion care services; media being the main source of information for 79.5%. The finding from an independent-sample t-test shows that the place where the respondents grew up (p< 0.006), history of past miscarriage, and previous information of abortion care service were significantly associated with the knowledge about safe abortion care services (p< 0.001). Conclusions: Women without prior health experiences and those with rural origin could be targeted for reproductive health information interventions including safe abortion care provision.

Introduction: Patients’ satisfaction was extensively researched over the last decades, given its role in building loyalty, compliance to treatment, prevention, and eventually higher levels of wellbeing and improved health status. Patients’ feedback on the perceived quality of health services can be incorporated into practice; therefore, understanding factors and mechanisms responsible for patients’ satisfaction allows providers to tailor targeted interventions. Method: A questionnaire assessing patients’ perception of the quality of health services was administered to a country-representative sample of 1500 Romanian patients. Using a partial least squares—path modeling approach (PLS-PM), with cross-sectional data, we developed a variance-based structural model, emphasizing the mediating role of trust and satisfaction with various categories of health services. Results: We confirmed the mediating role of trust in shaping the relationship between the procedural accuracy of health professionals, along with the perceived intensity of their interaction with patients, and patients’ experienced quality of the health services. We confirmed the mediating role of satisfaction by the categories of services in the relationship between waiting time on the premises, attention received, and the perceived reliability of the information received, as predictors, and the experienced quality of the health services. In addition, indirect assessment of patients’ satisfaction is a good predictor for direct assessment, thereby affirming the idea that the results of the two types of evaluations converge. Discussions: One of the most efficient solutions to increase both patients’ satisfaction and their compliance is to empower the communication dimension between patients and health practitioners. Given the non-linear relationships among variables, we advocate that, unless the nature of the relationships between satisfaction and its predictors is understood, practical interventions could fail. The most relevant variable for intervention is the degree of attention patients perceive they received. We suggest three methods to turn waiting time into attention given to patients.

Abstract: Background: To determine the impact of a patient's ethnicity on the seeking preventive dental services at the Community Health Centers (CHCs) in South-Central Texas. Methods: Pri-mary electronic health records (HER) data were collected regarding each patient's medical and dental history, and comprehensive treatment planning. The researchers retrieved EHR from Jan-uary 2016 to 2022. Bivariate analysis was completed to test outcome with predicator and covariates using appropriate statistical tests. A multiple linear regression model was used to understand the association between the predictor and outcome variable while controlling for confounders. Results: The study findings revealed significantly higher dental visits (2.26 ± 2.88) for Hispanic patients. The results from the multiple regression model indicated that non-Hispanic patients had a 8% fewer chance of visiting the CHCs for preventive dental services compared to the Hispanic population (p-value<0.001) when all other variables are held constant. However, the study results were not significant as the effect size was small to conclude the effect of ethnicity on the patients visiting the dental clinic at the CHCs for preventive services. Conclusion: The study concluded that there is no difference in the preventive dental services completed by Hispanics and Non-Hispanics when all other variables are controlled.

Survivors of sexual and gender-based violence (SGBV) are often hindered in their quest to access quality healthcare. This could complicate the achievement of the laudable SDG Target 3.7. The study used an ethnographic approach to solicit information from health providers, adolescents, and young women (AYW) in 10 communities from Lagos and Ibadan; two major cities in Nigeria. Findings indicated that the structural system of services provided in the health services at the primary healthcare level was limited, which posed a great challenge in AYW’s utilization of services for sexual and gender-based violence (SGBV). Some of the challenges identified by health providers included non-existing counseling services, rehabilitation centers, referral problems, and a lack of training for health providers in handling victims of SGBV. The study provided the context of the health providers’ inadequacy and structural problem of health services in providing comprehensive support services to victims of SGBV like adolescents and young women in the slum setting. This poses a barrier to the utilization of services by the survivors. Necessary inclusive services that will meet the need of the victims of SGBV should be in place at primary healthcare centers close to the people in the community for accessibility.

Objective: The private healthcare providers (PHCP) are believed to improve access to healthcare services in Public-Private Mix (PPM) projects, as they are considered first point of contact for healthcare. The purpose of this study was to know the satisfaction level of TB patients. Design: A questionnaire-based, cross-sectional study was carried out during November and December 2017 for 572 under-treatment patients registered with PHCPs in the PPM project. Lot quality assurance sampling technique was used to randomly select 19 districts from sample frame of 75 districts. In each selected district, data collector retrieved TB register of 8 months (Jan – Aug 2017) and systematically selected patients by fixed periodic interval. SPSS (version 24.0) was used to analyze the data. Results: Study included 53% (n=301) of males and 47% (n=271) of females, with mean age of 38 years (SD, ±18). Almost half of the participants were illiterate (51%, n=289) and 64% (n=365) were non-earning members of the family. In practice, most of the participants visit private providers (71%, n=407), including private hospital/clinic (44%) and traditional practitioners (27%; n=153). 55% of participants visited the current doctor because of clinic’s proximity to residence. 82% of the participants (n=469) were satisfied with the TB care services and 85% (n=488) said that they would recommend this clinic to others. Conclusion: PHCPs are preferred providers for individuals, which is consistent with findings of other studies. Though they are satisfied with TB care and services, interventions should be introduced to reduce the financial burden on the patient. Partnering PHCP is a way forward to ensure universal health coverage, health system strengthening and better health outcomes of the population.

Quality of life (QOL) is based on their perception of their position in life in respect to their goals, expectations, standards, and concerns, as well as their culture and value systems, their workflow and workplace situations while it influences quality of services. In this study we aim to report on dental and nursing academians’ QOL and well-being at the end of the third year of the COVID-19 pandemic. The World Health Organization Quality of Life-BREF Scale (WHOQOL-BREF) tool, recording Physical, Psychological, Social and Environmental dimensions of QOL, was used. The WHOQOL-BREF was modified on a spiritual, coaching/mentoring approach in a two-step designing and validated procedure. The modified SHQOL-BREF (Spiritual Healthcare version) designed for this study, was uploaded, and filled in online during April-June 2023. Staff (N=120, 75% female) of both departments of Dentistry (44.2%) and Nursing (55.8%) of the National and Kapodistrian university of Athens, participated in anonymity. QOL in terms of physical health was reported at a higher level (M=72.2 points) compared to social relationships (M=69 points), psychological health (M=65 points) and environment (M=59 points) (scores reported in 0-100 score). Overall QOL was rated at 66 points while satisfaction from health at 72 points. Job satisfaction (M1=3.2) and spirituality (M2=3.0) were reported at a medium level in a 5-point scale, while personal beliefs and values were reported at a high level (M3=4.0). Participants age presented a significant, moderate to strong effect on physical health [F(3,97)=2.89, p&lt;.05, η2p=.08] and on environment [F(3,97)=2.80, p&lt;.05, η2p=.08] and marital status on social relationships [F(1,97)=9.66, p&lt;.05, η2p=.09]. Married participants reported consistently higher levels of QOL compared to single participants, for all age groups. Department had a significant moderate effect on social relationships (F(1,97)=5.10, p&lt;.05, η2p=.05) and education a significant moderate to strong effect on psychological health (F(2,97)=3.74, p&lt;.05, η2p=.07). PhD level participants in both departments presented higher levels of psychological health compared to lower educational levels. Also, participants from the department of Dentistry reported higher levels of social relationships QOL in all educational groups, compared to the department of Nursing. Strategic planning on sustainability and QOL initiatives should be introduced after the COVID-19 pandemic for dental and nursing academic personnel to promote resilience and QOL scores.

Recent studies have emphasized the influence of resettlement factors on the mental health of refugees resettling in developed countries. However, little research has addressed gender differences in the nature and influence of resettlement stressors and sources of resilience. We address this gap in knowledge by investigating how gender moderates and mediates the influence of several sources of distress and resilience among 259 Afghan refugees residing in northern California. Gender moderated the effects of four factors on levels of distress. Intimate and extended family ties have little correlation with men’s distress levels, but are strongly associated with lower distress for women. English ability is positively associated with lower distress for women, but not men. In terms of gender ideology, traditionally oriented women and egalitarian men have lower levels of distress. And experiencing greater dissonant acculturation increases distress for men, but not women. The influence of gender interaction terms is substantial and patterns may reflect difficulty adapting to a different gender order. Future studies of similar populations should investigate gender differences in sources of distress and resilience, and efforts to assist new arrivals might inform them of changes in gender roles they may experience, and facilitate opportunities to renegotiate gender roles.

Relying on Random Utility Theory (RUT) as the guiding mechanism for the Data Generating Process (DGP), this paper uses households consumption choices on cooking fuel, drinking water, and sanitation from the 2014 United States Agency for International Development's (USAID) Demographic and Health Survey (DHS) data on Burkina Faso, to characterize and investigate the inter-linkages between health consciousness and environmental consciousness, and their relationship with wealth in a low income country context. We achieve this by specifying sequentially three econometric modeling frameworks: the first one being independent binary probit (IBP) models to describe each choice process, followed by a fully parametric trivariate probit (FPTP) model to account for choice dependency, and finally by a semi-parametric trivariate probit (SPTP) model to further relax the linearity assumption. Based on the Akaike Information criteria (AIC) and the estimated Trivariate model correlation coefficients, the SPTP framework is found to be the best specification for describing the observed consumption behaviors. The results show that increased wealth level raises households health and environmental consciousness, while leaving the relative preference ordering over the elements in the household consumption basket unchanged.

: Healthcare workers are affected by mental health issues, burnout and turnover, and this burden is even greater during epidemics and pandemics, such as COVID-19. The purpose of this research is to provide an overview of the measures introduced or supported in the institutions of Quebec’s health and social services network during the COVID-19 pandemic with the aim of protecting healthcare workers’ mental health. An online questionnaire survey was administered in 2021 among human resources department personnel in health and social services network institutions involved in workplace mental health in Quebec. A total of 223 key informants representing 31 of the 34 public health and social services institutions in the province of Quebec in Canada responded to the questionnaire. Measures that focus on the needs of staff, involve all levels of authority and the ones that provide flexibility, support and recognition at work were more successful, according to the advisors surveyed. Future research into whether the same measures are considered effective or ineffective outside of a pandemic context is needed.

Supporting the implementation of school food and nutrition policies (SFNPs) is an international priority to encourage healthier eating among children and youth. Schools are an important intervention setting to promote childhood nutrition, and many jurisdictions have adopted policies, guidelines, and programs to modify the school nutrition environment and promote healthier eating. The purpose of this study was to explore the association between perceived adequacy and capacity for SFNP implementation on food availability and policy adherence in the province of Nova Scotia (NS), Canada, one of the first regions in Canada to launch a comprehensive SFNP. A cross sectional online survey was conducted in 2014-15 to provide a current-state of policy implementation and adherence. Adequacy and capacity for food policy implementation was used to assess policy adherence through the availability of prohibited ‘minimum’ nutrition foods. An exploratory factor analysis was conducted on a selected of available foods and ‘slow’ and ‘quick’ service food composition measures were dichotomized for food availability. Schools with above perceived average adequacy and capacity for policy implementation had more than three times (3.62) greater odds of adhering to a lunch policy, while schools that adhered to a snack and lunch policy had 52% and 82% lower odds of serving quick service foods, respectively. This study identified the need for appropriate adequacy and capacity for policy implementation to ensure policy adherence and improve the school food environment. These findings highlight the potential of SFNPs to have a positive impact on childhood nutrition, but adequately supporting their implementation is critical to ensure their impact.

The aims of this study are to determine the oral health status of a rare sample of 19th-century migrant settlers to South Australia, how oral conditions may have influenced their general health, and how the oral health of this group compares with contemporaneous samples in Australia, New Zealand, and Britain. Dentitions of 18 adults and 22 subadults were investigated using non-destructive methods (micro-CT, macroscopic, radiographic). Extensive carious lesions were identified in 17 adults and 4 subadults, from this group 1 subadult and 16 adults had antemortem tooth loss. Sixteen adults showed evidence of periodontal disease. Enamel hypoplastic (EH) defects were identified in 14 adults and 9 subadults. Many individuals with dental defects also had skeletal signs of co-morbidities. South Australian individuals had the same percentage of carious lesions as the British sample (53%), more than other historic Australian samples, but less than a contemporary New Zealand sample. Over 50% of individuals from all the historic cemeteries had EH defects suggesting systemic health insults during dental development were common during the 19th century. The overall oral health of the South Australian settlers was poor but, in some categories, (tooth wear, periapical abscess, periodontal disease), better than the other historic samples.

Introduction: The COVID-19 pandemic overwhelmed health systems globally, and affected delivery of other health services. We conducted a study in Uganda to describe interventions for continuity of access to other health services. Methods: We reviewed documents and interviewed 21 key informants. Thematic analysis was conducted to identify themes using the World Health Organization health system building blocks as a guiding framework. Results: Governance strategies included establishment of coordination committees and development and dissemination of guidelines. Infrastructure and commodities strategies included review of drug supply plans and allowing emergency orders. Workforce strategies included provision of infection prevention and control equipment, recruitment and provision of incentives. Service delivery modifications included designation of facilities for COVID-19 management, patient self-management, dispensing drugs for longer periods and leveraging community patient networks to distribute medicines. However, multi-month drug dispensing led to drug stock-outs while community drug distribution was associated with stigma concerns. Conclusions: Health service maintenance during emergencies requires coordination to harness existing health system investments. The service continuity committee coordinated efforts to maintain services and should remain a critical element of emergency response. Self-management and leveraging patient networks should address stigma to support service continuity in similar settings and strengthen service delivery beyond the pandemic.

A small proportion of health care users are recognised to use a significantly higher proportion of health system resources, largely due to systemic, inequitable access and disproportionate health burdens. These high-resource health system users are routinely characterised as older, with multiple comorbidities, and reduced access to adequate health care. Geographic trends also emerge, with more rural and isolated regions demonstrating higher rates of high-resource use than others. Despite known geographical discrepancies in health care access and outcomes, health policy and research initiatives remain focused on urban population centers. To alleviate mounting health system pressure from high-resource users, their characteristics must be better understood within the context in which it arises. To examine this, a scoping review was conducted to provide an overview of characteristics of high-resource users in rural and remote communities in Canada and Australia. In total, 21 papers were included in the review. Using qualitative thematic coding, primary findings characterised rural high-resource users as those of an older age; with increased comorbid conditions and condition severity; lower socioeconomic status; and elevated risk behaviours.

Background: The COVID-19 pandemic has sped up digital health transformation across the health sectors to enable innovative health service delivery. Such transformation relies on competent managers with the capacity to lead and manage. However, the health system has not adopted a holistic approach in addressing the health management workforce development needs, with many hurdles to overcome. The objectives of this paper are to present the findings of a three-step approach in understanding the current hurdles in developing a health management workforce that can enable and maximise the benefits of digital health transformation, and to explore ways of overcoming such hurdles. Methods: A three-step, systematic approach was undertaken, including an Australian digital health policy documentary analysis, an Australian health service management postgraduate program analysis, and a scoping review of international literatures. Results: The main findings will guide the formulation of strategies in developing a digitally enabled health management workforce in the digital health era. Conclusions: With the ever-changing landscape of digital health, being able to lead and manage in times of system transformation requires a holistic approach to develop the necessary health management workforce capabilities and system-wide capacity. The evidence would support that this can be achieved with the required system, policy, educational and professional organizational enablers, which drive a digital health focused approach across all the healthcare sectors, in a coordinated and contextual manner.

Botswana, Eswatini and Lesotho are three Southern African countries which make use of re-turn-of-service (RoS) schemes to increase human resources for health in their countries. These initiatives bind beneficiaries to a pre-defined period of service upon completion of their studies based on the length of funding support received. We aim to review the history of these policies to understand the conceptualisation, intent and implementation of these schemes. We used a mul-ti-methods research design which consisted of a literature review, policy review and semi-structured interviews with policymakers and implementors. All three governments have a combination of grant-loan schemes and full bursaries or scholarships. The policies have all been operating for over 20-years, with Eswatini’s pre-service being the oldest since it was introduced in 1977 followed by Lesotho’s 1978 policy and Botswana’s 1995 pre-service policy. These policies have never been reviewed or updated. RoS schemes in these countries were introduced to ad-dress critical skills shortages, improve employability prospects for citizens, to have competent public sector employees by global standards, and to aid career progress of government employ-ees. Ministries of Health are passive role players. However, these schemes can only be efficient if there is clear cooperation and coordination between all stakeholders.

The supply of mental health processes in primary care has gaps. This study aims to analyze the association of agreement criteria and flows between primary care teams and the Family Health Support Center (NASF) for mental health collaborative care, considering the difference between capital and non-capital cities in Brazil. This cross-sectional study was conducted based on secondary data from the Primary Care Access and Quality Improvement Program. Agreement criteria and flows were obtained from 3883 NASF teams of the matrix support or collaborative care. The Chi-square test and multiple Poisson regression were used; p &lt; 0.05 was considered statistically significant. Prevalence ratios of negative associations demonstrated protective factors for support actions: follow-up at Psychosocial Care Center, management of psychopharmacotherapy, offer of other therapeutic actions, care process for users of psychoactive substances, and offer of activities to prevent the use of psychoactive substances. Collaborative care in primary care was effective, and capital cities were a protective factor compared with non-capital cities.

The negative implications of climate change for human health are now well-established. Yet these have not been fully considered into climate change communication strategies. Research suggests that reorienting climate change communication with a health frame could be a useful communication strategy. We conducted a long-term and broad overview of existing scientific literature in order to summarize the state of research activity in this area, by extent and by nature. The methodology is based on a scoping review of scientific articles published on climate change communication and health between 1990 and mid-2016 indexed in the PubMed, ScienceDirect, and Web of Science databases. The screened citations were reviewed for inclusion and data were extracted and coded in order to conduct quantitative (e.g. frequencies) and qualitative (i.e. content analysis) analyses.Out of 2,866 identified published papers, only 24 articles were eligible for analyses. The main themes identified were effective communication of climate change (n=10, 41.7%), the role of health professionals (n=10, 41.7%) and the perception of climate change (n=4, 16.7%). We identified a large proportion of secondary research articles (n= 15, 62.5%) including reviews (n=5, 20.8%) and opinion articles (n=10, 41.7%). A significant share - 37.57% (n=9) - of the identified articles were classified as original research articles, suggesting that the number of publications in this area - particularly original research - has not grown rapidly.This scoping review identified several themes including effective communication of climate change, the role of health professionals, and the perception of climate change in the selected articles on the subject. The research literature on the communication of climate change and health is relatively recent and emerging: the first articles on the subject were published from 2008 onward only.

Interprofessional learning (IPL) is essential to prepare healthcare trainees as the future public health workforce. WHIRL was an innovative IPL intervention that engaged multi-professional teams of volunteer healthcare trainees (n=20) to deliver health checks (n=464), including tailored advice and signposting, to employees in the UK construction industry (across 21 events, 16 sites, 10 organisations) as part of an ongoing research programme called Test@Work. Volunteers undertook a four-part training and support package of trainer-led education, observations of practice, self-directed learning and clinical supervision, together with peer mentoring. In a one-group post-test only design, IPL outcomes were measured using the Inventory of Reflective Vignette - Interprofessional Learning (IRV-IPL), and the psychometric properties of the IRV-IPL tool were tested. WHIRL demonstrably improved healthcare trainees’ interprofessional skills in all five areas of collaboration, coordination, cooperation, communication, and commendation. The IRV-IPL tool was found to be a valid and reliable measure of interprofessional competencies across three scenarios; before and after health promotion activities, and as a predictor of future health promotion competence. This industry-based workplace IPL programme resulted in attainment of health check competencies, and bridged the gap between research, education and clinical practice.

This observational study was ordered by the Medical Practitioners’ Chamber in Warsaw. The objective of the study was to evaluate the health status of physicians in relation to their occupational duties. Professional burnout was considered relative to different features of personality. This study was initially carried out from 2005–2008, but further analysis of burnout and personality was carried out from 2017–2018. The research tools were anonymous, validated questionnaires. The sample size was based on the size of the population— the registry of the Regional Chamber of Medical Practitioners— and literature on burnout prevalence. The respondents’ work places were randomly selected from the Mazovian District register. The test on burnout was completed by 378 respondents, while 62 subjects completed a personality test. Results showed that burnout syndrome was an occupational problem for healthcare workers. Professional burnout affected as many as 42% of respondents(n = 158). It affected two age groups in particular: physicians up to 31 years old and individuals aged 41-50. Moreover, neuroticism was found to be significantly related to burnout syndrome. In conclusion, burnout syndrome is common among medical practitioners, and neuroticism may be correlated with burnout syndrome.

Adolescence is a crucial phase marked by significant physical, psychological, emotional and social changes. India having the world's largest adolescent population, understanding and addressing their health needs are vital for the nation's social, political, and economic progress. The primary aim of this study is to examine the impact of key health policies on adolescent health outcomes in India. To achieve this objective, the research adopts a mixed-method approach, combining qualitative and quantitative analysis of health policies, strategies, and programs implemented since 2005 was conducted. Additionally, data from the most recent three Demographic Health Surveys (DHS) were analyzed and compared to assess changes in adolescent health indicators after the implementation of these policies/strategies. Major adolescent health policies in India were assessed, namely the Adolescent Reproductive and Sexual Health Strategy (ARSH 2005), Rashtriya Kishor Swasthya Karyakram (RKSK 2014), and School Health Programme 2020. All the strategies and programs aim to provide a comprehensive framework for sexual and reproductive health services, expand the scope of adolescent health programming, and address various health aspects. The SWOT analysis findings, highlighted strengths in targeted interventions, monitoring, and promotion, but weaknesses in awareness, societal barriers, and healthcare worker participation. Opportunities include female-friendly clinics and education about early pregnancy, while addressing substance abuse and training volunteers remain challenges. Family planning has improved, with higher contraception usage and a decrease in unmet needs. Violence reduced, and positive health behaviors increased, such as condom use. However, challenges remain, including limited access to health services, concerns about female providers, and low health insurance coverage. Nutrition indicators show a slight increase in overweight/obesity and anemia rates. Overall, progress has been made, but certain health aspects still require attention. Therefore, conducting targeted awareness campaigns, strengthening health worker and NGOs engagement, combating the increasing prevalence of overweight and obesity among adolescents are highly recommended. Further efforts are needed to achieve universal health coverage and improve adolescent health outcomes globally.

Zoonoses are diseases transmitted from (vertebrate) animals to humans. Control and prevention of these diseases require an appropriate way to measure health for prudent and well-balanced decisions in public health. We propose a framework that aims to explore, understand and open up a conversation about the non-monetary value of animals through environmental and normative ethics. As an example of its application, participants can choose what they are willing to give in exchange for curing an animal in hypothetical scenarios selecting a human health condition to suffer, the amount of money, and lifetime as a tradeoff. We believe that considering animals beyond their monetary value in public health decisions will contribute to a more rigorous assessment of the burden of zoonotic diseases, among other health decisions. This method might help us complement the existing metrics in health, adding more comprehensive values for animal and human health for the “One Health” approach.

International migrants comprised 14% of the UK population in 2020, but migrant health in the UK has rarely been studied at a population level using primary care electronic health records (EHRs). Given the difficulty of determining migration status using EHRs, this study developed a migration phenotype and assessed its validity. We developed a phenotyping algorithm using codes for country of birth, visa status, non-English main/first language and non-UK origin. It was applied to a Clinical Practice Research Datalink (CPRD) GOLD database of 16,071,111 primary care patients between 1997 and 2018. We compared the completeness and representativeness of the identified migrant population to Office for National Statistics (ONS) country of birth and 2011 census data by year, age, sex, geographic region of birth and ethnicity. Between 1997-2018, 403,768 migrants (2.51% of the CPRD GOLD population) were identified using the phenotype. 178,749 (1.11%) of these migrants were identified by codes indicating foreign country of birth or visa status, 216,731 (1.35%) a non-English main/first language, and 8,288 (0.05%) non-UK origin. The cohort was similarly distributed compared to ONS migration statistics in terms of sex and region of birth. Recording of migration improved from identifying approximately one-tenth of the expected proportion of migrants according to the ONS in 2004 to a quarter in 2018. Younger migrants were better represented than those aged 50 and over. The migration phenotype identified a large number of migrants and can be used to undertake large-scale migration health research in CPRD GOLD to inform healthcare policy, practice and action. While the cohort was representative of the UK migrant population in terms of sex and region of birth, migration status was under-recorded in earlier years and older ages, and future studies for these groups should therefore be interpreted with caution.

Effectively responding to children’s nutritional status and eating behaviors in Mozambique requires a community-based care approach grounded in sound nursing research that is evidence-based. The Community Assessment, Intervention, and Empowerment Model (MAIEC) is a nursing theoretical model that bases clinical decision-making for community health nurses using communities as a unit of care. We used the MAIEC to identify a community-based nursing diagnosis to address children’s nutritional status and eating behaviors in Mozambique. Objectives: (1) To conduct a descriptive study of children’s nutritional status and eating behaviors in a school community in Mavalane, Mozambique, and (2) to identify a community-based nursing diagnosis using the MAIEC clinical decision-making matrix in the same school community. Method: A cross-sectional, quantitative study was conducted to assess the nutritional status of children using anthropometric data, including brachial perimeter and the tricipital skinfold, and standard deviation for the relation of weight-height, in a sample of 227 children. To assess community management of the problem and identify a community-based nursing diagnosis, we surveyed 176 parents/guardians and 49 education professionals, using a questionnaire based on the MAIEC clinical decision matrix as a reference. Results: Malnutrition was identified in more than half of the children (51.3%). We also identified a community-based nursing diagnosis of impaired community management related to the promotion of child health and healthy eating as evident by lack of community leadership, participation, and processing among more than 70% of the community members (parents/guardians and education professionals). Conclusion: A nursing diagnosis and diagnostic criteria for nutritional status and community management were identified. The need to intervene using a multidisciplinary public health approach is imperative, with the school community as the unit of care. In addition, reliable anthropometric data were used to complement the nursing diagnosis and guide future public health interventions.

Hispanics are disproportionately affected by low rates of physical activity and high rates of chronic diseases. Hispanics generally and Mexican Americans specifically are underrepresented in research on physical activity and its impact on mental well-being. Some community-based interventions have been effective in increasing physical activity among Hispanics. This study examined data from a sample of low-income Hispanic participants in free community exercise classes to characterize the association between self-reported frequency of exercise class attendance, intensity of physical activity, and participant well-being. As part of two cross-sectional samples recruited from a stratified random sample of community exercise classes, 302 participants completed a questionnaire consisting of a modified version of the Godin-Shephard Leisure-Time Exercise Questionnaire (LTEQ) and the Mental Health Continuum Short Form (MHC-SF). Adjusted binary logistic regression analyses indicated that those who achieve moderate and strenuous self-reported physical activity have 130% higher odds (p = 0.0422) of positive mental well-being after adjustment for age, attendance, and self-reported health. This study provides evidence that physical activity intensity and time are associated with flourishing mental health among Hispanics. The study provides insight into the planning and development of community-based physical activity programming tailored to low-income populations.

Objective: To explore the effect of rural-urban residence on self-reported health status with UK cancer survivors. Design: A cross-sectional postal questionnaire that collected data on demographics, post-code and self-reported health status. Methods: Independent Samples t test was used to detect differences in health status between rural and urban respondents. Pearson’s χ2 was used to control for confounding variables and multivariate analysis was conducted using Stepwise linear regression. Setting: East Midlands of England. Participants: Adult cancer survivors who had undergone primary treatment in the last five years. Participants were excluded if they had recurrence or metastatic spread, started active oncology treatment in the last twelve months and were in receipt of palliative or end of life care. Main Outcome: Residence was measured using the UK ONS RUC2011 Rural-Urban Classifications and Health Status via the UK ONS self-reported health status measure. Results: 227 respondents returned a questionnaire. Forty-five per cent (N=103) were resident in a rural area and fifty-three per cent (N=120) in an urban area. Rural (4.11±0.85) respondents had significantly (p<0.001) higher self-reported health status compared to urban (3.65±0.93) respondents (MD 0.47; 95% CI 0.23, 0.70). Conclusion: Rural respondents had significantly higher self-reported health status compared to their urban counterparts. It is hoped that the results will stimulate further work in this area and that researchers will be encouraged to collect data on rural-urban residency where appropriate.

Resumo: Este estudo teve como objetivo avaliar a Saúde Mental Positiva (SPM) e a sua relação com características sociodemográficas, literacia em saúde mental e escala de vulnerabilidade psicológica (PVS) em estudantes universitários portugueses com idades compreendidas entre os 17 e os 62 anos. Foi realizado um estudo descritivo-correlacional. Uma pesquisa online foi realizada para avaliar variáveis ​​demográficas, e vários questionários foram aplicados para avaliar saúde mental positiva, vulnerabilidade psicológica e alfabetização em saúde mental. Os dados foram coletados de 1º de novembro de 2019 a 1º de setembro de 2020. No geral, 3.405 alunos participaram do estudo. Os resultados mostram que 67,8% dos alunos revelaram um alto nível de PMH, 31,6% apresentaram um nível médio de PMH e 0,6% apresentaram um nível baixo de PMH. Os estudantes do sexo masculino relataram maior satisfação pessoal (t (3170) = -2,39, p=0,017) e autonomia (t (3170) = -3,33, p=0,001), no PMH em relação ao sexo feminino. Alunos sem bolsa pontuaram mais alto (t (3.127) = -2,04, p=0,42) no PMH do que alunos com bolsa. Estudantes que não foram deslocados de casa relataram maior (t (3170) = -1,99, p=0,047) Autocontrole em PMH do que aqueles deslocados de sua casa. Estudantes universitários com resultados de PMH mais altos têm resultados de PVS mais baixos e resultados de Alfabetização mais altos. Os achados deste estudo contribuirão para identificar as necessidades de intervenção dos alunos na PMH. Estudantes universitários com resultados de PMH mais altos têm resultados de PVS mais baixos e resultados de Alfabetização mais altos. Os achados deste estudo contribuirão para identificar as necessidades de intervenção dos alunos na PMH. Estudantes universitários com resultados de PMH mais altos têm resultados de PVS mais baixos e resultados de Alfabetização mais altos. Os achados deste estudo contribuirão para identificar as necessidades de intervenção dos alunos na PMH.

The aim was to analyze the coping strategies used by primary health care (PHC) professionals. A cross-sectional, descriptive-analytical study was conducted with professionals working in primary health care units in São José do Rio Preto, a large city in the interior of São Paulo, Brazil. For data collection we used an instrument developed by the researchers, containing sociodemographic and professional variables, as well as the Problem Coping Modes Scale (EMEP). We evaluated 333 PHC professionals. A difference was observed between the scores of the four coping strategies (p<0.001), with the highest score for the problem-focused strategy (3.8) and the lowest score for the emotion-focused strategy (2.4). Physicians had the lowest scores in coping strategies focused on religious practices/fantastical thinking (p<0.001) and pursuit of social support (p=0.045), while community health agents had the highest scores in these coping strategies). Professionals working in PHC have different coping strategies for the problems and stressful situations experienced in the work environment. These strategies can involve more positive attitudes focused on confrontation and problem solving, to emotional responses that involve attitudes of avoidance and denial that involve attitudes of avoidance and denial of the problem.

In the following article, we analyse the determinants of the number of physicians in the context of ISTAT BES-Benessere Equo Sostenibile data among twenty Italian regions in the period 2004-2022. We apply Panel Data with Random Effects, Panel Data with Fixed Effects, and Pooled OLS-Ordinary Least Squares. We found that the number of Physicians among Italian regions is positively associated, among others, to “Trust in the Police and Firefighters”, “Net Income Inequality”, and negatively associated, among others, to “Research and Development Intensity” and “Soil waterproofing by artificial cover”. Furthermore, we apply the k-Means algorithm optimized with the Silhouette Coefficient and we find the presence of two clusters. Finally, we confront eight different machine-learning algorithms to predict the future value of physicians and we find that the PNN-Probabilistic Neural Network is the best predictive algorithm.

Type 1 diabetes (T1D) has shown an increase in the incidence rate of about 3% per year over the last two decades. Continuous Insulin Subcutaneous Therapy (CSII) is widely used in the paediatric population with diabetes; however, it requires more preparation by the treating team and careful selection of potential users. Prescriptive provisions vary from Region to Region and the perspective of health workers still remains an unexplored area. The aim of the research project is to explore the representations of a group of diabetologists and psychologists working in pediatric diabetology on the national territory, regarding roles, functions and activities as part of a multidisciplinary team; their views on the potential benefits of CSII and the types of individuals applying for the use of technology. A socio-anagraphic data sheet was administered and two homogeneous focus groups were conducted by profession; they were audio recorded. The transcripts produced were analysed using the Emotional Text Mining (ETM) methodology. Each of the two corpus generated three clusters and two factors: for diabetologists, a focus on the patient in different levels of care emerged, collaborating both with other health professionals and with the territory, through the proposal of an intervention where the medical aspect is often represented by technology; also for psychologists there was a representation of interdisciplinary networking, with a greater focus on the processes inherent the management of pathology, from acceptance to the elaboration and integration of diabetes in the family narrative. The understanding of the representations of health professionals working in pediatric diabetes about new technologies can contribute to the consolidation of a network of professionals through a targeted work on possible critical issues emerged.

This article delves into the pivotal role that biodiversity of soil microbes plays in bolstering tree health and overall agroecosystem productivity. With the advent of regenerative agricultural practices, there has been a resurgence of interest in understanding the complex interactions between soil microbiota and plant roots, particularly through processes like rhizophagy. Rhizophagy, the digestion of living root cells by soil microorganisms, stands out as a fundamental mechanism in nutrient cycling and overall tree vitality. By examining the impact of enhanced microbial diversity on tree health, we shed light on the practical applications, such as the utilization of the BEAM Inoculant product, which has demonstrated remarkable efficacy in augmenting soil health and, consequently, tree Vigor

COVID-19 has proven to be detrimental across the globe, most notably affecting the United States at an alarming rate compared to comparable countries. The pandemic has had multifactorial implications on the way communities in the United States prevent, prepare for, and address the virus; however, the impact of the pandemic on rural health is less well understood. Historically, rural communities have faced a unique set of challenges regarding accessing and receiving adequate healthcare, addressing chronic illness, and eliminating health disparities closely associated with the population’s socioeconomic status; the pandemic has exacerbated these challenges. The purpose of the current study was to conduct a systematic review of the literature to evaluate the effect of the COVID-19 pandemic on rural populations both at the individual and community level. Results indicated that rural health disparities increased both at the individual and system-wide levels as a direct result of the pandemic. Budget cuts significantly affected the infrastructure of rural hospitals resulting in them being unequipped to handle such high volumes of COVID-19 cases. The lack of infectious disease specialists, access to larger medical centers with substantial numbers of ICU beds and ventilators, and an overall lack of preparedness overwhelmed rural communities. Although comorbidities such as diabetes and heart disease were associated with poorer health outcomes for a multitude of reasons, the lack of clinic and physician availability for routine care during the pandemic further exacerbated the clinical link from COVID-19 positivity to comorbidities. Furthermore, mental health deteriorated as substance use increased to a greater extent in rural communities compared to urban, during the pandemic. This study shows that health comorbidities, mental health, substance use, health literacy, access to healthcare, among others can serve as key indicators for improving healthcare in rural communities. Future studies should seek to identify key issues that disproportionately affected rural communities in comparison to their urban counterparts considering the pandemic, as well as identify gaps in the availability of rural health resources that can improve the lives of millions of Americans now and during the next pandemic.

Trees provide key ecosystem services, but the health and sustainability of these plants is under increasing biotic and abiotic threat, including from the growing incidences of non-native invasive plant pests (including pathogens). The island of Ireland (Ireland and Northern Ireland) is generally accepted to have a high plant health status, in part due to its island status and because of the national and international regulations aimed at protecting plant health. To establish a baseline of the current pest threats to tree health for the island of Ireland, the literature and unpublished sources were reviewed to produce a dataset of pests of trees on the island of Ireland. The dataset contains 396 records of pests of trees on the island of Ireland, the majority of pests being arthropods and fungi, and indicating potentially more than 44 non-native pest introductions. The reliability of many (378) of the records was judged to be high, therefore the dataset provides a robust assessment of the state of pests of trees recorded on the island of Ireland. We analyse this dataset and review the history of plant pest invasions, including (i) discussion on notable native and non-native pests of trees, (ii) pest interceptions at borders and (iii) pests and climate change. The dataset establishes an important baseline for the knowledge of plant pests on the island of Ireland, and will be a valuable resource for future plant health research and policy making.

Along with environmental pollutions, urban planning has been connected to public health. The research indicates that the quality of built environments plays an important role in reducing mental disorders and overall health. The structure and shape of the city are considered as one of the factors influencing happiness and health in urban communities and the type of the daily activities of citizens. The aim of this study was to promote physical activity in the main structure of the city via urban design in a way that the main form and morphology of the city can encourage citizens to move around and have physical activity within the city. Functional, physical, cultural-social, and perceptual-visual features are regarded as the most important and effective criteria in increasing physical activities in urban spaces based on literature review. The environmental quality of urban spaces and their role in the physical activities of citizens in urban spaces were assessed by using the questionnaire tool and analytical network process (ANP) of structural equation modeling. Further, the space syntax method was utilized to evaluate the role of the spatial integration of urban spaces on improving physical activities. Based on the results, the consideration of functional diversity, spatial flexibility and integration, security, and the aesthetic and visual quality of urban spaces plays an important role in improving the physical health of citizens in urban spaces. Further, more physical activities, including motivation for walking and consequently, the sense of public health and happiness, were observed in the streets having higher linkage and space syntax indexes with their surrounding texture.

Health literacy describes skills and competencies that enable people to gain access to, understand and apply health information to positively influence their own health and the health of those in the social environment. In an increasingly media saturated and digitized world, these skill sets are necessary for accessing and navigating sources of health information and tools, such as television, the Internet, and mobile apps. The concepts of Media Health Literacy (MHL) and eHealth Literacy (eHL) describe the specific competencies such tasks require. This article introduces the two concepts, and then reviews findings on the associations of MHL and eHL with several contextual variables in the social environment such as socio-demographics, social support, and system complexity, as a structural variable. As eHL and MHL are crucial for empowering people to actively engage in their own health, a growing body of literature reports of the potential and the effectiveness of intervention initiatives to positively influence these competencies. From an ethical standpoint, equity is emphasized, stressing the importance of accessible media environments for all - including those at risk of exclusion from (digital) media sources. Alignment of micro and macro contextual spheres will ultimately facilitate both non-digital and digital media to effectively support and promote public health.

Aim: Shockwaves have been felt all over the world as a result of war, inflation, food shortages, and the COVID-19 pandemic's long tail. The aim of the study is to correlate present global conflicts, pandemic and socio-economic crises with present healthcare sustainability, identifying possible threats and visualize future global health crises if all these catastrophes persist for long. Materials and Methods: PubMed, ALTAVISTA, Embase, Scopus, Web of Science, and the Cochrane Central Registers were prioritized to collect public health issues. Results: The global economic slowdown, sharp decline in financial asset values, decline in imports and exports, contraction of industrial production, rise in inflation, decrease in wages, rise in unemployment, damage to the social security caused by numerous natural calamities, human displacement due to pandemic and ongoing conflicts tear down not only the economic sector but also the health sector. It is already late for taking corrective measure by the participation every country, community or intelligence. Only healthcare issues, highlighted in this study, if focused in the highest platforms, could compel global leaders to forego conflicts and work together. Conclusion: The global health sector will be collapsed soon, if proper initiatives are not taken right now, which has already been grossly mistreated by the pandemic.

The investment in digital e-Health services is a priority direction in the development of global health care systems. While people are increasingly using the Web for health information, it is not entirely clear what is the physicians’ attitude towards digital transformation, and the acceptance of new technologies in healthcare. The aim of this cross-sectional survey study was to investigate physicians’ self-digital skills, and their opinions on obtaining online health knowledge by patients, as well as the recognition of physicians’ attitudes towards e-Health solutions. Principal Component Analysis (PCA) was performed to emerge the variables from self-designed questionnaire, and cross-sectional analysis comparing descriptive statistics and correlations for dependent variables using the one-way ANOVA (F-test). 307 physicians participated in the study, reported using the internet mainly several times a day (66.8%). Most participants (70.4%) were familiar with new technologies and rate their e-Health literacy high, although 84.0% reported the need for additional training in this field, and reported a need to introduce a larger number of subjects shaping digital skills (75.9%) in medical studies 53.4% of physicians perceived Internet-sourced information as sometimes reliable, and in general assessed the effects of using it by their patients negatively (41.7%). Digital skills increased significantly with frequency of internet use (F = 13.167; p = 0.0001), and decreased with physicians’ age, and the need for training. Those who claimed that patients often experienced health benefits from online health showed higher digital skills (-1.06). Physicians most often recommended their patients to obtain laboratory test results online (32.2%), and to arrange medical appointments via the Internet (27.0%). Along with the deterioration of physicians’ digital skills, the recommendation of e-Health solutions decreased (r = 0.413), and lower the assessment of e-Health solutions for the patient (r = 0.449). Physicians perceive digitization as a sign of the times, and frequently use its tools in daily practice. The evaluation of Dr. Google’s phenomenon and online health is directly related to their own e-Health literacy skills, but there is still a need for practical training to deal with digital revolution.

Background: It is very important that nurses receive adequate training in Sexual and Reproductive Health (SRH). In this study, the contents of the SRH subject in the undergraduate nursing curricula of 77 Spanish universities were examined in order to determine what SRH training nursing students are receiving. Methods: The contents of the SRH subject of all the curricula that were available online were reviewed. The distribution of the contents (topics) in the two areas (reproductive health and sexual health) was analyzed, and the prevalence of each topic was established. It was also determined whether there were differences in topics between public (n=52) and private universities (n=25). Results: The training of nursing students focuses mainly on the area of Reproductive Health (15 topics). Most of the topics of this area had a prevalence greater than 50%. Although the area of Sexual Health had 14 topics, most of these topics had a low prevalence (&lt;20%), especially in private universities. Conclusions: It was found that there is considerable variation in the distribution and prevalence of SRH topics between universities. The contents of the area of Reproductive Health are usually prevalent in most of the curricula, however the contents of the area of Sexual Health are very limited in most of the universities. An organizational effort is required to determine and standardize the contents of SRH that nursing students should receive in Spain to avoid inequalities in their training.

Aedes aegypti mosquitoes are primary vectors of dengue, yellow fever, chikungunya and Zika viruses. Ae. aegypti is highly anthropophilic and relies nearly exclusively on human blood meals and habitats for reproduction. Socioeconomic factors may influence the spread of Ae. aegypti due to its close relationship with humans. This paper describes and summarizes the published literature on how socioeconomic variables influence the distribution of Ae. aegypti mosquitoes in the mainland United States. A comprehensive search of PubMed/Medline, Scopus, Web of Science, and EBSCO Academic Search Complete through June 12, 2019 was used to retrieve all articles published in English on the association of socioeconomic factors and the distribution of Ae. aegypti mosquitoes. Additionally, a hand search of mosquito control association websites was conducted in an attempt to identify relevant grey literature. Articles were screened for eligibility using the process described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Initially, 3,493 articles were identified through the database searches and previously known literature. After checking for duplicates, 2,145 articles remained. 570 additional records were identified through the grey literature search for a total of 2,715 articles. These articles were screened for eligibility using their titles and abstracts, and 2,677 articles were excluded for not meeting the eligibility criteria. Finally, the full text for each of the remaining articles (n = 38) was read to determine eligibility. Through this screening process, 11 articles were identified for inclusion in this review. The findings for these 11 studies revealed inconsistent relationships between the studied socioeconomic factors and the distribution and abundance of Ae. aegypti. The findings of this review suggest a gap in the literature and understanding of the influence of anthropogenic factors on the distribution of Ae. aegypti that could hinder efforts to implement effective public health prevention and control strategies should a disease outbreak occur.

Concerning the hippocampal mechanisms that simultaneously function to map environmental position and to generate episodic memories, a developing consensus emerged by the early 21st century. The hippocampus was recognized as embodying the primary location of personal narrative development, with the ability to create stable and coherent narrative largely representing the mental health of individuals. Determining recent advances regarding the relationship among the hippocampus, narrative, and mental health, a limited, six-database review was conducted for peer reviewed articles published since 2019. Of the 127 records located, 14 reports were included for study. The results support the necessity of creating and maintaining a stable and coherent narrative as fundamental to human mental health such that facts will be distorted in personal accounts, sleep will be disrupted, and DNA altered to retain one’s personal narratives. With narrative development fundamental to human mental health, a goal of interventions concerning hippocampal function and positive health outcomes is enhancing personal narratives in providing individuals with the ability to construct and recall those that are robust and effective. One such intervention that has proven successful in this regard, the Health Narratives Research Process, is outlined with its most recent results presented, offering opportunity for further such research.

The assessment of the prevalence of Subclinical Mastitis (SCM) in dairy farms is essential to validate the health status of the mammary gland. The aim of the study was to assess the prevalence of SCM in dual purpose livestock systems in Arauca, Colombian Orinoquia, through the analysis of the values found by the field diagnostic tests California Mastitis Test (CMT) and Electric Conductivity (EC). Milk samples were taken from the individual mammary quarters of 481 cows. The general prevalence, per affected room and the total number of rooms was determined according to the values obtained for each test using two methods of analysis. An ANOVA was performed to determine the difference between prevalence’s, a correlation analysis, and an analysis of sensitivity and specificity. The general prevalence was similar between the tests (CMT = 31.4%; EC = 29.7%) (p > 0.05). The prevalence of the total quarters was lower with EC (11.3% vs 14.2%) (p < 0.05). The correlations between tests were significant, but with low values (rs = 0.20-0.25). CMT and EC test concordance showed a sensitivity between 0.35-0.45 and a specificity of 0.75-0.90. The two tests showed positive results in detecting the same animals with or without the presence of the infection, although some animals that were positive for one test were not positive for the other test. The test EC classified animals and their quarters as SCM positive or negative in a more similar way to that obtained with CMT. The two diagnostic tests showed a general low prevalence of SCM in the livestock systems evaluated.

Health literacy is an indicator of a society’s ability to make better health judgement for themselves and the people around them. This study investigates the prevalence of health literacy among Malaysian adults and provides an overall picture of the current health literacy state of the society. The study also highlights socio-demographics markers of communities with limited health literacy which may warrant future intervention. A population based self-administered survey using the Health Literacy Survey Malaysian Questionnaire18 (HLS-M-Q18) instrument was conducted as part of the National Health Morbidity Survey 2019 in Malaysia. The nationwide survey utilized two-staged stratified random sampling method. A sample of 9478 individuals aged 18 and above participated in the study. The health literacy score was divided into three levels; limited, sufficient and excellent. Findings showed that majority Malaysian population has sufficient health literacy level, albeit leaning towards the lower end of the category with an average score of 35.5. The limited health literacy groups are associated with respondents with older age, lower education level and lower household income. Overall health literacy state for Malaysia is categorized at a lower sufficient level. Health literacy improvements should focus on communities with limited health literacy level.

Identifying health care equity indicators is an important first step in integrating the concept of equity into assessments of health care system performance, particularly in emergency care. We conducted a systematic review of administrative data-derived health care equity indicators and their association with socio-economic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PUBMED and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine. Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care sensitive condition-related ED visits were the two most frequently used equity indicators. Despite some conflicting results, all identified SEDH (social deprivation, income, education level, social class, insurance coverage and health literacy) are associated with inequalities in access to and use of emergency care. In conclusion, the use of administrative data-derived indicators combined with identified SEDH could improve healthcare equity measurement in emergency care settings across health care systems worldwide.

The study aimed to estimate the prevalence and correlates of overweight and obesity among adults in Iraq. Data from a 2015 nationally representative cross-sectional survey of 3,916 persons 18 years and older were analysed that responded to a questionnaire, physical and biochemical measures. Multinomial logistic regression was utilized to predict determinants of overweight and obesity relative to under or normal weight. Results indicate that 3.6% of the participants were underweight (BMI <18.5 kg/m²), 30.8% had normal weight (BMI 18.5-24.9 kg/m²), 31.8% were overweight (25.0-29.9 kg/m²), and 33.9% had obesity (BMI ≥ 30.0 kg/m²). In adjusted multinomial logistic regression, aged 40-49 years (Adjusted Relative Risk Ratio-ARRR: 4.47, Confidence Interval-CI: 3.39-5.91), urban residence (ARRR: 1.28, CI: 1.14-2.18), hypertension (ARRR: 3.13, CI: 2.36-4.17) were positively, and male sex (ARRR: 0.47, CI: 0.33-0.68), having more than primary education (ARRR: 0.69, CI: 0.50-0.94), and larger household size (≥5 members) (ARRR: 0.45, CI: 0.33-0.60) were negativey associated with obesity. About two in three adult participants were overweight/obese, and sociodemographic and health risk factors were found that can be utilized in targeting interventions.

The epidemic of Coronavirus Disease 2019 (Covid-19) has brought many changes to people's life. This study aims to analysis Chinese people's psychological change and life after quarantining Wuhan and explore the influencing factors. Based on data from a web-survey after quarantining Wuhan (N=3268), the principal-component-analysis (PCA), multiple-linear-regression (MLR), propensity-score-matching (PSM) were used to explore the psychological change of people in China and the influencing factors. 83.3% of the respondents said that the impact of the epidemic on their life had increased after quarantining Wuhan. A considerable proportion of people's anxiety increased, being reflected in negative emotion, behavioral response and physiological response. The proportion of people who said their anxiety had increased in Wuhan was higher than that in other regions (p <0.05). The anxiety of people who were in medical isolation increased less than those who were not (p <0.05). All three aspects of people’s anxiety were positively related with time of medical isolation and degree of the attention on the epidemic (p＜0.05) except the effect of attention degree on the physiological response (p＝0.06). The measure of medical isolation at home should be advocated. Yet people should reduce the concern for the epidemic while paying attention to self-protection.

The COVID-19 crisis has brought unprecedented strain on healthcare systems around the world. It has perhaps taught us some key lessons that are worth considering and addressing to help build more sustainable health systems as well as improve our ability to combat future epidemics.

Recently there is a growing concern regarding potential health hazards linked with 5G deployment and radio frequency emitted by these stations. It becomes fundamentally important to scientifically address these concerns. In this paper, the health risks incorporated with 5G are discussed critically in the light of scientific work and debunk these tittle-tattles where required. We confute scientifically the “5G appeal”, discuss effects of 5G on health, its implications on privacy, pandemics, ecosystem and role of world health organization in fighting these narratives. Finally, we provide future direction to negate these false claims linked with 5G.

Since the college years represent an important period for forming oral health behaviors during adulthood, it is important that college students establish proper oral health-promoting behaviors. Therefore, this study aims to identify the effects of oral health education experience, knowledge, and practice behaviors on oral health care self-efficacy among college students, as studies related to this topic are scarce. A total of 236 college students participated in a questionnaire survey comprising 21 questions. The collected data were analyzed through a chi-square test, independent-samples t-test, and logistic regression analysis using SPSS version 22.0. Participants with oral health education experience showed higher levels of oral health knowledge and practice behaviors than those who did not, and the odds of them having oral health care self-efficacy was 3.743 higher. Moreover, a one-unit increase in oral health knowledge and practice behaviors was associated with a 1.199 and 1.351 increase in oral health care self-efficacy, respectively. For oral health promotion among college students, oral health care self-efficacy reinforcement programs tailored to college students should be developed. These should focus on expanding oral health education opportunities to promote improvement in oral health care self-efficacy by strengthening oral health knowledge and the motivation to practice oral health behaviors.

Fungi constitute a diverse group with highly positive and negative impacts in different envi-ronments, having several natural roles and beneficial applications in human life, but also caus-ing several concerns. Fungi can affect human health directly, but also indirectly by being detri-mental for animal and plant health influencing food safety and security. Climate changes are al-so affecting fungal distribution, prevalence, and their impact on different settings. Searching for sustainable solutions to deal with these issues is challenging due to the complexity of the inter-actions among fungi and agriculture, animal production, environment, and human health. In this way, the “One Health” approach may be useful to get some answers since it recognizes that human health is closely connected to animal and plant health, as well as to the shared environ-ment. This review aims to explore and correlate each of those factors influencing human health in this “One Health” perspective.

(1) Influenza causes a significant health and socio-economic burden every year, and health personnel (HP) are at higher risk of exposure to respiratory pathogens than general population. (2) The study purpose was to describe and compare influenza vaccine uptake and its prognostic factors among Medical Doctors (MDs) and Non-Medical Health Personnel (NMHP) vs Non-HP (NHP). We analysed 2014-2018 data (N=105,608) from the Italian Behavioural Risk Factor Surveillance System PASSI that, since 2008, has been collecting health-related information continuously in sampled adults. (3) MDs and NMHP represented, respectively, 1.1% and 4.6% of the sample. Among HP, 22.8% (CI 19.8% - 26.1%) of MDs and 8.5% (CI 7.5% - 9.5%) of NMHP reported to have been vaccinated vs 6.3% (CI 6.1% - 6.5%) in NHP. This difference is confirmed in the three categories (MDs, NMHP, NHP), even more across age groups: in 18-34yy, respectively, 9.9%, 4.4%, 3.4% vs 28.4%, 13.9%, 10.6% in 50-64yy. PASSI surveillance shows an increasing influenza vaccination uptake over time, especially among MDs (22.2% in 2014 vs 30.5% in 2018). (4) Despite such increase, especially among younger HP, influenza vaccination uptake is low. Even more under pandemic scenarios, these figures represent key information to address effective strategies for disease prevention and health promotion.

Abstract Issue Addressed: Men’s Sheds (‘Sheds’) have been identified as inherently health promoting and as potential settings to engage ‘hard-to-reach’ men in more structured health promotion initiatives. However, little is known about the sociodemographic or health and wellbeing characteristics of Shed members (‘Shedders’) on which such initiatives might be based. This study captures a baseline cross sectional analysis of Shedders (n=384) who participated in ‘Sheds for Life’, a health promotion initiative tailored to Sheds. Methods: Objective health measure, (body composition, blood pressure, blood lipids) captured via health screening as well as sociodemographic and health and wellbeing measures (physical activity, subjective wellbeing, mental health, social capital, cooking and diet) via questionnaires were assessed. Results: Participants were mostly over 65 years, retired with limited educational attainment. The majority were in the ‘at-risk’ categories for objective health measures, with most being referred to their GP following health screening. Older Shedders were also more likely to meet physical activity guidelines. Mental wellbeing was positively correlated with life satisfaction and increased social capital and these were also positively correlated with physical activity. Conclusions: Findings highlight the potential of Sheds in reaching a ‘hard-to-reach’ and ‘at-risk’ cohort of men. Despite a high prevalence of ‘at-risk’ objective health measures, participants report their health in positive terms. Future health promotion initiatives should capitalise on the inherent health promoting properties of Sheds. So what? Findings raise important implications for prioritising and designing health promotion initiatives in Shed settings.

Health innovations are generally oriented on a techno-economic vision. In this perspective, technologies are seen as an end in themselves, and there is no arrangement between the technical and the social values of innovation. This vision prevails in sanitary crises, in which management is carried out based on the search for punctual, reactive, and technical solutions to remedy a specific problem without a systemic/holistic, sustainable, or proactive approach. This paper attempts to contribute to the literature on the epistemological orientation of innovations in the field of public health. Taking the Covid-19 and Ebola crises as examples, the primary objective is to show how innovation in health is oriented towards a techno-economic paradigm. Second, we propose a repositioning of public health innovation towards a social paradigm that will put more emphasis on the interaction between social and health dimensions in the perspective of social change.

Individuals with low health literacy (HL) are known to have poorer health outcomes and to have higher mortality rates compared to individuals with higher HL: hence, the improvement of HL is a key outcome in modern healthcare systems. Healthcare providers are therefore asked to support patients’ literacy skills by encouraging the implementation of autonomy-supportive patient centered communication (PCC), which in turn requires the enhancement of patient engagement. Our main hypothesis is that the well-known relationship between autonomy-supportive PCC and HL is mediated by patient engagement which is known to play a role in HL promotion and that is related to PCC as well. The purpose of this study was to formulate a hypothetical structural equation model (SEM) linking PCC to patient engagement and HL. A cross-sectional survey design was employed involving 1007 Italian chronic patients. The hypothetical model was tested using SEM to verify the hypothesized mediation of patient engagement between PCC and HL. Results show that the theoretical model has a good fit indexes and that patient engagement fully mediates the relationship between PCC and HL. This finding suggests healthcare systems to implement a new paradigm where patients are supported to play an autonomous role in their own healthcare.

Cyperus rotundus L. exhibits promising potential for the development of functional foods due to its documented pharmacological and biological activities. This study investigated the antioxidant and anti-diabetic properties of C. rotundus kombucha. The results demonstrated potent antioxidant activity with an IC50 value of 76.7±9.6 uL/mL for the DPPH assay and 314.2±16.9 uL/mL for the ABTS assay. Additionally, the kombucha demonstrated alpha-glucosidase inhibitory with an IC50 value of 142.7±5.2 µL/mL. This in vitro antioxidant potential was further validated in vivo using Drosophila. Drosophila fed a high-sugar diet and supplemented with pure kombucha revealed significant increases in DPPH and ABTS free radical scavenging activity. Drosophila on a high-sugar diet supplemented with varying kombucha concentrations manifested enhanced resistance to oxidative stresses induced by H2O2 and paraquat. Concurrently, there was a notable decline in lipid peroxidation levels. Additionally, significant upregulations in CAT, SOD1, and SOD2 activities were observed when the high-sugar diet was supplemented with kombucha. Furthermore, in vivo assessments using Drosophila demonstrated significant reductions in alpha-glucosidase activity when fed with kombucha. A comprehensive GC-MS and HPLC analysis of C. rotundus kombucha detected the presence of antioxidative and anti-glucosidase compounds. In conclusion, C. rotundus kombucha exhibits considerable antioxidant and anti-diabetic properties, demonstrating its potential as a beneficial beverage for health promotion.

This article addresses the socioeconomic gradient in immigrant health by exploring immigration status and social capital as key considerations in measurement and development of health-promoting research and practice. This paper also seeks to draw attention to the importance of understanding how researchers approach the study of health disparities affecting minoritized and immigrant populations. A critical examination of the measures used in comparative health research challenges scholars to consider the different pathways through which socio-economic factors impact health and underscores the ethical commitment of health disparities researchers to consider the relevance and implications of their work. Given the reliance on existing data from national population health surveys to test the assumptions of the immigrant paradox, any immigrant-specific measure of SES with limited application to a large, representative sample of immigrants would likely hold little appeal to both researchers and practitioners. Understanding the mechanisms through which socioeconomic status influences immigrant health can allow scholars to address the needs of immigrant populations and advocate more effectively for programs and policies that seek to advance the health of all people.

With enhanced life expectancy and ageing global populations, the prevalence of multimorbidity continues to increase. However, there is a dearth of evidence linked to multimorbidity diagnoses, treatments and health outcomes which remains a concern for future proofing optimal healthcare services. Generating evidence is critical to managing multimorbidity, promoting public health and minimizing health inequalities via effective healthcare policies that improve quality of life for vulnerable populations. This study assessed meta-epidemiology of multimorbidity to report the gaps in scientific knowledge and clinical practice. A systematic methodology was designed and published in PROSPERO (CRD42022347308) to report meta-epidemiology analyses using databases including PubMed, Web of Science, ScienceDirect, EMBASE, The Cochrane Gynaecology and Fertility Group Specialised Register of Controlled Trials and MEDLINE for studies published between the 1^st of January 1980 - 31^st December 2022. A random-effects model was used to estimate the pooled proportion of multimorbidity in adults. Forest plots, pooled odds ratios and statistical heterogeneity metrics were used to assess the association between multimorbidity and investigated factors. Funnel plots and Egger’s regression were used to detect and correct for publication bias. Our findings identified women to be 0.32 times more likely to have multimorbidity in comparison to males. In regard to ethnicity, white people were 0.47 times less likely to develop comorbidities than black people. People who identified as a drinker or unmarried were more likely to develop comorbidities than those who are non-drinkers or married, respectively. Regardless of smoking status, people were equally likely to have comorbidity. In terms of environmental influences, people in rural areas were found to be 0.2 times less likely to have comorbidity in comparison to those living in urban areas. Interestingly, people with a higher education level were 0.57 times more likely to develop comorbidities than those with only a high school education. It is evident that multimorbidity has a significant burden globally and impacts the provision of care necessitated across populations given its association with several social determinants of health. Robust research and healthcare policies are required to better manage multimorbidity in patients. An example of such intervention includes employing prevention programs to reduce risk and incidence of multimorbidity within at-risk populations.

Metabolomics is an advanced technology, still under development, with multiple research applications, especially in the field of health. Individual metabolic profiles, the functionality of the body, as well as its interaction with the environment can be established using this technology. The body's response to various external factors, including the food consumed and the nutrients it contains, has increased researchers' interest in nutrimetabolomics. Establishing correlations between diet and the occurrence of various diseases or even the development of personalized nutrition plans, could contribute to advances in precision medicine. The interdependence between humans, animals and the environment are of particular importance today, with the dramatic emergence and spread of zoonotic diseases, food, water and soil contamination, and the degradation of resources and habitats. All these events have led to an increase of risk factors for functional diseases, burdening global health. Thus, this study aimed to highlight the importance of metabolomics, in particular of nutrimetabolomics, as a technical solution for a holistic, collaborative, and precise approach for the advancement of the One Health strategy.

Objective: This study aimed to determine impact of eHealth literacy on health promotion activities and preventive health practice among adolescents. Methods: This cross-sectional study was conducted between March and May 2022 with 706 adolescents in Çorum, Turkey. A face to face questionnaire form including socio demographic characteristics, preventive health practices, eHealth Literacy scale and Adolescent Health Promotion Scale were used. The data of the research were analyzed with the SPSS 22.0 program. Percentage, mean, Pearson Correlation analysis and multiple regression analysis were used in the analyzes. The p<0.05 value was considered statistically significant in the evaluations. Results: In the study, 55.8% were female and the mean age of the whole group was 16.09±2.63 years. The mean score of eHealth Literacy scale was 29.40±6.29. The mean of the total scores obtained from the Adolescent Health Promotion Scale was 137.97±21.87. Among the adolescents 96.0% didn’t use alcohol and 81% didn’t smoke. The rate of annual weight measure was 68.8%. Measurements of annual blood pressure, annual blood iron, annual cholesterol, annual dental examination and regular exercise rate were below 50%. There was a significant positive correlation between eHealth literacy and the Adolescent Health Promotion Scale (p<0.001). Multiple linear regression analysis was performed to predict eHealth literacy using the variables of Adolescent Health Promotion and preventive health practices. eHealth literacy was positively and significantly predicts health promotion behaviors (β= 0.27, t (695)= 7.54, p<0.001). eHealth literacy increased annual weight measurement by more than 0.13 (β=0.13), the annual blood iron measurement by more than 0.16 (β=0.16), annual dental examination by more than 0.11 (β=0.11). Conclusions: Adolescents ehealth literacy was high and effected via health promotion activities and preventive health practices. Developing eHealth litracy interventions will be important for environments with a high concentration of adolescents (schools, courses). Also, primary health care services should be entegrated with school environment.

Background: The potential of Artificial intelligent (AI) models to process and interpret large health datasets at scale could revolutionize public health and epidemiology, providing a foundation for public health. Ethics has been recognized as a priority concern in the development and deployment of AI. Because AI technology can jeopardize patient safety, privacy, and posing a new set of ethical problems that must be addressed. Objectives: We aim to provide a holistic view on what are the different ethical and legal principles that was addressed in the included studies regarding the use of AI in public health and what are the ethical challenges that can arise.Methods: Following PRISMA guideline, five bibliographic databases were used in our search: PubMed, Scopus, JSTOR, IEEE Xplore, and Google Scholar from 2015 to February 2022. Four reviewers carried out study selection and data extraction, and the data extracted was synthesized by a narrative approach. Results: This review included 23 unique publications out of a total of 1123 items that were initially identified. Different ethical principles regarding the uses of AI in public health and community health were identified and discussed distinctly in the current review. The common ethical and legal themes that this review focused on are equity, bias, privacy and security, safety, transparency, confidentiality, accountability, social justice, and autonomy. In addition, five ethical challenges were mentioned. Conclusion: Research regarding ethical and legal principles and challenges about using AI in public health specifically consider a new filed, because all previous themes are concerning the physical and patients’ area where it focuses only on the clinical settings.

Antimicrobial resistance (AMR) is an increasingly pressing threat to human, animal, and environmental health. Reducing the use of antibiotics in agriculture has been identified as a key way to curb the spread of AMR. However, the effect of such policies on AMR prevalence, and their broader impacts on agricultural, health, and economic outcomes at the population level have proven very difficult to estimate and compare. This paper draws on and formalises ideas presented at the JPIAMR New Perspectives on Bacterial Drug Resistance workshop in June of 2022. With reference to emerging literature on the topic, it proposes a quantitative framework for estimating the relevant causal relationships needed to quantify the cross-sectoral impacts of AMR policies in agriculture, and for comparing these outcomes in like terms in a way which can feed directly into policy decision-making, notably without prohibitive data requirements. The ability of researchers to apply frameworks such as this will be increasingly necessary in order to holistically capture the impacts of AMR policies and to situate them in the broader policy context; especially where the mechanisms of transmission are opaque or complex, where data availability is limited; and where policymakers must allocate scarce resources among many competing objectives.

Objectives: This study validated the Japanese version of O’Donovan et al.’s (2020) composite measure of psychological safety scale and examined the associations of psychological safety with mental health and job-related outcomes. Methods: Online surveys were administered twice to Japanese employees with teams of more than three members. Internal consistency and test-retest reliability was tested using Cronbach’s α and intra-class correlation coefficient (ICC). Structural validity was examined using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Convergent validity was tested. Multiple linear regression analyses were conducted to examine the relationship between psychological safety and psychological distress, work engagement, job performance, and job satisfaction. Results: Two hundred healthcare workers and 200 non-healthcare workers were analyzed. The Cronbach’s alpha of the total score was 0.92 - 0.96 and ICC was 0.88 - 0.92. CFA demonstrated poor fit, and EFA yielded a two-factor structure, suggesting one factor combined with peers and team. The scale showed good convergent validity. The total score of the scale showed significant associations with all outcomes in adjusted model in all workers. Conclusions: The Japanese version of the measure of the psychological safety scale presented good reliability and validity. Psychological safety is important for employees’ mental health and performance.

The Ministry of Health (MOH) in the Kingdom of Saudi Arabia (KSA) established a National School-based Screening Program (NSBSP) for health screening of school-going children. Students from specific grades were systematically screened for several health problems including obesity, visual and auditory problems, dental cavities, scoliosis, and attention-deficit/hyperactivity disorder (ADHD). This cross-sectional study aimed to determine the prevalence of these health problems among primary school students based on secondary data obtained from the NSBSP. We included 444,259 screened school children from the 1st and 4th grades of 50% of the selected schools (both private and public) across the KSA during the academic year 2018-2019. Among them, the most prevalent health problems identified were dental cavities (38.7%), eye refractory errors (10.9%), and overweight and obesity (10.5%); the less prevalent problems included ADHD (2.81%), auditory problems (0.6%), and scoliosis (0.48%). A greater prevalence of most health problems was observed in girls than boys. The NSBSP successfully aided the detection of health conditions with high and low prevalence among primary school students in the KSA, and thus, identification of health problems of specific concern. Implementation of effective school health services for the prevention, early detection, diagnosis, and treatment of these health problems is imperative.

COVID-19 is a potentially fatal viral infection. This study investigates geography, demography, socioeconomics, health conditions, hospital characteristics, and politics as potential explanatory variables for death rates at the state and county levels. Data from the Centers for Disease Control and Prevention, the Census Bureau, Centers for Medicare and Medicaid, Definitive Healthcare, and USAfacts.org were used to evaluate regression models. Yearly pneumonia and flu death rates (state level, 2014-2018) were evaluated as a function of the governors’ political party using repeated measures analysis. At the state and county level, spatial regression models were evaluated. At the county level, we discovered a statistically significant model that included geography, population density, racial and ethnic status, three health status variables along with a political factor. State level analysis identified health status, minority status, and the interaction between governors’ parties and health status as important variables. The political factor, however, did not appear in a subsequent analysis of 2014-2018 pneumonia and flu death rates. The pathogenesis of COVID-19 has greater and disproportionate effect within racial and ethnic minority groups, and the political influence on the reporting of COVID-19 mortality was statistically relevant at the county level and as an interaction term only at the state level.

Dust inhalation is a huge concern in the mining environment and within all its operations. In fact, dust to be one of the most serious occupational hazards in the mining industry. Coal and crystalline silica dust are the causes of serious, sometimes fatal lung diseases such as pneumoconiosis, which affects coal miners, as well as silicosis, tuberculosis, chronic bronchitis, emphysema, chronic obstructive pulmonary disease, and chronic renal disease, which affect coal and other types of miners. The resulting effects both affect workers and nearby communities. The mining industry has in the past, employed several approaches to reduce effects of dust. But these strategies have often been ineffective because the grass withers during the dry season and sprayed water is rapidly absorbed or evaporates. This paper endeavors to review information on dust in the mining environment and how it is a nuisance to workers and communities and establish what strategies exist for this.

The WHO European Region defined the role of a new central professional for primary care, the Family and Community Nurse (FCN). The introduction of FCN in the framework of health policies highlight a key role of nurses in addressing the families’ and communities’ needs. A scoping review was conducted in order to identify and describe the available tools which has been adopted for the assessment of the community health needs by FNC. A comprehensive literature review on Embase, Cochrane Library, PubMed, CINAHL, Scopus and PsycInfo databases was conducted including all studies up to May 2021. A total of 1563 studies were identified and 36 of them were included. The literature review had made possible to identify studies employing twelve different community assessment's tools or modalities. Referring the WHO framework proposed in 2001 some common themes have been identified with an uneven distribution, as profiling the population, deciding on priorities for action and public healthcare programmes, implementing the planned activities, evaluation of health outcomes, multidisciplinary activity, flexibility and involving the community. To the best of our knowledge, this work is the first attempt to provide an overview of community assessment tools, keeping the guidance provided by the WHO as a reference.

An evaluation of emerging issues in One Health (OH) in Sub-Saharan Africa was undertaken to map the existing OH initiatives in Sub-Saharan African (SSA) countries. Desk review, expert opinions survey, limited interviews and wider consultations with selected OH stakeholders were conducted. The strengths, weaknesses, opportunities and threats to OH initiatives were identified. OH influence, interest and impacts were evaluated. One Health is transiting from multidisciplinary to transdisciplinary concepts and OH viewpoint should move from ‘proxy for zoonoses’, to include issues of climate change, nutrition and food safety, social sciences, geography, policy and planning, economics, welfare and well-being, antimicrobial resistance (AMR), vector-borne diseases, toxicosis and pesticides issues. While the identified major strengths should be boosted, the weaknesses should be addressed.OH Networks in SSA were spatially and temporally spread across SSA and stakeholders were classified as key, latent, marginal and OH defenders. Imbalance in stakeholders’ representation led to hesitation in buying-in from stakeholders who are outside the main networks. Theory of change, monitoring and evaluation frameworks, and tools to standardized evaluation of OH policies is needed for sustained future of OH and the future OH engagement should be outputs and outcomes-driven and not activity-driven.National roadmap for OH implementation and institutionalization is necessary and proofs of concepts in OH should be verified and scaled-up. Dependence on external funding is unsustainable and must be addressed. Necessary policy and legal instrument to support OH nationally and sub-nationally should be implemented taking cognizance of contemporary issues like urbanization, endemic poverty and other emerging issues. Utilizing current technologies and OH approach to address ongoing pandemic of COVID-19 and other emerging diseases is desirable. Finally, OH implementation should be anticipatory and not reactive to significantly benefit budgeting and contain disease outbreaks in animal sources before the risk of spillover to human can be envisaged.

Burden of diseases measured as disability-adjusted life years per 100,000 people can be mined from public domain data, when they are made available by population health surveillance systems. This can be analysed to allow insightful comparisons with the national average, and to understand differences in trends between the sexes, age groups, time periods, geographic regions and sub-regions. In this illustrative case study, we have analysed the Scottish burden of disease database to understand what ailed the population of the Grampian region before the COVID-19 pandemic. We have identified selected cancers, ischaemic heart disease, Alzheimer’s disease and other dementias amongst the highest contributors to the burden; that drug use disorders and colorectal cancer are showing worsening trends and require health promotion and disease prevention measures from ages 15 and 25 respectively, especially in Aberdeen City; and that males are more vulnerable to atrial fibrillation and flutter, diabetes mellitus and oesophageal cancer, while females are to cerebrovascular disease. We demonstrate the usefulness of our analysis and methodology for the wider health system, allowing targeted medical research investments and coordinated response from public health and health service delivery. We also show the need for up-to-date surveillance data, forecasts and evidence on the impact of interventions to be made available widely.

Accountable Care Organizations (ACOs) are healthcare delivery systems that aim to coordinate and improve the quality of care for patients while reducing costs. ACOs bring together doctors, hospitals, and other healthcare providers to work as a team to care for a defined population of patients. The idea behind ACOs is to shift the focus from paying for each individual service provided to patients, known as fee-for-service, to paying for the overall care and well-being of patients.ACOs typically operate under a shared savings model and also encourages providers to use data and technology to better coordinate care and improve patient outcomes.ACOs can be physician-led organizations, hospital-led organizations, and collaborations between healthcare providers. The success of ACOs depends on many factors, including the level of cooperation and collaboration among healthcare providers, the quality of care provided, and the ability to effectively manage costs.Despite their potential benefits, ACOs also face challenges, including the difficulty of coordinating care across multiple healthcare providers, the need to invest in technology and data management systems, and the challenge of changing provider behavior.This study assessed a number of systemic reviews and journals to assess the impact of ACO’s on population health. ACO’s have shifted away from costly care patterns and thus helped many countries.

The climate crisis is developing to a life-changing event on a global level. Health promotion with the aim to increase the health status of individuals, independent from the present health status has been developed on scientific basis at least for the last eight decades and follows. There are some basic principles, which are prerequisites for both, health promotion and climate protection. Those principles include (1) sustainability, (2) orientation on determinants, and (3) requirement of in-dividual as well as community approaches. People are generally aiming to protect their lifestyle habits (e.g. traveling, consumer habits) and personal properties (e.g. car, house) by easy solution with as little effort as possible, and this can affect both, health and climate. To reduce the emission of greenhouse gases and to protect our environment, changes towards a sustainable lifestyle have to be embed into everybody’s mind. Examples for domains, that need to be addressed in health promotion as well as in climate protection include education/ knowledge/ (health) literacy, physical activity, nutrition and dietary habits, mental health, and social capital. If health promo-tion fails to tackle those domains, this will continue to drive climate crisis. And climate change, in turn, will affect health. On the other hand, developing and promoting health resources in the domains mentioned could again help to mitigate the health-damaging effects of climate change.

The study aimed to identify clinical pharmacology patterns of prescribed and taken medications in older cardiovascular patients using electronic health records (EHRs) (n = 704) (2019–2022). Medscape Drug Interaction Checker was used to identify pairwise drug-drug interactions (DDIs). Prevalence rates of DDIs were 73.5% and 68.5% among taken and prescribed drugs, respectively. However, total number of DDIs was significantly higher among prescribed medications compared with the list of taken drugs (p < 0.05). Serious DDIs comprised 16% and 7% of all DDIs among prescribed and taken medications, correspondingly (p < 0.05). Median DDI numbers between prescribed versus taken medications were Me = 2, IQR 0-7 and Me = 3, IQR 0-7 per record, respectively. Prevalence of polypharmacy was significantly higher among prescribed medications compared with taken medications (p < 0.05). Women were taking significantly more drugs and had higher rates of polypharmacy and DDIs (p < 0.05). No sex-related differences were observed in the list of prescribed medications. ICD code U07.1 (COVID-19, virus identified) was associated with the highest median DDI number per record. Further research is warranted to improve EHR structure, patient engagement in reporting adverse drug reactions, and genetic profiling of patients to avoid potentially serious DDIs.

Semantic interoperability facilitates exchange and access of health data that is being documented in EHRs with various semantic features. In the EU, the regulation proposal of European health data space requires development of semantic interoperability. To achieve a fully integrated EHDS ecosystem leveraging the value of health data, stakeholders need to overcome challenges of implementing common standards and other semantic interoperability features. We aimed to research what scientific evidence is available on developing semantic interoperability. Our research questions focused specifically on key features and approaches for semantic interoperability and on possible benefits of these choices. For that purpose, we performed a systematic literature review by defining our study framework based on previous research. Our results consisted of 10 studies where data models, ontologies, terminologies, classifications, and standards were applied for building interoperability. Through increased access to interoperable patient information, a better quality and outcomes in care can be achieved. Better communication based on easily accessible data is facilitated between health professionals and between clinicians and the patients. When heading towards semantic harmonization as outlined in the EHDS proposal, more experiences and analyses are needed to assess how applicable the chosen solutions are for semantic interoperability of European health care data.

The practice of nurse health coaching (NHC) draws from the art and science of nursing, behavioral sciences, and evidence-based health coaching methods. This secondary analysis of the audio-recorded natural language of participants during NHC sessions of our recent 8-week RCT evaluates improvement over time in cognitive-behavioral outcomes: Change Talk, Resiliency, Self-Efficacy/Independent Agency, Insight & Pattern Recognition, and Building Towards Sustainability. We developed a measurement tool for coding, Indicators of Health Behavior Change (IHBC), that was designed to allow trained health coach experts to assess the presence and frequency of the indicators in the natural language content of participants. We used a two-step method for randomly selecting the 20-minute audio-recorded session that was analyzed at each time point. Fifty-six participants had high-quality audio recordings of the NHC sessions. Twelve participants were placed in the social determinants of health (SDH) group based on the following: low income (<$20,000/year), early-onset hypertension, and social disadvantages. Our analyses significantly improved Change Talk and the other four factors over time. Our factor analyses indicated two distinct factors at each measurement point of the study, demonstrating the stability of the outcome measures over time. Our newly developed measurement tool, IHBC, proved stable in structure over time and sensitive to change. This NHC program shows promise in improving cognitive-behavioral indicators associated with health behavior change in both non-SDH and SDH individuals.

Background: During the COVID-19 pandemic some family physicians were overburdened and experienced difficulties reaching vulnerable patients and meeting the increased need for psycho-social support. This randomized controlled trial (RCT) tested whether a primary healthcare (PHC) based community health worker (CHW) intervention could tackle psychosocial suffering due to physical distancing measures in patients with limited social networks. Methods: CHWs provided 8 weeks of tailored psychosocial support to the intervention group. Control group patients received ‘care as usual’. The impact on feelings of emotional support, social isolation, social participation, anxiety and fear of COVID-19 were measured longitudinally using a face-to-face survey to determine their mean change from baseline. Self-rated change in psychosocial health at 8 weeks was determined. Results: We failed to find a significant effect of the intervention on the prespecified psychosocial health measures. However, the intervention did lead to significant improvement in self-rated change in psychosocial health. Conclusions: This study confirms partially the existing evidence on the effectiveness of CHW in-terventions as a strategy to address mental health in PHC in a COVID context. Further research is needed to elaborate the implementation of CHWs in PHC to reach vulnerable populations during and after health crises.

The present short communication aimed to determine the effects of vegetable cultivation on health. We conducted a qualitative study using responses to an open-ended question that was part of a survey on regional differences on vegetable intake. Participants in this study were residents of Gunma Prefecture, Japan, and were aged between 20–74 years. In the questionnaire, we asked: “Aside from increasing vegetable intake, how does vegetable cultivation affect your health?” We were able to categorize the answers into six subcategories related to physical health, mental health, and social well-being.

The COVID-19 pandemic, which has affected the entire world, has not only created a number of emerging issues for each country, especially in the field of public health, but has also provided a number of opportunities for risk management, alternative strategies and completely new ways of looking at challenges. This paper examines the COVID-19 pandemic response in Türkiye and the possible implications of the experience for future responses to other health emergencies and disaster risk management, based on the lessons learned. This study uses publicly available literature from government, private sector, and academic sources to analyse the conflicts, changes and lessons learned during the COVID-19 pandemic, which are components of the World Health Organization (WHO) Health Emergency and Disaster Risk Management (Health EDRM) framework. The COVID-19 experience in Türkiye has several aspects, including the significant role of healthcare workers, the existence of an effective health system accustomed to emergencies, applications based on information technologies, partial transparency of public authorities in providing information, and socio-cultural environment related to cooperation on prevention strategies, including wearing masks and vaccination. Challenges in Türkiye include distance learning in schools, lockdowns that particularly affect the elderly, ensuring environmental sustainability, hesitation about the effectiveness of social/financial support programmes, socio-cultural trivialisation of pandemics after a while, and relaxation of prevention strategies. Lessons learned from the COVID-19 pandemic include the value of transparency in public health/healthcare information, the strengthening of all aspects of the health system in terms of health workers, and the importance of a balanced economy prepared for foreseeable risks.

To describe the main health surveillance strategies for the control of COVID-19 in Brazil, with emphasis on decisions and actions taken at the federal level to prevent the infection caused by the new SARS-CoV-2. This is a scoping review study carried out from November 2019 to January 2021 using the DECS and MeSH health descriptors in Portuguese and English in four databases, in addition to the legislation found on the Brazilian Government's legislation portal. Based on the analysis of the documents, the actions describe non-pharmacological and pharmacological measures, measures related to decisions on closing and opening international borders, the acquisition of supplies and essential services. Although some strategies for containing the pandemic were identified, discrete and unnoticed surveillance measures are observed in view of the number of cases and number of deaths during the period of research analysis. The results show the absence of the federal level as support for the states and municipalities and imply decision-making and planning of actions by the Unified Health System to control the pandemic.

Background and objective: Research shows that 60–90% of school children have caries, representing a serious public health issue. Here, we present a model of oral health promotion that has been conducted in the Primorje-Gorski Kotar County (PGC), Croatia, from 2008 to 2019. We assessed the oral status of first and fifth grade elementary students and determined the sustainability and influence of our model on the status and behavior regarding the children’s oral status. Additionally, during the observed period, promotional and preventative activities aiming to improve oral health were conducted. Since 2014, the Program has begun to be continuously, comprehensively, and systematically introduced into preschools as well. Material and methods: We assessed the number of children with caries by analyzing the changes in the decayed, missing, and filled teeth for primary teeth (dmft)/decayed, missing, and filled teeth for permanent teeth (DMFT) index mean during the observed period. Results: From 2008 to 2019 we assessed 44422 children in the PGC (21714 first grade and 22708 fifth grade students). The average response rate throughout the Program has been 83%. We have noted a dmft/DMFT index decrease from 4,66 to 3,73 (first graders) and from 2,50 to 1,00 (fifth graders). Conclusions: The Program has improved the behavior and oral health of children; stakeholders from various professions have been included, such as health visitors, school medicine teams, and pediatricians, avoiding additional financial expenses, increasing the number of children in care, and proving the sustainability of our oral health improvement model.

Objectives This article focuses on exploring the evolution of Palliative Care in Portugal. Ten years after the approval of its Basic Law, the aim was to investigate the quality of the path followed and the guidelines that could promote its development. Thus, this study sought to identify a) the goals of the current members of parliament concerning Palliative Care, b) the major priorities that should guide the development of Palliative Care in the coming decade, c) the facilitating or hindering factors to accelerating the process, and d) to propose consensually agreed measures for an integral development of Palliative Care within the health system. Methods Qualitative data analysis was performed from the reading of literature and interviews conducted via Zoom with several intentionally chosen participants, leading to the creation of a Focus Group. The NVivo® 10 was used for data processing and categorisation. Results Three key themes emerged concerning the current status of palliative care: the policymakers, the technicians, and the society. This first line of structuring is explained by a second set of categories, namely, a) knowledge about palliative care; b) Palliative care organisation from the policymakers’ perspective. In the technicians' domain: a) knowledge about palliative care, b) clinical training, and c) medical specialty. Finally, in society: a) knowledge about palliative care. Significance of the Results Advancing general education, increasing qualitative training for the different health professionals, reformulating laws supporting them, promoting flexibility of the implementation methodologies, and establishing medical specialty, are crucial to achieving the proposed goal.