Search Results (269)

Background/Objectives: Strengthening antimicrobial stewardship (AMS) programs is an invaluable intervention in the ongoing efforts to contain the threat of antimicrobial resistance (AMR), particularly in low-resource settings. This study evaluates the impact of the Telementoring, Education, and Advocacy Collaboration initiative for Health through Antimicrobial Stewardship (TEACH AMS), which uses the virtual Extension for Community Healthcare Outcomes (ECHO) learning model to enhance AMS capacity in Kenya, Ghana, and Malawi. Methods: A mixed-methods approach was used, which included attendance data collection, facility-level assessments, post-session and follow-up surveys, as well as focus group discussions. Results: Between September 2023 and February 2025, 77 virtual learning sessions were conducted, engaging 2445 unique participants from hospital-based AMS committees and health professionals across the three countries. Participants reported significant knowledge gain, and data showed facility improvements in two core AMS areas, including the implementation of multidisciplinary ward-based interventions/communications and enhanced monitoring of antibiotic resistance patterns. Along those lines, participants reported that the program assisted them in improving prescribing and culture-based treatments, and also evidence-informed antibiotic selection. The evidence of implementing ward-based interventions was further stressed in focus group discussions, as well as other strengthened practices like point-prevalence surveys, and development or revision of stewardship policies. Substantial improvements in microbiology services were also shared by participants, particularly in Malawi. Other practices mentioned were strengthened multidisciplinary communication, infection prevention efforts, and education of patients and the community. Conclusions: Our findings suggest that a virtual case-based learning educational intervention, providing structured and tailored AMS capacity building, can drive behavior change and strengthen healthcare systems in low resource settings. Future efforts should aim to scale up the engagements and sustain improvements to further strengthen AMS capacity. Full article

Chronic diseases are a leading cause of death worldwide and have a significant negative impact on public health, overall well-being, national economies, and the long-term sustainability of already burdened health systems. In addressing some of the current health challenges, the contribution of pharmacists and community pharmacies is of particular significance. Pharmacists play a vital role in the medication use process, enhancing the efficacy of pharmacological interventions and facilitating the delivery of health services. Community pharmacies occupy a key position within the healthcare system, acting as a primary point of contact with the public and frequently representing the most accessible healthcare facility for patients. In recent times, community pharmacies have undergone a process of adaptation, shifting from a narrow focus on the dispensing of medications towards a more comprehensive approach that is patient-centered and incorporates a range of healthcare services, while also prioritizing the quality of the services provided. This work aims to explore the role of pharmacists in the provision of pharmaceutical services in three countries with distinct healthcare systems, examining how these services operate, the requirements for their delivery, the associated remuneration structures, and the extent of out-of-pocket costs for patients—ultimately analyzing their impact on health outcomes. Full article

Improving community walkability can encourage older adults to walk, which is beneficial for enhancing their physical activity level (PAL) and keeping healthy. The first purpose of this study was to formulate an optimized community Walk Score measurement system from the perspective of Chinese seniors. It will be optimized from the aspects such as community service facility selection, weight determination, and distance decay function calculation. The second purpose was to verify its validity by exploring the correlation between Walk Score and subjective/objective community environment variables based on Spearman correlation analysis and the ANOVA method. The third purpose was to examine the relationship between Walk Score and Chinese seniors’ PAL and health outcomes by means of ordered/binary logistic regression. The results show the following: (1) Walk Scores are significantly correlated with partial objective environmental variables. (2) Walk Score was related to older adults’ physical activity level. (3) There was no significant relationship between Walk Score and two health outcomes. Walk Score can provide a supporting basis for urban renewal, older-community renovation, age-friendly community planning and design, and public health practitioners or policymakers. Full article

The selection of a suitable site for a new university in southern Jordan involves a comprehensive approach to ensure sustainability, accessibility, and community service. This study applies a Geographic Information System (GIS)-based weighted overlay analysis, integrating multiple spatial criteria to identify optimal locations. Key factors include terrain characteristics, such as elevated or moderately sloped areas; proximity to main roads for accessibility; and distance from industrial zones, water bodies, and existing universities to minimize environmental and educational overlap. Additionally, proximity to populated areas, health facilities, and banking services is prioritized to enhance convenience and support for the university community. The criteria were assigned different weights, with population and residential areas receiving the highest priority (30%), followed by terrain, roads, and existing institutions (14% each). The results showed that around 8% of the study area was classified as highly suitable, 22% as moderately suitable, and 70% as unsuitable. The top three locations achieved suitability scores exceeding 85%, being situated near major roads, within 2 km of populated areas, and in terrain with slopes under 15%. The GIS-based model offers a replicable framework for similar projects, facilitating data-driven decision-making in higher education planning. Full article

The COVID-19 pandemic has profoundly influenced urban planning and disease management in residential areas. Focusing on Beijing as a case study (3898 communities), this research develops a big data analytics framework integrating anonymized mobile phone signals (China Mobile), location-based services (AMAP.com), and municipal health records to quantify COVID-19 transmission dynamics. Using logistic regression, we analyzed 15 indicators across four dimensions: mobility behavior, host demographics, spatial characteristics, and facility accessibility. Our analysis reveals three key determinants: (1) Population aged 65 and above (OR = 62.8, p < 0.001) and (2) housing density (OR = 9.96, p = 0.026) significantly increase transmission risk, while (3) population density exhibits a paradoxical negative effect (β = −3.98, p < 0.001) attributable to targeted interventions in high-density zones. We further construct a validated risk prediction model (AUC = 0.7; 95.97% accuracy) enabling high-resolution spatial targeting of non-pharmaceutical interventions (NPIs). The framework provides urban planners with actionable strategies—including senior activity scheduling and ventilation retrofits—while advancing scalable methodologies for infectious disease management in global urban contexts. Full article

The current design of community smart health spaces lacks a systematic theoretical framework. This study innovatively proposes a hybrid model combining a SWOT analysis, the “four orders of design”, AHP, and TOPSIS to optimize the design of community smart health spaces systematically. First, a SWOT analysis is employed to assess the current state of community smart health spaces, and strategies are proposed based on this study. Subsequently, the “four orders of design” framework is integrated to clarify the design priorities for symbols, tangible objects, action events, and system environments. The AHP hierarchical analysis method is then used to quantify the weights of 16 design indicators, ensuring the objectivity and scientific rigor of decision-making. Finally, the TOPSIS method is introduced to validate the feasibility of the proposed solutions. The study found that (1) among the four categories of needs—behavioral experience, perceptual experience, hardware facilities, and software facilities—behavioral experience (weight 0.470) is the core indicator, with telemedicine (0.197) and autonomous driving (0.121) being the key functions. (2) The overall alignment of this design scheme is 0.844, with user satisfaction significantly superior to traditional schemes, proving the feasibility of the hybrid model. The research findings support decision-making in constructing smart health spaces in communities, thereby helping to upgrade smart health space services in communities. Full article

Background: Client satisfaction with HIV service delivery reflects the ability of healthcare providers to effectively deliver care and treatment that meets the requirements and expectations of clients, and is associated with improved health outcomes, including increased retention in care and HIV viral suppression. The aim of the study was to conduct a client satisfaction study among PLHIV attending a large HIV clinic in Trinidad to identify the gaps in service delivery and factors associated with reduced HIV viral suppression. Methods: This cross-sectional study was conducted over the period April 2023–March 2024 among 362 clients attending the HIV clinic. A structured, pre-tested questionnaire collected demographic data and factors that affected client clinic experiences, including wait time, communication with staff, confidentiality, physical amenities and HIV viral suppression. Multivariable logistic regression was used to assess the likelihood of reporting satisfaction based on key independent variables. Results: Among participants, 219 (60.5%) were females, 202 (55.8%) were aged 30–49 years and 337 (93.1%) were virally suppressed. Participants reported satisfaction with overall care (95.3%), confidentiality (95.9%) and interactions with doctors (96.1%), nurses (98.6%) and other staff. Dissatisfaction was reported with facility-related, elements including the outdoor/tented waiting area (46.1%), the toilet/washrooms (37.0%) and the clinic wait time (31.8%). Participants were less likely to be satisfied with the amount of medication received if they had unsuppressed viral loads (p = 0.035), were aged 20–29 years old (p = 0.048) or had a tertiary education (p = 0.008). Conclusions: The study showed that 93.1% of the study participants were virally suppressed, and there was a general level of satisfaction with the overall care at the clinic, confidentiality and healthcare workers’ service delivery; however, gaps involving the physical facilities, wait times and medication services should be prioritized. Full article

Background/Objectives: Postnatal immunisation is critical for maternal and child health, particularly in low-income countries. Despite international efforts, maternal awareness and access to care remain limited. Understanding the drivers behind postnatal immunisation services is critical for improving neonatal and maternal healthcare interventions. Methods: A tertiary healthcare facility’s postpartum mothers who were seeking immunisation services participated in a prospective cross-sectional electronic survey. Convenience sampling was used to select respondents, who then answered a structured electronic questionnaire intended to obtain information on immunisation practices. To evaluate important trends and correlations, data was analysed using both descriptive and inferential statistics. A factor analysis was performed using the principal component analysis method, eigenvalue criteria, communalities, and confirmatory factor analysis. The study adhered to the STROBE guidelines. Results: We found that postnatal mothers’ good immunisation practices were influenced by their adherence to immunisation schedules (% variance: 56.407; Eigenvalue: 7.33), and significant satisfaction with communication (% variance: 8.338; Eigenvalue: 1.084); giving a cumulative variance explained of 64.745% of the total variance of variables under study. However, suboptimal practices include limited resource availability, poor record maintenance, insufficient support for side effects, a lack of support from healthcare providers, and a decline in immunisation recommendations, all of which had Eigenvalue <1 and insignificant percentage of variance contribution to the total variance explained. We developed a two-factor model of postnatal immunisation practices, focusing on adherence and effective communication. The model showed high loadings and adequate fit indices (χ²(34) = 91.333, p < 0.001; CFI = 0.945; TLI = 0.927; RMSEA = 0.071; SRMR = 0.042), good evidence of internal consistency (α = 0.823–0.877), and composite reliability (ω = 0.832–0.877). Conclusions: The study recommends a comprehensive approach to increasing newborn vaccine coverage, which includes health education, improved service delivery, and culturally sensitive communication strategies. Future research should focus on digital health interventions, community-based initiatives, and policy-driven postnatal care. Full article

With the development of the Global Sustainable Development Goals, urban communities are increasingly focusing on sustainable development and all-age health and well-being, and the aging level of China will reach 21.1% in 2024. The aging process is accelerating, and the problem of population aging is becoming more and more serious, so it is more and more necessary and urgent to study the aging of the public space environment in urban settlements. Based on the research data of Urumqi settlements, this study utilizes importance performance analysis to evaluate the performance and importance of the aging public space environment. The main criteria elements for aging are identified as function and space, traffic and streamlining, services and facilities, green landscape and microclimate, and subjective soft needs; and the key evaluation indicators for aging are further refined. The results show that the surrounding urban environment, activity space abundance, building quality, building environment, external spatial layout, internal transportation, facilities, management, aging facilities, elderly service facilities, landscape, microclimate, and cultural activities are the key elements that need to be improved in order to improve the aging of the public space environment of cold urban settlements. Full article

Biosecurity is essential in livestock farming to prevent the spread of diseases, ensure animal welfare, and maintain farm sustainability. In Portugal, small ruminant farms are predominantly extensive and small-scale, and most of them are familiar, especially in the northern and inland regions. Thus, biosecurity implementation on these farms is low due to factors such as an aging livestock farmer population, poor training, limited veterinary support, and economic constraints. This study, the first to assess biosecurity on Portuguese small ruminant farms, evaluated compliance levels and the influence of sociodemographic factors. A cross-sectional study was conducted between July 2023 and April 2024, through structured interviews with 276 farmers. A 32-question checklist covering nine biosecurity categories was used to assess compliance. The results revealed poor implementation of key biosecurity measures, particularly cleaning and disinfection, quarantine protocols, and visitor control. Inadequate premises infrastructure, including the absence of quarantine areas, isolation facilities for sick animals, and farrowing rooms, further hampered disease prevention. Compliance was influenced by farmers’ age, education level, herd size, and production. Larger farms, particularly dairy farms, demonstrated better biosecurity practices, likely due to better management and infrastructure. This study highlights the challenges of implementing biosecurity measures on small-scale, extensive farms and argues that standardized plans are ineffective. Instead, region- and farm-specific strategies are needed, considering the socioeconomic realities of farmers. Improving farmers’ education and access to veterinary services is crucial. Furthermore, public policies should provide financial incentives and educational programs to improve biosecurity without compromising farm viability. Strengthening biosecurity on small ruminant farms is vital to protecting animal and public health and ensuring the long-term sustainability of rural communities in Portugal. Full article

Background: The framework of measuring effective coverage is conceptually straightforward, yet translation into a single metric is quite intractable. An estimation of a metric linking need, access, utilization, and service quality is imperative for measuring the progress towards Universal Health Coverage. A coverage metric obtained from a household survey alone is not succinct as it only captures the service contact which cannot be considered as actual service delivery as it ignores the comprehensive assessment of provider–client interaction. The study was thus conducted to estimate a one-composite metric of effective coverage by linking varied datasets. Methods: The study was conducted in a rural, remote, and fragile setting in India. Tools encompassing a household survey, health facility assessment, and patient exit survey were administered to ascertain measures of contact coverage and quality. A gamut of techniques linking the varied surveys were employed such as (a) exact match linking and (b) ecological linking using GIS approaches via administrative boundaries, Euclidean buffers, travel time grid, and Kernel density estimates. A composite metric of effective coverage was estimated using linked datasets, adjusting for structural and process quality estimates. Further, the horizontal inequities in effective coverage were computed using Erreygers’ concentration index. The concordance between linkage approaches were examined using Wald tests and Lin’s concordance correlation. Results: A significantly steep decline in measurement estimates was found from crude coverage to effective coverage for an entire slew of linking approaches. The drop was more exacerbated for structural-quality-adjusted measures vis-à-vis process-quality-adjusted measures. Overall, the estimates for effective coverage and inequity-adjusted effective coverage were 36.4% and 33.3%, respectively. The composite metric of effective coverage was lowest for postnatal care (10.1%) and highest for immunization care (78.7%). A significant absolute deflection ranging from −2.1 to −5.5 for structural quality and −1.9 to −8.9 for process quality was exhibited between exact match linking and ecological linking. Conclusions: Poor quality of care was divulged as a major factor of decline in coverage. Policy recommendations such as bolstering the quality via the effective implementation of government flagship programs along with initiatives such as integrated incentive schemes to attract and retain workforce and community-based monitoring are suggested. Full article

Background/Objectives: The outpatient healthcare experiences of patients with chronic diseases significantly impact disease management and quality of life. Patient satisfaction with healthcare services serves as a critical indicator of the responsiveness of healthcare systems and the advancement of patient-centered care. This study aimed to identify key factors influencing patient satisfaction and propose strategies for improvement. Methods: Using secondary data from the 2023 Healthcare Service Experience Survey (HSES), we analyzed patient satisfaction and its associated factors among respondents aged 15 years and older from households nationwide. Through multiple regression analysis and statistical testing, we examined the impact of the healthcare facility type, sociodemographic characteristics, and healthcare service experiences on satisfaction levels. Results: Information provided by physicians and nurses, communication with healthcare providers, and shared decision-making processes had a significant impact on patient satisfaction. Satisfaction levels were highest in hospitals and lowest in clinics. Older patients and those who discontinued treatment due to the financial burden reported lower satisfaction. Notably, information provided by nurses had the most substantial positive influence on satisfaction. Conclusions: Delivering patient-centered outpatient healthcare services is essential in improving satisfaction and health outcomes. Enhancing the service quality, reducing financial burdens, and adopting digital platforms to promote patient engagement are critical measures. These approaches will strengthen chronic disease management systems and contribute to improving the overall quality of life of the population. The entire study focused on outpatient care. Full article

At present, China is facing a serious aging problem. Although community daycare centers have been built, they generally have problems such as inadequate facilities, single-service provision, and insufficient environmental design. These problems make it impossible to meet the multifaceted needs of the elderly in their old age, enhance their sense of wellbeing, and achieve sustainable development. Therefore, relevant policies indicate that the elderly service model of community day care centers should be actively constructed and upgraded. However, most of the existing research focuses on service models or single-design practice studies, and there are relatively few studies that address the integration of restorative environmental design and sustainability. Therefore, this paper systematically explores the current research status of restorative environmental design in daycare centers for the elderly through macro quantitative bibliometric analysis and micro qualitative content analysis based on Web of Science (WOS) data, then proposes design practice strategies, implementation paths, and evaluation methods to enhance wellbeing. Through keyword network visualization analysis, this paper identifies eight main clusters: physical literacy, public preschool services, social support, elderly day care centers, hospice use, designing leisure products, risk factors, and communicative skills. The high-frequency keywords “health”, “elderly”, “cultural diversity”, “children”, and “quality of life” are further categorized into “caregiving”, “Alzheimer’s disease”, “adult day care”, and “daycare centers”, with the latter split into three further categories: design strategy, implementation approach, and evaluation. In addition, this paper combines SDG3 goals such as reducing premature mortality from non-communicable diseases, achieving universal health coverage, etc., in order to explore the potential of resilience-based environmental design to promote the sustainable development of elderly daycare centers. This study not only complements the research related to restorative environmental design in daycare centers for the elderly but also provides specific guidelines and references for future environmental design, policy planning, and elderly service practices. Full article

The Health Online Service Provision Index (HOSPI) is an instrument to assess and monitor hospitals’ websites. The index comprises four criteria—Content, Services, Community Interaction and Technology Features—each with a subset of indicators and sub-indicators. HOSPI was applied to the Portuguese hospitals’ websites in 2023, originating the dataset described in this article. The article also provides a detailed account of the data collection process, which involved direct observation of the websites and specific treatment methods, ensuring the reliability and validity of the dataset. It underscores the relevance of having this data available and how it can improve service provision online in health facilities and support policymaking. Full article

Background: Immunization coverage varies across Papua New Guinea. In East New Britain (ENB) Province in 2022, only 65.5% and 50.2% of children under one year received their first dose of pentavalent (DTP1) and measles–rubella (MR1) vaccine, respectively. This study aimed to examine barriers and enablers to routine immunization in areas of un(der)-vaccination in ENB. Methods: A face-to-face survey was conducted with caregivers of children aged 12–23 months in ENB. We used Poisson regression to calculate incidence rate ratios (IRR) and 95% confidence intervals (95% CI) for factors associated with timely receipt of DTP1 or MR1 vaccines, defined as a child who was vaccinated between –2 and +30 days of the vaccine schedule. Delayed receipt is defined as a child who was vaccinated >30 days from the recommended due date. Results: Among 237 caregivers surveyed, 59.9% of children were vaccinated within the “timely” window for DTP1 and 34.1% for MR1. Timely DTP1 receipt was associated with a facility-based birth (IRR:1.93; 95% CI: 1.10–3.38) and trusting healthcare workers “very much”, compared to “a little or moderately” (IRR:1.53; 95% CI: 1.17–1.99). For MR1, the caregiver having completed tertiary/vocational education (IRR:1.79; 95% CI: 1.15–2.78), reporting taking a child to be vaccinated is affordable (IRR:1.52; 95% CI: 1.04–2.22), and healthcare workers explaining immunization services and answering associated questions (IRR:1.68; 95% CI: 1.18–2.41) were associated with timely vaccination. Conclusions: Activities to improve timely vaccination in ENB could include strengthening healthcare worker interpersonal communication skills to optimize trust and incentivizing women to give birth in a health facility. Full article