Public Health Care Research Articles

Telehealth for the management of patients with type 2 diabetes in remote areas of Taiwan: a best practice implementation project.

Telehealth services integrate technology with specialized medical care, and can be used to improve blood sugar management and reduce complications in patients with type 2 diabetes. This study aimed to improve telemedicine care for patients with type 2 diabetes in public health centers in remote Indigenous communities in Taiwan through evidence-based practices. This included increasing the rates of ophthalmic examinations and enhancing the capacity of health care providers. This project followed the JBI Evidence Implementation Framework and was supported by the JBI Practical Application of Clinical Evidence System (PACES). Baseline and follow-up audits were conducted among health care providers and patients with type 2 diabetes to measure compliance with best practices and determine any improvements in practice after implementation. HbA1c levels in patients with type 2 diabetes were analyzed using paired sample t-tests, with statistical significance set at p < 0.05. The follow-up audit revealed that compliance rates for the six audit criteria improved, with Criteria 1-5 increasing from 62.5% to 87.5% or 100%. Additionally, Criterion 6 improved from 37.5% to 62.5%. The HbA1c values of the patients showed pre- and post-intervention means of 7.8291% and 7.3236%, respectively. Using a coaching leadership model along with JBI audit criteria to enhance the knowledge and skills of health care providers was essential for the success of the project. This approach resulted in significant advancements in caring for people with type 2 diabetes. http://links.lww.com/IJEBH/A377.

Cost-effectiveness of ruxolitinib in Singapore for patients with chronic graft-versus-host disease

ABSTRACT Objective To evaluate the cost-effectiveness of ruxolitinib in Singapore for patient with chronic graft-versus-host disease (GVHD) and inadequate response to corticosteroids. Methods A three-state partitioned survival model was developed to evaluate the cost-effectiveness of ruxolitinib from the Singapore healthcare system perspective over a five-year time horizon. Clinical data were sourced from the REACH3 trial, health state utilities were retrieved from literature, and direct costs were obtained from public healthcare institutions in Singapore. Sensitivity and scenario analyses were conducted to explore the impact of uncertainties and assumptions on the cost-effectiveness results. Results Compared to best available therapy, ruxolitinib yielded a base-case incremental cost-effectiveness ratio (ICER) of S$776,653 (US$574,724) per quality-adjusted life-years QALY gained. Sensitivity analyses revealed that the ICER was particularly sensitive to utilities in failure-free and progressed disease states. Scenario analyses confirmed that the ICERs remained high even under favorable assumptions, and a substantial price reduction was necessary to lower the ICER. Conclusion At its current price, ruxolitinib is not cost-effective for treating chronic GVHD in Singapore. This finding helps to inform funding decision-making, which also considers other factors such as clinical effectiveness, safety, and budget impact, in addition to cost-effectiveness.

Legislating a Strategic Plan: Anti-2SLGBTQIA+ Discourse and the Political Agenda Reshaping Higher Education in Oklahoma

Oklahoma has become a focal point in the national escalation of anti-2SLGBTQIA+ and anti-DEI efforts, emerging as one of the most aggressive states in proposing and advancing bills that undermine queer and trans rights across sectors, including public education, healthcare, free speech, and civil liberties. Although many bills do not pass into law, the volume, language, and momentum constitute a discursive and political terrain that actively regulates 2SLGBTQIA+ lives. This study retools the concept of strategic planning—typically associated with institutions’ mission-setting—as an analytical heuristic to examine how legislative efforts operate as a coordinated political agenda. Drawing on critical policy analysis (CPA) and critical discourse analysis (CDA), the authors map selected legislative texts from 2021 to 2024 to demonstrate how Oklahoma lawmakers are using policy discourse to reshape higher education into an extension of state power, advancing white cisheteronormative logics. By framing these efforts as ideologically coherent rather than isolated, this analysis contributes to the urgent work of identifying and resisting the restructuring of public education against 2SLGBTQIA+ communities.

Securing the harvest: how health insurance enhances agricultural capital investment in rural China

ABSTRACT This study examines the impact of the NCMS, the world’s largest public health insurance programme, on agricultural capital investment. Using data tracking rural households across 300 villages in China from 2003 to 2013, we find robust evidence that the NCMS significantly increases agricultural capital investment, particularly in households that are heavily reliant on agriculture as their primary income source. Furthermore, the impact is more pronounced for low-income, elderly and less-educated households. This study elucidates the spillover effects of health insurance in the agricultural sector and provides insights into its role in supporting rural households’ investment decisions.

Bridging the Gap Between Research and Policy: Exploring Political Determinants of Immigrant Health in an Urban County With High Cervical Cancer Disparities.

BackgroundCervical cancer disproportionally burdens Hispanic immigrant communities in the United States, despite its preventable nature and curability when detected early. These persistent disparities represent a "wicked problem," characterized by contested evidence, fragmented data, and a politicized health policy environment.MethodsThis study uses Tarrant County, Texas-a high-disparity urban region-as a case study to explore how multilevel governance structures shape immigrant health inequities. Drawing on the concept of wicked problems and the political determinants of health (PDoH) framework, we analyze archival data through a policy science lens to examine how electoral, legal, and institutional forces perpetuate barriers to life-saving care for immigrant women.ResultsFour key themes emerged from our analysis: (1) a reactive political environment that amplifies exclusion, (2) decision-making shaped by legal ambiguity, (3) passive enforcement of immigration policies through institutional design, and (4) blame-shifting between public and private healthcare systems. These dynamics collectively sustain health disparities by limiting access to preventive care and delaying treatment among immigrant populations.ConclusionFindings demonstrate that cervical cancer disparities are not solely the result of individual health behaviors but are produced and sustained by structural and political forces. Addressing these disparities requires interdisciplinary partnerships and place-based strategies that confront the institutional barriers embedded in local governance. We call for strategic alliances among researchers, community stakeholders, and policymakers to foster shared accountability and develop responsive, equity-driven policies for addressing cervical cancer and other preventable conditions in immigrant communities.

‘Meat and eggs’ dietary pattern in overweight and obese adolescents and its relationship with cardiometabolic markers

To associate dietary patterns with cardiometabolic markers in overweight and obese adolescents. A cross-sectional study was conducted with 227 adolescents aged 10 to 19 years, who were attending six public healthcare services in a city in Southern Brazil. A semi-quantitative food frequency questionnaire was administered. Dietary patterns were identified using principal component analysis followed by orthogonal Varimax rotation. Independent associations between dietary patterns and marker values (glucose, fasting insulin, Homeostatic Model Assessment index, total cholesterol, triacylglycerols, Low-Density Lipoprotein, High-Density Lipoprotein, cholesterol not transported by HDL, C-reactive protein, and blood pressure) were tested using quantile regression. The scores of dietary patterns were categorized into tertiles and associated with the outcomes of altered cholesterol transported by HDL or triacylglycerols levels due to their significant associations. A significance level of p&lt;0.05 was considered. Five dietary patterns were identified: ‘Meat and eggs’, ‘Coffee, dairy, and vegetables’, ‘Breads and processed meats’, ‘Sugar and fat’, and ‘Soup and cereals’. The ‘Meat and eggs’ pattern, characterized by red meat, white meat, and eggs, was the most representative and showed a negative association with cholesterol transported by HDL and a positive association with triacylglycerols. The ‘Soup and cereals’ pattern had a positive association with triacylglycerols. Adolescents belonging to the third tertile of the ‘Meat and eggs’ pattern had 2.76 times higher odds of elevated triacylglycerols. Greater adherence to the ‘Meat and eggs’ pattern was associated with lower levels of cholesterol transported by HDL and higher plasma triacylglycerols.

Strategies used by healthcare professionals to increase the human papillomavirus vaccine uptake among adolescents in Ireland: A qualitative study.

Strategies used by healthcare professionals to increase the human papillomavirus vaccine uptake among adolescents in Ireland: A qualitative study.

Enhancing metacognition and nursing competency in undergraduate students utilizing multi-user virtual environment simulations: A multi-site multi-group comparative study.

Enhancing metacognition and nursing competency in undergraduate students utilizing multi-user virtual environment simulations: A multi-site multi-group comparative study.

Mapping fertility trajectories: An endarkened narrative inquiry of Black women's fertility experiences and pathways through infertility treatment.

Mapping fertility trajectories: An endarkened narrative inquiry of Black women's fertility experiences and pathways through infertility treatment.

The impact of health system responsiveness on tuberculosis treatment adherence in public primary healthcare facilities in Indonesia

The impact of health system responsiveness on tuberculosis treatment adherence in public primary healthcare facilities in Indonesia

Diagnostic radiographers' lived experiences of trauma imaging.

Diagnostic radiographers' lived experiences of trauma imaging.

Refining early detection of Marburg Virus Disease (MVD) in Rwanda: Leveraging predictive symptom clusters to enhance case definitions.

Refining early detection of Marburg Virus Disease (MVD) in Rwanda: Leveraging predictive symptom clusters to enhance case definitions.

Enablers and barriers to practice planned home birth for midwives in Spain: A qualitative study.

Enablers and barriers to practice planned home birth for midwives in Spain: A qualitative study.

PENGARUH EDUKASI PASIEN BERBASIS VIDEO EDUKASI TERHADAP KEPATUHAN PASIEN DIABETES TIPE 2 DI PUSKESMAS PASAR SIMPANG, LAMPUNG

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycaemia due to ineffective insulin use. In Indonesia, DM is a leading non-communicable disease. Medication adherence plays a critical role in managing DM, yet barriers such as long treatment regimens and limited patient-provider communication often hinder adherence. This study evaluated the effectiveness of a video-based digital intervention in improving medication adherence among DM patients at Public Health Center of Pasar Simpang in Kota Agung Timur, Tanggamus Regency. The study employed a cross-sectional design with 62 respondents divided into control and experimental groups. The intervention involved educational videos shared via WhatsApp. Adherence was assessed using the MMAS-8 (Morisky Medication Adherence Scale). Results revealed that adherence levels significantly improved in the experimental group post-intervention. The pre-test MMAS-8 mean score was 11.23±1.26, increasing to 13.97±1.33 post-intervention, with a mean difference of 2.74 (p = 0.000). In contrast, the control group showed no significant change, with pre- and post-test mean scores of 12.55±1.55 and 12.90±1.42, respectively (p = 0.315). Overall, 79% of respondents demonstrated good adherence, with significant improvements noted in the intervention group. These findings highlight the potential of video-based digital interventions in enhancing adherence among DM patients, providing valuable insights into diabetes care.

A Family’s Knowledge and Attitudes Toward the Prevention of Pulmonary Tuberculosis in Tasikmalaya City, Indonesia, in 2023: A Cross-sectional Study

Background: Disease prevention is an important component of health care. Knowledge and attitudes are supportive factors in implementing healthy behaviour for tuberculosis (TB) prevention. This study aims to identify the relationship between the level of knowledge and family attitudes in preventing pulmonary TB. Methods: This cross-sectional study employed a quantitative analytical design. The study sample comprised a family of TB patients obtained with the total sampling technique (82 respondents). The study instrument was valid and reliable, with favourable Cronbach α values for knowledge (0.961) and attitudes (0.976). Data analysis in the study used univariate (category with cut-off point for all variables), bivariate (Chi-square) and multivariate analysis (logistic regression). The study was conducted at the Tamansari Public Health Center in Tasikmalaya City, Indonesia. Results: A total of 82 samples participated in this study. The results showed that the majority of respondents have good knowledge (63.4%), positive attitudes (62.2%) and good prevention strategies (67.1%). Based on the results of statistical tests using the chi-square, there was a significant association between family knowledge of TB prevention (P=0.012) and family attitudes toward TB prevention (P=0.020). The most dominant factor influencing TB prevention was knowledge (odds ratio (OR)=3.333) compared with attitudes. Conclusion: Knowledge becomes a dominant factor compared to attitudes among TB patients. A family with good knowledge can support better information relating to the disease of TB patients during treatment and may increase self-care adherence.

Bridging gaps in medical education for digital healthcare: A Singapore case study

Introduction: As healthcare becomes increasingly digital, undergraduate medical students receive limited formal training in digital healthcare technologies (DHTs). Additionally, stakeholders’ perspectives on essential digital health competencies (DHCs) across generations remain underexplored. This comparative study aims to identify knowledge gaps, inform evolving expectations, and promote continuous learning by comparing medical students’ and senior clinicians’ views on essential DHCs in Singapore. Methods: Individual semi-structured interviews were conducted with medical students, clinical educators, and clinical teachers. Clinical-year medical students from all three local medical schools were recruited using convenience and snowball sampling, while purposive sampling ensured diverse representation of clinicians across Singapore’s public healthcare organisations, focusing on those engaged in education-related activities. Data were collected from September 2020 to February 2023 until thematic saturation was achieved, and analysed using qualitative thematic analysis. Results: Sixty-three participants took part, including 30 medical students, 12 clinical educators and 21 clinical teachers. All clinicians had more than 10 years of clinical experience and came from 24 different disciplines and 12 healthcare institutions. The findings showed unanimous support for integrating electronic health records in patient communication, and training in DHTs like telemedicine and point-of-care ultrasound. Discrepancies emerged; clinicians prioritised physical examination, while students viewed it as potentially replaceable by DHTs. Furthermore, while students valued healthcare-related smartphone applications in patient care, few clinicians shared this view, citing privacy and security concerns. Conclusion: Evaluating stakeholders’ perspectives highlights evolving clinical skills and essential DHCs for medical students, potentially informing global DHC training programmes. Keywords: Technology, Medical Education, Curriculum, Clinical Competence, Digital Competence, Qualitative, Singapore

Evaluating variability in decision-making among spine surgeons treating adult spine deformity.

Evaluating variability in decision-making among spine surgeons treating adult spine deformity.

New options determining the success of treatment for neovascular age-related macular degeneration

Neovascular age-related macular degeneration (nAMD) is a progressive retinal disease that can lead to severe and irreversible vision loss despite the availability of effective anti-VEGF agents. One of the potential causes of suboptimal treatment outcomes in nAMD is undertreatment, which may result from the need for frequent injections and follow-up visits, limitations in public healthcare funding, and challenges in achieving sustained and long-term control of disease activity (DA). Aflibercept 8 mg is a novel formulation with a higher concentration and improved molecular stability, enabling a fourfold increase in the molar dose of the active substance delivered to the vitreous body. The phase III PULSAR trial, a 96-week randomized, double-masked, active-controlled study, evaluated the efficacy and safety of 8 mg aflibercept compared with the standard 2 mg dose in treatment-naïve patients with nAMD. Participants were randomized 1:1:1 into three groups: aflibercept 2 mg every 8 weeks (2q8), 8 mg every 12 weeks (8q12), or 8 mg every 16 weeks (8q16) after three initial monthly loading doses. The study demonstrated the benefits of the 8 mg dose in extending interinjection intervals. By week 96, 88% of patients achieved an interval of ≥12 weeks, 71% ≥16 weeks, and 47% ≥20 weeks; in the 8q16 group, 53% of patients reached an interval of ≥20 weeks and 31% - 24 weeks. Over the 2-year period, patients in the 8q16 group received approximately 8 injections, compared to around 13 in the 2q8 group, with comparable anatomical and functional outcomes and no additional safety concerns. Given the proven effectiveness in improving best-corrected visual acuity (BCVA), superior outcomes in resolving intra- and/or subretinal fluid (IRF/SRF), and reduced treatment burden, it appears optimal to broadly transition patients already receiving aflibercept 2 mg to the higher molar concentration (aflibercept 8 mg) regardless of treatment phase or the interinjection interval. This approach aims to achieve a longer anti-VEGF effect duration and sustained DA control with the fewest possible injections.

Childbirth; A traumatic event for women in Pakistan

To the editor, Childbirth is a beautiful experience that millions of women go through worldwide. A woman goes through a rollercoaster of emotions throughout the pregnancy, and one of the most recurring thoughts in a mother’s mind is the event of labour and delivery. Although many have the privilege of having a near-perfect experience, this is not true for many women in Pakistan. Despite being the most cost-effective, only 15% of women choose government setups, most prefer private providers, which can be more expensive, or opt for midwives or untrained staff which although affordable, can have dire consequences [1]. Research indicates that approximately 1.5% of women may experience post-traumatic stress disorder (PTSD) as a consequence of their childbirth experience [2]. Although PTSD can be due to several reasons, many women report a lack of empathy from the healthcare workers, which can directly or indirectly lead to PTSD. The process of giving birth can be very traumatizing in some parts of the world, especially in government hospitals in 3rd world countries like Pakistan. Abuse during childbirth can be of any nature, ranging from physical, verbal, or emotional abuse leading up to disrespect, neglect, or coercion. According to a study conducted across the Sindh province in Pakistan, approximately 97% of women reported experiencing at least one form of disrespectful and abusive behaviour during childbirth [3]. Another study found that poorer women, those less educated on birth preparedness and postnatal care, and those who lacked social support were more vulnerable to mistreatment during childbirth [4]. All the abuse leaves the mother traumatized, which can result in severe mental health disorders, including post-traumatic stress disorder, postpartum depression, and postpartum psychosis. A scoping review concluded that women who reported at least one type of disrespect and abuse were 1.6 times more likely to experience postpartum depression [5]. This is one of the many reasons why women in Pakistan don't seek out proper maternal care. To address the issue, medical and nursing colleges should have a module on medical ethics which should focus on the importance of informed consent, respect for autonomy, and cultural sensitivity. A robust feedback system should be established to allow patients to report complaints. Public awareness campaigns should be held, and regular audits should be conducted in hospitals to find out the gaps in quality healthcare. Lastly, policies should be made to make public healthcare setups more reliable and accessible to patients.

Sergey Nikolaevich Lozhechnikov - a prominent Russian ophthalmologist and healthcare organizer

The biography and multifaceted professional activities of Sergey Nikolaevich Lozhechnikov (1838 - March 6, 1911), one of the most respected figures of the Moscow ophthalmological school and Chief Physician of the Moscow Eye Hospital, remain insufficiently explored. This report attempts to generalize scattered and extremely scarce journalistic accounts along with some discovered archival documents that shed light on the key stages of S.N. Lozhechnikov's life, as well as his contributions to the development of ophthalmology and advancement of public healthcare in Russia. The article highlights the close and historically significant connection of the Moscow Eye Hospital with the Moscow University and its medical faculty and clinical infrastructure.