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PloS One 2024Several hepatitis A outbreaks have recently been reported in Kerala state, India. To inform coverage decision of hepatitis A vaccine in Kerala, this study aimed to...
Several hepatitis A outbreaks have recently been reported in Kerala state, India. To inform coverage decision of hepatitis A vaccine in Kerala, this study aimed to examine the cost-effectiveness of 1) hepatitis A vaccination among children aged 1 year and individuals aged 15 years, and 2) serological screening of individuals aged 15 years and vaccination of susceptible as compared to no vaccination or vaccination without serological screening. Both live attenuated hepatitis A vaccine and inactivated hepatitis A vaccine were considered in the analysis. A combination of decision tree and Markov models with a cycle length of one year was employed to estimate costs and benefits of different vaccination strategies. Analysis were based on both societal and payer perspectives. The lifetime costs and outcomes were discounted by 3%. Our findings indicated that all strategies were cost-saving for both societal and payer perspectives. Moreover, budget impact analysis revealed that vaccination without screening among individuals aged 15 years could save the government's budget by reducing treatment cost of hepatitis A. Our cost-effectiveness evidence supports the inclusion of hepatitis A vaccination into the vaccination program for children aged 1 year and individuals aged 15 years in Kerala state, India.
Topics: Humans; India; Cost-Benefit Analysis; Hepatitis A; Adolescent; Hepatitis A Vaccines; Vaccination; Infant; Child; Female; Male; Child, Preschool; Adult; Markov Chains; Young Adult
PubMed: 38935781
DOI: 10.1371/journal.pone.0306293 -
PloS One 2024Among the consequences of systemic racism in health care are significant health disparities among Black/African American individuals with comorbid physical and mental...
Among the consequences of systemic racism in health care are significant health disparities among Black/African American individuals with comorbid physical and mental health conditions. Despite decades of studies acknowledging health disparities based on race, significant change has not occurred. There are shockingly few evidence-based antiracism interventions. New paradigms are needed to intervene on, and not just document, racism in health care systems. We are developing a transformative paradigm for new antiracism interventions for primary care settings that integrate mental and physical health care. The paradigm is the first of its kind to integrate community-based participatory research and systems science, within an established model of early phase translation to rigorously define new antiracism interventions. This protocol will use a novel application of systems sciences by combining the qualitative systems sciences methods (group model building; GMB) with quantitative methods (simulation modeling) to develop a comprehensive and community-engaged view of both the drivers of racism and the potential impact of antiracism interventions. Community participants from two integrated primary health care systems will engage in group GMB workshops with researchers to 1) Describe and map the complex dynamic systems driving racism in health care practices, 2) Identify leverage points for disruptive antiracism interventions, policies and practices, and 3) Review and prioritize a list of possible intervention strategies. Advisory committees will provide feedback on the design of GMB procedures, screen potential intervention components for impact, feasibility, and acceptability, and identify gaps for further exploration. Simulation models will be generated based on contextual factors and provider/patient characteristics. Using Item Response Theory, we will initiate the process of developing core measures for assessing the effectiveness of interventions at the organizational-systems and provider levels to be tested under a variety of conditions. While we focus on Black/African Americans, we hope that the resulting transformative paradigm can be applied to improve health equity among other marginalized groups.
Topics: Humans; Primary Health Care; Health Equity; Racism; Black or African American; Community-Based Participatory Research; Healthcare Disparities; Antiracism
PubMed: 38935743
DOI: 10.1371/journal.pone.0306185 -
PloS One 2024In South Africa, uptake of HIV services remains lower amongst men compared to women, resulting in poorer clinical outcomes. Several factors contribute to this situation,...
INTRODUCTION
In South Africa, uptake of HIV services remains lower amongst men compared to women, resulting in poorer clinical outcomes. Several factors contribute to this situation, including stigma, confidentiality concerns, inconvenient clinic operating hours, fear of an HIV-positive test result, and long-waiting times. Additionally, women living with HIV are frequently identified whilst accessing other routine services, particularly antenatal and well-baby care. Novel approaches and strategies are needed to increase men's routine utilization of health services. For many men, fatherhood is an important part of being a man. Maternal, neonatal and child health services (MNCH) present an opportunity to improve male engagement with routine health services and subsequent uptake of integrated HIV care. However, men's involvement in MNCH services remains low. This study explored the concept of fatherhood and factors influencing men's involvement in MNCH services.
METHODS
This was an exploratory, qualitative study. Three focus group discussions (FGDs), involving 33 male participants, were conducted with men living in communities across Johannesburg. Men were recruited by male peer counsellors, employed by Anova Health Institute under the men's health programme. Data was collected between May and July 2021. Authors had no access to information that identify individual participants during or after data collection. Data were transcribed inductively and analyzed thematically using NVivo software.
RESULTS
The study found that male participants were eager to be involved in MNCH services. They valued fatherhood and were making concerted efforts to be involved fathers. However, multiple factors influenced men's involvement in MNCH services. Barriers included sociocultural norms, employment commitments, boredom and disengagement while waiting for services, negative staff attitudes and long waiting times. Participants identified multiple facilitators that would encourage their attendance at MNCH services including positive staff attitudes, quick service, active engagement, positive affirmations by health care workers and the visibility of male health workers' in MNCH spaces.
CONCLUSIONS
The study highlights that men strongly desire to be involved fathers and included in MNCH services. HIV programmes should support this and harness it to actively engage men in HIV services. However, to encourage greater male involvement in MNCH, socio-economic and healthcare system related factors need to be addressed when designing strategies that create more inclusive, family-orientated, male-friendly, and integrated MNCH services.
Topics: Humans; Male; South Africa; HIV Infections; Fathers; Adult; Female; Focus Groups; Infant, Newborn; Qualitative Research; Child; Middle Aged; Young Adult; Child Health; Social Stigma; Pregnancy
PubMed: 38935612
DOI: 10.1371/journal.pone.0296955 -
Journal of Medical Internet Research Jun 2024The Nordic countries are, together with the United States, forerunners in online record access (ORA), which has now become widespread. The importance of accessible and...
The Nordic countries are, together with the United States, forerunners in online record access (ORA), which has now become widespread. The importance of accessible and structured health data has also been highlighted by policy makers internationally. To ensure the full realization of ORA's potential in the short and long term, there is a pressing need to study ORA from a cross-disciplinary, clinical, humanistic, and social sciences perspective that looks beyond strictly technical aspects. In this viewpoint paper, we explore the policy changes in the European Health Data Space (EHDS) proposal to advance ORA across the European Union, informed by our research in a Nordic-led project that carries out the first of its kind, large-scale international investigation of patients' ORA-NORDeHEALTH (Nordic eHealth for Patients: Benchmarking and Developing for the Future). We argue that the EHDS proposal will pave the way for patients to access and control third-party access to their electronic health records. In our analysis of the proposal, we have identified five key principles for ORA: (1) the right to access, (2) proxy access, (3) patient input of their own data, (4) error and omission rectification, and (5) access control. ORA implementation today is fragmented throughout Europe, and the EHDS proposal aims to ensure all European citizens have equal online access to their health data. However, we argue that in order to implement the EHDS, we need more research evidence on the key ORA principles we have identified in our analysis. Results from the NORDeHEALTH project provide some of that evidence, but we have also identified important knowledge gaps that still need further exploration.
Topics: Humans; Scandinavian and Nordic Countries; Europe; Electronic Health Records; European Union
PubMed: 38935430
DOI: 10.2196/49084 -
Neurologia I Neurochirurgia Polska Jun 2024Trigeminal autonomic cephalgias (TACs) are a well-defined subset of uncommon primary headaches that share comparable onset, pathophysiology and symptom patterns. TACs...
Trigeminal autonomic cephalgias (TACs) are a well-defined subset of uncommon primary headaches that share comparable onset, pathophysiology and symptom patterns. TACs are characterised by the presentation of one-sided and high-intensity trigeminal pain together with unilateral cranial autonomic signs, which can include lacrimation, rhinorrhea, and miosis. The International Classification of Headache Disorders 3rd Edition recognises four different headache entities in this group, with cluster headache as the most recognised among them. Hemicrania continua (HC) and paroxysmal hemicrania (PH) are both distinctive cephalgias of which the diagnostic criteria include an absolute response to indomethacin. Consequently, for this reason they are often referred to as 'indomethacin-responsive' TACs. The main focus of this review was to discuss the state of knowledge regarding the pathophysiology and key characteristics of PH and HC. Given the limited understanding of these conditions, and their exceptionally uncommon prevalence, a correct diagnosis can pose a clinical challenge and the search for an effective treatment may be prolonged, which frequently has a serious impact upon patients' quality of life. The information provided in this review is meant to help physicians to differentiate indomethacin-sensitive cephalgias from other distinct headache disorders with a relatively similar clinical presentation, such as cluster headache, trigeminal neuralgia, and various migraine conditions.
PubMed: 38935422
DOI: 10.5603/pjnns.99747 -
JAMA Network Open Jun 2024The US has the highest maternal mortality rate among developed countries. The Centers for Disease Control and Prevention deems nearly all of these deaths preventable,... (Observational Study)
Observational Study
IMPORTANCE
The US has the highest maternal mortality rate among developed countries. The Centers for Disease Control and Prevention deems nearly all of these deaths preventable, especially those attributable to mental health conditions. Coordination between US health care and social service systems could help further characterize circumstances and risks associated with perinatal suicide mortality.
OBJECTIVE
To examine contextual and individual precipitating circumstances and risks associated with perinatal suicide.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional observational study used a convergent mixed methods design to explore factors contributing to maternal suicides and deaths of undetermined intent (hereinafter, undetermined deaths) identified in National Violent Death Reporting System (NVDRS) data for January 1, 2003, to December 31, 2021. Analyses included decedents who were aged 10 to 50 years and pregnant or post partum at death (collectively, the perinatal group) and demographically matched female decedents who were not pregnant or recently pregnant (nonperinatal group) at death. Analyses were performed between December 2022 and December 2023.
EXPOSURES
Pregnancy status at death (perinatal or nonperinatal).
MAIN OUTCOMES AND MEASURES
The main outcomes included contributing circumstances associated with suicides and undetermined deaths cited in coroner, medical examiner, or law enforcement case narratives. The study examined quantitative differences between groups using a matched analysis and characterized key themes of salient suicide circumstances using qualitative content analysis.
RESULTS
This study included 1150 perinatal decedents identified in the NVDRS: 456 (39.6%) were pregnant at death, 203 (17.7%) were pregnant within 42 days of death, and 491 (42.7%) were pregnant within 43 to 365 days before death, yielding 694 postpartum decedents. The nonperinatal comparison group included 17 655 female decedents aged 10 to 50 years. The mean (SD) age was 29.1 (7.4) years for perinatal decedents and 35.8 (10.8) years for nonperinatal decedents. Compared with matched nonperinatal decedents, perinatal decedents had higher odds of the following identified contributing circumstances: intimate partner problems (IPPs) (odds ratio [OR], 1.45 [95% CI, 1.23-1.72]), recent argument (OR, 1.33 [95% CI, 1.09-1.61]), depressed mood (OR, 1.39 [95% CI, 1.19-1.63]), substance abuse or other abuse (OR, 1.21 [95% CI, 1.03-1.42]), physical health problems (OR, 1.37 [95% CI, 1.09-1.72]), and death of a family member or friend (OR, 1.47 [95% CI, 1.06-2.02]). The findings of the qualitative analysis emphasized the importance of mental health and identified 128 decedents (12.4%) with postpartum depression.
CONCLUSIONS AND RELEVANCE
This study provides insights into complex factors surrounding maternal suicide, and it highlights opportunities for further research to understand long-term consequences of perinatal mental health. These findings also underscore the need for targeted evidence-based interventions and effective policies targeting mental health, substance use, and IPPs to prevent maternal suicide and enhance maternal health outcomes.
Topics: Humans; Female; Pregnancy; Cross-Sectional Studies; Adult; Suicide; United States; Adolescent; Middle Aged; Young Adult; Child; Risk Factors; Maternal Mortality; Perinatal Mortality
PubMed: 38935375
DOI: 10.1001/jamanetworkopen.2024.18887 -
Indian Journal of Public Health Oct 2023A major group of the population, especially antenatal checkup (ANC) mothers and their spouses, people admitted for surgery, and people attending STI clinics, are...
BACKGROUND
A major group of the population, especially antenatal checkup (ANC) mothers and their spouses, people admitted for surgery, and people attending STI clinics, are reluctant to pretest counseling.
OBJECTIVES
This study has been taken up to explore the barriers and possible solutions to improve the utilization of Facility based integrated counseling and testing center (F-ICTC) counseling services.
MATERIALS AND METHODS
Phase 1: In-depth interview and ranking with stakeholders from the F-ICTC center (n = 13) were conducted to identify the barriers to utilization of F-ICTC and solution for the same. Phase 2.
A
Delphi panel with experts (n = 17) was invited through mail to find out the potential solution to improve the utilization of F-ICTC counseling services.
RESULTS
Possible barriers from the stakeholders' perspectives were fear of the disease, violate the privacy, unacceptance, gender bias, fear of social stigma and discrimination, and neglect attached to the disease. At third round of Delphi experts had arrived at a consensus regarding of following possible potential solutions: 1. Those who refuse pretest counseling they should be asked to answer a set of questions(which are usually told during counseling), only those questions not answered correctly by them can be corrected, 2.conducive hospital environment, 3.zero discrimination policy, 4. group counseling for ANC mothers and patients in waiting area of the hospital,5. phone counseling for unwilling patients and relocation of testing center and health education camping.
CONCLUSION
Context-specific proactive evidence-based intervention will help in improving the proper utilization of the F-ICTC center.
Topics: Humans; Delphi Technique; Female; Counseling; Prenatal Care; Male; Pregnancy; Adult; India; Social Stigma; Interviews as Topic; Patient Acceptance of Health Care
PubMed: 38934833
DOI: 10.4103/ijph.ijph_1529_22 -
Indian Journal of Public Health Oct 2023The activity of daily living (ADL) related to stair climbing is one of the most compromised ADLs among the elders. It requires good muscle strength, balance, and range...
Effect of Combined Intervention of Yoga and Physiotherapy as Compared to Only Physiotherapy on Lower Limb Muscle Strength, Balance and Range of Motion among Elders with Compromised Stair Climbing in Puducherry - A Parallel Arm Non-Randomized Control Trial.
The activity of daily living (ADL) related to stair climbing is one of the most compromised ADLs among the elders. It requires good muscle strength, balance, and range of motion (ROM) in the lower limb. We aimed to investigate the effects of Yoga complemented with physiotherapy (Intervention group) compared to only physiotherapy (control group) on lower limb muscle strength, balance, and ROMs among elders with ADL limitation in stair climbing. Sixty-five community-dwelling elders with compromised stair climbing were enrolled. Elders who consented to yoga along with physiotherapy were enrolled in the intervention arm. Data were collected and analyzed following 12 weeks of intervention. Endline assessment showed that the intervention group had more improvement in all test scores and ROMs as compared to the control group, although there were improvements in both arms as compared to baseline. Considering the beneficial effects of both interventions, yoga can be added to gain additional advantages.Trial Registration:Indian Clinical Trials Registry number CTRI/2021/08/035825.
Topics: Humans; Yoga; Muscle Strength; Male; Female; Aged; Postural Balance; Lower Extremity; Range of Motion, Articular; Physical Therapy Modalities; Stair Climbing; India; Activities of Daily Living; Middle Aged; Combined Modality Therapy
PubMed: 38934820
DOI: 10.4103/ijph.ijph_1718_22 -
Heliyon Jun 2024Cryostimulation involves using water environments and low temperatures as intervention mediums, with main methods including CWI (cold water immersion), CWT (contrast...
A evidence-based approach to selecting post-exercise cryostimulation techniques for improving exercise performance and fatigue recovery: A systematic review and meta-analysis.
RATIONALE
Cryostimulation involves using water environments and low temperatures as intervention mediums, with main methods including CWI (cold water immersion), CWT (contrast water therapy), and WBC (whole-body cryostimulation). Previous systematic reviews focused on the effect of cryostimulation on muscle fatigue and sports performance. However, studies on the selection of different cryostimulation methods and their intervention effects present inconsistent results.
INTRODUCTION
To systematically review and methodologically appraise the quality and effectiveness of existing intervention studies that the effects of various cryostimulation methods, including CWI, CWT, and WBC, on exercise performance and fatigue recovery.
METHODS
Following PRISMA guidelines, we conducted searches in PubMed, Embase, The Cochrane Library, Web of Science, and EBSCO databases to gather randomized controlled trials or self-controlled trials involving CWI/CWT/WBC and their effects on exercise performance or fatigue recovery. The search period ranged from November 2013 to November 2, 2023. Literature screening was performed using EndNote X9.1, and the quality of included studies was assessed using the Cochrane risk of bias assessment tool. Meta-analysis was conducted using RevMan 5.3 software.
RESULTS
This study included a total of 18 articles, included a total of 499 healthy participants, comprising 479 males and 20 females. Among them, participants underwent cryostimulation, including 102 using CWT, using CWI, and 58 using WBC. Compared to the control group, cryostimulation can significantly alleviate muscle pain intensity (SMD -0.45, 95% CL -0.82 to 0.09, P = 0.01). Specifically, CWI significantly reduced muscle pain intensity (SMD = -0.45, 95% CI: 0.820.09, P = 0.01), WBC significantly decreased C-reactive protein levels (SMD = -1.36, 95% CI: 2.350.36, P = 0.008). While, CWT showed no significant differences from the control group in exercise performance and fatigue recovery indicators (P > 0.05).
CONCLUSION
Cryostimulation can significantly reduce muscle pain intensity and perceived fatigue. Specifically, CWI significantly alleviates muscle pain intensity, WBC significantly lowers markers of inflammation caused by fatigue after exercise, in contrast, CWT does not significantly improve exercise performance and fatigue recovery. After exercise, compared with rest, using cryostimulation may have more noticeable benefits for muscle fatigue and muscle pain, with recommendations prioritizing WBC and CWI particularly for addressing inflammation and muscle pain. However, all cryostimulation may have no significant influence on exercise performance.
PubMed: 38933969
DOI: 10.1016/j.heliyon.2024.e32196 -
Frontiers in Psychology 2024To explore the psychological personality characteristics of transgender groups and to determine whether these characteristics differ according to sociodemographic...
OBJECTIVE
To explore the psychological personality characteristics of transgender groups and to determine whether these characteristics differ according to sociodemographic factors.
METHODS
This cross-sectional study was conducted between January 2021 and April 2023 at a psychosexual outpatient clinic in a psychiatric hospital in Beijing, China. In total, 481 individuals were included in this study, and demographic information was collected using a self-administered general questionnaire. Psychological personality traits were assessed using the Minnesota Multiphasic Personality Inventory (MMPI).
RESULTS
The mean scores of the assigned male at birth (AMAB) group were significantly higher than those of the male controls for all 10 clinical factors of the MMPI ( < 0.01 or < 0.001). The scores for both the Masculinity-femininity (Mf) and Depression (D) factors in the AMABs group exceeded the clinical threshold ( > 60) and were the highest and second-highest scores on the entire scale, respectively. Individuals assigned female at birth (AFAB) had significantly higher scores than female controls for Hysteria (Hy), Psychopathic Deviate (Pd), and Hypomania (Ma) ( < 0.05, < 0.01, and < 0.001, respectively). There were significant differences in the rates of abnormal values for the various factors of the MMPI ( > 60) according to gender, age, and education ( < 0.05, < 0.01, and < 0.001, respectively). Compared to AFABs, AMABs had higher rates of abnormal scores ( > 60) on the Hypochondriasis (Hs), D, Hy, Mf, Paranoia (Pa), Psychasthenia (Pt), Schizophrenia (Sc), and Social Introversion (Si) scales ( < 0.05, < 0.01, and < 0.001, respectively). Second, the transgender group aged ≤25 years had higher rates of abnormal scores ( > 60) on the Hs, D, Hy, Pd, Pa, Pt, Sc, and Ma scales ( < 0.05, < 0.01, and < 0.001, respectively). Finally, outliers ( > 60) for the Hs, D, Hy, Pd, Pa, Pt, Ma, and Si factors were more prevalent among those with a primary to high school level of education ( < 0.05, < 0.01, and < 0.001, respectively).
CONCLUSION
Assigned male at births may have a variety of psychological vulnerabilities, and there is a need to focus especially on those with a primary to high school level of education, those aged ≤25 years, and transgender females.
PubMed: 38933582
DOI: 10.3389/fpsyg.2024.1416011