Search Results (173)

Antimicrobial resistance (AMR) represents a critical global health threat, with inappropriate antibiotic self-medication (ASM) being a key contributor. China—as the world’s largest antibiotic consumer—faces significant challenges despite regulatory efforts, compounded by limited contemporary data during the COVID-19 pandemic. A nationwide cross-sectional study was conducted using the 2021 China Family Health Index Survey (n = 11,031 participants across 120 cities). Trained investigators administered face-to-face questionnaires assessing ASM practices, decision-making factors, and sociodemographic characteristics. Multivariate logistic regression identified determinants of ASM. Overall, ASM prevalence was 33.7% (n = 3717), with no urban-rural difference (p > 0.05). Physician advice (78.2%), drug safety (67.1%), and efficacy (64.2%) were primary selection criteria; rural residents prioritized drug price and salesperson recommendations more than their urban counterparts (p < 0.01). Key predictors included higher ASM odds among females (OR = 1.30, 95%CI:1.18–1.43), middle-aged adults (46–59 years; OR = 1.20, 95%CI:1.02–1.42), those with health insurance (resident: OR = 1.33; commercial: OR = 1.62), and individuals with drinking histories (OR = 1.20, 95%CI:1.10–1.31). Lower odds were associated with primary education (OR = 0.69, 95%CI:0.58–0.81), unemployment (OR = 0.88, 95%CI:0.79–0.98), and absence of chronic diseases (OR = 0.56, 95%CI:0.47–0.67). One-third of Chinese residents engaged in ASM during the pandemic, driven by intersecting demographic and behavioral factors. Despite converging urban-rural prevalence rates, distinct decision-making drivers necessitate context-specific interventions, including strengthened pharmacy regulation in rural areas, tailored education programs for high-risk groups, and insurance system reforms to disincentivize self-medication. Full article

The increasingly observable financial vulnerability of households in emerging market countries makes it imperative to investigate the factors influencing it. Considering that China stands as a representative of emerging market economies, analyzing the factors influencing household financial vulnerability in China presents great reference significance for the sustainable development of households in emerging market countries. Using data from the China Household Finance Survey (CHFS) household samples, this paper presents the regional distribution of households with financial vulnerability in China. Utilizing machine learning (ML), this research examines the factors that influence household financial vulnerability in China and determines the most significant ones. The results reveal that households with financial vulnerability in China takes up a proportion of more than 63%, and household financial vulnerability is lower in economically developed coastal regions than in medium and small-sized cities in the central and western parts of China. The analysis results of the SHAP method show that the debt leverage ratio of a household is the most significant feature variable in predicting financial vulnerability. The ALE plots demonstrate that, in a household, the debt leverage ratio, the age of household head, health condition, economic development and literacy level are significantly nonlinearly related to financial vulnerability. Heterogeneity analysis reveals that, except for household debt leverage and insurance participation, the key characteristic variables exerting the most pronounced effect on financial fragility differ between urban and rural households: household head age for urban families and physical health status for rural families. Furthermore, digital financial inclusion and social security exert distinct impacts on financial vulnerability, showing significantly stronger effects in high per capita GDP regions and low per capita GDP regions, respectively. These findings offer valuable insights for policymakers in emerging economies to formulate targeted financial risk mitigation strategies—such as developing household debt relief and prevention mechanisms and strengthening rural health security systems—and optimize policies for household financial health. Full article

Healthcare disparities in cancer care remain pervasive, driven by intersecting socioeconomic, racial, and insurance-related inequities. These disparities manifest in various forms such as limited access to medical resources, underrepresentation in clinical trials, and worse cancer outcomes for marginalized groups, including low-income individuals, racial minorities, and those with inadequate insurance coverage, who face significant barriers in accessing comprehensive cancer care. This manuscript explores the multifaceted nature of these disparities, examining the roles of socioeconomic status, race, ethnicity, and insurance status in influencing cancer care access and outcomes. Historical and contemporary data highlight that minority racial status correlates with reduced clinical trial participation and increased cancer-related mortality. Barriers such as insurance coverage, health literacy, and language further hinder access to cancer treatments. Addressing these disparities requires a systemic approach that includes regulatory reforms, policy changes, educational initiatives, and innovative trial and treatment designs. This manuscript emphasizes the need for comprehensive interventions targeting biomedicine, socio-demographics, and social characteristics to mitigate these inequities. By understanding the underlying causes and implementing targeted strategies, we can work towards a more equitable healthcare system. This involves improving access to high-quality care, increasing participation in research, and addressing social determinants of health. This manuscript concludes with policy recommendations and future directions to achieve health equity in cancer care, ensuring optimal outcomes for all patients. Full article

Managed competition is a key driver in healthcare systems in countries like Germany, Switzerland, and The Netherlands. Trust in health insurers is vital but currently low in The Netherlands. This may be due to perceptions regarding profit motives, negative experiences, media coverage, and a lack of understanding of insurers’ roles. This study explores how enrollees perceive health insurers and how the aforementioned factors contribute to these perceptions. Semi-structured interviews were conducted with 17 participants from the Nivel Dutch Health Care Consumer Panel in March and April 2023. Data were analysed using Braun and Clarke’s six-step method for inductive thematic analysis. Participants generally view health insurers positively in terms of managing finances and ensuring care accessibility. However, some perceive insurers as profit-driven and prioritising cost reduction over individual needs, leading to dissatisfaction. Negative experiences and media coverage also shape these perceptions. Participants believe that insurers should ensure care accessibility and quality, distribute costs fairly, provide guidance, and prioritise preventive measures. To foster trust, insurers should communicate their non-profit status and use of benefits, increase transparency in purchasing decisions, and maintain clear communication about payment obligations. Enhancing communication about their contributions to healthcare and raising awareness of their broader roles may also help build trust. Full article

This study aims to examine the mediating effects of health literacy on the relationship between frailty and medical costs among community-dwelling older adults. Methods: This study conducted a secondary data analysis of the research data that were constructed by linking the Korean Frailty and Aging Cohort Data (KFACD) and the National Health Insurance Database (NHID). Frailty was measured using the Modified Fried Phenotype. Medical costs were calculated using insurance-covered medical costs, including both inpatient and outpatient medical costs, from January 1 to December 31 of the year when the participants were enrolled in the Korean Frailty and Aging Cohort Study. Health literacy was assessed using questions from the Behavioral Risk Factor Surveillance System (BRFSS) conducted by the US Centers for Disease Control and Prevention. To examine the mediating role of health literacy in the relationship between frailty and medical costs, Baron and Kenny’s method was used. Linear regression was applied to estimate the association between frailty and health literacy, and Poisson regression was used to model the relationship between frailty, health literacy, and medical costs. Results: Frailty showed a negative correlation with health literacy (r = −0.27, p < 0.001) and a positive correlation with medical costs (r = 0.15, p < 0.001). Health literacy had a negative correlation with medical costs (r = −0.07, p = 0.008). We verified that health literacy played a partial mediating role in the relationship between frailty and medical costs. Conclusions: To reduce medical costs in older adults, intervention measures to improve health literacy as well as prevention and management measures for frailty should be considered simultaneously. In addition, primary medical institutions’ active participation in such projects is needed. Full article

Background/Objectives: Breast reconstruction (BR) following mastectomy plays a critical role in post-cancer care by offering both physical and psychological benefits. Despite advancements in techniques and shared decision-making (SDM), BR uptake remains inconsistent. This systematic review aims to synthesize evidence on objective (medical and socioeconomic) and subjective (psychological and personal) factors influencing BR decision-making among women undergoing mastectomy for breast cancer. Methods: A systematic search was conducted across PubMed, ScienceDirect, OVID, and Google Scholar, identifying peer-reviewed studies published between January 2013 and 25 July 2024. Eligible studies examined determinants of BR decisions in women undergoing therapeutic mastectomy, excluding perspectives of non-patient stakeholders and post-decision outcomes. The risk of bias and study quality were assessed using the Quality Appraisal for Diverse Studies (QuADS) tool. This review was registered in PROSPERO (CRD42023456198) and followed PRISMA guidelines. Results: Twenty-seven studies comprising 994,528 participants across 16 countries met the inclusion criteria. The objective factors included age, comorbidities, insurance coverage, physician recommendations, and healthcare access. The subjective factors encompassed body image concerns, self-esteem, fear of recurrence, and emotional readiness. Younger age, private insurance, and active physician counseling were associated with increased BR uptake, while older age, lack of information, and financial or logistical barriers reduced uptake. Regional disparities were noted across healthcare systems. Conclusions: BR decisions are influenced by complex, interrelated clinical, psychological, and systemic factors. Integrating SDM tools, enhancing patient education, and addressing healthcare inequities are essential for supporting informed and equitable BR decision-making. Future research should prioritize longitudinal studies and policy interventions to improve access to and patient satisfaction with BR outcomes. Full article

In Chile, lesbian-parent families have faced legal and social advancements as well as challenges, generating new dynamics through assisted reproduction. The reproductive justice framework allows for an analysis of the inequities and injustices experienced by LGBTIQA+ people in relation to their reproductive rights. Objective: To analyze the narratives of lesbian-parent families who have accessed parenthood through assisted reproduction techniques within the Chilean healthcare system, identifying barriers and facilitators in the process, as well as possible instances of discrimination. Methodology: This research adopted a qualitative approach with a descriptive scope and was based on a constructivist paradigm, utilizing a narrative design and analysis. Four lesbian-parent families participated, selected through purposive or convenience sampling. Results: The findings revealed that the main barriers were related to health insurance coverage and social and geographical factors. Among the key facilitators were support networks, educational level, and healthcare professionals’ guidance. Discussion: The study highlighted the presence of inequalities affecting the exercise of parenthood and the right to form a family, shaped by institutional and social barriers from a reproductive justice framework. Conclusions: The study underscores the need to advance inclusive public policies and systemic changes that recognize and protect family diversity in Chile. Furthermore, it highlights the role of narratives as a tool to make visible and challenge the inequalities surrounding lesbian parenthood. Full article

Background: Patient satisfaction is a key indicator for improving healthcare delivery, yet the influence of gender preferences on healthcare providers remains underexplored. Cultural norms and gender perceptions often shape the patient preferences, affecting access to care, patient–provider relationships, and overall satisfaction. Thus, this study investigates the patients’ gender preferences and their impact on satisfaction in Tanzania. Methods: The study utilized a cross-sectional design, collecting data from five health centres: Mikongeni, Konga, Mzumbe, Tangeni, and Mlali. A total of 240 randomly selected respondents participated in the study. Gender preferences were categorized as male, female, and both, and determinants were analyzed using a multivariate probit model (MPM), while satisfaction was analyzed using an ordered logit model (OLM). Results: Results reveal that female providers were preferred for empathy (58.30%), intimate care (50.00%), and receptionist roles (50.00%), while males were favored for surgery (50.00%), professionalism (0.86), and IT roles (41.70%). Professionalism (0.75) and communication (0.70) had the strongest positive effects on very high satisfaction. Male provider preference was strongly linked to higher satisfaction (0.84), while female preference showed a mild effect (0.23). Insurance (0.32) and care at Tangeni Health Centre (0.70) boosted satisfaction, while consultation fees (−0.26) reduced it. Conclusions: The study recommends that healthcare systems address gender stereotypes by equipping all providers with both technical and relational care skills, regardless of gender. It also highlights the need for culturally and religiously sensitive care practices that acknowledge how societal norms shape patient preferences and satisfaction. To enhance patient-centered care, policies should promote affordability, broaden insurance coverage, and integrate patient feedback on gender preferences into healthcare delivery models. Full article

Background/Objectives: This study identifies barriers to maternal and child healthcare access in Afghanistan under the Taliban and proposes solutions using the WHO Health System Building Blocks Framework. Methods: Midwives and mothers were recruited via chain-referral sampling. After obtaining IRB and the participants’ informed consent, in-depth virtual interviews, guided by Social Cognitive Theory, were recorded, transcribed, and analyzed using content analysis in MAXQDA 2020. Results: Data analysis revealed four primary consequences of the political unrest in Afghanistan that have exacerbated barriers to accessing maternal and child healthcare: (a) Taliban-imposed restrictions on women’s education and mobility, reducing female healthcare providers and limiting mothers’ access to care; (b) increased poverty, preventing women from attending perinatal visits due to out-of-pocket costs; (c) the deterioration of healthcare services, including medicine shortages, weakened health financing due to donor withdrawals, lack of insurance, and poor governance; and (d) the increased perpetuation of misinformation and harmful practices, such as the use of clergymen for medical advice instead of doctors. Using the WHO Health Systems Framework, we recommend solutions that address issues in service delivery, health workforce, health information systems, access to essential medicines, financing, and governance. Conclusions: This is the first qualitative study capturing Afghan mothers’ and healthcare providers’ experiences under Taliban rule. Our findings can inform international efforts to advocate for women’s healthcare and education rights and guide global aid programs in strengthening Afghanistan’s healthcare system in alignment with Sustainable Development Goal 5. Full article

(1) Background: This study aims to identify the sociodemographic, behavioural, and systemic predictors of colorectal cancer (CRC) screening among primary healthcare attendees in Riyadh, Saudi Arabia, to inform targeted interventions and policy strategies. (2) Methods: This cross-sectional study was conducted between March and July 2023 across 48 randomly selected primary healthcare centers in Riyadh, Saudi Arabia. The target population for this study was adults aged 18 and above attending primary healthcare centers in Riyadh. Multi-stage random sampling was used to recruit participants. Multivariate logistic regression was performed to identify independent predictors of CRC screening. (3) Results: CRC screening uptake was found to be only 4.2%. Age was a significant predictor, with individuals aged 50–75 years (adjusted odds ratio [AOR]: 1.90, 95% confidence interval [CI]: 1.50–2.42) and those aged 75 years or older (AOR: 1.37, 95% CI: 1.01–1.87) being more likely to undergo screening compared to younger individuals. Insurance coverage strongly influenced screening behaviour (AOR: 1.64, 95% CI: 1.37–1.96). Smokers were nearly four times more likely to participate in screening than non-smokers (AOR: 3.87, 95% CI: 3.21–4.69), and physical activity was positively associated with screening (AOR: 1.43, 95% CI: 1.11–1.82). (4) Conclusions: CRC screening uptake in Riyadh is critically low, highlighting the need for targeted public health interventions. Key predictors such as age, insurance coverage, smoking, and physical activity underscore the importance of addressing sociodemographic disparities and promoting health awareness. The findings emphasize the need for culturally tailored educational campaigns, improved healthcare access, and enhanced screening programs to increase uptake. Full article

Climate-induced migration has emerged as a major concern in India and Bangladesh, due to their geographical vulnerability and socioeconomic conditions. Coastal areas, such as the Sundarbans and the Ganges–Brahmaputra Delta, face relentless threats due to rising sea levels, cyclones, and floods. These factors force millions to relocate, resulting in rural–urban transitions and cross-border movements that worsen urban challenges and socioeconomic vulnerabilities. For this, a systematic literature review of the Scopus database was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A detailed review analysis of 65 papers was carried out. The study highlighted key climatic and non-climatic drivers of migration, including natural disasters, resource depletion, poverty, and poor governance. Despite existing adaptation strategies, such as early warning systems, micro-insurance, and climate-resilient practices, gaps remain in addressing long-term resilience and legal recognition for climate migrants. The research emphasizes the need for a holistic, multi-stakeholder approach, integrating adaptive infrastructure, sustainable livelihoods, and international cooperation. Recommendations include bridging research gaps, increasing community participation, and implementing global frameworks, like the Fund for Responding to Loss and Damage. Addressing climate migration through fair, inclusive measures is essential for building resilience and ensuring long-term development in the region. Full article

Background: The rapid rise of e-commerce has intensified last-mile logistics challenges, fueling the need for sustainable, efficient solutions. Parcel locker crowdshipping systems, integrated with public transport networks, show promise in reducing congestion, emissions, and delivery costs. However, operational and physical constraints (e.g., crowded stations) and liability complexities remain significant barriers to broad adoption. This study investigates the demographic and operational factors that influence the adoption and scalability of these systems. Methods: A mixed-methods design was employed, incorporating survey data from 368 participants alongside insights from 20 semi-structured interviews. Quantitative analysis identified demographic trends and operational preferences, while thematic analysis offered in-depth contextual understanding. Results: Younger adults (18–34), particularly gig-experienced males, emerged as the most engaged demographic. Females and older individuals showed meaningful potential if safety and flexibility concerns were addressed. System efficiency depended on locating parcel lockers within 1 km of major origins and destinations, focusing on moderate parcel weights (3–5 kg), and offering incentives for minor route deviations. Interviews emphasized ensuring that lockers avoid station congestion, clearly defining insurance/liability protocols, and allowing task refusals during peak passenger hours. Conclusions: By leveraging public transport infrastructure, parcel locker crowdshipping requires robust policy frameworks, strategic station-space allocation, and transparent incentives to enhance feasibility. Full article

Background. Cow’s Milk Protein Allergy (CMPA) is a prevalent pediatric food allergy affecting 2–5% of infants globally. CMPA presents significant clinical and economic challenges, requiring specialized diagnostic procedures, dietary management with hypoallergenic formulas, and multidisciplinary care. The financial burden on families and healthcare systems includes direct costs (e.g., diagnostic tests, medical consultations, and formula expenses), indirect costs (e.g., caregiver absenteeism and productivity loss), and intangible costs (e.g., psychological distress and impaired quality of life). Economic disparities further exacerbate these challenges, particularly in low-resource settings where access to specialized care is limited. Methods. A systematic review was conducted following PRISMA guidelines using PubMed, CINAHL, Scopus, and Cochrane databases to identify studies on the economic and psychosocial burden of CMPA. Studies published between 2010 and 2024 were analyzed. From an initial search of 11,565 articles, 802 duplicates were removed, leaving 10,763 articles for title and abstract screening. Twenty full-text articles meeting the inclusion criteria were included in the final analysis. Thematic categories focused on direct, indirect, and intangible costs, with findings synthesized to highlight global disparities and policy gaps. Results. CMPA management imposes substantial economic burdens, with hypoallergenic formulas alone accounting for up to 15% of household income in some regions. Indirect costs, including lost workdays and additional childcare expenses, further strain families. Intangible costs, such as heightened caregiver anxiety and reduced social participation, are significant yet frequently overlooked. Healthcare system disparities, particularly regarding insurance coverage for diagnostic tests and therapeutic formulas, contribute to financial inequities. The use of extensively hydrolyzed casein formulas with probiotics has demonstrated cost-effectiveness in promoting immune tolerance while reducing healthcare utilization. Conclusions. Addressing the economic impact of CMPA would benefit from standardized cost assessment frameworks and equitable access to cost-effective therapeutic options. Further analysis of reimbursement policies across diverse healthcare systems may provide insights into optimizing support for essential treatments. Integrating clinical and economic strategies can alleviate the burden on affected families and optimize healthcare resource allocation. Future research should prioritize longitudinal analyses and cross-regional comparisons to guide sustainable and equitable management strategies. Full article

This study focuses on the psychological state and economic preparedness of socially isolated older individuals in China’s rapidly aging society. Both a simple model and an extended model were developed and tested to explore the impact of social isolation on the subjective well-being of older adults by analyzing how social isolation, self-assessment of health, and anxiety about old age affect subjective well-being. The results indicated that both social isolation and self-assessment of health have a strong influence on subjective well-being, and that social isolation significantly alters older individuals’ perception of caregiving responsibility. While private insurance participation had a significant impact on the well-being of younger individuals, its effect on older adults was limited. These findings provide valuable insights for improving support systems for older people. Full article

Background and Objectives: Mental health disorders, including major depressive disorder and adjustment disorder with mixed anxiety and depressed mood, present a significant global burden, with early onset and progression leading to substantial individual and social impacts. While pharmacotherapy remains the standard treatment, many patients experience inadequate symptom relief or intolerable side effects. In this context, transcranial magnetic stimulation (TMS) has emerged as a non-invasive, well-tolerated neuromodulation technique offering an alternative treatment option. Although its clinical efficacy is well-documented, limited research exists on patient perceptions, decision-making processes and barriers to TMS utilization in private healthcare settings, particularly in Romania. This study explores patients’ experiences with TMS, factors influencing their treatment choices and comparative views on its acceptability relative to pharmacological interventions. Materials and Methods: A qualitative research design was employed, using semi-structured interviews with 20 patients diagnosed with MDD or AD who had undergone TMS therapy as part of two pilot studies which were non-randomized in Romanian private practices. Data were collected via interviews and analyzed thematically to identify patterns in patient perceptions, decision-making factors and treatment experiences. Results: Participants reported predominantly positive perceptions of TMS, citing improvements in mood, anxiety reduction, and enhanced daily functioning. The most common motivations for seeking TMS included dissatisfaction with pharmacotherapy, recommendations from physicians or peers and information obtained via online sources. TMS was perceived as a safer and more tolerable alternative to medication, particularly due to its lack of systemic side effects. However, barriers such as high treatment costs, limited insurance coverage and logistical challenges in accessing TMS services were noted as significant deterrents. Conclusions: The study highlights the strong preference for TMS among patients who seek alternatives to pharmacotherapy, with key motivators including efficacy, tolerability and non-invasiveness. However, systemic barriers to access remain a critical challenge in private healthcare settings. Future research should focus on expanding accessibility, improving patient education and integrating TMS into broader mental healthcare frameworks to optimize treatment outcomes. Full article