Health Outcomes Research Articles

Patient care on the ramp: Who is legally responsible?

Ambulance ramping, the delay to transfer of a patient arriving at an ED by ambulance into an ED treatment space and handover of care to ED clinicians, is a problem in all Australian states and territories and New Zealand. It is a symptom of ED overcrowding and access block and has been associated with adverse health outcomes for some patient groups. The questions arise, who might be legally responsible for the care of patients who are ramped and does their physical location matter? The short answers are 'everyone' and 'no', however, whether there will be a breach of duty depends on the reasonableness of responses and resource allocation considerations.

Health anxiety and related factors among the rural population: A cross-sectional study in China.

This study investigated the prevalence and correlates of health anxiety among rural populations in China, due to the unique socio-economic challenges in these areas, such as limited healthcare access. A sample of rural residents (N = 909) was analyzed to identify key predictors of health anxiety, such as age, education level, living type, anxiety sensitivity, and perceived information overload. Results indicated that older individuals and those with lower educational levels exhibited significantly higher levels of health anxiety. Furthermore, living alone was associated with increased health anxiety, while anxiety sensitivity and perceived information overload were found to exacerbate anxiety levels. These findings highlight the critical need for tailored interventions aimed at mitigating health anxiety in rural areas, thereby contributing to improved mental health outcomes and overall well-being.

Population health and public health: Commonalities and differences.

To explore the synergy between population health and public health by initiating a discourse about their interconnected roles, responsibilities, and approaches in achieving optimal health outcomes. Population health and public health, although distinct, are interconnected disciplines critical for enhancing health outcomes. Population health focuses on analyzing health determinants and outcomes within specific groups, employing data to guide targeted interventions and policies. Public health, on the other hand, prioritizes broader preventive measures and community-wide interventions to safeguard health. Both fields benefit from a transdisciplinary approach that integrates strategies to address and improve health. Such integration is essential for addressing health disparities and improving the efficiency of health systems. By combining the analytical strengths of population health with the implementation capabilities of public health, a more comprehensive framework can be developed. These collaborations will not only enhance the effectiveness of health programs but also promote health equity by leveraging collective expertise and resources. They will facilitate the development of interventions that are both preventive and responsive, capable of addressing the upstream determinants of health and the immediate needs of communities. Such transdisciplinary efforts were demonstrated within the oral health field during the COVID-19 pandemic. The synergy between population and public health can lead to robust health outcomes, fostering comprehensive health promotion and disease prevention strategies. By aligning research, practices, and policies, these integrated approaches will transcend traditional boundaries within the healthcare sector to build efficient health systems.

Assessing the utility of epigenetic clocks for health prediction in South Korean

Epigenetic clocks have been developed to track both chronological age and biological age, which is defined by physiological biomarkers and the risk of adverse health outcomes. Epigenetic age acceleration (EAA) has been found to predict various diseases, aging-related factors, and mortality. However, epigenetic clocks have predominantly been developed with individuals of European or Hispanic ancestry, and their association with health outcomes and environmental factors has not been sufficiently assessed in East Asian populations. Here, we investigated nine epigenetic clocks: five trained on chronological age (first-generation) and four on biological age (second-generation), using DNA methylation data from blood samples of South Koreans. EAAs of second-generation epigenetic clocks reflected the risk of chronic diseases (type 2 diabetes and hypertension), levels of health-related blood markers (alanine aminotransferase, aspartate aminotransferase, high density lipoprotein, triglyceride, and high sensitivity C-reactive protein), and lung functions (percentage of predicted FEV1 and percentage of predicted FVC), while EAAs of first generation clocks did not. Using follow-up data, we also found that EAAs of second-generation clocks were associated with the time to onset risks of chronic diseases. Health behavior factors (drinking, smoking, exercise, body mass index, and waist-hip ratio), socioeconomic status (income level and educational attainment), and psychosocial status were associated with EAAs of second-generation clocks, while only smoking status was associated with EAAs of first-generation clocks. We conducted validation analyses in an independent South Korean cohort and replicated the association of EAAs with health outcomes and environmental factors. Age acceleration of epigenetic clocks is influenced by various environmental factors and can serve as an effective predictor of health in South Korea.

Analysis of the health effects of multiple social networks on the older adult: the substitution role of labor participation

ObjectivesThis study aims to examine the role of social networks in influencing the physical and mental health of older Chinese adults, investigating both the underlying mechanisms and the associations between social networks, labor force participation, and health outcomes.MethodsUsing data from the 2021 China General Social Survey (CGSS), we analyzed a sample of 1,332 older adults, incorporating demographic and health-related variables. Ordinary least squares (OLS) regression and mediation analysis were conducted to evaluate the effects of social networks on health outcomes, with subgroup analyses by gender and education level. Stata 18.0 and SPSS were employed to perform all statistical analyses.ResultsSocial networks demonstrate a significant positive effect on overall, physical, and mental health at the 1% level, with weak-tie networks exhibiting a more substantial impact on health (β = 0.1146, p < 0.01). In promoting physical health, social networks have a coefficient of 0.1371 (p < 0.001) for females and 0.2128 (p < 0.001) for males. Among individuals with lower education, the coefficient is 0.1561 (p < 0.001), while for those with higher education, it is 0.2184 (p < 0.001). Regarding mental health, social networks yield a coefficient of 0.0747 (p > 0.05) for females and 0.1095 (p < 0.01) for males; for individuals with lower education, the coefficient is 0.0914 (p < 0.01), and for those with higher education, it is 0.0441 (p > 0.05). Media use, subjective wellbeing, and perceived social class are key explanatory mechanisms in the relationship between social networks and health of the older adult. Notably, subjective wellbeing and perceived social class function as chain mediators between social networks and health outcomes. The interaction between social networks and labor participation reveals a significant negative coefficient (β = −0.1864, p < 0.01).ConclusionSocial networks contribute to improved health in older adults, with weak ties playing a particularly significant role, although the effect varies across subgroups. Media use, subjective social class, and wellbeing are important mechanisms linking social networks with older adult health, while labor force participation may serve as a substitute for social networks in health promotion among older adults. This study will inform the improvement of older adults health and the development of labor policies for older adults.

Physicians' Stigma Towards Ethnicity of Patients with Cancer and Its Effects on the Health Outcomes: The Moderating Effect of Ethnic Dissimilar Medical Encounters.

This study aimed to examine the moderating effect of ethnic patient-physician similarity versus dissimilarity on the relationship between physicians' stigma towards ethnicity and physicians' communication behaviors during medical encounters and patients' post-meeting anxiety. A prospective nested study design with 146 encounters, including 146 patients with cancer and 32 oncology/surgery physicians, was conducted between November 2019 and July 2022 in two medical centers. Before the medical encounters, physicians were asked to complete sociodemographic, professional and the Perceived Ethnic Discrimination Questionnaires (PEDQ-CV). Patients completed sociodemographic, clinical characteristics and State-Trait Anxiety Inventory (STAI) questionnaires before and following the encounters. During the medical encounters, structured "real-time" observations of the physicians' behaviors were assessed using the Four Habits Coding Scheme (4HCS). The mixed linear analysis model revealed that the two-way interaction effects between physicians' stigma toward ethnicity and the ethnic similarity between the physician and patient on physician communication behaviors (b = - .822, p < .05) and patients' post-meeting anxiety (b = .580, p < .05) were significant. In ethnic dissimilar medical encounters, physician stigma towards ethnicity was associated with poor communication behaviors and higher post meeting patients' anxiety. However, in ethnic similar medical encounters, physician ethnic stigma was associated with improve communication behaviors and stable levels of anxiety. Our study highlights the significant role of similar versus dissimilar ethnic medical encounters on the effect of ethnic stigma on health outcomes. These findings call for implementing a climate of diversity management to limit the additive effect of stigma towards ethnicity and to provide fair and equal care.

How primary and tertiary care services collaborate in urgent care delivery: an evaluation of general practice advice lines

BackgroundTo address the rising demand for urgent care and decrease hospital use, health systems are implementing different strategies to support urgent care patients (i.e. patients who would have typically been treated in hospital) in the community, such as general practitioner (GP) advice lines. The aims of this study were to: identify the support and resources GPs need to manage urgent care patients in the community; assess the need for GP advice lines by primary care services in Australia; and identify the facilitators and barriers to adoption, and strategies to support the sustainability of GP advice lines.MethodsQualitative study involving semi-structured interviews with GPs, hospital-based healthcare providers, consumers, and healthcare management, recruited via existing investigator networks and snowballing approach. The interviews were conducted between February and August 2023. Major themes were identified by an iterative and inductive thematic analysis.ResultsWe interviewed 16 participants (median age 50, IQR 38–59). Based on the aims of the study, three themes emerged: support and resources for GPs; motivation for GP advice lines; and factors influencing the uptake and sustainability of GP advice lines. Participants reported that better communication from hospital services with GPs is critical to ensure continuity of care between tertiary and primary settings. They also noted that GP advice lines can help increase capacity to manage urgent care patients in the community by providing timely decision-support to GPs. However, a reported barrier to the uptake and ongoing use of GP advice lines was the limited hours of the service. To sustain GP advice lines, participants highlighted a need to broaden the scope of the service beyond the pandemic, conduct rigorous evaluation on health outcomes, and further digitise the service so that a tiered level of support could be provided based on risk stratification.ConclusionsThe benefits of GP advice lines are yet to be fully realised. With increasing technology sophistication, there remain opportunities to further digitise and optimise GP advice lines, whilst ensuring better integration within and across primary and tertiary care services. This is however dependent on continued financial and policy support from the government.

Childhood conduct problems and adolescent medical service use: serial mediating effects of peer victimization and internalizing problems.

Adolescents with a history of conduct problems (CP) are at heightened risk of increased service utilization as they develop. While the mechanisms underlying this association are unclear, early CP have also been linked with peer victimization and internalizing problems. The goals of the current study were: (1) to examine peer victimization and internalizing problems as potential serial mediators explaining increased medical and psychiatric service use in adolescents with a history of childhood CP, and; (2) to explore whether the proposed mediation models vary by sex. Participants (N = 744; 53% boys, Mage = 8.39 years) from an ongoing longitudinal study that began in 2008 in Québec, Canada were recruited and assessed for CP, service use, and other behaviours via self-, parent- and teacher-reported questionnaires. Serial mediation analyses were conducted to examine the effects of peer victimization and internalizing problems on the association between childhood CP and adolescent medical and psychiatric service use, controlling for sex and household income. Adolescents with childhood CP reported higher medical and psychiatric service use than non-CP peers. Peer victimization and internalizing problems significantly mediated this association in both general medical and psychiatric service use models. The models did not vary by sex. Findings support higher levels of service use in adolescents with a history of CP, mediated by peer victimization and internalizing problems. Specifically, results highlight the importance of examining peer and socioemotional factors that may explain the increased service usage observed among youth with CP, to support better health outcomes.

Establishing a telemedical supported trans-sectoral collaboration network from community support to emergency care for outpatient care recipients: study protocol of a prospective non-randomized complex intervention study with a pragmatic approach, Stay@Home – Treat@Home

BackgroundDemographic changes in Germany are increasing the number of outpatient care recipients, who often resort to emergency care due to difficulties accessing timely outpatient medical care. Previous studies suggest that early detection and telemedical interventions could reduce unnecessary hospitalizations. The new form of healthcare aims to provide continuous, flexible healthcare for outpatient care recipients using digital technologies to detect health deteriorations and facilitate interventions at home. The goal of our study is to evaluate, whether the number of emergency situations and hospital stays will be reduced, and health outcomes will be improved compared to standard care.MethodsIn this prospective non-randomized complex intervention study with a pragmatic approach, we aim to evaluate a new form of healthcare focused on establishing an interdisciplinary network for outpatient care in the homes of care-dependent individuals. Utilizing a digital interactive health diary, health data will be gathered from participants, caregivers, and healthcare providers, covering both stable primary care and acute situations. A telemedical network will coordinate measures, including non-medical aid, nursing care, and medical assistance. A total of 1,500 participants will be recruited for the intervention group, matched with a control group from health insurance data. A second control group with n=300 will provide self-reported measures. The study is planned to span eight quarters, with data collected from the digital interactive health diary and health insurance records. Evaluation perspectives include health insurance, patients, and healthcare providers, assessing utilization and costs compared to standard care, health status, health-related quality of life, care dependency, interdisciplinary cooperation, and usability of the new technology.DiscussionDemographic change results in a larger older people population, exacerbating mobility issues and care dependency, worsened by the shortage of medical personnel. Stay@Home – Treat@Home aims to enable home health monitoring and care, reducing hospitalizations. The digital interactive health diary supports direct communication, allows remote monitoring, and empowers patients and caregivers to manage health changes. Nursing aid personnel and physicians can access entries for informed interventions. The development of the digital interactive health diary aims to improve the situation of care-dependent individuals. Evaluating its effectiveness and efficiency is crucial for the development and implementation of new technologies.Trial registrationGerman Clinical Trials Register, ID: DRKS00034260, registered on May 14, 2024 (retrospectively registered): https://drks.de/search/de/trial/DRKS00034260 and https://who.int/clinical-trials-registry-platform/network/who-data-set.

Reporting a regular medical doctor index: A new measure of patient-physician affiliation for health administrative data.

Having a regular medical doctor is associated with better process of care and health outcomes. The goal of this study was to harness the richness in health administrative data to create a measure which accurately predicted whether patients self-identified as having a regular medical doctor. The Canadian Community Health Survey (2007-2012) was linked with health administrative data (HAD) (2002-2012) from Quebec, Canada's second largest province. The Canadian Community Health Survey includes respondents' answer to whether they have a regular medical doctor, but health administrative data does not. We therefore used LASSO and Random Forests to build prediction models that predict whether a patient reports having a regular medical doctor using their data only available in the HAD. Our results show that predicting patient responses to 'do you have a regular medical doctor?' using an average of single-year Usual Provider Continuity over 3 years results in an area under the receiver operator characteristic curve of 0.782 (0.778-0.787). This was almost a 14% improvement in predictive accuracy compared to the frequently used single-year Usual Provider Continuity (0.688 (0.683-0.694)). We have called this new measure the Reporting a Regular Medical Doctor (RRMD) index. The RRMD index is easy to implement in HAD, is an elegant solution to the difficulties associated with low-users having unstable UPC scores, and brings a patient-oriented perspective to previous efforts to capture patient-physician affiliations in HAD. We recommend that researchers seeking to measure whether patients have a regular medical doctor using HAD consider using the RRMD index.

Integration of Hospital Dentistry in the Interdisciplinary Care of the Armed Forces: Perspectives and Practices

Context: This study aims to investigate the implementation and effectiveness of hospital dentistry (HD) in the Armed Forces, incorporating an integrative literature review and a detailed case report. It seeks to highlight the importance of an interdisciplinary approach to oral and systemic health in military patients, as well as identify significant gaps in current research that need to be addressed to achieve improved healthcare outcomes. Evidence Acquisition: An integrative review methodology was adopted, with articles selected through the PubMed/MEDLINE and Scielo databases using specific inclusion and exclusion criteria focused on the practice of HD in military settings. This approach ensured a comprehensive understanding of the existing literature. Simultaneously, a case report of an elderly patient treated within the military context was presented, detailing the diagnosis, intervention, and outcomes of HD, thus providing a practical example of the concepts discussed in the review. Results: The literature review revealed a scarcity of specific studies on HD in military settings, despite evidence highlighting the crucial role of an interdisciplinary team, including dentists, for the effective treatment of oral conditions affecting the overall health of patients. This lack of research underscores the need for further studies to address these gaps. The case report demonstrated the positive impact of HD on the patient's recovery, emphasizing the critical need for its integration into military healthcare to achieve improved patient outcomes. Conclusions: The integration of HD in military settings is essential but currently underutilized. The research emphasizes the need to develop and document HD practices that enhance both the oral and systemic health of military personnel, promoting a more comprehensive and interdisciplinary care approach. This integration can lead to better health outcomes, reduced hospital stays, and overall improved quality of life for military patients.

Decolonizing urban Indigenous healthcare: The potential of urban reserves.

The urbanization of Indigenous peoples in Canada has increased substantially during recent decades, with over 44% of Indigenous peoples now residing in urban centres. Despite the urban concentration of healthcare services, Indigenous health outcomes remain significantly worse than non-Indigenous health outcomes for people living in urban centres. The historical and subsisting impacts of colonialism have had a profound negative influence on social determinants of health for Indigenous peoples, resulting in higher rates of chronic disease and mortality. Mistrust of the healthcare system, racial discrimination, and medical paternalism remain barriers to accessing care and diminish the quality of care received. This commentary explores how Indigenous-led health services can improve Indigenous health outcomes and how urban reserves could be used to improve the health of urban Indigenous residents.

The Impact of Migration Considerations on Healthcare Professionals in Albania: A Statistical Analysis

Objective: This study investigates the relationships between various demographic factors and the migration intentions of healthcare professionals in Albania. Theoretical Framework: The healthcare sector is essential for the well-being of a population, as it has a direct impact on health outcomes, quality of life, and societal productivity. In Albania, the healthcare system has faced considerable challenges in recent years, particularly in maintaining a stable and effective workforce Method: This is a cross-sectional study, and 1037 healthcare professionals in Albania were included, with equal gender representation (50% male, 50% female). All the participants were given self-administered questionnaires that addressed demographic characteristics, migration intentions, perceptions of working conditions, and factors influencing migration. Statistical analysis included descriptive statistical and chi-square tests or logistic regression. Results and Discussion: The majority of respondents were aged from 31 to 40 years old (28.9%), highlighting a productive workforce. 62.7% of healthcare professionals expressed intentions to migrate abroad, primarily due to higher salaries (38.6%) and better career opportunities (28.8%). Concerns about local working conditions were prevalent, with 72.3% of respondents considering transfer possibilities as very important or important. Participants rated the overall job situation in healthcare as average or poor (63.0%). Economic stability was deemed very important by 48.3% of respondents. Research Implications: This study provides importante data about migration intentions and perceptions of healthcare professionals in Albania, an area that has not been extensively explored in existing literature. Originality/Value: The findings offer practical recommendations for policymakers and healthcare leaders to improve the retention of healthcare professionals.

Evaluation of Some Haemorheologic Parameters amongst Automotive Spray Painters in Port Harcourt, Nigeria

Background/Objectives: Automotive Spray-Painters are at a higher risk of exposure to hazardous chemicals such as polycyclic aromatic hydrocarbons – benzene inclusive, and heavy metals which may cause adverse health outcomes. The aim of the study was to evaluate effect of exposure to spray paints on some haemorheological parameters in individuals involved in automotive spray painting within Port Harcourt Metropolis. Method: This case control study recruited 52 participants: 30 automotive spray-painters and 22 controls. The study was carried out in Port Harcourt Metropolis, Nigeria. Venous blood samples were drawn from the participants (age 20 to 65 years) and examined for packed cell volume, erythrocyte sedimentation rate, fibrinogen and haemoglobin. Semi-structured questionnaire was used to obtain information from participants. Result: Participants from painting occupation had significantly higher ESR (p = 0.0450) as a result of increase in number of years in Automotive Spray-Painting. Increased ESR may be an indication of inflammation in the body. There was no statistical significance between Automotive Spray-Painters and control subjects when values of haemoglobin concentration, packed cell volume, fibrinogen concentration and erythrocyte concentration was compared in Automotive Spay-Painters, however, their values were increased than that control subjects at p&lt;0.05. Conclusion: The study revealed that prolonged inhalation of benzene and other aromatic toxic compounds in paints caused slight increase in haemorheological parameters (PCV, HB, ESR and fibrinogen) of Automotive Spray-Painters due to exposure to paint fumes, a risk factor for inflammation of vital organs, venous thrombosis and thromboembolism; and predisposes Spray-Painters to many health disorders which can affect their lungs, heart, blood vessels, and ultimately the transport of oxygen to the brain.

The Ukrainian version of the Perceived Injustice Questionnaire: A psychometric evaluation

IntroductionPerceived injustice is increasingly recognized as a key factor influencing mental health in war survivors. This cross-sectional study aimed to evaluate the psychometric properties of the Ukrainian translation of the Perceived Injustice Questionnaire (PIQ) among individuals directly exposed to the war in Ukraine.Methods170 war-exposed Ukrainians completed the Ukrainian PIQ and measures of post-traumatic tress disorder (PCL-5), depression (PHQ-9), generalized anxiety disorder (GAD-7), and potentially traumatic life events (LEC-5). Internal consistency, factor structure, and criterion validity were assessed.ResultsWhile the factor structure of the English version could not be reproduced, indicating an issue with factor validity in the Ukrainian version, the Ukrainian PIQ demonstrated strong correlations with post-traumatic stress disorder (PTSD) symptoms (r = .71, p &amp;lt;.01), moderate associations with depression (r = .62, p &amp;lt;.01) and generalized anxiety disorder (r = .61, p &amp;lt;.01), and a weaker link with potentially traumatic life events (PTLEs, r = .35, p &amp;lt;.01). It significantly predicted PTSD, depression, and generalized anxiety disorder (GAD) symptoms beyond PTLE exposure, explaining 33% of variance in depression, 31% in GAD, and 45% in PTSD These findings provide evidence supporting the construct validity of the PIQ in terms of its relationships with mental health outcomes. The Ukrainian PIQ also demonstrated excellent overall reliability (α = .90), with factor reliabilities ranging from α = .74 to α = .81.ConclusionsThe Ukrainian version of the PIQ demonstrates promising psychometric properties and emerges as a highly significant correlate of mental health outcomes. This underscores its potential utility in clinical practice for assessing the treatment needs of Ukrainians affected by the consequences of war. Moreover, the findings highlight the importance of developing therapy modules specifically tailored to address perceived injustice. Further research is warranted to investigate the cross-cultural adaptability and comparability of the PIQ.

Historical Traces Of Health Law: Tracing The Dynamics Of Health Regulation Development Through Literature

This article discusses the historical development of health law, focusing on the evolution and dynamics of health regulation. The study in this research uses the literautr research method. The purpose of this study is to provide insight into the current legal challenges and future directions of Health regulation. The results found that the historical development of health law was influenced by various socio-political factors and significant medical advances. Key milestones such as 19th century sanitary regulation and public health policy in the 1918 influenza pandemic show how health law has evolved. Important figures such as health activists and legal academics were instrumental in shaping influential legal frameworks, such as the Public Health Act and bioethics. The impact of these legal reforms on public health varies depending on the responsiveness and adaptivity of the regulations to current global health challenges, such as health data privacy and access to medicines. By understanding the historical evolution of health law, it can be concluded that an adaptive legal framework is necessary to achieve optimal public health outcomes in the future.

Review of current status and ongoing reforms of the mental health system in Uzbekistan

Uzbekistan's mental health system is undergoing significant reform aimed at improving care and service delivery. This article provides a comprehensive evaluation of the current state of Uzbekistan's mental health system using the WHO 2010 monitoring and evaluation framework. It also details ongoing reforms designed to address systemic issues, enhance mental healthcare and ensure better health outcomes for the population.

Correlates of Premenstrual Syndrome in Polish Adolescents—Results from POLKA 18 Youth-Led Cross-Sectional Study

Objectives: This study aims to evaluate the prevalence of premenstrual syndrome (PMS) among Polish adolescents and explore its associations with mental health outcomes, lifestyle factors, and risk behaviours. Additionally, it seeks to examine the impact of PMS on quality of life, contributing to the foundation for initiatives that enhance adolescent menstrual health. Methods: This research is part of the POLKA 18 study, a youth-led cross-sectional survey conducted between April and December 2019. Final-year high school students were surveyed using paper-based, self-reported questionnaires. Statistical analysis was performed using the R programming language in RStudio, with a significance threshold of p-value &lt; 0.05. Results: A total of 1545 valid responses were analysed. PMS was reported by 33.9% of respondents, with over 80% experiencing premenstrual symptoms. Adolescents with negative mental health outcomes, such as self-harm or suicidal ideation, were significantly more likely to report PMS (p ≤ 0.001). PMS was also strongly associated with anxiety and panic attacks (p &lt; 0.001). Risk behaviours, including smoking (p = 0.006), illicit substance use (p &lt; 0.01), and increased alcohol consumption in the past 30 days (p &lt; 0.001), were more prevalent among adolescents with PMS. Furthermore, respondents with PMS reported poorer school performance (p = 0.002), higher stress levels (p &lt; 0.001), and a more negative perception of their overall health (p &lt; 0.001) compared to peers without PMS. Conclusions: PMS is significantly associated with mental health issues, engagement in risky behaviours, higher stress, and diminished self-perceived health and academic performance. These findings highlight the need for further research and the development of targeted interventions to improve adolescent menstrual health.

Relationship Between Population Density, Availability of Gynecological Services, and Cervical Cancer Incidence and Mortality Across Administrative Units in Serbia and Bosnia and Herzegovina During 2016–2020

Background and Objectives: Burden of cervical cancer in Central and Eastern Europe is higher than in other parts of Europe. We analyzed cervical cancer epidemiology in Serbia and Bosnia and Herzegovina (the Federation of Bosnia and Herzegovina and the Republic of Srpska) from January 2016 to December 2020, exploring the role of available sociodemographic factors and healthcare service parameters on incidence and mortality rates, using an ecological approach based on aggregated data. Materials and Methods: Incidence and mortality rates are standardized using the method of direct standardization with the World-ASR-W. Administrative units are grouped by tertiles of incidence and mortality to explore sociodemographic factors and healthcare parameters across these groups. Results: Average age-standardized incidence rates of cervical cancer per 100,000 females were 19.28 in Serbia, 12.48 in the Federation of Bosnia and Herzegovina, and 22.44 in the Republic of Srpska. Mortality rates per 100,000 females were 6.67, 5.22, and 4.56 in Serbia, the Federation of Bosnia and Herzegovina, and the Republic of Srpska, respectively. Several parameters of sociodemographics and health service usage differed significantly across units grouped by tertiles based on incidence level, i.e., female population ≥ 15 years old (p = 0.028), population density (p = 0.046), percent of gynecologists in the primary healthcare (p = 0.041), number of gynecologists per 10,000 females ≥ 15 years (p = 0.007), and the area-to-gynecologist ratio (p = 0.010). A moderate negative correlation was found between incidence and population density (rho = −0.465, p = 0.017), and a moderate positive correlation between incidence and area-to-gynecologist ratio (rho = 0.534, p = 0.005). Conclusions: Cervical cancer remains a leading cause of cancer among women in developing countries. Implementing tailored activities, such as educational programs, preventive services, and investments in healthcare infrastructure, particularly at the administrative units’ level, can help in reducing health disparities and improving health outcomes.

Environmental Exposure to Per- and Polyfluorylalkyl Substances (PFASs) and Reproductive Outcomes in the General Population: A Systematic Review of Epidemiological Studies

This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review synthesized effects of background levels of per- and polyfluorylalkyl substance (PFAS) levels on reproductive health outcomes in the general public: fertility, preterm birth, miscarriage, ovarian health, menstruation, menopause, sperm health, and in utero fetal growth. The inclusion criteria included original research (or primary) studies, human subjects, and investigation of outcomes of interest following non-occupational exposures. It drew from four databases (Web of Science, PubMed, Embase and Health and Environmental Research Online (HERO)) using a standardized search string for all studies published between 1 January 2017 and 13 April 2022. Risk of bias was assessed by two independent reviewers. Data were extracted and reviewed by multiple reviewers. Each study was summarized under its outcome in terms of methodology and results and placed in context, with recommendations for future research. Of 1712 records identified, 30 were eligible, with a total of 27,901 participants (33 datasets, as three studies included multiple outcomes). There was no effect of background levels of PFAS on fertility. There were weakly to moderately increased odds of preterm birth with higher perfluorooctane sulfonic acid (PFOS) levels; the same for miscarriage with perfluorooctanoic acid (PFOA) levels. There was limited yet suggestive evidence for a link between PFAS and early menopause and primary ovarian insufficiency; menstrual cycle characteristics were inconsistent. PFAS moderately increased odds of PCOS- and endometriosis-related infertility, respectively. Sperm motility and DNA health were moderately impaired by multiple PFAS. Fetal growth findings were inconsistent. This review may be used to inform forthcoming drinking water standards and policy initiatives regarding PFAS compounds and drinking water. Future reviews would benefit from more recent studies. Larger studies in these areas are warranted. Future studies should plan large cohorts and open access data availability to capture small effects and serve the public. Funding: Great Lakes Water Authority (Detroit, MI), the Erb Family Foundation through Healthy Urban Waters at Wayne State University (Detroit, MI), and Wayne State University CLEAR Superfund Research (NIH P42ES030991).