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Journal of Public Health Policy Jul 2024Armed conflicts exacerbate public health challenges in Sub-Saharan Africa. Inequality across groups and poverty in rural areas can be an important factor in triggering...
Armed conflicts exacerbate public health challenges in Sub-Saharan Africa. Inequality across groups and poverty in rural areas can be an important factor in triggering local wars. This study investigates whether equitable distribution of public services by governments across urban and rural geographical regions reduces the risk of local wars initiated by armed groups in Sub-Saharan African countries. Does an equitable distribution of public services such as healthcare and clean water public services across regions decrease the risk of armed conflicts? Uneven distribution of public services can increase the risk of conflict by contributing to group grievances, rural poverty, and rent-seeking competition over government resources. Analyses of 39 Sub-Saharan African countries from 1947 to 2021 show that a one-standard deviation increase in equal access to public services by urban-rural location lowers the risk of armed conflict, a substantial 37 to 53 percent with consideration of a battery of control variables.
PubMed: 38961278
DOI: 10.1057/s41271-024-00472-7 -
Quality of Life Research : An... Jul 2024To identify utility-based patient-reported outcome measures (PROMs) for assessing health-related quality of life (HRQoL) in cardiac rehabilitation and secondary... (Review)
Review
PURPOSE
To identify utility-based patient-reported outcome measures (PROMs) for assessing health-related quality of life (HRQoL) in cardiac rehabilitation and secondary prevention programs (CR) and appraise existing evidence on their measurement properties. Secondly, to link their items to the International Classification of Functioning Disability and Health (ICF) and the International Consortium of Health Outcome Measures (ICHOM) domains for cardiovascular disease (CVD).
METHODS
Eight databases were searched. The review followed the COSMIN and JBI guidelines for measurement properties systematic reviews and PRISMA 2020 reporting guidelines. Non-experimental and observational empirical studies of patients ≥ 18 years of age with CVD undergoing CR and assessed quality of life (QoL) or HRQoL using utility-based PROMs or one accompanied by health state utilities were included.
RESULTS
Nine PROMs were identified with evidence on measurement properties for three measures: the German translations of SF-12, EQ-5D-5L, and MacNew heart disease HRQoL questionnaire. There was moderate quality evidence for responsiveness and hypothesis testing of the SF-12 and EQ-5D-5L, and high-quality evidence for responsiveness and hypothesis testing for the MacNew. All items of SF-12 and EQ-5D were linked to ICF categories, but four items of the MacNew were not classified or defined. All the PROM domains were mapped onto similar constructs from the ICHOM global sets.
CONCLUSION
Three utility-based PROMs validated in CR were identified: the German versions of the EQ-5D and SF-12 and the MacNew questionnaire. These PROMs are linked to a breadth of ICF categories and all ICHOM global sets. Additional validation studies of PROMs in CR are required.
PubMed: 38961008
DOI: 10.1007/s11136-024-03657-5 -
The American Journal of Emergency... Jun 2024
PubMed: 38960749
DOI: 10.1016/j.ajem.2024.06.014 -
Journal of the American Medical... Jul 2024To examine whether comfort with the use of ChatGPT in society differs from comfort with other uses of AI in society and to identify whether this comfort and other...
OBJECTIVES
To examine whether comfort with the use of ChatGPT in society differs from comfort with other uses of AI in society and to identify whether this comfort and other patient characteristics such as trust, privacy concerns, respect, and tech-savviness are associated with expected benefit of the use of ChatGPT for improving health.
MATERIALS AND METHODS
We analyzed an original survey of U.S. adults using the NORC AmeriSpeak Panel (n = 1787). We conducted paired t-tests to assess differences in comfort with AI applications. We conducted weighted univariable regression and 2 weighted logistic regression models to identify predictors of expected benefit with and without accounting for trust in the health system.
RESULTS
Comfort with the use of ChatGPT in society is relatively low and different from other, common uses of AI. Comfort was highly associated with expecting benefit. Other statistically significant factors in multivariable analysis (not including system trust) included feeling respected and low privacy concerns. Females, younger adults, and those with higher levels of education were less likely to expect benefits in models with and without system trust, which was positively associated with expecting benefits (P = 1.6 × 10-11). Tech-savviness was not associated with the outcome.
DISCUSSION
Understanding the impact of large language models (LLMs) from the patient perspective is critical to ensuring that expectations align with performance as a form of calibrated trust that acknowledges the dynamic nature of trust.
CONCLUSION
Including measures of system trust in evaluating LLMs could capture a range of issues critical for ensuring patient acceptance of this technological innovation.
PubMed: 38960730
DOI: 10.1093/jamia/ocae164 -
American Journal of Epidemiology Jul 2024When studying the impact of policy interventions or natural experiments on air pollution, such as new environmental policies and opening or closing an industrial...
When studying the impact of policy interventions or natural experiments on air pollution, such as new environmental policies and opening or closing an industrial facility, careful statistical analysis is needed to separate causal changes from other confounding factors. Using COVID-19 lockdowns as a case-study, we present a comprehensive framework for estimating and validating causal changes from such perturbations. We propose using flexible machine learning-based comparative interrupted time series (CITS) models for estimating such a causal effect. We outline the assumptions required to identify causal effects, showing that many common methods rely on strong assumptions that are relaxed by machine learning models. For empirical validation, we also propose a simple diagnostic criterion, guarding against false effects in baseline years when there was no intervention. The framework is applied to study the impact of COVID-19 lockdowns on NO2 in the eastern US. The machine learning approaches guard against false effects better than common methods and suggest decreases in NO2 in Boston, New York City, Baltimore, and Washington D.C. The study showcases the importance of our validation framework in selecting a suitable method and the utility of a machine learning based CITS model for studying causal changes in air pollution time series.
PubMed: 38960671
DOI: 10.1093/aje/kwae171 -
Psycho-oncology Jul 2024Prostate cancer can significantly impact mental wellbeing, creating uncertainty and morbidity. This study described patterns of psychotropic medication and mental health...
OBJECTIVE
Prostate cancer can significantly impact mental wellbeing, creating uncertainty and morbidity. This study described patterns of psychotropic medication and mental health service use, as a proxy measure for mental health problems, 5 years before and 5 years after prostate cancer diagnosis.
METHODS
Population-based registry data were linked with Pharmaceutical Benefits Scheme and Medicare Benefits Schedule data for all prostate cancer patients diagnosed in South Australia between 2012 and 2020 (n = 13,693). We estimated the proportion and rates of psychotropic medication and mental health service use before and after diagnosis. Multivariable adjusted interrupted time series analyses (ITSA) were conducted to uncover temporal patterns.
RESULTS
Fifteen percent of men commenced psychotropic medications and 6.4% sought out mental health services for the first time after diagnosis. Psychotropic medication use rose from 34.5% 5 years before to 40.3% 5 years after diagnosis, including an increase in use of antidepressants (from 20.7% to 26.0%) and anxiolytics (from 11.3% to 12.8%). Mental health service use increased from 10.2% to 12.1%, with the increase mostly being general practice mental health visits (from 7.8% to 10.6%). Multivariable ITSA indicated a significant rise in medication and service utilisation immediately before and in the first 2 years following prostate cancer diagnosis.
CONCLUSION
There is a clear increase in psychotropic medication use and mental health service use around the time of prostate cancer diagnosis. Mental health outcomes of men with prostate cancer may be improved with early mental health screening, particularly during the diagnosis process, to enable early intervention.
Topics: Humans; Male; Prostatic Neoplasms; Aged; Mental Health Services; Middle Aged; Psychotropic Drugs; South Australia; Aged, 80 and over; Mental Health; Mental Disorders; Registries; Interrupted Time Series Analysis; Anti-Anxiety Agents; Antidepressive Agents; Patient Acceptance of Health Care
PubMed: 38960607
DOI: 10.1002/pon.6369 -
BMJ Open Jul 2024Complex trauma can have serious impacts on the health and well-being of Aboriginal and Torres Strait Islander families. The perinatal period represents a 'critical...
Healing the Past by Nurturing the Future: trauma-aware, healing-informed care to improve support for Aboriginal and Torres Strait Islander families - implementation and evaluation study protocol.
INTRODUCTION
Complex trauma can have serious impacts on the health and well-being of Aboriginal and Torres Strait Islander families. The perinatal period represents a 'critical window' for recovery and transforming cycles of trauma into cycles of healing. The Healing the Past by Nurturing the Future (HPNF) project aims to implement and evaluate a programme of strategies to improve support for Aboriginal and Torres Strait islander families experiencing complex trauma.
METHOD
The HPNF programme was codesigned over 4 years to improve awareness, support, recognition and assessment of trauma. Components include (1) a trauma-aware, healing-informed training and resource package for service providers; (2) trauma-awareness resources for parents; (3) organisational readiness assessment; (4) a database for parents and service providers to identify accessible and appropriate additional support and (5) piloting safe recognition and assessment processes. The programme will be implemented in a large rural health service in Victoria, Australia, over 12 months. Evaluation using a mixed-methods approach will assess feasibility, acceptability, cost, effectiveness and sustainability. This will include service user and provider interviews; service usage and cost auditing; and an administrative linked data study of parent and infant outcomes.
ANALYSIS
Qualitative data will be analysed using reflexive thematic analysis. Quantitative and service usage outcomes will be described as counts and proportions. Evaluation of health outcomes will use interrupted time series analyses. Triangulation of data will be conducted and mapped to the Consolidated Framework for Implementation Research and Reach, Effectiveness, Adoption, Implementation and Maintenance frameworks to understand factors influencing feasibility, acceptability, effectiveness, cost and sustainability.
ETHICS AND DISSEMINATION
Approval granted from St Vincent's Melbourne Ethics Committee (approval no. 239/22). Data will be disseminated according to the strategy outlined in the codesign study protocol, in-line with the National Health and Medical Research Council Aboriginal and Torres Strait Islander Research Excellence criteria.
Topics: Humans; Native Hawaiian or Other Pacific Islander; Health Services, Indigenous; Victoria; Female; Program Evaluation; Wounds and Injuries; Australian Aboriginal and Torres Strait Islander Peoples
PubMed: 38960467
DOI: 10.1136/bmjopen-2024-085555 -
BMJ Open Jul 2024Long-term sickness absence from employment has negative consequences for the economy and can lead to widened health inequalities. Sick notes (also called 'fit notes')...
OBJECTIVES
Long-term sickness absence from employment has negative consequences for the economy and can lead to widened health inequalities. Sick notes (also called 'fit notes') are issued by general practitioners when a person cannot work for health reasons for more than 7 days. We quantified the sick note rate in people with evidence of COVID-19 in 2020, 2021 and 2022, as an indication of the burden for people recovering from COVID-19.
DESIGN
Cohort study.
SETTING
With National Health Service (NHS) England approval, we used routine clinical data (primary care, hospital and COVID-19 testing records) within the OpenSAFELY-TPP database.
PARTICIPANTS
People 18-64 years with a recorded positive test or diagnosis of COVID-19 in 2020 (n=365 421), 2021 (n=1 206 555) or 2022 (n=1 321 313); general population matched in age, sex and region in 2019 (n=3 140 326), 2020 (n=3 439 534), 2021 (n=4 571 469) and 2022 (n=4 818 870); people hospitalised with pneumonia in 2019 (n=29 673).
PRIMARY OUTCOME MEASURE
Receipt of a sick note in primary care.
RESULTS
Among people with a positive SARS-CoV-2 test or COVID-19 diagnosis, the sick note rate was 4.88 per 100 person-months (95% CI 4.83 to 4.93) in 2020, 2.66 (95% CI 2.64 to 2.67) in 2021 and 1.73 (95% CI 1.72 to 1.73) in 2022. Compared with the age, sex and region-matched general population, the adjusted HR for receipt of a sick note over the entire follow-up period (up to 10 months) was 4.07 (95% CI 4.02 to 4.12) in 2020 decreasing to 1.57 (95% CI 1.56 to 1.58) in 2022. The HR was highest in the first 30 days postdiagnosis in all years. Among people hospitalised with COVID-19, after adjustment, the sick note rate was lower than in people hospitalised with pneumonia.
CONCLUSIONS
Given the under-recording of postacute COVID-19-related symptoms, these findings contribute a valuable perspective on the long-term effects of COVID-19. Despite likely underestimation of the sick note rate, sick notes were issued more frequently to people with COVID-19 compared with those without, even in an era when most people are vaccinated. Most sick notes occurred in the first 30 days postdiagnosis, but the increased risk several months postdiagnosis may provide further evidence of the long-term impact.
Topics: Humans; COVID-19; Male; Female; Adult; Middle Aged; Primary Health Care; Sick Leave; SARS-CoV-2; England; Adolescent; Young Adult; Cohort Studies; State Medicine; Hospitalization
PubMed: 38960458
DOI: 10.1136/bmjopen-2023-080600 -
BMJ Sexual & Reproductive Health Jul 2024Uptake of long-acting reversible contraception (LARC) is lower in Australia compared with other high-income countries, and access to early medical abortion (EMA) is...
What do Australian primary care clinicians need to provide long-acting reversible contraception and early medical abortion? A content analysis of a virtual community of practice.
BACKGROUND
Uptake of long-acting reversible contraception (LARC) is lower in Australia compared with other high-income countries, and access to early medical abortion (EMA) is variable with only 11% of general practitioners (GPs) providing EMA. The AusCAPPS (Australian Contraception and Abortion Primary Care Practitioner Support) Network is a virtual community of practice established to support GPs, nurses and pharmacists to provide LARC and EMA in primary care. Evaluating participant engagement with AusCAPPS presents an opportunity to understand clinician needs in relation to LARC and EMA care.
METHODS
Data were collected from July 2021 until July 2023. Numbers of online resource views on AusCAPPS were analysed descriptively and text from participant posts underwent qualitative content analysis.
RESULTS
In mid-2023 AusCAPPS had 1911 members: 1133 (59%) GPs, 439 (23%) pharmacists and 272 (14%) nurses. Concise point-of-care documents were the most frequently viewed resource type. Of the 655 posts, most were created by GPs (532, 81.2%), followed by nurses (88, 13.4%) then pharmacists (16, 2.4%). GPs most commonly posted about clinical issues (263, 49% of GP posts). Nurses posted most frequently about service implementation (24, 27% of nurse posts). Pharmacists posted most about health system and regulatory issues (7, 44% of pharmacist posts).
CONCLUSIONS
GPs, nurses and pharmacists each have professional needs for peer support and resources to initiate or continue LARC and EMA care, with GPs in particular seeking further clinical education and upskilling. Development of resources, training and implementation support may improve LARC and EMA provision in Australian primary care.
PubMed: 38960413
DOI: 10.1136/bmjsrh-2024-202330 -
Maternal & Child Nutrition Jul 2024Breastfeeding offers ideal food and nutrition for infants; however, structural barriers may amplify breastfeeding inequities. We aimed to identify whether household food... (Review)
Review
Breastfeeding offers ideal food and nutrition for infants; however, structural barriers may amplify breastfeeding inequities. We aimed to identify whether household food insecurity (HFI) is associated with exclusive and continued breastfeeding (EBF and CBF) as recommended by the World Health Organization/United Nations Children's Fund (UNICEF) Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, literature searches using 'breastfeeding', 'food insecurity' and 'infant' terms were conducted in PubMed/MEDLINE, Embase, CINAHL, Global Health and LILACS from inception through November 2023, without language restrictions, yielding 1382 publications (PROSPERO:CRD42022329836). Predetermined eligibility criteria yielded the 12 included studies (nine cross-sectional and three cohorts). The risk of bias was assessed through the Effective Public Health Practice Project. Meta-analysis was performed for studies assessing EBF (n = 10), and metaregression was used to explore heterogeneity across studies. Prevalence of EBF ranged from 1.6% to 85.3%, with a lower prevalence among HFI. The pooled effect of the association between HFI and EBF presented an odds ratio (OR) of 0.61 (95% CI = 0.49-0.76) with consistent results across marginal (OR = 0.72, 95% CI = 0.55-0.94), moderate (OR = 0.59, 95% CI = 0.41-0.84) and severe HFI (OR = 0.49, 95% CI = 0.32-0.76). High heterogeneity was found only when HFI was dichotomized. The prevalence of CBF ranged from 35.4% to 78.0%, with inconsistent prevalence among HFI; a meta-analysis was not performed due to the low number of studies (n = 3). We concluded that HFI levels are associated with lower odds of EBF. Integrating service and policy-level strategies, such as screening, referrals, skilled breastfeeding counseling and access to comprehensive nutrition and social programs, could reduce structural inequities and promote adherence to the World Health Organization/UNICEF breastfeeding recommendations among food-insecure families.
PubMed: 38960401
DOI: 10.1111/mcn.13696