Public Practice Research Articles

Public engagement with consumer sleep technology for obstructive sleep apnea screening: implications for equity, access, and practice.

To characterize public practices and perspectives on the use of consumer sleep technology (CST) and evaluate perspectives on using CST as a screening tool for obstructive sleep apnea (OSA). We designed a survey instrument incorporating content from validated instruments (STOP-BANG and the Epworth Sleepiness Scale) and hypothesis-generated questions. Survey development involved multidisciplinary collaboration among three board-certified sleep medicine experts, researchers, and consumers. The survey was disseminated across a national sample of adults living in the United States via an online platform. Among 897 respondents, the mean (SD) age was 47.5 (16.9) years; 73.1% were female, 81.8% were White, and 505 respondents (56.3%) reported having tracked sleep using CS. Factors associated with decreased odds of CST use included household income <$30,000 (OR 0.47, 95% CI 0.28-0.79; p=0.004), Medicaid insurance (OR 0.43, 95% CI 0.26-0.69; p=0.001), Medicare insurance (OR 0.59, 95% CI 0.41-0.84; p=0.004), and lack of a primary care physician (OR 0.55, 95% CI 0.33-0.91; p=0.021). Most respondents (91.1%) agreed or strongly agreed that screening for OSA would be a useful feature of CST, but respondents reporting an education of high school diploma or less (OR 0.48, 95% CI 0.29-0.79; p=0.004) were less likely to agree with this statement. Attitudes toward and use of CST differed based on demographic and socioeconomic factors. Further study is needed to understand and address barriers to CST adoption and to characterize implications for equitable access to care for sleep disorders.

Socioeconomic factors and COVID-19 mortality in immune-mediated rheumatic diseases patients: regional analysis from Argentina, Mexico and Brazil

BackgroundSARS-CoV-2 infection has become a major international issue, not only from a medical point of view, but also social, economic and political. Most of the available information comes from the United States, Europe, and China, where the population and the socioeconomic status are very different from Latin American countries. This study evaluates the effect of regional socioeconomic characteristics on mortality due SARS-CoV-2 infection in patients with immune-mediated rheumatic diseases (IMRD) from Argentina, Mexico and Brazil.MethodsData from three national registries, SAR-COVID (Argentina), CMR-COVID (Mexico) and ReumaCoV-Brasil (Brazil), were combined. Adult IMRD patients with SARS-CoV-2 infection were recruited. National data for each province/state, including population density, number of physicians per inhabitant, income, unemployment, GINI index, Municipal Human Development Index (MHDI), stringency index, vaccination rate and most frequent viral strains per period were assessed as risk factors for mortality due to COVID-19.ResultsA total of 4744 patients were included, 2534 (53.4%) from SAR-COVID, 1166 (24.6%) from CMRCOVID and 1044 (22.0%) from ReumaCoV-Brasil. Mortality due to COVID-19 was 5.4%. In the multivariable analysis, higher number of physicians per 1000 inhabitants and being infected during the vaccination period of each country were associated with lower mortality. After adjustment for socioeconomic factors, there was no association with country of residence and mortality.ConclusionThese findings corroborate the complex interplay between socioeconomic factors, rheumatic disease activity, and regional disparities as determinants of death due to COVID-19 in Argentina, Brazil and Mexico. Thus, this research provides valuable insights for guiding public health policies and clinical practice in the ongoing fight against the COVID-19 pandemic.

Publics' Expectation Toward Ethical Leadership and Ethical Corporate Social Responsibility (CSR): Evidence From the U.S. and South Korea

ABSTRACTDespite continuous academic attempts to investigate the relationship between public expectations of ethical leadership and corporate social responsibility (CSR) efforts, little research has demonstrated the subliminal process of the relationship. This study focuses on the publics' power distance perceptions as a key driver to lead individuals to prioritize CSR, mediated by the expectations of corporate ethical leadership. To further understand the mechanism and the way power distance perception influences public attitudes toward CSR operations, this study suggests a theoretical model illustrating the relationships among power distance perception, expectancy of ethical leadership, expectancy of ethical CSR, and willingness to support socially responsible companies. A cross‐national survey was conducted to provide empirical evidence from the United States (U.S.) and South Korea. Given that strategic approaches of CSR prioritize meeting public expectations toward corporate social roles, this study provides meaningful implications on public relations practice and CSR scholarship by demonstrating how public expectations of corporate ethical operations are shaped and how these expectations influence the public evaluation of corporate behaviors.

WASTEFUL GOVERNMENT SPENDING AND MARKET DISTORTION: AN EMPIRICAL ACCOUNT OF MODERN INTERVENTIONISM’S UNINTENDED CONSEQUENCES IN PUBLIC PROCUREMENT

Wasteful government spending can be seen in the Misesian tradition as a type of interventionism with unintended consequences, such as market distortion and the creation of privilege. An underlying problem that helps the distortion become a tradition is that of ‘wasteful spending cultures’. The latter reflects a hardly identifiable problem in practice, i.e. the creation of welfare losses through public administration practices that are influenced by bureaucratic inertia. The growing acceptance of the compatibility of the Austrian tradition and public policy studies allows for a better understanding of imperfect policies, their consequences, and ways to improve both the process and its result. Using data from government-driven procurement of armored cars in Colombia, this paper illustrates how the distortion of the market mechanism is affected by narrative-driven practices and how special interest groups derive rents at the expense of citizens. Using a cost-effectiveness analysis, the study identifies how a tradition is built around procuring high-end vehicles, portraying a failed central planner in the modern public administration context of a developing country.

Legal and organizational problems of development and production of innovative medicines in Russia

The article outlines the range of problems facing the Russian pharmaceutical industry as a segment of the real sector of the economy that ensures the health of the population. The necessity of an integrated approach to the formation of a model for the organization of scientific research, innovation and production activities in the designated area is substantiated; an organizational model is proposed that ensures the development and production of innovative medicines; individual legal measures aimed at increasing the effectiveness of state support for the development and production of innovative medicines (normative consolidation of the concept of an innovative drug and a scientific and technological consortium, the inclusion of scientific and educational organizations of higher education among the subjects of industrial clusters). The results of the research can be used in law-making activities and public administration practice.

Provider costs of treating opioid dependence with extended-release buprenorphine in Australia.

The costs of providing medication-assisted treatment for opioid dependence can determine its scale of provision. To provide estimates of the costs of extended-release buprenorphine (BUP-XR), we performed a bottom-up costing analysis of provider operational treatment costs. Data were collected in a single-arm open label trial of BUP-XR injections conducted in specialist public drug treatment services and primary care private practices in three Australian states (the CoLAB study). The unit costs of resources used for each activity were combined with quantities used at each participating facility to arrive at the average annual cost per client. One hundred participants across the six health facility sites received monthly subcutaneous BUP-XR injections administered by a health-care practitioner. The average cost of providing 1 year of treatment per participant was $6656 ($6026-$8326). Screening cost (initial assessment and medical history) was $282 while monthly follow-up appointments cost $531 per client. The main cost driver was the monthly treatment costs accounting for 79% of the average annual client cost, with medication costs comprising 95% of this cost. With medication costs making up the largest proportion of treatment costs, treatment using BUP-XR has the potential to free up other health system resources, for example, staff time. The costs reported in this study can be used in an economic evaluation to estimate the net benefit or cost-effectiveness of BUP-XR especially when compared to other opioid agonist treatments.

Searching for effective strategies to reach boys and young men; a mixed-methods study protocol for youth clinics in Sweden

BackgroundEfforts to engage boys and young men in sexual and reproductive health (SRH) services in Sweden remain limited, with only a small proportion accessing youth clinics, the primary providers of such services. Existing initiatives are often ad-hoc and lack institutionalization within public policy and practice. This study aims to identify feasible and effective interventions to improve boys’ and young men’s access to youth clinics in Sweden.MethodsEmploying a mixed-methods approach, this study investigates interventions, strategies, and factors influencing access to SRH services for boys and young men in Sweden. Firstly, a systematic literature review will be conducted to identify evaluated interventions globally. Secondly, strategies to attracts boys and young men in youth clinics in Sweden will be mapped. Thirdly, case studies in two regions in Sweden – chosen for their demographic and geographic diversity – will be conducted interviewing healthcare providers, managers, policymakers, and boys and young men. Lastly, Q-methodology will be used to rank all identified strategies. Healthcare providers and managers will rank these strategies based on their perceived effectiveness and feasibility while boys and young men will rank the interventions based on perceived effectiveness.DiscussionThe added value of this project is generating robust evidence regarding boys and young men’s involvement in SRH services, especially their access to youth clinics. This is crucial for (1) developing gender-sensitive services and service delivery models that effectively promote young men’s SRH; (2) informing future young men’s health policies ensuring that their unique SRH concerns are addressed; and (3) improving young men’s participation in SRH provision. This will ultimately foster a culture of shared responsibilities and advance gender equality.

Unhealthy Eating Habits and Determinants of Diet Quality in Primary Healthcare Professionals in Poland: A Cross-Sectional Study

Background/Objectives: The aim of this work was to understand the factors influencing the prevalence of dietary behaviors, as well as determinants of unhealthy eating and diet quality among primary care physicians and nurses in Poland. Methods: A cross-sectional study involving 161 doctors and 331 nurses was conducted in the years 2020–2022 in primary healthcare settings. Results: Unhealthy eating habits affected GPs aged 40–54 years (42.9%), females (64.3%), those of normal body weight (67.9%), representing private medical practice (67.9%), who had over 20 years of work experience (42.8%). Similarly, among the group of nurses, unhealthy eating habits were reported in subjects aged 40–54 (46.5%), individuals with normal body weights (49.5%), those with one chronic disease (38.4%), representing public medical practice (63.6%), with over 20 years of work experience (40.4%), seeing ≤100 patients during the work week (84.8%). The univariable logistic regression analyses for unhealthy dietary habits showed that overweight GPs had lower odds of unhealthy eating habits (OR = 0.35; 95% CI: 0.11–1.08; p &lt; 0.05). Among the nurses, the odds of unhealthy eating habits increased with the number of years of work. Nurses with 10–20 years of work experience had 1.23 times greater odds of unhealthy eating habits, while people working for more than 20 years had 1.81 times greater odds of unhealthy eating habits than individuals working for a period shorter than ten years (OR = 1.23; 95% CI: 0.68–2.23; p &gt; 0.05 vs. OR = 1.81; 95% CI: p &lt; 0.05). The multivariable logistic regression analysis did not show statistically significant results. Conclusions: These issues should be addressed when planning educational activities aimed at supporting healthcare professionals in implementing lifestyle changes.

“Giving them the best information I could with whatever I had at hand”. Physicians' online health communication practices in a post-normal science context

This study describes US-based physicians' online public communication practices, particularly on the social media platform Twitter/X, during the COVID-19 pandemic. We draw on 28 semi-structured interviews to examine how they responded to the unique COVID-19 context with respect to each of the four features of post-normal science (PNS): facts uncertain, values in dispute, stakes high, and decisions urgent. Our analysis reveals that the pandemic shifted what, why, and how physicians used the platform, and with whom they aimed to communicate. We discuss the implications of these changes in their online communication habits, discourses, and representations around social media as a reaction to the context of PNS brought about by the pandemic.

Poor registration and publication practices in clinical trials of targeted therapeutics for endocrine and metabolic diseases: an observational study

ObjectiveTo assess the completeness and concordance of reporting in registries and corresponding publications of interventional trials on targeted therapeutics for endocrine and metabolic disorders. Study Design and SettingWe searched clinical trial registries in September 2022 for completed interventional trials of target therapeutics for endocrine and metabolic disorders registered from 2005 onwards. We used ClinicalTrials.gov and the World Health Organization International Clinical Trial Registration Platform (WHO ICTRP) registration requirements to extract data and assess the completeness of initial entry and final updates to trial registration and concordance with their published journal articles. ResultsAmong 149 clinical trials included, 121 (81%) had corresponding publications. Missing mandatory registration data items were identified in 88 (67%) trials at the initial registration, 17 (13%) at the last registration, and in 85 (77%) corresponding publications. All trials showed changes between initial registration and final registration update, and 98% showed changes from the initial registration to publication. Changes between initial registration and final update were most common in the categories ‘Completion date’ (92%), ‘Key secondary outcomes’ (82%), and ‘Date of first enrolment’ (70%). Changes between initial registration and publication were most common in categories ‘Sample size’ (91%), ‘Key inclusion and exclusion criteria’ (81%), ‘Key secondary outcomes’ (84%), and ‘Completion date’ (83%). ConclusionDespite the legal and journal registration requirements, the completeness and consistency of reporting mandatory data items in registries and corresponding publications regarding targeted therapeutics for endocrine and metabolic disorders are inadequate. Our findings raise questions about the integrity and reliability of clinical trials focusing on targeted therapeutics.

RETRACTION: Oncologic, Fertility, and Obstetric Outcomes With MPA Therapy in Women with Endometrial Cancer and Atypical Endometrial Hyperplasia.

A. Takeda , Y. Yamamoto , K. Tamura , H. Aoki , H. Noguchi , S. Minato , S. Kamada , R. Arakaki , T. Kaji , and T. Iwasa , "Oncologic, Fertility, and Obstetric Outcomes With MPA Therapy in Women with Endometrial Cancer and Atypical Endometrial Hyperplasia," The Journal of Obstetrics and Gynaecology Research 50, no. 4 (2024): 633-638, https://doi.org/10.1111/jog.15872. The above article, published online on 28 December 2023 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors; the journal Editor-in-Chief, Hiroaki Kajiyama; and John Wiley & Sons, Australia, Ltd. The retraction has been agreed upon following an investigation into concerns raised by a third party, which revealed major conceptual overlap and significant primary data redundancy with a previously published article by an overlapping group of authors. Such publishing practice is against the journal's policy and Wiley's Best Practice Guidelines on Research Integrity and Publishing Ethics.

Collaboration for Lead Poisoning Prevention in Puerto Rico.

In 2010, Puerto Rico experienced a cluster of childhood lead poisoning cases stemming from parental occupational exposure to lead. Following the immediate response to this crisis, a dedicated coalition of pediatricians and public health practitioners sustained a collaborative effort to advance pediatric environmental health initiatives across Puerto Rico. Their commitment laid the groundwork for the establishment and evolution of Puerto Rico's comprehensive Childhood Lead Poisoning Prevention and Blood Lead Level Surveillance Program. This compelling case study showcases the potential for concerted, multidisciplinary action to leverage an acute event to influence public policy and clinical practice to promote children's health. By drawing on the lessons learned and strategies used in Puerto Rico, other jurisdictions can overcome challenges in pursuit of enhanced secondary lead poisoning prevention measures, with the goal of achieving primary prevention in the near future.

Stigmatizing attitudes and beliefs about obesity among dental team members.

Weight stigma is prevalent within healthcare settings and is an aspect of the lived experience of people living with obesity. There is international evidence of weight stigma in the dental setting, where currently there is also evidence indicating limited training amongst dental professionals regarding obesity or obesity-related stigma. There has been Australian research and none have included dental support staff. This cross-sectional survey aimed to assess stigmatizing attitudes and beliefs of dental professionals (registered general dentists, oral health therapists) and support staff (dental assistants, dental receptionists) working in private and public regional practices in New South Wales and specialists in Special Needs Dentistry across Australia toward people living with obesity. An anonymous electronic validated survey was administered through REDCap™ to assess stigmatizing attitudes and beliefs held amongst respondents in relation to people living with obesity. Fifty-three participants completed the survey (n=33 clinicians, n=20 support staff). The majority 47/53 (88.7%) held positive attitudes toward people living with obesity. Of the clinicians, 15/33 (45.5%) reported 1hour or less and 14/33 (42.4%) reported two to 5hours of obesity-related education. 14/20 (70%) of the support staff reported no prior education or training about obesity. Of responses reflecting weight stigma, only three clinicians reported negative reactions toward the appearance, or discomfort during examination, of a patient with obesity, or a perception of laziness, compared with normal weight individuals. A higher proportion 4/20 (20%) of support staff reported responses indicating negative attitudes for people with obesity compared with normal weight individuals. Survey responses reflected evidence of weight stigma in both dental professionals and support staff. Professional development targeting weight stigma reduction in the dental setting is needed for both clinicians and support staff.

Discursive AI Infrastructures: Envisioned and Overlooked Museum Futures

ABSTRACTPrompted by recent innovations, artificial intelligence (AI) is increasingly being discussed across the museum sector regarding its implications for institutional roles and practices. However, AI in particular, is an ambiguous term, a ‘black box’ which is capable of containing and reflecting numerous values and ideals (Crawford, 2021). This paper positions discourse around AI as a ‘discursive’ infrastructure, capable of not only embodying ideals but also shaping and justifying certain institutional practices and roles. This paper thematically analyses 115 pieces of grey literature produced and shared by professional governance bodies in the museum sector from 1995–2023, mainly across Canada, the United Kingdom, and the United States. In doing so, it identifies four preliminary themes encompassing shifts in discourse over time which give shape to a contemporary discursive infrastructure. This prompts timely critical reflections of museum professionals and stakeholders on both imagined and overlooked public roles, responsibilities, and practices of the museum in relation to AI.

Understanding the public knowledge, attitude, and practice toward screening and risk factors of lung cancer in Saudi Arabia: A cross-sectional study

Understanding the public knowledge, attitude, and practice toward screening and risk factors of lung cancer in Saudi Arabia: A cross-sectional study

Corruption in unlikely places

Corruption, defined as the “misuse of public position for private gain”, represents an act of deviance from official duties in the interest of self-enrichment. Denmark is ranked as one of the least corrupt countries in the world. Danish court records, however, show that corruption cases have appeared in the 21st century. Using Luhmann’s systems theory and Foucault’s method of genealogy, this article asks how this has happened. I argue that understanding corruption in Denmark may go back to changes in public administration ideas and practices since the 1990. New Public Management reform has increased the complexity in public administration where meaning horizons of communication related to different functional systems – especially the sub-systems of law and economy – clashes. I theorise and illustrate using court cases how the coexistence of different codes creates an environment for public employees that in some circumstances – however still rare – result in corruption.

The merging of knowledge? Lived experience of poverty and its place in public debate

This article reflects on the recent ‘turn to lived experience’ within academia and the third sector in the UK and discusses some issues arising. It then focuses on ways in which these issues might be addressed – including through a methodology employed by ATD Fourth World, an international human rights-based anti-poverty organisation founded after the Second World War that works in partnership with people affected by poverty. ATD developed the ‘merging of knowledge and practice’ to bring together different kinds of expertise, including that acquired from lived experience, to create a richer form of knowledge and better-informed practice. The article discusses this method and suggests various ways in which the lived experience of poverty can be embedded in public debate, policy and practice. People with experience of poverty can be involved in examining and conveying the many dimensions of that experience; providing training for officials dealing with people in poverty; and designing and evaluating relevant policies.

The Scientific Reference Model—A Methodological Approach in the Hypothetical 3D Reconstruction of Art and Architecture

Scientific practice relies on the rigorous documentation of procedures, methods, and outcomes, governed by principles like method verification, objectivity, and source disclosure. In the computer-based hypothetical 3D reconstruction of destroyed or never realised art and architecture, adhering to these principles faces challenges due to evolving software, methods, and data types, leading to a lack of standardised documentation and publication practices for 3D models. Consequently, the traceability, accessibility, and sustainability of research outcomes are compromised. Decades after the advent of computer-aided 3D visualisation in cultural heritage, there is a critical need to define applicable methodology and comprehensive documentation standards. Web-based platforms necessitate technical infrastructures and clear scientific methodologies to ensure understandable model creation and sustainable accessibility to 3D research data. The Scientific Reference Model proposes an accessible academic framework for this kind of 3D reconstruction, aiming to facilitate broad adoption. Developed and tested in research projects and educational contexts, this model aims to establish clear, accessible 3D models on the web, serving as foundational references for future research and knowledge dissemination.

The Impact of 24 h Urinary Potassium Excretion on High-Density Lipoprotein Cholesterol and Chronic Disease Risk in Chinese Adults: A Health Promotion Study.

Research into the pivotal role of potassium in chronic diseases and their comorbidities remains scarce. Our aim is to elucidate the relationship between potassium and chronic diseases, including comorbid conditions, and to provide evidence-based recommendations for potassium intake in patients. This study is anchored in a representative, population-based survey conducted in Zhejiang Province, China, in 2017, encompassing participants aged 18 to 69 years. Data collection included questionnaire responses, physical measurements, and biological samples, obtained through a multistage cluster random sampling method. A subset of 1496 participants provided complete 24 h urine samples. The median age of the participants was 48.0 years (interquartile range [IQR] 24.0), with 51.1% being female, and hypertension was identified in more than one third (35.6%) of the participants. The prevalence of diabetes was approximately 9.0%, dyslipidemia was found in 34.2%, and microalbuminuria in 8.8%. The 24 h urinary excretion levels were 3613.3 mg/24 h (IQR 2161.7) for sodium and 1366.0 mg/24 h (IQR 824.9) for potassium, respectively. Potassium excretion exhibited an inverse relationship with blood pressure. Furthermore, a positive correlation was observed between potassium excretion and high-density lipoprotein cholesterol (HDL-C) levels, with an elevation of 0.03 mmol/L (95% confidence interval [CI] 0.00 to 0.05). In binary logistic regression analysis, individuals in the fourth quartile of potassium excretion (Q4) exhibited an odds ratio (OR) of 0.56 (95% CI 0.36-0.87) for hypertension compared to those in the first quartile (Q1). Urinary potassium excretion was inversely associated with low HDL-C levels, with Q4 individuals having 0.62 times the odds of having low HDL-C levels (OR, 0.62; 95% CI 0.39-1.00) compared to Q1. Potassium excretion demonstrated a direct negative correlation with certain comorbidities. This study underscores the pivotal role of potassium in the management of chronic diseases and associated comorbidities, thereby highlighting the significance of potassium in both public health initiatives and clinical practice.

Three Shanghai General Meetings and Catholic Publishing in the First Half of the Twentieth Century

The Catholic publishing undertaking in China experienced significant growth in the first half of the twentieth century, both in the scale and in the form of organization. This effort’s importance is twofold: for the Church in China back then, publications facilitated communications both inside and outside the Church; for researchers today, these files contain a vast amount of information on Catholic life, valuable for the enrichment of historical understanding. This paper uncovers the internal driving mechanism of this process through three Shanghai general meetings: the Plenary Council in 1924, the All-China General Congress of Catholic Action in 1935 and the Catholic Press Convention in 1947. The co-ordination fostered by these meetings generated resilience and efficiency for publishing activities allowing them to be sustained and to prosper during an unsettling period. The Council heralded cross-congregational and cross-national co-operation by standardizing publishing practices and forming designated central organizations. Inheriting these guidelines, Catholic journalist delegates of the Catholic Action Congress in 1935 gathered to discuss practical methods, leading to a proliferation of Catholic publications. Despite setbacks during the Sino-Japanese War, Catholic publishing quickly resumed following the Press Convention held in 1947, which reinforced collaboration regardless of affiliations through a central organization. The three general meetings not only showcase the historical trajectory of Catholic publishing, but also the constant endeavor to bridge gaps between communities.