Integrated Health Research Articles

Barriers and Facilitators to Integrating Acupuncture into the U.S. Health Care System: A Scoping Review.

Background: Acupuncture is a widely practiced complementary and integrative health modality that has multiple clinical applications. The use of acupuncture in the United States is rapidly increasing. Although studies have shown the efficacy and effectiveness of acupuncture for various ailments, the integration of acupuncture into the U.S. health care system remains a challenge. Little is known about the factors affecting this integration. Objective: To provide a systematic review of the barriers and facilitators affecting the integration of acupuncture into the U.S. health care system. Methods: Four electronic databases were searched. Three independent reviewers were involved in the screening and data charting processes. Findings were synthesized and categorized into four levels based on the Social Ecological Model. Results: A total of 22 studies were included in the final review. The barriers and facilitators affecting the integration of acupuncture were mapped into four levels (individual, interpersonal, organizational, and policy). The most frequently reported barriers and facilitators were mapped into the Social Ecological Model constructs within the "Individual" level (i.e., beliefs and attitudes of acupuncture, and practical issues) and the "Organizational" level (i.e., credentialing, space and facility, referral system). Conclusion: This review has identified and synthesized the breadth of evidence on the barriers and facilitators to the integration of acupuncture into the U.S. health care system. Results of this review will guide future implementation studies to develop and test implementation strategies to integrate acupuncture into the U.S. health care system.

The Glycocalyx: The Importance of Sugar Coating the Blood-Brain Barrier.

The endothelial glycocalyx (GCX), located on the luminal surface of vascular endothelial cells, is composed of glycoproteins, proteoglycans, and glycosaminoglycans. It plays a pivotal role in maintaining blood-brain barrier (BBB) integrity and vascular health within the central nervous system (CNS), influencing critical processes such as blood flow regulation, inflammation modulation, and vascular permeability. While the GCX is ubiquitously expressed on the surface of every cell in the body, the GCX at the BBB is highly specialized, with a distinct composition of glycans, physical structure, and surface charge when compared to GCX elsewhere in the body. There is evidence that the GCX at the BBB is disrupted and partially shed in many diseases that impact the CNS. Despite this, the GCX has yet to be a major focus of therapeutic targeting for CNS diseases. This review examines diverse model systems used in cerebrovascular GCX-related research, emphasizing the importance of selecting appropriate models to ensure clinical relevance and translational potential. This review aims to highlight the importance of the GCX in disease and how targeting the GCX at the BBB specifically may be an effective approach for brain specific targeting for therapeutics.

Trajectories of adolescents living with vertical transmission-HIV virus.

This study analyzes the life stories of eight young people living with vertically transmitted HIV in order to understand their perceptions marked by secrecy and silence regarding their experiences with the virus. Conducted at a specialized outpatient clinic in Rio de Janeiro, the study adopted circle dance, a Complementary and Integrative Health Practice, as a care tool. Using a qualitative approach and Life History as a data collection method, the focus was to understand the youth's experiences related to the disease and the crucial aspects of their lives. Three girls and five boys participated in the study, all aware of their diagnosis. The principal emerging themes included family dynamics, school environment connection, challenges in treatment adherence, age at the time of diagnosis disclosure, and time elapsed since then. Analyzing these young people's narratives allowed us to explore individual and social aspects of their experiences, revealing their similarities and differences. The circle dance workshops provided a playful space for expressing emotions and feelings through body movements, expanding young people's perspectives on the future.

The use of community-oriented primary care (COPC) model to generate vaccine demand: The case of a remote fishing community in Cameroon

BackgroundCameroon, a country in sub-Saharan Africa, ranks among the top 15 countries worldwide with the highest number of zero-dose (unvaccinated) children. Among other reasons, pockets of hard-to-reach communities that traditionally miss essential healthcare services, including childhood immunization, largely contribute to this sub-optimal vaccination coverage. This is the case of Manoka Health District (MHD), an archipelago district with a zero-dose proportion of 91.7%. High disease burdens such as malaria and water-borne diseases have forced the population to depend on herbalists and roadside drug vendors, eroding trust in the primary healthcare system and worsening vaccine hesitancy. This study, therefore, aims to describe how a project optimized vaccine demand generation in these hard-to-reach settlements using an integrated community health worker service delivery package developed using the Community-oriented primary healthcare (COPC) model. MethodologyThis cross-sectional descriptive study was based on data collected from November 2021 to August 2022 in three project-implementing health areas (Kombo Moukoko, Kooh, and Toube) in the Manoka health district. Data was collected on the integrated health packages offered by Community Health Workers (CHWs). It comprised health education on malaria and water-borne diseases, screening for malaria using Rapid Diagnostic Test (RDT), treatment of under-5 for uncomplicated malaria and diarrhea, conduct of essential Antenatal Care (ANC) services, and vaccination counseling and referral in the three health areas. Microsoft Excel 2013 was used to analyze descriptive data and expressed results as percentages, with tables and column charts used for data visualization. All missing data were considered in the final analysis. ResultsOver 550 under-5 children and 187 pregnant women were identified to be in need of curative and preventive care services during the project period. About 81% of pregnant women received a minimum ANC package by CHWs, and 47% adhered to referrals to health facilities for continuous ANC and delivery. Half of the children under 5 with health issues were diagnosed and managed for uncomplicated malaria. Also, during home visits, 617 under-immunized and zero-dose children less than two years of age were identified, referred, and vaccinated either during an outreach program or at the nearest health post in a neighboring health area, representing about 64% (617/964) of under-2 children identified in these communities. There was a gradual increase from 0% vaccine acceptance post-referral in the first month to 47% after six months and 64% at one year of intervention. ConclusionThe use of the COPC model to co-develop integrated essential health service packages that meet the needs of communities showed value in building trust and increasing childhood immunization uptake in hard-to-reach communities.

Vagal Stimulation and Body Balance: A New Frontier in Neuroscience and Integrative Health

Vagal Stimulation and Body Balance: A New Frontier in Neuroscience and Integrative Health

Factors influencing compliance with multiple injection immunization among mothers of toddlers at The Public Health Center Porong Integrated Health Service Post, Sidoarjo, East Java, Indonesia: A Descriptive Study

Introduction: Immunization significantly reduces infant and child morbidity and mortality rates globally. However, basic immunization coverage in 65 countries must catch up to the 90% global target. Multiple injection immunization involves administering multiple immunizations in one visit, enhancing early protection during vulnerable periods. This approach reduces the need for multiple health visits, which is particularly beneficial for children facing access barriers. It also improves healthcare efficiency, minimizes missed opportunities, and lessens the burden on parents needing frequent facility visits. Objective: The objective of this study was to explore the factors influencing compliance with multiple injection immunization among mothers of toddlers at the Public Health Center Porong Integrated Health Service Post, Sidoarjo, East Java, Indonesia Method: Conducted in March 2024 at Public Health Centre Porong, Indonesia, this study employed a consecutive sampling method. It involved 100 mothers with infants aged 13 to 24 months who had received immunizations at the Post. Data were collected through structured interviews and analyzed to determine compliance rates and associated factors. Result: Among the participants, 91% of mothers were aged between 20 to 35 years, indicating a productive age group. The compliance rate for multiple injection immunization was 61%. Additionally, 74% of mothers had completed high school, suggesting a positive association between higher education and enhanced health decision-making capabilities. A significant proportion of mothers (75%) were not employed, highlighting the influence of occupation on health-related knowledge and practices. Conclusion: The study underscores the necessity for targeted health education initiatives tailored to the diverse demographic and occupational characteristics of mothers. Such interventions should improve maternal knowledge and promote adherence to essential childhood immunizations, leveraging the cognitive advantages associated with higher education and non-working status. This approach aims to foster informed decision-making and proactive health behaviours among mothers in community health settings.

High-Altitude Medicinal Plants as Promising Source of Phytochemical Antioxidants to Combat Lifestyle-Associated Oxidative Stress-Induced Disorders.

Oxidative stress, driven by reactive oxygen, nitrogen, and sulphur species (ROS, RNS, RSS), poses a significant threat to cellular integrity and human health. Generated during mitochondrial respiration, inflammation, UV exposure and pollution, these species damage cells and contribute to pathologies like cardiovascular issues, neurodegeneration, cancer, and metabolic syndromes. Lifestyle factors exert a substantial influence on oxidative stress levels, with mitochondria emerging as pivotal players in ROS generation and cellular equilibrium. Phytochemicals, abundant in plants, such as carotenoids, ascorbic acid, tocopherols and polyphenols, offer diverse antioxidant mechanisms. They scavenge free radicals, chelate metal ions, and modulate cellular signalling pathways to mitigate oxidative damage. Furthermore, plants thriving in high-altitude regions are adapted to extreme conditions, and synthesize secondary metabolites, like flavonoids and phenolic compounds in bulk quantities, which act to form a robust antioxidant defence against oxidative stress, including UV radiation and temperature fluctuations. These plants are promising sources for drug development, offering innovative strategies by which to manage oxidative stress-related ailments and enhance human health. Understanding and harnessing the antioxidant potential of phytochemicals from high-altitude plants represent crucial steps in combating oxidative stress-induced disorders and promoting overall wellbeing. This study offers a comprehensive summary of the production and physio-pathological aspects of lifestyle-induced oxidative stress disorders and explores the potential of phytochemicals as promising antioxidants. Additionally, it presents an appraisal of high-altitude medicinal plants as significant sources of antioxidants, highlighting their potential for drug development and the creation of innovative antioxidant therapeutic approaches.

Predicting air quality index and fine particulate matter levels in Bagdad city using advanced machine learning and deep learning techniques

Particulate matter pollution is recognized globally as one of the most hazardous forms of air pollution, profoundly impacting environmental integrity and public health. Key metrics for assessing this pollution include the Air Quality Index (AQI) and fine particulate matter with diameters ≤2.5 μm (PM2.5). These indicators are closely associated with severe health consequences, such as premature death from chronic exposure. While traditional statistical methods have been employed in some studies to evaluate AQI and PM2.5, the application of advanced machine learning techniques has been limited. This research employs deep learning and artificial neural networks (ANN) to forecast AQI and PM2.5 levels in Baghdad, Iraq. The study utilizes an extensive dataset from July 1, 2016, to December 12, 2021, comprising over 48,000 data points for AQI and PM2.5. Time serves as an independent input variable influencing these dependent variables. The analysis employs a diverse set of machine learning algorithms, including random forest, decision tree, K-Nearest Neighbors (KNN), Multi-Layer Perceptron (MLP), and Long Short-Term Memory networks (LSTM). The findings demonstrate that MLP and LSTM models outperform other methods, providing the most accurate predictions. The correlation coefficients were 0.977 and 0.983 for the prediction of AQI and 0.973 and 0.985 for the prediction of PM2.5 using MLP and LSTM, respectively. In addition, the outcomes showed that both AQI and PM2.5 were within the moderate to unhealthy ranges, and their distribution levels pointed to the need for addressing air quality in Baghdad city. Furthermore, this study contributes to the burgeoning field of machine learning applications in environmental science by establishing a robust and nuanced predictive framework for evaluating air quality. It highlights the potential of deep learning in public health applications and offers actionable insights for policymaking to mitigate air pollution and its adverse effects.

Loneliness and its correlation with self-care and activities of daily living among older adults: a partial least squares model

BackgroundThe growing elderly population worldwide is accompanied by an increased disrupting daily activities and self-care. Neglecting the multifaceted needs of the elderly can lead to detrimental effects such as loneliness or social isolation, threatening healthy aging. Self-care is a key strategy to enhance daily functioning and mitigate feelings of loneliness among the elderly. This study was conducted with the aim of investigating the feelings of loneliness and its relationship with self-care and Activities of Daily Living (ADL) among the older adults of Tabriz city.MethodsIn this observational cross-sectional study, we engaged 315 older adults using a simple random sampling. Participants were selected randomly from Iran’s Integrated Health System (IIHS) framework. Three questionnaires including de Jong Gierveld Loneliness Scale, Persian version of self-care scale, and ADL-Katz were used for data collection. The Partial Least Squares and Spearman’s correlation were used to investigate the relationships between demographic characteristics, loneliness, self-care, and ADL.ResultsThe sample comprised 315 respondents 51.1% were female, 49.5% had a middle school literacy and 86% were married. A significant negative relationship was observed between loneliness and self-care (P < 0.001 and r =-0.311). Demographic characteristics, including age and marital status, were found to negatively moderate the relationship between self-care (path coefficient − 0.07, P = 0.044) and positively moderate the relationship with loneliness (path coefficient 0.29, p < 0.001). ADL was positively associated with self-care (path coefficient 0.41, p = 0.046) and also a direct and significant relationship was observed between ADL and daily self-care (P < 0.001 and r = 0.335).ConclusionThis study underscores the complex interplay between loneliness, self-care, and ADL. It highlights the need for interventions that address emotional health and daily living skills as part of comprehensive self-care strategies. Further research is needed to explore these relationships in more detail and to develop targeted interventions for different demographic groups.

Social determinants and work-related musculoskeletal disorders in Brazil.

This study aimed to analyze the prevalence of work-related musculoskeletal disorders (WMSD) and their association with individual and contextual factors in the Brazilian population. This quantitative cross-sectional study used secondary data from the Brazilian National Health Survey from August 2013 to February 2014. The dependent variable included WMSD, and independent variables were analyzed as individual and contextual factors. WMSD was mostly prevalent in females, individuals aged 43 to 59 years, with chronic physical or mental disorders, reporting frequent sleep disorders, and performing integrative and complementary health practices, physical exercise or sports, and heavy physical activity or housework. Regarding contextual factors, high social classes and proportion of individuals with formal work were associated with a high prevalence of WMSD, whereas a high Gini index was associated with a low prevalence. Thus, a high prevalence of WMSD in the Brazilian population was associated with individual and contextual factors, which should be the target of health professionals for actions of promotion, prevention, and intervention at individual or collective care levels.

Modeling Contaminant Transport from a Red Mud Pond – A Case Study from South India

The present study focused on impact assessment of redmud pond on groundwater using numerical groundwater flow and contaminant transport modeling using pertinent data including water quality and 2D electrical resistivity imaging data. The observed groundwater depths range from 1.2 to 25.8 meters below ground level with deeper levels observed in upstream and higher elevated regions in the study area. Elevated pH and electrical conductivity (&gt;3000 μS/cm) characterize the Redmud ponds, while other groundwater samples meet BIS drinking water standards. Major ion concentrations contouring indicates high total dissolved solids (TDS) around Redmud ponds due to leakage and in the downstream due to domestic sewage pollution. Most locations adhere to BIS drinking water limits except for one downstream site. The resistivity data indicated hard formations (&gt;18 m depth) with resistivity &gt;500 Ohm.m, weathered basalt (12-18 m, 60-150 Ohm.m), and saturated water (12 m, 1-5 Ohm.m). Contaminated aquifers (&lt;1 Ohm.m) are detected up to 3 m depth, and noticed accumulating contaminated water (27 m depth) in the NW corner of the Redmud pond from seepage. Predominant groundwater flow from the Redmud pond towards public water bodies and streams is highlighted by simulated contaminant transport model. Collaboration and comprehensive management are recommended to protect the watershed’s environmental integrity and public health.

Prevalence of Four Types of Social Support and Their Relation to Mental Health among low-income U.S. Veterans: Implications for Community Health.

To provide a comprehensive examination of different types of social support and associations with mental health among U.S. military veterans, a group vulnerable to psychosocial dysfunction. Using a nationally representative sample of 1,004 low-income U.S. veterans, this study examined the prevalence and mental health correlates of emotional, informational/tangible, positive social interaction, and affectionate social support. In the sample,49-60%of participants perceived the four types of social support "most of the time" with the lowest prevalence being positive social interaction and the highest being affectionate support. Multivariable analyses found higher levels of all four types of social support were significantly associated with being married and greater mental health functioning. Some types of social support were uniquely associated with income level and positive screens for specific psychiatric disorders. Low social support is common among low-income U.S. veterans, and there is a need for community health interventions that target different types of social support to improve mental health and community integration.

The influence of patient, provider, and system level characteristics on anxiety diagnostic specificity in the Veterans Health Administration

This retrospective study sought to identify patient-, provider-, and system-level characteristics associated with anxiety diagnostic specificity in mental health clinics in the Veterans Health Administration. It used administrative data extracted from Veteran Health Administration outpatient records to identify patients with a new anxiety or trauma-related diagnosis in fiscal year 2019 (N = 383,418). Logistic regression was used to model the probability of receiving an unspecified anxiety diagnosis as a function of patient-, provider-, and system-level characteristics. Unspecified anxiety disorder was diagnosed in 27% of the sample, with higher rates in primary care mental health integration clinics (42.6%) than in general mental health clinics (22.4%). Patient demographic and clinical characteristics including gender and comorbid diagnoses; provider type; provider use of an anxiety screening instrument; and facility size, complexity, and location were significant predictors of unspecified anxiety diagnosis. Anxiety diagnosis is a complex process influenced by multiple patient-, provider-, and system-level characteristics. Additional assessment tools and guidance for differential diagnosis are needed to support mental health providers in busy clinical settings to facilitate accurate and timely diagnosis of anxiety disorders.

Educator experiences with postgraduate psychology students exhibiting professional competence issues

ABSTRACT Psychology training programs emphasize competencies like professional behavior, interpersonal skills, and emotional intelligence. Some students, known as students with problems of professional competence (SPPC), struggle in these areas. This study explored SPPC characteristics and educator experiences in managing them through semi-structured interviews with twelve Australian psychology educators. Thematic analysis revealed that SPPC often struggle with professional attitudes, feedback integration, reflective skills, and mental health, placing demands on resources and contributing to educator stress. The role of educators as gatekeepers, assessors, and evaluators also raises concerns about maintaining ethical standards. Findings highlight the need for better understanding, support, and strategies for managing SPPC to uphold ethical standards.

Know the Science from the National Center for Complementary and Integrative Health (NCCIH)

The National Center for Complementary and Integrative Health’s (NCCIH) “Know the Science” web site is designed for users to learn how to comprehend scientific information regarding various health approaches. Through the use of infographics, quizzes, and interactive modules, users can learn about important concepts in complementary health. This site also emphasizes health literacy through modules about comprehending scientific journals and health media articles. The main purpose of this site is to provide resources to help users make informed and science-backed decisions about their health care.

Learning Underlies Change: The National School of Rehabilitation, Integration, and Recovery in Mental Health

Learning Underlies Change: The National School of Rehabilitation, Integration, and Recovery in Mental Health

Performance of OC-Auto Micro 80 Fecal Immunochemical Test in an Integrated Academic-Community Health System.

We aimed to determine the performance of the OC-Auto Micro 80 fecal immunochemical test (FIT) in an average-risk population receiving care in an integrated, academic-community health system. The FIT is the most used colorectal cancer (CRC) screening test worldwide. However, many Food and Drug Administration-cleared FIT products have not been evaluated in clinical settings. We performed a retrospective cohort study of patients (50 to 75y old) in the University of Washington Medicine health care system who were screened for CRC by OC-Auto Micro 80 FIT between March 2016 and September 2021. We used electronic health records to extract patient-level and clinic-level factors, FIT use, colonoscopy, and pathology findings. The primary outcomes were the FIT positivity rate and neoplasms detected at colonoscopy. Secondary outcomes were FIT positivity by sex and safety-net versus non-safety-net clinical settings. We identified 39,984 FITs completed by 26,384 patients; 2411 (6.0%) had a positive FIT result (>100 ng/mL of hemoglobin in buffer), and 1246 (51.7%) completed a follow-up colonoscopy. The FIT positive rate was 7.0% in men and 5.2% in women ( P <0.01). Among those who completed a colonoscopy after an abnormal FIT result, the positive predictive value for CRC, advanced adenoma, and advanced neoplasia was 3.0%, 20.9%, and 23.9%, respectively. In a retrospective analysis of a large heterogeneous population, the OC-Auto Micro 80 FIT for CRC screening demonstrated a positivity rate of 6.0% and a positive predictive value for CRC of 3.0%.

Predicting COVID-19 Cases in Nursing Homes of California and Ohio: Does the Work Environment Matter?

The cross-sectional study evaluates if the prepandemic work environments in nursing homes predict coronavirus disease 2019 (COVID-19) cases among residents and staff, accounting for other factors. Leveraging data from a survey of California and Ohio nursing homes (n = 340), we examined if Workplace Integrated Safety and Health domains - Leadership, Participation, and Comprehensive and Collaborative Strategies predicted cumulative COVID-19 cases among nursing home residents and staff. In Ohio, a 1-unit increase in Leadership score was associated with 2 fewer staff cases and 4 fewer resident cases. A 1-unit increase in Comprehensive and Collaborative Strategies score in California showed an average marginal effect of approximately 1 less staff case and 2 fewer resident cases. These findings suggest that leadership commitment and interdepartment collaboration to prioritize worker safety may have protected against COVID-19 cases in nursing homes.

Factors Related to The Utilization of Integration Health Program (Posbindu) Among Older Adults in Indonesia: A Scoping Review.

Indonesia is experiencing an increase in the elderly population, which is a challenge for health services. One of the health programs specifically designed for older people is the integration health program, known as "Posbindu". Posbindu is a community-based health service that provides health promotion, disease prevention, and early detection services for the elderly. However, its utilization has not been maximized, so a study was conducted to analyze the factors related to the utilization of Posbindu in Indonesia. The research design used a scoping review and data analysis narrative approach. The researcher searched articles using the PCC framework, with the elderly as the population (including pre-elderly), the factors as concept, and the context as utilization of Posbindu. It used Indonesian and English keywords in the Google Scholar, Pubmed, ProQuest, and Researchgate databases. Then, the article selection process used the PRISMA-ScR flow chart, and 201 articles were obtained that matched the inclusion criteria, 192 articles, and the final result was nine articles were analyzed. The results of the article analysis showed that the average value of older people's participation in Posbindu was 47.51%, which means it did not reach the target. Factors related to this are predisposition factors found in eight articles (intentions, knowledge, attitudes, education, traditions, beliefs, and control over actions), enabling factors in five articles (distance to Posbindu, access to information, and quality of Posbindu for older people), and reinforcing factors in seven articles (family support and health voluntary support). From all p-values for these factors, the most strongly related to Posbindu for the elderly was reinforcing elements, with a p-value of less than 0.03 in all analyzed articles. So, it can be concluded that the reinforcing factor is the most related to the utilization of the elderly Posbindu. So, it is crucial to involve all sector to increase the participation of older people in Posbindu program.

WORK LIFE INTEGRATION AND MENTAL HEALTH: QUANTITATIVE STUDY OF EMPLOYEE WELL BEING

With an emphasis on employee well-being, this study investigates the connection between work-life integration and mental health. Achieving a healthy balance between work and home life is essential for mental health and overall productivity given the complexity of current professional demands. This research used a quantitative methodology to evaluate important facets of work-life integration and its impact on stress levels, job satisfaction, and emotional well-being. The sample size consisted of 230 respondents with a range of professional backgrounds. Structured questionnaires were used to gather data, and statistical analysis showed a strong relationship between better mental health outcomes and successful work-life integration. The results emphasize how crucial it is for organizations to have policies that enable flexible work schedules and mental health support networks.