Preventive Health Care Services Research Articles

Lifetime prevalence and correlates of colorectal cancer screening among low-income U.S. Veterans.

The Veterans Health Administration (VHA) is the largest integrated healthcare system in the U.S. While preventive healthcare services are high priority in the VHA, low-income U.S. Veterans experience adverse life circumstances that may negatively impact their access to these services. This study examined lifetime prevalence as well as demographic, socioeconomic, military-specific, and clinical correlates of colorectal cancer (CRC) screening among low-income U.S. Veterans ≥ 50years of age. Cross-sectional data on 862 participants were analyzed from the 2021-2022 National Veteran Homeless and Other Poverty Experiences study. Overall, 55.3% (95% confidence interval [CI] 51.3-59.3%) reported ever-receiving CRC-screening services. In a multivariable logistic regression model, never-receivers of CRC screening were twice as likely to reside outside of the Northeast, and more likely to be married (odds ratio [OR] = 1.86, 95% CI 1.02, 3.37), have BMI < 25kg/m2 [vs. 25- < 30kg/m2] (OR = 1.75, 95% CI 1.19, 2.58), or ≥ 1 chronic condition (OR = 1.46, 95% CI 1.06, 2.02). Never-receivers of CRC screening were less likely to be female (OR = 0.53, 95% CI 0.29, 0.96), aged 65-79y [vs. ≥ 80y] (OR = 0.61, 95% CI 0.40, 0.92), live in 5 + member households (OR = 0.33, 95% CI 0.13, 0.86), disabled (OR = 0.45, 0.22, 0.92), with purchased health insurance (OR = 0.56, 95% CI 0.33, 0.98), or report alcohol-use disorder (OR = 0.10, 95% CI 0.02, 0.49) and/or HIV/AIDS (OR = 0.28, 95% CI 0.12, 0.68). Nearly 55% of low-income U.S. Veterans reported ever screening for CRC. Variations in CRC-screening behaviors according to veteran characteristics highlight potential disparities as well as opportunities for targeted behavioral interventions.

Immunization adherence among children with sickle cell disease and sickle cell trait: Results of a population-based study.

Despite the importance of timely vaccine completion for protection from infectious disease, there is limited knowledge of the immunization adherence rates of children with sickle cell disease (SCD). This is a retrospective cohort study comparing the immunization rates of children with SCD to those with sickle cell trait between 2008 and 2019 in Georgia. Completion rates for each vaccine and the proportion of children with up-to-date status at 24 and 35 months were calculated and compared between the cohorts. Chi-square tests with odds ratios (OR) for differences and 95% confidence intervals (CIs) were reported on the overall up-to-date rates and rates for individual vaccines at 24 and 35 months for the two cohorts. Children with SCD had higher up-to-date rates than children with sickle cell trait at 24 and 35 months. At 35 months, the overall up-to-date rates (OR=1.17; 95% CI, 1.04-1.31; p=.004) and the four-dose pneumococcal conjugate vaccine series (OR=1.36; 95% CI, 1.18-1.57; p<.001) were significantly different between the groups. Both cohorts had the highest completion rates for the hepatitis B series and the lowest rates for the varicella vaccine. Doses of diphtheria, tetanus, and acellular pertussis vaccine; varicella; and pneumococcal conjugate vaccines were most commonly missed by children in both cohorts. Children with SCD have better immunization coverage than children with sickle cell trait, but there is an opportunity for improvement. Policymakers and healthcare professionals should focus on increasing access to care coordination services among children with SCD to ensure on-time and preventive healthcare services.

Health care: life stories by trans women in Colombia

BackgroundIn Colombia, health care for people with trans life experiences is characterised by countless barriers to health services and care. Commonly, trans people have experienced stigma and discrimination among health professionals, a lack of services and professionals specialized to guarantee affirmative processes from non-hegemonic gender perspectives, and there exists a marked pathologization and medicalization of services. Therefore, it is necessary to provide affirmative health services to improve health and well-being from the recognition of their needs and experiences. The article describes life narratives about health care for the gender transitions of trans women in Colombia.MethodsA qualitative narrative study was conducted with 139 trans women in seven cities in Colombia. In-depth interviews and discussion groups were conducted between June 2019 and March 2020. Data were analyzed using thematic analysis and the Atlas Ti cloud program. National and international ethical guidelines were followed in the development of the research.ResultsThis research provided an overview of the health experiences of Colombian trans women. They reported their experiences of pathologizing approaches to transgender healthcare, stigma, discrimination, and barriers to accessing preventive, specialized, and regular healthcare services. For this reason, they opted for self-medicated gender transition processes and self-management of health care. An important aspect to consider within healthcare is that not all women want binary gender transition processes.ConclusionParticipants felt that in Colombia there is a lack of affirmative health care for transgender women and that there are many limitations to care related to the gender transition processes. This exposes them to more situations that violate their rights and influences their lack of confidence and their search for professional health care. In Colombia, it is important to develop strategies for education, information, and communication, as well as a handbook for health workers on specialized healthcare for trans women.

The role of sociodemographic, psychosocial, and behavioral factors in the use of preventive healthcare services in children and adolescents: results of the KiGGS Wave 2 study

BackgroundIn Germany, various preventive services are offered to children and adolescents. These include regular standardized examinations (so called U/J examinations) and several vaccinations. Although strongly recommended, most of them are not mandatory. Our aim is to identify factors associated with the use of U/J examinations and vaccination against diphtheria, hepatitis B, Hib, pertussis, polio, and tetanus. While previous research has focused on sociodemographic factors, we also include socioeconomic, behavioral, and psychosocial factors.MethodsWe analyzed cross-sectional data from 15,023 participants (aged 0–17 years) of the nationwide representative KiGGS Wave 2 Survey. Participation in U/J examinations was assessed using a questionnaire, filled out by participants and/or their parents. Information on vaccination status was drawn from the participants’ vaccination booklets. To identify relevant determinants for the use of preventive examinations and vaccinations, unadjusted and adjusted logistic regression models were employed with up to 16 different independent variables.ResultsVarious independent variables showed an association with the use of preventive services. Higher socioeconomic status, absence of migration background, and lower household size were associated with significantly higher utilization of U examinations. Parents’ marital status, area of residence, behavioral and psychosocial factors yielded insignificant results for most U/J examinations. Higher vaccination rates were found for children with no migration background, with residence in eastern Germany, lower household size, and with married parents.ConclusionThis study attempted to depict the influence of sociodemographic, psychosocial, and behavioral factors on the use of several preventive services. Our results indicate that predominantly sociodemographic variables influence the use of preventive services. Further efforts should be made to investigate the interplay of different determinants of healthcare use in children and adolescents.

Analisis Strategi Pemasaran dalam Meningkatkan Omzet Penjualan pada Usaha Apotek Aditara 2 Surabaya

The purpose of this research is to analyze and understand the implementation of the best marketing strategies at Apotek Aditara 2 in Surabaya. This research employs a descriptive method with a qualitative approach implemented through SWOT analysis and data collection techniques involving in-depth interviews, observations, and documentation related to the 7P marketing strategy, namely product, place, price, promotion, people, process, and physical evidence. The IFAS and EFAS analyses indicate a strength score of 2.23 and a weakness score of 0.77. Meanwhile, the EFAS results show an opportunity score of 2.56 and a threat score of 0.72. Based on the SWOT Analysis diagram, Apotek Aditara 2 is positioned in quadrant 1, applying an aggressive strategy by leveraging its strengths and opportunities. The applicable SO strategy for Apotek Aditara 2 in Surabaya includes maintaining a complete and varied product supply, preserving the cleanliness and tidiness of the pharmacy, sustaining preventive healthcare services, upholding good service provision, and establishing collaborations with health centers and doctor's practices.

Association between long working hours and engagement in preventive healthcare services in Korean workers: Findings from the Korean National Health and Nutrition Examination Survey

BackgroundEngagement in preventive healthcare services is crucial for preventing diseases. We explored how working hours are associated with engagement in preventive healthcare services, with a focus on gender differences. MethodsThis cross-sectional study used data from the 2007–2012 Korean National Health and Nutrition Examination Survey. The dependent variable was engagement in each of the five preventive healthcare services (health check-ups, influenza vaccination, and stomach, breast, and cervical cancer screenings). We estimated the prevalence ratios (PRs) and 95% confidence intervals (CIs) using robust Poisson regression. ResultsThe study analyzed 19,819 workers (9119 women). The adjusted PRs (95% CI) of the association between working ≥55 h per week and engagement in preventive healthcare services among men were 0.95 (0.90–1.00) for health check-ups, 0.86 (0.77–0.96) for influenza vaccination, and 0.95 (0.87–1.03) for stomach cancer screening compared to working 35–40 h per week. Among women, the adjusted PRs (95% CI) of the association between working ≥55 h per week and engagement in preventive healthcare services were 0.84 (0.78–0.91) for health check-ups, 0.82 (0.73–0.92) for influenza vaccination, and 0.88 (0.80–0.97) for stomach, 0.85 (0.78–0.94) for breast, and 0.82 (0.74–0.91) for cervical cancer screenings. ConclusionLong working hours were negatively associated with engagement in preventive healthcare services, and the association was pronounced among female workers. Efforts to promote preventive healthcare participation among individuals with long working hours are necessary, and it is essential to consider the unique vulnerabilities of women when developing such policies.

The National Health Policy, 2017: Health Seeker’s Profile and Accrued Benefit Analysis

The landscape of health is fast changing in developing countries. India being a signatory to the Alma Ata Declaration on “Health for All” has transformed the landscape of health in the country through Constitutional guarantees, plans, and policy measures. Constitutional bindings like those like Art 21, 38, 39(A) and the Directive Principles of State Policy have put compulsion on the Government of India to take measures for the universalization of health care and this is one of the ambitious targets of the 12th five-year plan aimed at comprehensive health care security to all. It mandates the country to ensure affordable, accountable, appropriate promotive, preventive, curative, and rehabilitative health care services and equitable access to health care to all citizens of India despite their caste, class, gender, religion, etc. In this context. In 2017, the Government of India introduced its health policy to provide coverage to the entire population of the developing country, i.e., India. It was a welcome initiative on the part of the country. After 6 years, the present article tries to map the health seekers' profile and how far benefits of health reform have been accrued by them. The researchers in this article have employed descriptive design with quantitative methods of data collection in the city of Bhubaneswar. The study concludes that the 2017 Healthcare policy has undoubtedly addressed the discrepancies in healthcare services to the population in terms of gender, age, and economic status, but still finds private healthcare services to cover more commoners and ensure services to them.

Understanding Social, Cultural, and Religious Factors Influencing Medical Decision-Making on BRCA1/2 Genetic Testing in the Orthodox Jewish Community.

Although the prevalence of a pathogenic variant in the BRCA1 and BRCA2 genes is about 1:400 (0.25%) in the general population, the prevalence is as high as 1:40 (2.5%) among the Ashkenazi Jewish population. Despite cost-effective preventive measures for mutation carriers, Orthodox Jews constitute a cultural and religious group that requires different approaches to BRCA1 and BRCA2 genetic testing relative to other groups. This study analyzed a dialog of key stakeholders and community members to explore factors that influence decision-making about BRCA1 and BRCA2 genetic testing in the New York Orthodox Jewish community. Qualitative research methods, based on Grounded Theory and Narrative Research, were utilized to analyze the narrative data collected from 49 key stakeholders and community members. A content analysis was conducted to identify themes; inter-rater reliability was 71%. Facilitators of genetic testing were a desire for preventive interventions and education, while barriers to genetic testing included negative emotions, feared impact on family/romantic relationships, cost, and stigma. Views differed on the role of religious leaders and healthcare professionals in medical decision-making. Education, health, and community were discussed as influential factors, and concerns were expressed about disclosure, implementation, and information needs. This study elicited the opinions of Orthodox Jewish women (decision-makers) and key stakeholders (influencers) who play critical roles in the medical decision-making process. The findings have broad implications for engaging community stakeholders within faith-based or culturally distinct groups to ensure better utilization of healthcare services for cancer screening and prevention designed to improve population health.

Rural/Urban differences in uptake of preventive healthcare services: Variability in observed relationships across measures of rurality.

Rural residents are generally less likely to receive preventive healthcare than are urban residents, but variable measurement of rurality introduces inconsistency to these findings. We assessed the relationships between perceived and objective measures of rurality and uptake of preventive healthcare. In our sample, rural participants generally had equal or higher uptake of healthcare (i.e. private health insurance, check-up in the past year, being up-to-date on colorectal and cervical cancer screening) than urban participants. Importantly, the perceived measure of rurality performed similarly to the objective measures, suggesting that participant report could be a valid way to assess rurality in health studies. Significance for Public Health The ability to access routine preventive healthcare is a key component of public health. Comparing uptake of cancer screening in rural versus urban areas is one way to assess equity of healthcare access. Generally, rural areas have a higher burden of cancer than urban areas. The built environment, socioeconomic status, and patient perceptions can impact an individual's access to routine cancer screening. Preventive healthcare is of great importance to public health as a whole because screening can facilitate earlier diagnosis and more successful treatment for many preventable cancers, which may ultimately increase the quality and quantity of life.

BARRIERS TO DISEASE SELF-CARE AMONG OLDER NON-HISPANIC BLACK AND HISPANIC MEN WITH CHRONIC CONDITIONS

Abstract Disease self-care is multi-faceted and influenced by physical, mental, social, and environmental factors. Because males traditionally underutilize preventive healthcare services, self-care is increasingly important to manage disease symptomatology and slow disease progression. This study examines factors associated with barriers to disease self-care among Hispanic and non-Hispanic Black men ages ≥65 years with ≥1 chronic condition. Data were analyzed from a national sample of 470 Hispanic (43.2%) and non-Hispanic Black (56.8%) men and collected with an internet-delivered questionnaire. The 5-item Barriers to Self-Care Scale served as the dependent variable (range=5-20). A least squares regression model was fitted to identify factors associated with barriers to disease self-care. The model adjusted for sociodemographics, disease characteristics, health status, and social engagement and support. On average, participants were age 70.1 (±4.5) years and reported 3.9 (±2.6) chronic conditions. Men with higher body mass index (β=0.13, P=0.001), more depressive symptomatology (β=0.09, P=0.046), and lower self-rated quality of life (β=-0.23, P&amp;lt; 0.001) reported higher barriers to disease self-care. Further, men with poorer access to healthcare (β=-0.17, P&amp;lt; 0.001) and higher healthcare frustrations (β=0.17, P&amp;lt; 0.001) reported higher barriers to disease self-care. Barriers to self-care were positively associated with being more socially disconnected (β=0.09, P=0.049) and higher reliance on others to manage health problems (β=0.14, P&amp;lt; 0.001). Findings reinforce the importance of mental health, healthcare access, and social support for disease self-management among Hispanic and non-Hispanic Black men. Efforts are needed in clinical and community-based settings to reduce self-care barriers through culturally appropriate self-management education, interventions, and services.

Access, Participation, Control, and Advantage of Digital-Based Healthcare Service for Women Living with HIV/AIDS

Gender inequality contributes to HIV/AIDS transmission, increased number of women living with HIV/AIDS (WLHA), and women’s reduced ability of resolving this epidemic. Mobile Health (mH) is used to treat, support, and medicate more efficiently people with HIV/AIDS (PWHA) including WLHA. This research studies access, participation, control, and advantage of digital-based healthcare service to WLHA using Harvard’s gender analysis model. Informants employed in this exploratory research were Surakarta City’s Health Service Office, medical workers, nurses, administrative staffs, patients, NGO Caring for AIDS, WLHA, Peer Support Group, and Citizens caring for AIDS di Surakarta Indonesia. Data validity test was conducted using source triangulation and data was analyzed using an interactive model of analysis. Result shows that several digital platforms have been developed by Public Health Centers and Hospitals in Surakarta including telemedicine, telenursing, telepharmacy, website, youtube and social media for promotive, preventive, curative, and rehabilitative healthcare services to WLHA in Surakarta Indonesia. WLHA, public, and medical personnel in Surakarta Indonesia have participated in and access mH, despite gender inequality. The factor determining gender inequality in digital-based healthcare service is men’s domination in mastering digital-based health technology, negative stigma, and discriminative treatment given by medical personnel and public to WLHA. The use of mH by WLHA has positive impact on knowledge, stance, access, participation, decision, and changing behavior of WLHA and the medical personnel responsible for the service.

Preventive healthcare behavior: A hybrid systematic literature review (1998–2023)

AbstractPreventive healthcare behavior (PHB) refers to actions taken by consumers to avert possible incidences of lifestyle diseases. Over the years, diverse approaches have been used to comprehend the complex nature of PHB. This paper follows a three‐step process to examine work done in the PHB domain. At the outset, past literature was examined. This review included PHB models and frameworks, followed by a root‐cause analysis to identify factors that impacted PHB adoption. A systematic literature review (SLR) using a domain‐based hybrid review approach was the study's third and most crucial part. The SPAR‐4‐SLR (scientific procedures and rationales for systematic literature reviews) protocol was used to conduct the hybrid review, involving two separate review studies. In the first study, a bibliometric analysis was carried out, wherein a trend analysis was conducted on an initial pool of 1011 primary peer‐reviewed publications (1998–2023). The trend analysis was followed by a co‐citation network analysis of 39,608 secondary articles, which validated the importance of primary articles as indicated by the co‐citations in these secondary articles. Further, a purification process based on reliability, validity, and replicability criteria resulted in a final pool of 190 relevant articles. These articles were subjected to a thematic analysis. Next, a framework‐based review based on the theories, contexts, characteristics, and methods (TCCM) framework was conducted on the 190 articles. This step validated the primary study findings. Additionally, it examined and reported the underlying theories, context (country level), characteristics, and methods adopted by previous PHB studies. This analysis helps in indicating the future research agenda regarding PHB. Furthermore, the inferences drawn from the two studies were used to propose a conceptual framework for understanding consumers' PHB decisions based on the antecedents, decisions, and outcomes (ADO) framework. The framework posits that specific personal, demographic, cultural, social and socioeconomic factors are precursors to PHB adoption. This PHB adoption, in turn, has positive outcomes such as enhanced quality of life, consumer wellbeing, health promotion, health behavior change, and planning. The comprehensive review and proposed framework will significantly help advance knowledge about PHB. Apart from contributing to the academic literature, learnings from this study hold value for practitioners at the global level for designing actionable strategies for preventive healthcare products and services.

Social network associated with depressed mood and sarcopenia among older adults in Taiwan

Social isolation is increasing in aging societies; however, its relationship with depressed mood and sarcopenia is not well studied. This study aims to examine the influence of social network on depressed mood and sarcopenia among community-dwelling older adults in Taiwan. We collected data from a sample of 981 older adults residing in the community. These individuals received government-subsidized preventive healthcare services for adults at a district hospital in Taipei in 2021. The social network of the older adults who participated was assessed using the Lubben Social Network Scale, while depressed mood was assessed using the Geriatric Depression Scale. The definition of sarcopenia used in this study was based on the 2019 Asian Working Group for Sarcopenia. According to this study, sarcopenia was present in approximately 15% of older adults. Multiple logistic regression analysis showed that older adults who had poor social network and did not meet the recommended 150min of regular physical activity per week were more likely to have depressed mood. Additionally, older adults who were older, underweight, did not engage in regular physical activity, and had poor social network were more likely to have sarcopenia. Poor social network was associated with increased risks of depressed mood and sarcopenia among older adults.

Determinants and effectiveness of annual wellness visits among Medicare beneficiaries in 2020.

Annual wellness visits (AWVs) have the potential to improve general health and well-being, but little is known about the role of AWVs during the COVID-19 pandemic. We examined the determinants and effectiveness of having an AWV among Medicare beneficiaries in 2020. We employed a cross-sectional study design using data from the 2020 Medicare Current Beneficiary Survey. Our outcomes included AWV utilization, preventive care utilization, health status, and care satisfaction. To examine the determinants for having an AWV, we performed a linear regression model and explored the associations with other individual-level variables (demographic, socioeconomic, and health characteristics). To examine the effectiveness of having an AWV, we performed a linear regression model on each outcome measure while adjusting for individual-level variables. We found that there were several determinants of having an AWV. The four most notable determinants were having a usual source of care, enrolling in Medicare Advantage, being non-Hispanic Black, and being Hispanic. We also found that having an AWV was associated with increases in preventive care use (COVID vaccine, flu shot, pneumonia shot, and blood pressure measurement), but was limited in improving health status and care satisfaction. Our finding raises critical concerns about inequitable access to health care services for disease prevention and health promotion during the pandemic. Furthermore, the effectiveness of AWVs was mostly in increased preventive care use, suggesting a limited role in meeting the wellness needs of a diverse population of older adults.

N.C. officials tout ‘once in a lifetime’ investment in MH services

Between federal COVID relief funds and the $1.4 billion sign‐on bonus North Carolina received for expanding Medicaid, state lawmakers were able to make significant investments in mental health services in the latest state budget, the Carolina Public Press reported on Oct. 8. Though state budget negotiations are done almost entirely behind the closed doors of the majority party in the state general assembly — currently the Republicans — health leaders in the House and Senate said they took care to listen to patients, families and providers while creating their mental health spending plan while also working closely with the North Carolina Department of Health and Human Services Secretary Kody Kinsley. “Everybody saw that to make big changes was gonna take a lot of money,” Sen. Jim Burgin (R‐Angier) said in an interview with NC Health News last week. “And I think one of the attractions to Medicaid expansion for all of us was this once‐in‐a‐generation, or maybe even once‐in‐a‐lifetime opportunity to say, ‘Mental health is a big deal,’” he said, explaining the significance of the federal sign‐on bonus that came with Medicaid expansion, which lawmakers decided to use to invest in mental health services. The result is pages of mental health policy and spending in this year's budget document, where lawmakers committed to significant rate increases, bonuses and education for a variety of mental health workers. They set into motion big structural changes to the way behavioral health services are delivered to the most vulnerable populations across the state. And they directed hundreds of millions of dollars to support children in foster care and expand preventive mental health care and crisis care services.

Abstract P226: Length Of Stay Discrepancies Between Rural And Urban Hospital Settings For Hypertension Admissions

Introduction: Rural populations experience greater barriers to healthcare access compared to urban populations. This can be attributed to fewer public health services, greater uninsured rate, and greater burden of healthcare shortages in urban healthcare settings. Our study aims to quantify the disproportionate allocation in healthcare resources through analysis of Length of Stay (LOS) in-respect to hypertensive urgency and hypertensive urgency. Methods: This cross-sectional study reviewed the LOS estimates for patients with ICD-10 diagnoses for Hypertension Emergency or Hypertension Urgency within the state of New York, categorized by the type of community hospital; rural or urban. This study utilizes the 2020 National Inpatient Sample (NIS), specifically for urban and rural hospitals in New York. ICD-10 codes included I16.1 &amp; I16.9 for Hypertensive Emergency and I16.0 for Hypertensive Urgency. Community hospital setting was categorized as either rural or urban based on the overlying zip code of the admitting inpatient hospital. Results: LOS was unique to the community setting (p&lt;0.01), but not to hypertensive disease (p=0.11). In summary, the LOS was longer in rural-level inpatient hospital systems when compared to their urban counterparts in both Hypertensive Urgency, 4.4 days vs 3.1 days (p=0.01), and Hypertensive Emergency, 5.5 days vs 3.4 days (p&lt;0.01). Conclusion: The LOS of patients admitted for both hypertensive urgency and emergency were significantly higher in rural hospitals. Furthermore, increased disease severity emphasizes the divide in LOS between the community healthcare settings. Redistribution of resources to rural communities can enhance access to preventative healthcare services, specialty healthcare, and potentially decrease overall community disease burden.

Hepatocellular Carcinoma Diagnosis and Management in 2021: A National Veterans Affairs Quality Improvement Project

The coronavirus disease-2019 pandemic profoundly disrupted preventative health care services including cancer screening. As the largest provider of cirrhosis care in the United States, the Department of Veterans Affairs (VA) National Gastroenterology and Hepatology Program aimed to assess factors associated with hepatocellular carcinoma (HCC) stage at diagnosis, treatment, and survival. Veterans with a new diagnosis of HCC in 2021 were identified from electronic health records (N= 2306). Structured medical record extraction was performed by expert reviewers in a 10% random subsample of Veterans with new HCC diagnoses. Factors associated with stage at diagnosis, receipt of treatment, and survival were assessed using multivariable models. Among 199 patients with confirmed HCC, the average age was 71 years and most (72%) had underlying cirrhosis. More than half (54%) were at an early stage (T1 or T2) at diagnosis. Less-advanced liver disease, number of imaging tests adequate for HCC screening, HCC diagnosis in the VA, and receipt of VA primary care were associated significantly with early stage diagnosis. HCC-directed treatments were administered to 145 (73%) patients after a median of 37 days (interquartile range, 19-54 d) from diagnosis, including 70 (35%) patients who received potentially curative treatments. Factors associated with potentially curative (vs no) treatments included HCC screening, early stage at diagnosis, and better performance status. Having fewer comorbidities and better performance status were associated significantly with noncurative (vs no) treatment. Early stage diagnosis, diagnosis in the VA system, and receipt of curative treatment were associated significantly with survival. These results highlight the importance of HCC screening and engagement in care for HCC diagnosis, treatment, and survival while demonstrating the feasibility of developing a national quality improvement agenda for HCC screening, diagnosis, and treatment.

The association between Adverse Childhood Experiences and HPV vaccination coverage in U.S. young adults: a cross-sectional study.

Adverse childhood experiences (ACEs) contribute to adverse health outcomes in adulthood. Access to preventive healthcare services, including HPV vaccinations, may mitigate the impact of ACEs on adverse health outcomes. Our objective was to assess associations between ACEs and HPV vaccination coverage among young adults. We included 3415 18-29-year-old respondents to the 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) ACE and HPV vaccination modules. ACEs included emotional, physical and sexual abuse; household intimate partner violence, substance abuse, mental illness; and parental separation/divorce and incarcerated household member. We used log-binomial regression models to calculate prevalence ratios (PRs) with 95% confidence intervals for associations between ACEs and self-reported HPV vaccination and completion. Secondary outcomes included influenza vaccination uptake, time since routine checkup, HIV testing history, and HIV-related risk behavior. Several ACEs were positively associated with HPV vaccine initiation, including emotional abuse (PR:1.29, 95%CI:1.17-1.43), intimate partner violence (PR:1.14, 95%CI:1.00-1.30), substance abuse (PR:1.20, 95%CI:1.08-1.33), and mental illness (PR:1.35, 95%CI:1.22-1.50). Similar associations were observed for completion. Conversely, most ACEs were negatively associated with influenza vaccination (PRs from 0.72-1.00), and with recent checkup (PRs from 0.92-1.00). ACEs were positively associated with having had an HIV test (PRs from 1.19-1.56) and HIV-related risk behavior (PRs from 1.19-2.07). The unexpected positive associations between ACEs and HPV vaccination coverage could be due to opportunities to receive HPV vaccination in late adolescence or early adulthood while accessing STI/HIV prevention or treatment services. Future studies should evaluate associations between ACEs and timely HPV vaccination in early adolescence.

Status of the utilization of preventive care services and its associated socio-demographic factors among Iranian elderly.

The growing population of the elderly, the rising costs of medical care and the low use of preventive services are three factors that highlight the importance of using preventive health care services in the Iranian population. This study aimed to determine the status of the use of preventive care services and its associated socio-demographic factors in the elderly referred to health centers. In this analytical cross-sectional study, a number of 160 elderly people referred to health centers in East Guilan, Iran was selected by multi-stage cluster sampling. Data were obtained from May to September, 2021 using a questionnaire containing utilization of preventive care services (9 items) and socio-demographic characteristics. The highest and the lowest utilization rates of preventive care services among study participants were related to the blood pressure test (96.9%) and colonoscopy (17.5%), respectively. Multivariate analysis showed that only income had a significant association with performing fasting blood sugar test (p = 0.004), blood lipid test (p = 0.004), and blood pressure test (p = 0.013). Also, the associations between having an underlying disease and performing fasting blood sugar test (p = 0.032) and blood pressure test (p = 0.002), the association between gender and performing the bone mineral density test (p < 0.001), and the association between occupation and performing Pap-smear test (p = 0.011), were statistically significant. The utilization rates of screening tests for most cancers, including gastrointestinal cancers, were low. Since, there were a significant association between income, disease, gender and occupation with the utilization of some preventive care services, considering them in health centers' preventive care program design might be useful.

Causal Modelling of the Key Competitiveness Assessment Factors of Wellness Tourism Destinations: A DEMATEL Approach

Objectives: The objectives of this study are 1) to identify and prioritize the significant competitiveness factors that need to be considered in the context of wellness tourism destinations and 2) to identify the causal interrelationships between competitiveness factors that need to be considered in the context of wellness tourism destinations. Methods/Analysis: The theoretical framework of this research began with documentary research of secondary data, followed by semi-structured interviews and quantitative research using questionnaires to collect primary data from wellness tourism clusters and experts. Based on these responses, a multiple-criteria decision-making framework using the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method was implemented to prioritize wellness tourism destination competitiveness factors and their relationships. Findings: The destination strategy and roadmap for wellness tourism were the most important competitiveness factors for wellness tourism destinations, and the wellness service experience and activities factor was the most significant cause factor, with strategies to improve service and restoration being the most significant source of effect. Novelty/Improvement:This research sheds light on wellness tourism destinations' competitiveness assessment factors and indicators and how to improve them to attract wellness tourists seeking preventive health care or health promotion services. Doi: 10.28991/HEF-2023-04-02-01 Full Text: PDF