Older family care partners of persons with heart failure (HF-FCPs) face physical, psychosocial, and financial burden, yet their self-care difficulties and unmet needs remain poorly understood. We examined older HF-FCPs' self-management challenges, care-related needs, and health status. A qualitative study was conducted using semi-structured, one-on-one interviews with 15 HF-FCPs between September 2022 and January 2023. HF-FCPs (mean age = 65.9 years [SD = 4.4 years]) were predominantly female (n = 11) and spouses (n = 13), providing care for 9.3 years and 35.4 hours per week. Arthritis was the most common chronic condition among HF-FCPs, followed by obesity and hearing or vision impairments. Four key themes emerged: Self-Management Challenges, Motivation for Self-Care, Need for Social Connection, and Need for Caregiver Resources in Supporting Patients With HF. Findings highlight the need to develop and implement caregiver-centered health programs tailored to the unique needs of older HF-FCPs.

Background The escalating out-of-pocket medical expenses pose a significant threat to the financial stability of households worldwide. Identifying persistent catastrophic health expenditure (CHE) is imperative for alleviating medical-related economic difficulties. This study comprehensively investigated the spatio-temporal dynamics and key determinants of persistent CHE in China across the 2012–2020 period. Methods This longitudinal quantitative study leveraged data from five waves of the China Family Panel Studies (CFPS), conducted biennially from 2012 to 2020. Variables pertaining to the incidence, depth, and duration of CHE were scrutinized, with covariates informed by the Andersen health service utilization model, including predisposing, enabling, and need factors. Spatio-temporal patterns were analyzed through spatial autocorrelation analysis. Tobit regression was employed to analyze CHE depth, whereas a Generalized Estimating Equation model was used to investigate factors influencing the duration of CHE. Results The analytical sample comprised a balanced panel of 2,544 households, yielding a total of 12,720 observations. Although the incidence of CHE decreased from 16.27 to 13.88%, there was a persistent upward trajectory in the intensity of CHE, which rose from 0.026 in 2012 to 0.069 in 2020. The proportion of households experiencing persistent CHE saw a marked increase, escalating from 0% in 2012 to 14.32% in 2020. Rural households demonstrated a higher incidence of CHE compared to urban households, and significant regional variations in persistent CHE were evident. The spatial clustering of persistent CHE experienced a dynamic transition from aggregation to dispersion and then to a partial recovery during 2012–2020. Factors such as poor self-assessed health status (OR = 1.015, 95% CI 0.011 to 0.194; p < 0.05), a greater number of family dependents (OR = 1.047, 0.040 to 0.053; p < 0.05), the presence of chronic diseases (OR = 1.013, 0.006 to 0.021; p < 0.05), and hospitalization (OR = 1.069, 0.053 to 0.081; p < 0.05) were significantly associated with an elevated risk of persistent CHE. Conclusion Financial protection against persistent CHE remains a challenge in China, particularly for rural households, low-income groups, families with chronic diseases, and regions with underdeveloped economies. Policy must prioritize enhancing insurance benefit packages, establishing persistent CHE-linked targeted assistance, and implementing region-specific strategies to address the root causes of health-induced poverty.

Pediatric primary care providers (PPCPs) often report discomfort with managing behavioral health issues. Child psychiatry access programs (CPAPs) offer psychiatric consultation, education, and referral support. This exploratory, sequential mixed-methods study aimed to identify factors influencing PPCPs' perceived ability to manage behavioral health issues and the impact of these factors on PPCPs' use of psychiatric consultation from California's CPAP. Focus group data from 11 pediatric practices (N=52 PPCPs) were analyzed to identify factors shaping PPCPs' perceived ability to address behavioral health issues. Consultations (N=188) involving the participating practices (March 2022-April 2024) were analyzed for their purpose, patients' demographic and clinical characteristics, and disposition (i.e., ongoing management in primary care or referral to specialty behavioral health care). Logistic regression was used to examine factors associated with disposition. PPCPs felt somewhat capable of managing care for patients with attention-deficit hyperactivity disorder (ADHD), depression, or anxiety and for those receiving psychotherapy, but they felt less capable when patients had multiple psychiatric diagnoses or clinical risk factors such as suicidal ideation. Many PPCPs reported discomfort with initiating or changing psychotropic medications. Seventy percent of consultations were related to medication. Consultations resulted in disposition to primary care management for 72% of patients, and this disposition was positively associated with an ADHD, a depression, or an anxiety diagnosis (adjusted odds ratio [AOR]=4.90) and younger patient age (≤11 years; AOR=2.58) but negatively associated with clinical risk factors (AOR=0.31). Availability of psychiatric consultation via CPAPs may enhance PPCPs' ability to manage behavioral health issues within primary care.

The COVID-19 pandemic negatively affected sexual and reproductive health and rights (SRHR) and increased unwanted pregnancies among young people, yet scant evidence documents SRH service-access trajectories and experiences of young people living with HIV during this time. We conducted a remote study, comprised of qualitative Facebook and telephonic data collection with adolescents living with HIV and young parents in South Africa (n = 41, ages 16-29) in 2020/2021. Following this, we conducted in-depth research through calls, WhatsApp and Facebook to explore narratives of two young people living with perinatally-acquired HIV who accessed SRH services and became parents during COVID-19 lockdowns. We engage a narrative approach to illustrate the trajectories of these two young people - documenting their biopsychosocial lives and experiences accessing SRH services - with attention to personal, structural and relational factors. Findings illustrate their agency while detailing gaps in provisions that significantly affected their health and well-being. This study applies practice theory, exploring how gendered, relational, social and geographic factors shaped young people's experiences and SRH. Despite being well-acquainted with the biomedical technologies and relationships governing their care, they struggled to navigate an altered health landscape. Findings document how they were subject to narratives of individual responsibility for their SRH amidst system-level shortcomings. Results highlight significant gaps in service provision and an imperative to enhance the material conditions for young parents living with HIV in South Africa. They underscore the need for resilient, shock-responsive health and social protection systems to maintain continuous SRH services for adolescents living with HIV during crises.

Purpose Unmet mental health need is increasing across the Asian immigrant adolescent populations internationally and in New Zealand (NZ). Southeast Asian (SEA) immigrants are a growing population in New Zealand. This paper aims to determine whether the mental health needs and access to healthcare of 1.5- and second-generation SEA immigrant adolescents differ from those of Europeans in NZ. Design/methodology/approach Analysis of secondary data from a representative survey of NZ adolescents (Youth19) was conducted. Measures assessed included significant depressive symptoms, anxiety symptoms, suicide ideation, difficulty getting help for emotional concerns (as a measure of healthcare access) and reasons for not accessing healthcare when having a hard time. Findings A total of 2,166 participants, SEA immigrants (n = 185) and reference groups: European immigrants (n = 326) and European non-immigrants (n = 1,655) were included. SEA immigrants were more likely than European non-immigrants to report significant depressive symptoms (OR = 1.54, 95%CI = 1.12–2.09), anxiety (OR = 1.54, 95%CI = 1.11–2.09), serious thoughts about suicide (OR = 2.11, 95%CI = 1.55–1.87) and difficulty getting help for emotional concerns (OR = 1.55, 95%CI = 1.08–2.23) after adjusting for age, gender and area-based socioeconomic deprivation. Originality/value This study highlights high mental health need for SEA immigrant adolescents in NZ, a population group not widely represented in literature. Despite high mental health need, low utilisation of mental health services indicates needs are currently not being met. Further research is needed to explore the kinds of effective support needed to ensure this important and growing population group receive equitable access to health services.

Despite the ongoing mental health crisis among US youth and the critical role that pediatricians caring for children and adolescents in emergency departments (EDs) play, there are limited studies capturing these pediatricians' concerns, experiences, and needs. National weighted survey data on mental health care were collected in 2022 from the American Academy of Pediatrics Pediatrician Life and Career Experience Study (PLACES) participants (response=67%). We analyzed responses from 115 pediatricians caring for children and adolescents in the ED. Participants reported perspectives on: (a) overall pediatric mental health concerns; (b) frequency of mental health presentations; (c) experience prescribing psychotropic medication; and (d) referral difficulty. We systematically examined open-ended responses on the most pressing mental health needs. Eighty-four percent of pediatricians caring for children and adolescents in the ED reported that mental health is a significant problem for youth in their community. Nearly all (98%) reported caring for children and adolescents with mental health conditions in the past month. Many reported daily encounters with pediatric patients experiencing mental health conditions, including anxiety, depression, and suicidal ideation. One in five reported prescribing psychotropic medication in the past year, none of whom reported being "very" comfortable doing so. One in five said resources to care for children and adolescents with mental health conditions were very or moderately available in their community. Open-ended responses (n=79) highlighted the urgent need for resources and solutions at the national level. Pediatricians in the ED have significant concerns about child and adolescent mental health in their communities, and many see youth with anxiety, depression, and suicidal behavior daily. Findings underscore a need for more support for pediatricians in the ED and innovative solutions to improve child and adolescent mental health.

Frameworks, theories and models used in the development of health policies: A systematic review of systematic reviews.

Abstract Recognising and understanding that a child might be autistic is an important first step in the autism diagnostic pathway. For many families, this process involves working alongside school staff and, in England, this tends to be led by the Special Educational Needs Coordinator (SENCO). Existing research highlights the importance of how and when clinical professionals disclose an autism diagnosis to parents, yet there is limited knowledge on how SENCOs might broach initial interactions with parents earlier in the process. In the current study, we used a qualitative survey with 105 SENCOs in England, to understand how they work with parents at this critical point. Using reflexive thematic analysis, seven themes were identified, which were organised into areas that SENCOs felt they did and did not have control over in relation to their interactions with parents. Specifically, SENCOs highlighted the need for preparation when speaking with parents, alongside the importance of a personalised approach, where they truly listened to parents and aimed to move into alignment with them (all factors perceived to be under their control). SENCOs also discussed the need for additional support and training for working with parents, the importance of the ethos around how the school approaches inclusion, and the need for education and health to work together (all factors perceived to be outside their control). Implications for practice are discussed.

South Asian immigrants in Southeast Queens County, New York City face healthcare, housing, and digital access challenges shaped by English proficiency. Despite community growth, data remains limited. This assessment examines English proficiency as a social determinant of health. A mixed-methods study was conducted across nine ZIP codes in Southeast Queens County, New York City. From August 1-October 31, 2023, the quantitative phase included a multilingual survey (English, Bengali, Hindi) that reached 395 South Asian participants, covering demographics, living conditions, food security, safety, mental health, and digital literacy. The qualitative phase (December 2023-March 2024), guided by IDEO's Human-Centered Design, included five interviews and a focus group. Analysis revealed significant disparities between Limited English Proficiency (LEP, n = 288) and non-LEP (n = 107) individuals. LEP respondents reported more housing issues, especially pest infestations (91.1% vs. 82.4%, p = 0.042), and lower homeownership (19.1% vs. 34.6%, p = 0.031). Computer literacy was lower among LEP individuals (50.6% vs. 80.8%, p < 0.001), though internet access was high in both groups (87.0% for LEP vs. 91.4% for non-LEP, p = 0.24). Housing instability persisted, with a greater share of LEP participants renting (70.6% vs. 56.4%, p = 0.031). This assessment highlights how language proficiency shapes social determinants of health for South Asian immigrants in Southeast Queens County, New York City. LEP individuals faced more housing, food, safety, and digital literacy challenges, underscoring the need for language-accessible, culturally tailored services.

Abstract Recent cross-scale models for spatial disaggregation have likelihoods at region level, but the main model at neighbourhood level, where data are missing, with the object of predicting neighbourhood outcomes. In existing studies, the neighbourhood model involves a single latent indicator, and includes a regression and spatial error, but does not account for demographic variability in risk of the outcome. We instead propose methods for neighbourhood outcomes in the form of age-standardized relative risks. We propose further novel extensions: to borrow strength from comorbid indicators which are observed for neighbourhoods; to pool information on health need or risk from multiple target indicator regressions; and to spatio-temporal specifications for changing relative risk. We therefore provide a comprehensive approach to applying disaggregation to spatial morbidity profiling. We consider two data analyses. One involves cross-validation to assess recoverability of neighbourhood data, and the substantive plausibility of cross-scale neighbourhood models. We demonstrate over 90% recoverability of neighbourhood data. The second application where neighbourhood data are latent involves three target indicators, and investigates drug-related problems for 342 neighbourhoods in North East England, where the observed data are for 12 local authorities. We include a cross-scale trend analysis for drug mortality.

Objective: There is growing recognition of biopsychosocial health in medical training, but it remains inconsistent. Faculty are crucial in this realm, leading to the inquiry: “What are the experiences of medical faculty regarding the concept of health needs?” This study focused on faculty experiences at a higher education institution in the interior of São Paulo, Brazil, from the 1st to 6th grades, in handling health needs within a competency-based curriculum. Method/Approach: Using grounded theory, the study performed remote semi-structured interviews, analyzing data through microanalysis, open, axial, and selective coding. 17 faculty members participated, with theoretical saturation defining sampling. Results: Four categories emerged: A) Approaching the concept in phases: contact, construction, and apprehension; B) Recognizing varied approaches in different teaching scenarios based on faculty roles within the curriculum; C) Experiencing doubts about operationalizing the concept due to insufficient teaching training, unclear content, and inadequate support from educational and institutional management; D) Identifying the potential for curriculum restructuring and suggesting improvements while also expressing uncertainties about implementing these changes. In Category A, introducing faculty to the concept is essential, with ongoing construction and comprehension through practice. Categories B and C highlighted variation in students’ understanding based on teaching environments and curriculum roles, coupled with a lack of clarity and support causing doubts about implementation. Category D underscored potential curriculum restructuring benefits but emphasized practical strategies. Conclusions: Achieving clarity in institutional documents and engaging stakeholders in continuous education is crucial for addressing health needs in care. Permanent education should ensure both students and graduates focus on users' health needs.

The topic of the social determinants of health has become increasingly relevant in the contemporary context of global social, economic, and demographic change. This article examines the influence of social, economic, and cultural factors on population health and the course of disease progression, emphasizing inequalities in access to healthcare services and support. It analyzes the interactions among social structures, individual behaviors, and institutional practices that shape population health. A multi-level model of interventions - individual, organizational, and community - is presented, aimed at reducing vulnerability and fostering social resilience. The relevance of this research lies in the need for health and social policy to integrate new approaches such as social prescribing, culturally competent care, and interinstitutional collaboration. The article provides an analytical framework and practical guidelines for social work and healthcare professionals in developing interventions that strengthen public health and reduce social disparities arising from illness.

The high incidence of tick-borne diseases (particularly Lyme disease) and the challenges associated with their serious health consequences motivated us to undertake research aimed at developing robust protection against ticks. There is still no effective method for preventing or treating Lyme disease, and humans who spend time outdoors—whether for occupational or recreational purposes—remain unprotected. This paper presents an innovative design of anti-tick textile bands intended for standalone use or integration into protective trousers. The bands are designed to receive repellent-sprayed inserts and provide a barrier layer separating the chemical from the user. In the research, the protective performance of the bands was evaluated using a novel test stand specially constructed for tick repellency testing. Experiments involving live ticks demonstrated the highest effectiveness for bands incorporating an insert impregnated with 20% DEET. Two limitations were noted: peak protection was achieved approx. 15 min after DEET application, and repellent reapplication was required after three hours to maintain protection. These findings are directly relevant to protective equipment design, offering a practical solution for high-risk groups such as forestry workers. By providing an experimentally validated strategy for tick bite prevention, this work addresses an urgent need in occupational and public health.

Children with special healthcare needs (CSHCN), especially those with mental health needs, often receive services from multiple service sectors, including schools. Thus, care coordination may play a critical role in access to mental health care for these children. This pooled cross-sectional study used multivariable logistic regression with data from the National Survey of Children’s Health (2020-2023), focusing on a subsample of children with caregiver-reported mental health problems and need for mental healthcare. It estimates the prevalence of parent-reported need for and receipt of effective care coordination and provider communication with schools. It also measures the association between parent-reported receipt of these services with unmet need for mental healthcare. Most caregivers reported need for care coordination (51.3%) and provider communication with schools (60.7%). Among those with need, 48.3% reported not having their care coordination needs met, and 57.2% of families reported unmet need for provider communication with schools. The probability of reported unmet mental health needs was 12 percentage points lower when children had all needs for care coordination met and 10 points lower when providers communicated with schools. Results suggest that having care coordination needs met and provider communication with schools may play an important role in children accessing needed mental healthcare.

The increasing antibiotic resistance of Helicobacter pylori poses challenges in selecting effective eradication therapies for patients with gastric cancer. This study aimed to assess the antibiotic resistance patterns of clinical H. pylori strains isolated from gastric cancer patients, to guide H. pylori eradication strategies for those with residual gastric mucosa after gastrectomy. This study enrolled 115 consecutive patients with gastric cancer who had a positive 13C urea breath test, all of whom were scheduled for gastric resection at West China Hospital of Sichuan University. Gastric mucosa samples were collected for pathological examination, H. pylori culture, and susceptibility testing using E-test and disk diffusion methods. From 115 specimens, 86 H. pylori strains were cultured (74.8% culture rate). Of the 86 patients (59 males, 27 females; median age 59, range 34-79) with successful H. pylori isolation, histopathology revealed 37 intestinal-type, 27 diffuse-type, 9 mixed-type, and 13 unclassified gastric cancers. Sixty-one patients underwent distal gastrectomy, and 25 had radical total gastrectomy. Notably, 12 patients were diagnosed at ≤45 years, including 9 females, all with signet ring cell carcinoma. Antibiotic resistance rates were rifampicin (RIF) (69.8%), metronidazole (MTZ) (75.6%), clarithromycin (CLR) (41.9%), levofloxacin (LEV) (32.6%), amoxicillin (AML) (2.3%), tetracycline (TET) (1.2%), and furazolidone (FZD) (0%). H. pylori isolates from gastric cancer patients exhibited high resistance to RIF, MTZ, CLR, and LEV, but negligible resistance to AML, FZD, and TET. Given the compromised health status and need for concurrent therapies in these patients, AML- and/or minocycline-based regimens may represent a practical and effective treatment option for H. pylori eradication in gastric cancer patients with residual gastric mucosa after distal gastrectomy, to reduce the risk of metachronous gastric cancer.

BackgroundMental health problems are widespread among young adults in Germany, yet the use of professional help remains low. This study aimed to identify the most common perceived barriers to help-seeking and to examine which individual and regional factors are associated with unmet need for mental health care.MethodsA total of 3,051 former participants of the KiGGS cohort study (aged 16 to 25 years) took part in an online survey. Group comparisons and regression analyses were conducted to examine associations of individual and regional characteristics with unmet need for care.ResultsOverall, 42.6 % of respondents reported not having used professional help despite being advised to do so or perceiving a need themselves. The most frequently reported barriers were difficulties in acknowledging one’s own need for help (problem denial) and negative attitudes towards seeking professional help (help-seeking stigma). Within this group, unmet need was more likely reported by women, individuals with lower subjective social status, depression or anxiety symptoms, low mental health-related quality of life, or inadequate health literacy. Regional characteristics such as the density of care provision or socioeconomic deprivation were not significantly associated with unmet need.ConclusionsThe findings highlight the importance of subjective barriers to help-seeking behaviour. Low-threshold interventions may help improve self-awareness, appraisal competence, and openness in dealing with psychological distress, thereby reducing the risk of mental health disorders.

Objective:To assess perceptions of effective communication training needs among US state and local government public health employees and examine variations across generations and other worker characteristics.Design:Cross-sectional survey analysis using data from the 2024 Public Health Workforce Interests and Needs Survey.Setting:State health agencies and local health departments across 48 states in the US.Participants:A total of 56 595 state and local government public health employees (37% response rate) representing 4 generations: Baby boomers (16%), Gen X (39%), millennials (38%), and Gen Z (7%).Main Outcome Measures:Training needs for effective communication, defined as the combination of ability to communicate effectively across audiences and ability to communicate persuasively. Training needs were identified when respondents rated skills as moderately or very important but reported being unable to perform or at beginner level.Results:Overall, 11% of respondents identified a training need for effective communication, including 7% with gaps in communicating effectively with different audiences and 9% in persuasive communication. Gen Z staff ranked persuasive communication as their top training need regardless of skill level. Logistic regression revealed that Communications and Policy staff (adjusted odds ratio 1.46, 95% CI 1.21-1.76) and Environmental Health staff (adjusted odds ratio 1.20, 95% CI 1.04-1.37) had higher odds of prioritizing communication training. Women and older generations were less likely to prioritize communication training compared to men and Gen Z, respectively.Conclusions:Although effective communication was identified as a training need, respondents did not consistently identify effective communication as their top perceived training need. Given the importance of communication to effective public health practice, training interventions should be tailored to different generations, roles, and programmatic areas.

To evaluate the health and developmental concerns for children in out-of-home care in Central Australia and assess whether they received timely and comprehensive paediatric health assessments. A retrospective audit of paediatric outpatient assessments for all children in out-of-home care in Central Australia, from 1 September 2018 to 1 May 2020. Timeliness of paediatric assessment was compared with the recommended timeframes in the National Clinical Assessment Framework. A total of 304 children, aged 0-17 years were in out-of-home care during the audit period, with 174 (57%) children seen through paediatric clinics. Ninety-five percent of children were Aboriginal and Torres Strait Islander and all children had health needs identified. Developmental concerns were most common in children over 1-year-old (70%). Sixty-three percent of school-aged children had behavioural concerns and 43% had mental health concerns identified. Foetal alcohol spectrum disorder (FASD) was diagnosed or suspected in 50%-66% of primary school-aged and younger and 43% of high school-aged children. More than 50% of primary school-aged children had diagnosed or suspected attention-deficit/hyperactivity disorder (ADHD). Nearly all children were referred for ongoing paediatric care. Less than half of the children had a comprehensive health assessment within the recommended 3 months of entry into out-of-home care. Children in out-of-home care in Central Australia experience significant physical, developmental, behavioural and mental health care needs. The findings highlight significant delays in the provision of paediatric health assessments, with most children not seen within recommended timeframes. The findings from this study highlight the importance of timely and consistent access to assessments and should challenge stakeholders to prioritise service, system and policy development.

The EQ-DAPHNIE (EuroQol Data for Assessment of Population Health Needs and Instrument Evaluation) project is a large, multi-country survey initiative designed to generate population norms and enable comparative research using self-reported health measures. This paper describes the quality control processes and summarizes data quality metrics from the United Kingdom (UK) pilot and full implementation across 15 countries. Representative samples were recruited via Dynata, an online survey panel provider, using quota sampling by age, sex, income, community setting, and language (where applicable). The UK pilot (n = 3012) informed survey refinements ahead of full rollout (n = 68,411). Quality metrics included completion rates, bot detection, speeding, missing data, outliers, and quota achievement. Across countries, response rates ranged from 80.1 to 100%, with completion rates varying widely (22.9% in Brazil to 60.8% in Japan; average 42.4%). Bot exclusions averaged 3.0%, peaking in China (11.7%). Speeding was low (0.3% average), and duplicate records were rare. Completion times ranged from 18.3 (France) to 31.4min (New Zealand). Missing data varied substantially (0.0-48.7%), with Japan and Spain showing the least. Quota fulfillment ranged from 68.7 to 98.6%. Consistency checks showed strong agreement for repeated items-marital status (92.8-98.9%) and age (92.3-98.7%). The quality control measures implemented throughout the EQ-DAPHNIE project effectively addressed common issues such as bot responses, speeding, and missing data, resulting in generally high-quality and representative datasets. However, variability across countries underscores the need to account for quality indicators when using the data for norm-setting or cross-country comparisons.

Threonine, an essential amino acid, plays a vital role in promoting growth, maintaining health, and enhancing the overall performance of fish in aquaculture. Different fish species require varying amounts of threonine due to their unique physiological and metabolic characteristics. An adequate supply of threonine is necessary for protein, mucin, and antibody synthesis that are key components that support growth and immune response. This amino acid also contributes to intestinal integrity, improves nutrient absorption, and helps reduce oxidative stress. Determining the precise threonine needs of each fish species is important for achieving better growth rates, efficient feed utilization, and stronger disease resistance. A deficiency in threonine can result in stunted growth, poor fillet quality, and higher vulnerability to infections. Therefore, incorporating the correct threonine levels in formulated diets is essential for enhancing fish productivity and sustaining aquaculture operations. Species-specific dietary formulations that meet threonine requirements can significantly improve fish production efficiency and contribute to long-term food security.