Health Policy Research Articles

Fortifying Physical and Psychological Wellbeing: Leveraging Capital for Resilience Against Racism and Adversity Across Racial Groups.

This study examines the impact of various adversities-including racism, indirect adversity, loss of a loved one, and adverse police contact-on psychological and physical health outcomes such as sleep quality, depressive symptoms, serious illness, and self-reported health. Additionally, it investigates how economic, educational, social, and spiritual capital moderate these effects, with attention to racial differences. Leveraging a sample of 1139 participants from the 1995 Detroit Area Study, analyses reveal nuanced effects of adversity, with the impact being neutralized, attenuated, or amplified by coping capacities. Economic and educational supports generally provide protectivehealth benefits, while social and religious supports reveal complex, sometimes divergent effects. Subgroup analyses reveal racial differences: for instance, Black individuals face a higher likelihood of developing aserious illness in connection with adverse police encounters, and White individuals benefit from liquid assets in buffering depressive symptoms. These findings underscore the need for multifaceted, context-sensitive health interventions and policies that enhance economic stability, educational opportunities, and mental health services, while strengthening social and spiritual support systems to build resilience and mitigate the adverse health effects of these adversities.

Risk of Discontinuance in Contraceptive Uptake Among Kenya Women: A Survival Analysis Using the Cox Proportional Hazard Model

A problem of equal importance is the substantial challenge posed by the discontinuance of contraceptive use in family planning programs, particularly for developing countries such as Kenya. Investigating the determinants of contraceptive discontinuation using demographic factors can provide insights to enhance the efficacy of family planning. Using data from the Performance Monitoring for Action (PMA) survey, this study examined the demographic and contraceptive method-related covariates associated with the risk of discontinuation of contraception among Kenyan women. The study employed Cox proportional hazards models to analyze sampled data of Kenyan women from the PMA survey. Two separate models were used: a standard model which included demographic characteristics with a baseline contraceptive variable (Ever use contraceptive) and an extended model showing how specific contraceptive methods impact the likelihood of the risk of discontinuing contraception. Older age (Coefficient of -0.268 with a hazard ratio of 0.765) was associated with a decreased risk of contraceptive discontinuation. At the same time, women with higher educational levels (Coefficient of 0.015, with a hazard ratio of 1.015) were related to an elevated hazard and were more likely to discontinue their current method of contraception. The extended model showed that subcutaneous injectable contraceptives (Coefficient of -2.040 with a hazard ratio of 0.130) and male condoms (Coefficient of -1.137 with a hazard ratio of 0.321) were conditionally related to a significantly decreased hazard of discontinuation. The results highlight the importance of contraception choice and the significance of age and education in maintaining continuous contraception. To support Kenyan women in maintaining continuous contraception in achieving their reproductive health goals comprehensive education on emergency contraception and the provision of long-acting reversible contraceptives should be provided by health and family planning organizations. There is a call for a longitudinal study to offer an understanding of the dynamic behavior of contraception over time and the need for time-varying analyses to capture the evolving nature of contraception and its discontinuation.

INCIDÊNCIA DE SÍFILIS NA POPULAÇÃO CARCERÁRIA MASCULINA ENTRE OS ANOS DE 2000 À 2024: UM ESTUDO DE REVISÃO INTEGRATIVA DA LITERATURA

This study analyzed the incidence of syphilis among the male prison population in Brazil from 2000 to 2024. It emphasizes that syphilis, caused by Treponema pallidum, is a Sexually Transmitted Infection (STI) with high prevalence in this vulnerable group, primarily due to poor hygiene conditions and limited access to healthcare services. An integrative literature review was conducted, including eight articles that met the inclusion criteria of studies published between 2000 and 2024 specifically addressing syphilis in the male prison population. Articles focusing on other STIs without direct relevance and studies with inadequate methodologies were excluded. The search was performed in the databases PubMed, BVS, MedLine, and Scielo, using descriptors such as “syphilis,” “prison population,” and “Sexually Transmitted Infections (STIs).” The findings indicate a high incidence of syphilis, exacerbated by risk practices such as unprotected sex and the sharing of syringes, along with the absence of adequate health policies. The study highlights the urgent need for effective interventions, including systematic screening and health education, to control the spread of the disease and improve the quality of life for inmates. These measures are essential not only for the health of prisoners but also for preventing the transmission of syphilis to the broader population.

Hybrid managers in an evolving healthcare: Does gender matter?

Hybrid managers have the potential to respond to the need for more integrated, responsive and accountable healthcare. Scholars have studied the antecedents of hybridization, but the role of gender has been neglected. Therefore, we study whether and how gender impacts on the way in which medical professionals exercise their managerial role. We adopted a qualitative approach in order to gain an in-depth understanding of the specificities of women hybrids. Data was collected through semi-structured interviews, focusing on hybrids in Italy in the field of neurology. We found that women hybrids show specific abilities and motivations, but they also encounter a specific lack of opportunities. Women hybrid managers appear well positioned to foster the evolution of professionalism, but healthcare organizations should implement policies and practices to effectively support them. While existing research has treated hybrid managers as a homogenous group, we underline the specificities of women hybrids. They can support the evolution of healthcare organizations towards logics of service integration, user centricity, and staff engagement. Therefore, our findings have important theoretical and practical implications for health policy and management.

Information seeking behaviour of informal caregivers at the premier tertiary teaching hospital in Nigeria

This study was conducted to examine the information behaviour of informal caregivers in a university college hospital in Ibadan, Nigeria. Informal caregivers in the teaching hospitals constitute critical pubic health care players whose information behaviours have not been studied. Data was collected from 208 caregivers using a questionnaire that consisted of structured and open-ended questions. The study found that healthcare providers were the primary source of health for caregivers, with 34.1% actively seeking information from them. The caregivers seldom utilised sources like the internet, community organizations, books, family, and friends. The preference for healthcare providers as sources is due to their accessibility and ability to provide prompt and accurate answers. Caregivers have diverse information needs, including medication-related information, first aid techniques, nutrition, exercise, mental health, and lifestyle choices. They seek this knowledge to make informed decisions that improve their loved ones’ well-being. The study also revealed that caregivers heavily rely on information technology for health information due to its accessibility and reliability. The study highlights the need for ongoing training and proactive information sharing by healthcare providers to better support informal caregivers in Nigeria, emphasizing the importance of integrated support systems within healthcare facilities. To meet diverse information needs, healthcare institutions should diversify dissemination strategies, including culturally sensitive materials and digital literacy programs, while developing tailored mobile applications and online support communities for caregivers. Policymakers must focus on creating supportive healthcare policies, funding caregiver programs, and expanding insurance coverage to alleviate financial burdens, ensuring that caregivers have access to necessary resources and information.

The effects of seasonal human mobility and Aedes aegypti habitat suitability on Zika virus epidemic severity in Colombia.

The Zika virus epidemic of 2015-16, which caused over 1 million confirmed or suspected human cases in the Caribbean and Latin America, was driven by a combination of movement of infected humans and availability of suitable habitat for mosquito species that are key disease vectors. Both human mobility and mosquito vector abundances vary seasonally, and the goal of our research was to analyze the interacting effects of disease vector densities and human movement across metapopulations on disease transmission intensity and the probability of super-spreader events. Our research uses the novel approach of combining geographical modeling of mosquito presence with network modeling of human mobility to offer a comprehensive simulation environment for Zika virus epidemics that considers a substantial number of spatial and temporal factors compared to the literature. Specifically, we tested the hypotheses that 1) regions with the highest probability of mosquito presence will have more super-spreader events during dry months, when mosquitoes are predicted to be more abundant, 2) regions reliant on tourism industries will have more super-spreader events during wet months, when they are more likely to contribute to network-level pathogen spread due to increased travel. We used the case study of Colombia, a country with a population of about 50 million people, with an annual calendar that can be partitioned into overlapping cycles of wet and dry seasons and peak tourism and off tourism seasons that drive distinct cyclical patterns of mosquito abundance and human movement. Our results show that whether the first infected human was introduced to the network during the wet versus dry season and during the tourism versus off tourism season profoundly affects the severity and trajectory of the epidemic. For example, Zika virus was first detected in Colombia in October of 2015. Had it originated in January, a dry season month with high rates of tourism, it likely could have infected up to 60% more individuals and up to 40% more super-spreader events may have occurred. In addition, popular tourism destinations such as Barranquilla and Cartagena have the highest risk of super-spreader events during the winter, whereas densely populated areas such as Medellín and Bogotá are at higher risk of sustained transmission during dry months in the summer. Our research demonstrates that public health planning and response to vector-borne disease outbreaks requires a thorough understanding of how vector and host patterns vary due to seasonality in environmental conditions and human mobility dynamics. This research also has strong implications for tourism policy and the potential response strategies in case of an emergent epidemic.

A Narrative Review of Congenital Syphilis in the United States: Innovative Perspectives on a Complex Public Health and Medical Disease.

Over the past two decades, congenital syphilis cases have risen 11-fold in the United States. While disparities across geography, race, and ethnicity exist, lack of timely screening or treatment is identified in 88% of cases nationally. Congenital syphilis is a public health and medical problem rooted in systematic and societal structural determinants of health and healthcare limitations. Early syphilis in pregnancy leads to congenital syphilis if untreated in 50 - 70% of cases, with risk for fetal demise, and among survivors, congenital anomalies, organ damage, and central nervous system disease. Prevention of congenital syphilis lies in early detection and treatment in pregnant persons. In this narrative review, we describe the evolving epidemiology of syphilis and congenital syphilis, highlighting unique aspects among women. We explore the role of novel screening and treatment strategies, public health policy, and medical considerations in terms of congenital syphilis prevention. Readers of this review will understand CS as a complex public health and medical disease that can be prevented through innovative and coordinated strategies in public health policy, expanded screening and research opportunities.

Attitudes towards geroprotection: measuring willingness, from lifestyle changes to drug use

IntroductionGeroprotection is an emerging field of research focused on devising strategies for combating the mechanisms of ageing. This study held three aims: 1) to explore the willingness to utilise five different geroprotective measures (i.e., exercise, supplements, intermittent fasting, metformin, and rapamycin use), 2) to explore whether the willingness differs based on respondents’ sociodemographic characteristics and 3) to explore the association between trust in medical institutions and willingness to utilise different geroprotective measures.MethodsA questionnaire was used to assess the attitudes of a sample of the Dutch population by way of both convenience and snowball sampling (final N = 178). Descriptive data and bivariate correlations were used in the analyses.ResultsRelatively high social acceptance of both exercise (66%) and supplements (82%) was found, whereas intermittent fasting (30%), metformin (26%), and rapamycin (10%) were less supported. Males were significantly more likely to be open to exercise and women to supplement use. Trust in medical institutions correlated significantly with the willingness to start metformin.DiscussionExploratory research can only provide a first step in understanding the social acceptance of geroprotection measures. Nevertheless, this study clearly illustrates more well-known measures promoted by public health policy are also more accepted and used. Public health campaigns could consider the sex differences in the uptake of exercise and supplements, and future research may want to delve deeper into the role of facilitating trust relations between medical institutions and the public in promoting the use of geroprotective drugs.

Navigating wicked problems: the unrecognised contribution of social pedagogy to Aotearoa New Zealand’s successful Covid-19 response

Aotearoa New Zealand’s government, alongside its Indigenous Māori and Pacific communities, spearheaded a unique and effective response to the first three years of the Covid-19 crisis that swept the world. The measures taken enabled the country to largely keep its society within its borders open and functional, minimise the impact of the pandemic on individual lives and community well-being and keep morbidity rates low. While there have been numerous studies and articles exploring this national response, to this point no examination has been undertaken through a social pedagogical lens. This article identifies key concepts from the discipline that are relevant to Aotearoa New Zealand’s context, discusses the ways in which these were (albeit unknowingly) applied during the peak of the pandemic and explores future potential for application in social and public health policy and practice. Weaving together a shared framework of Māori, Pacific and unique Aotearoa New Zealand world views and cultural practices alongside the principles of social pedagogy presents an exciting opportunity to shape a national crisis response that is effective and meets the needs of diverse communities. It is argued that making the contribution of social pedagogy visible has the potential to enhance responses to wicked problems in times of crisis and further the acceptance of the discipline in the southern hemisphere.

Applying arts to health interventions and health research in Ghana: a scoping review.

This review documents arts applied to health interventions and health research in Ghana, examines evidence of their impact on health outcomes, and identifies research and practice gaps. Eight databases (MEDLINE, Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, Humanities International Complete, Scopus, African Journals Online and PsycINFO) were searched for articles published between 2000 and 2022. Following screening, seventeen articles reporting sixteen eligible studies were selected. Ten art forms (including comedy, music, theatre) were applied to eight health conditions (including HIV/AIDS, mental illness, COVID-19). Most studies involved artists and artist-researchers. The majority of studies were cross-sectional. Impact was reported on health education, illness management and community health development. Some studies engaged with health policy communities, but none reported impact on health policy change. Creative arts have a reported measurable impact on selected health outcomes in Ghana. Participatory arts-based projects have the greatest potential for sustainable and transformational social health impact.

Cross-sectional study on urinary metal concentrations in young adult residents of Emirate of Sharjah, United Arab Emirates.

Human biomonitoring is crucial for regulatory toxicology, yet data on biomarker concentrations in the UAE are lacking. This study addresses this gap by analyzing urinary concentrations of 16 metals in UAE young adults, assessing correlations with personal characteristics, dietary patterns, and lifestyle habits. A cross-sectional pilot study was conducted among 144 randomly selected young adults (71 males and 73 females) from Sharjah, UAE, between January and March 2023. Participants provided urine samples, which were analyzed for 16 heavy metals using ICP-OES, and completed detailed questionnaires covering sociodemographic factors, lifestyle, and dietary habits. Descriptive statistics were used to summarize participant characteristics, and linear regression analysis was applied to explore associations between metal concentrations and factors such as gender, dietary habits, and exposure to environmental risks. Non-parametric tests, including the Mann-Whitney test, were used to assess differences by gender. Statistical significance was set at p < 0.05. Ethical approval was obtained, and informed consent was secured before participation. Significant findings include dietary influences on metal exposure, with rice consumption linked to higher metal concentrations. Sex differences were significant, with females showing elevated levels of arsenic, lead, and cadmium. Lifestyle factors, such as smoking and incense use, were correlated with increased barium and boron levels. This study highlights the significant role of dietary habits, especially the consumption of rice, in metal exposure among young adults in Sharjah. The findings highlight the urgent need for comprehensive human biomonitoring to understand environmental exposures and reform public health policies. The gender-specific differences in metal distribution suggest the necessity for targeted public health strategies. The study, however, is limited by its cross-sectional nature and the focus on a specific geographic area, warranting further research for broader generalizability. Future investigations, particularly on the impact of incense exposure on metal levels, are essential for developing comprehensive health interventions and preventive strategies in the UAE.

MENTAL HEALTH IN THE CONTEXT OF CLIMATE CHANGE

Climate change has intensified in recent decades, generating devastating consequences for the environment and, consequently, for human health. Mental health has emerged as a critical area of concern, since extreme weather events such as natural disasters, droughts and floods directly impact the psychological well-being of vulnerable populations. This study aims to analyze how climate change influences mental health, focusing on the psychological effects these changes have on communities in situations of vulnerability. The aim of this analysis is to explore how climate change impacts the mental health of vulnerable populations, discussing the main risk factors involved and addressing strategies that can be adopted to minimize these effects. This discussion is relevant because recognizing the emotional consequences of the climate crisis creates a basis for developing public health practices and psychosocial approaches that promote resilience and adaptation. By focusing on the psychological impact of climate change, we aim to contribute to a more comprehensive and inclusive response to the challenges of a changing world. This is a literature review, based on a qualitative approach, using the Scielo, Google Scholar and PubMed databases. To enhance the research, the health descriptors “climate change”, “mental health”, “psychological impacts” and “solastalgia” were used, with a time frame between 2007 and 2020. The methodology adopted for this analysis consists of a comprehensive literature review, using academic sources and reports from health and environmental organizations. The study addresses how extreme weather events, food insecurity and forced displacement affect mental health, leading to an increase in disorders such as anxiety, depression and post-traumatic stress disorder (PTSD). In addition, the social inequalities that aggravate these impacts are discussed, considering that populations with less access to health resources and services are more susceptible to the adverse effects of climate change. It is concluded that climate change poses a significant threat to mental health, especially for vulnerable populations already facing socio-economic challenges. It is essential that public health policies integrate mental health considerations into climate change adaptation and mitigation strategies. Promoting psychological support programs and implementing targeted interventions can help minimize the negative impacts on mental health, strengthening the resilience of affected communities and promoting a more effective response to climate crises.

Maternal and newborn health prioritization in Yobe State, Nigeria: analysis of stakeholders' perspective.

Maternal and newborn mortality and morbidity in conflict-affected northeastern areas of Nigeria, such as Yobe State, are disproportionately higher than those in the rest of the country. There is limited evidence on the factors that influence maternal and newborn health (MNH) policymaking and implementation in this region, particularly with respect to the impact of conflict and context-specific issues. This study explores the political, economic and health system factors that drive the prioritization of MNH policies in Yobe State. The aim of this study was to elucidate the conflict-related factors influencing MNH outcomes, which could inform targeted interventions to improve MNH. The study is a descriptive case study that relies on multiple data sources and is guided by the Health Policy Analysis Triangle. We reviewed national and subnational research, technical reports and policies related to reproductive health and the MNH in Nigeria since 2010. Following stakeholder mapping, we identified and invited prospective participants in the MNH policymaking space. Nineteen stakeholders from the government, civil society and nongovernmental organizations, donor agencies, and public and private sector health providers in Yobe State participated in the semistructured in-depth interviews. Data were collected from November 2022 through January 2023 and were thematically analysed via Dedoose software. MNH services in Yobe State have received considerable attention through initiatives such as the National Midwifery Service Scheme, free MNH services, training of midwives with deployment to rural areas, and health facility renovations. The effective implementation of MNH services and policies faces challenges due to insufficient funding, and sustainability is hampered by changes in governance and political transitions. The Boko Haram insurgency exacerbated the humanitarian crisis in Yobe State and disrupted MNH services due to the displacement of populations and the decline in the number of health workers. Additionally, sociocultural and religious beliefs hinder timely access to and utilization of MNH services. Although policies and guidelines for MNH services exist in the state, they are inadequately disseminated to health providers, which affects their effective implementation across facilities. Collaboration and intersectoral coordination platforms exist, but competition and rivalries among unions, political entities, and implementing agencies sometimes impede progress. Enhancing MNH services in Yobe state requires increased commitment for funding through the Northeast Development Commission rehabilitation fund; strengthening the health workforce, safety and retention plan; promoting gender inclusivity within the health sector; and addressing sociocultural barriers to women's health-seeking behaviors. Concrete, time-bound plans for policy dissemination are necessary to ensure effective service implementation.

Gene-Based Targeting for Treatment of Hypercholesterolemia and Prevention of Atherosclerotic Cardiovascular Disease

Familial hypercholesterolemia, characterized by high levels of LDL cholesterol is a monogenic metabolic disorder linked to atherosclerotic cardiovascular disease. Several genetic mutations in genes such as LDLR and PSK9 are thought to cause familial hypercholesterolemia. This ultimately causes dysfunction of the LDLR pathway, increasing circulating LDL levels. Current treatment revolves around decreasing LDL cholesterol levels in the blood. Statins are the current gold standard while sterol absorption inhibitors (ezetimibe) and PCSK9 inhibitors (evolocumab) are either used as primary treatment in individuals with statin intolerance, or supplementary treatment otherwise. However, CRISPR-Cas9 offers an upstream therapeutic intervention, inducing mutations in pathogenic genes (such as LDLR) to upregulate or downregulate gene expression and subsequently reduce LDL cholesterol levels. This technology thus has great potential as a two-fold treatment option, offering an effective solution for familial hypercholesterolemia, while simultaneously diminishing the risk of atherosclerotic cardiovascular disease. A limitation to current research exists in the sole analysis of monogenic factors in genetic screening, thus polygenic, multifactorial analyses are required to assess more holistic treatment plans. Furthermore, there exist current limitations to CRISPR-Cas9 including ethical limitations and social considerations revolving around the perpetuation of social inequities through technology necessitating future research on global health policies.

RECOMMENDATIONS ON THE ORGANIZATION OF CARE IN PRIMARY HEALTH CARE IN PRISONS

The research aims to develop recommendations for the organization of care in primary health care in prisons. An integrative review was used, which covered 267 articles in databases such as SciELO, PubMed and LILACS, resulting in the final selection of 12 studies. The research included articles published between 2019 and 2024, with some texts from previous years due to their methodological relevance. The main findings highlight the importance of intersectorality, continuous training of professionals and gender-sensitive health policies. Challenges include the precariousness of working conditions and the need to adapt the PNAISP to better serve different groups, especially women. The conclusion stated that the organization of health care in primary care in prisons requires an integrated and intersectoral approach, based on evidence and solid public policies. The work emphasizes the importance of humanized practices and collaboration between health and justice to ensure equity in access to health for the population deprived of liberty (PDL).

Disability and Vulnerable Groups Inclusion in COVID-19 Policy and Planning in Sub-Sahara African Countries

Background: The COVID-19 pandemic has caused an excess burden of disease in disabled and vulnerable populations. These populations may face an increased risk of contracting COVID-19, greater demand for services and social support, and reduced access to treatment. Despite various national and international efforts towards disability rights and inclusion, substantial gaps exist between disability rights legislation and its implementation. Aims: To assess the inclusion of people with disability and other vulnerable groups in policy and planning documents related to the COVID-19 pandemic response in sub-Sahara Africa. Methods: We conducted content analysis using the EquiFrame policy analysis tool and assessed commitment to 12 vulnerable groups and 21 core human rights in policy and planning documents related to the COVID-19 pandemic. We included documents on general pandemic response, stakeholder engagement, risk communication, and the COVID-19 vaccine from five sub-Saharan African countries, including Nigeria, South Africa, Ethiopia, Kenya, and Zambia. Results: The study highlights the varying degrees to which countries integrate disability, vulnerable groups, and other core human rights concepts into their COVID-19 health policies and planning documents. Only Kenya mentioned disability in their pandemic response plan. However, all countries have explicitly mentioned disability in their stakeholder engagement plans. Except for Kenya, all countries have included disability in their risk communication plans. Notably, South Africa and Zambia demonstrated extensive disability inclusion in their stakeholder engagement and vaccine plan. Thus, these countries have the potential for comprehensive and inclusive health policymaking. In contrast, Nigeria and Ethiopia lag, therefore highlighting areas of improvement across all policy domains. Conclusion: The findings emphasize the critical importance of not only mentioning disability and other vulnerable groups, but also ensuring the depth and quality of this inclusion. While there are positive strides in certain areas, there remains a consistent need for deeper and broader inclusion across all policy domains. Received: 10 September 2024 | Reviewed: 16 October 2024 | Revised: 03 November 2024 | Accepted: 05 November 2024.

A Health Economics Inquiry into Regulatory Constraints on the European Tobacco Market.

Despite the implementation of significant measures by European countries in recent years, smoking rates in Europe remain persistently high. TheEuropean Commission is currently undertaking a comprehensive review of itstobacco regulations. This article aims to address critical inquiries that arise during the amendment of the regulatory framework. We evaluate the effectiveness of existing tobacco control methods and observe a diminishing impact on promoting smoking cessation. Additionally, we explore how individuals of varying genders respond to the regulatory environment. We propose a comprehensive and evidence-based framework for implementing a taxation system in response to the proliferation of emerging products, including e-cigarettes and heated tobacco. This system is designed to align effectively with health policy objectives, providing a strategic approach to curbing tobacco use and promoting public health.

English

Introduction: The prison population in Peru exceeds 90,000 individuals, many of whom face conditions that increase their vulnerability to human immunodeficiency virus (HIV), such as exposure to illicit substances, risky sexual behaviors, and discrimination. Materials and Methods: A secondary analysis was carried out, using data from the 2016 national prison population census to identify factors associated with HIV risk in the incarcerated population of Peru. A total of 75,613 male inmates from prisons across the country participated, answering a comprehensive questionnaire consisting of 405 items. Multivariable regression Poisson models were used to calculate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results: Our findings revealed significant associations between HIV risk and sexual orientation, with homosexual (aPR: 5.50; CI: 2.62-11.56) and bisexual (aPR: 4.92; 95% CI: 2.26-10.72) individuals being at higher risk. Additionally, a history of tuberculosis (aPR: 2.82; 95% CI: 1.75-4.56) and sexually transmitted diseases (aPR 48.14; 95% CI: 31.07-74.56) were strongly correlated with increased HIV risk. Marital status, specifically being widowed, divorced, separated, or single, also showed a statistically significant association with HIV infection in both raw and adjusted regression models. Discussion: Our study highlights important risk factors for HIV infection among the male prison population in Peru. The identified associations will inform the development of effective health policies aimed at identifying and addressing HIV transmission within the country’s prisons. Furthermore, our findings provide a basis for future research in similar settings with a comparable male prison population profile.

Motivations of Israeli physicians to return, or not, to Israel after their fellowship abroad.

Emigration of healthcare professionals, particularly physicians, is an unresolved "pandemic", influenced by various factors. In high-income countries, the training phase (fellowship) abroad is critical for career development, yet it poses challenges for the retention of these professionals upon their completion of training. This study aimed to identify the determinants influencing Israeli physicians' decisions to return to their home country after completing fellowship training abroad. This cross-sectional study conducted in early 2024, surveyed Israeli physicians with post-graduate training who pursued a fellowship abroad between 2013 and 2024. An anonymous survey included questions on demographics, training experience, and professional challenges. Analytical methods included descriptive statistics and regression analysis to explore factors associated with the decision to return. Of the 323 individuals surveyed, 297 met the inclusion criteria. Among them, 141 (47.5%) have returned to Israel, while 156 (52.5%) currently reside abroad, 48 (31%) of them have completed their fellowship. Respondents identified several challenges, beginning with a complex application process prior to fellowship (47% stated this as a major challenge), substantial financial burdens averaging 35,546 USD in direct out-of-pocket expenses during, and job uncertainty, with only 55% having secured positions upon return. Of the 156 Israeli fellows still abroad, 107 (69%) reported medium to low confidence in returning. Factors associated with a higher likelihood of confidence in returning to Israel included a secured job position upon return (OR 8.6, 95% CI 3.1-28.9) and having an opportunity for a position that would utilize the skills gained during the fellowship (OR 3.5, 95% CI 1.3-10.2). The decision to return to Israel after a fellowship abroad is influenced by a mix of professional, personal, and geopolitical factors. To counteract the critical issue of brain drain, it is essential to enhance occupational certainty for returning physicians. These findings highlight the urgent need for healthcare policies that provide robust support for returning professionals and address their specific challenges.

Evaluating the Effectiveness of Lifestyle Interventions in Preventing Chronic Diseases: A Systematic Review

This systematic review evaluates the effectiveness of lifestyle interventions, including dietary changes, physical activity, smoking cessation, and alcohol reduction, in preventing chronic diseases such as cardiovascular disease, diabetes, and obesity. Chronic diseases pose a significant burden globally, and lifestyle interventions are increasingly recommended to reduce risk factors. A comprehensive search was conducted in databases like PubMed, Cochrane Library, and Embase, focusing on studies published in the past decade. Included studies assessed adult populations at risk of chronic diseases, using interventions targeting lifestyle modifications with measurable health outcomes. Findings indicate that dietary changes and increased physical activity significantly reduce chronic disease risk, while smoking cessation and alcohol reduction further contribute to improved health outcomes. Combination interventions generally showed the most substantial impact on preventing chronic disease. Although the evidence strongly supports lifestyle changes for disease prevention, variations in intervention type, duration, and adherence remain a limitation. Future research should explore long-term effects and implementation strategies in diverse populations. This review underscores the need for integrating effective lifestyle interventions into healthcare policies to improve public health.