Public Health Service Research Articles

Maternal anaemia prevention and control in China: A policy review.

Maternal anaemia is a major public health problem. Developing maternal anaemia prevention and control policies is an important prerequisite for carrying out evidence-based interventions. This articlereviews maternal anaemia prevention and control policies in China, identifies gaps, and provides references for other countries. We examined policies concerning maternal nutrition and other related literature in China, identified through key databases and government websites, and conducted a narrative review of the relevant documentations guided by the Smith Policy-Implementing-Process framework. A total of 65 articles and documents were identified for analysis. We found that Chinese government has committed to reducing maternal anaemia at the policy level, with established objectives and a clear time frame. However, most of policies were not accompanied by operational guidelines, standardized interventions, and vigorous monitoring and evaluation mechanisms, and 85% of the policies don't have quantifiable objectives on anaemia. Maternal anaemia prevention and control services offered in clinical settings were primarily nutrition education and anaemia screening. Population-based interventions such as iron fortification have yet to be scaled up. Furthermore, medical insurance schemes in some regions do not cover anaemia prevention and treatment, and in other regions that offer coverage, the reimbursement rate is low. The number and capacity of health professionals is also limited. Policy changes should focus on the integration of evidence-based interventions into routine antenatal care services and public health service packages, standardization of dosages and provision of iron supplementation, streamline of reimbursement for outpatient expenses, and capacity building of health professionals.

Clinical outcomes of self-glazed zirconia veneers produced by 3D gel deposition: a retrospective study.

Self-glazed zirconia (SZ) restorations are made by a novel additive three-dimensional gel deposition approach, which are suitable for a straightforward completely digital workflow. SZ has recently been used as minimally invasive veneer, but its clinical outcomes have not been clarified yet. This study aimed to evaluate the preliminary clinical outcomes of SZ veneers compared with the widely used lithium disilicate glass-ceramic veneers made by either pressing (PG) or milling (MG) process. Fifty-six patients treated with SZ, PG, and MG veneers by 2 specialists between June 2018 and October 2022 were identified. Patients were recalled for follow-up at least 1 year after restoration. Clinical outcomes were assessed by 2 independent evaluators according to the modified United States Public Health Service (USPHS) criteria. Overall patient satisfaction was assessed using visual analogue scale (VAS), and analyzed by one-way ANOVA. Chi-square test was applied to compare the difference in the success and survival rates among the 3 groups. A total of 51 patients restored with 45 SZ, 40 PG, and 41 MG veneers completed the study, with a patient dropout rate of 8.9%. Mean and standard deviation of follow-up period was 35.0 ± 14.7months. All restorations performed well at baseline,except for 2 SZ veneers with mismatched color (rated Bravo). During follow-up, marginal discrepancy (rated Bravo) was found in 4 MG veneers and 1 PG veneer, and partially fractured (rated Charlie) was found in another 2 PG veneers. The survival rate of SZ, PG, and MG veneers was 100%, 95%, and 100%, with a success rate of 95.56%, 92.50%, and 90.24%, respectively, none of which were significantly different (p = 0.099 and 0.628, respectively). The mean VAS score of SZ, PG, and MG was 95.00 ± 1.57, 93.93 ± 2.40, and 94.89 ± 2.00 respectively, without significant difference (p > 0.05). SZ veneers exhibited comparable preliminary clinical outcomes to PG and MG veneers, which could be considered as a feasible option for minimally invasive restorative treatment.

Aspects of public health development in China's western region.

The public health level in a country is closely related to national development and quality of life. In order to appraise the level of health services in the western region of China, panel data of 124 prefecture-level units covering the period 2011 to 2021 was used together with a health evaluation index system based on four dimensions: quality of life, environmental situation, the level of health services and longevity. To assess this, we used entropy weights, standard deviation and coefficient of variation together with the geographical detector model that measures the stratified spatial heterogeneity. The results show that although public health services have improved overall, the various dimensions are still not balanced as longevity did not match up everywhere. While the developmental level of the various health dimensions presents a pattern of a relatively smooth increasing gradient in the west-central- east direction, the situation with respect to the north-centralsouth is more uneven with both ups and downs. However, a trend of continuous enhancement of all health dimensions was found with a significant positive correlation of spatial clustering, with hotspots and 'sub-hotspots' contracting from north to south, while coldspots and 'sub-coldspots' expanded from west to east. This can be seen as the result of multiple factors, with the level of urbanization and economic level as the dominant factors and government guidance, agglomeration capacity and industrial structure being auxiliary.

A Summary Prospecting of Possibilities of Providing Public Health Services at the Level of North-East Region of Romania

This paper investigates issues related to the public health system in the North-East Region of Romania, focusing on possibilities for addressing/improving specific deficiencies/difficulties. The concerned region is characterized by the highest and densest population in the country, with a significant proportion of residents in rural areas (55%) and a high level of poverty. Population health indicators are among the weakest nationally, and the healthcare infrastructure is inadequate for the population's needs, with an uneven distribution that generates significant inequalities in access to medical services in the respective counties. Starting from the (statistical) certainty that Romania ranks among EU member states with the highest avoidable mortality, the paper addresses both preventable causes through public health interventions and treatable causes through quality care. After a brief introduction, the overall state of the public health system in Romania is examined, followed by a detailed analysis of the main issue stated in the title, highlighting multiple critical aspects based on data and information from official reports of prestigious institutions. Special attention is given to specific issues in local communities related to healthcare infrastructure and the provision of medical services, as well as possible solutions offered through the implementation of the General Regional Health Services Plan 2021-2027 in the North-East Region. The paper concludes with a section of conclusions, which includes perspectives on the future development of the analyzed sector.

Migration process of Venezuelan women to Brazil: living conditions and use of health services in Manaus and Boa Vista, 2018-2021.

The last decade saw the emergence of a new significant migration corridor due to the mass migration of Venezuelans to neighboring countries in South America. Since 2018, Brazil became the third host country of Venezuelan displaced populations. Little is known about how migratory processes affect needs, access to social programs, and public health services of migrant women. The goal of this study is to shed light on the socio-economic profile, living conditions, and use of health services of Venezuelan migrant women in two main reception cities in Brazil. A survey was conducted using respondent-driven sampling (RDS) in the cities of Boa Vista (Roraima), and Manaus (Amazonas). The study included 2012 Venezuelan migrant women aged between 15 and 49 years old who migrated from Venezuela to Brazil between 2018 and 2021. Relative prevalence was calculated, and the χ2 test was used to analyse the homogeneity of proportions. All analyses considered the complex sampling. The main reasons for migrating relate to difficulties obtaining food (54%) and accessing health services (37.8%) in their country of origin. They were young and mixed race (65.7%) and had high school education (69.9%). In Manaus, 3.7% of the interviewees declared that they had no family income in the last month, while in Boa Vista, it was higher (66.2%) (p-value < 0.001). Almost one-third of them sought health care in the last 15 days, and 95% of them received care. The residents of Boa Vista arrived more recently and family income and access to paid work improved with time of residence in Brazil. Given the increasing flow of Venezuelan migrants crossing to Brazil, a reception system was established for the provision of food, shelter, access to health services, and income transfer programs to migrants. This was the case despite high unemployment and poverty levels and income inequality, particularly in the city of Boa Vista. However, the majority had legal migrant status and had access to the public and universal healthcare system in Brazil (SUS). The use of the SUS was similar in both cities, acting as a buffer for the differences in opportunities offered.

Experiences and lessons from using digital technology for noncommunicable disease services during the COVID-19 pandemic in the Eastern Mediterranean Region

Background: Harnessing digital technology for health service provision is inevitable, especially after the dramatic increase in demand during the COVID-19 pandemic and the observed global disruption of health services especially for People Living with Noncommunicable Diseases (PLWNCDs). Aims: To document and share experiences, challenges and lessons learned from the use of digital health interventions (DHIs) for noncommunicable disease (NCD) service delivery during the COVID-19 pandemic in the Eastern Mediterranean Region (EMR). Methods: We conducted a documentary research on the use of DHIs for continuity of NCD services during the COVID-19 pandemic in EMR. We collected our data using a questionnaire that was developed and administered by email to WHO NCD focal persons at the ministries of health of all EMR countries. Using the WHO classification of DHIs we then mapped the various interventions and the stakeholders involved. Results: Seven countries – Islamic Republic of Iran, Jordan, Oman, Qatar, Saudi Arabia, Sudan, and United Arab Emirates – shared their documentations. Documented DHIs used by countries to overcome the disruption of services during the pandemic were mostly on the use of client-to-provider telemedicine for NCD services. The level of implementation varied between countries. NCD and mental health helplines and COVID-19 prevention awareness campaigns for PLWNCDs were the most mentioned interventions. Conclusions: DHIs for NCD service provision were implemented during the COVID-19 pandemic in all settings: highmiddle- and low-income countries in the EMR. There is a high potential for incorporating DHIs within health systems to increase access to health services beyond the pandemic. Documentation, regulation and national capacity-building for mainstreaming DHIs in public health services in the EMR are strongly encouraged, based on each country’s needs.

Insulin regulation of regional lipolysis in upper-body obese and lean humans.

Upper body obesity (UBO) results in insulin resistance with regards to free fatty acid (FFA) release; how this differs by fat depot and sex between UBO and lean adults is unknown. We tested the hypothesis that insulin suppression of FFA release from the splanchnic bed, leg fat and upper body non-splanchnic (UBNS) adipose tissue would be impaired in UBO. Fourteen UBO (7 men, 7 women) and 14 healthy, normal weight (7 men, 7 women) volunteers participated in studies that included femoral artery, femoral vein and hepatic vein catheterization. We then measured leg and splanchnic plasma flow as well as FFA kinetics (using isotopic tracers) under overnight fasting, low- and high-dose insulin infusion using the insulin clamp technique. We found the expected insulin resistance in UBO; the most quantitatively important difference between UBO and lean adults was greater FFA release from UBNS adipose tissue when plasma insulin concentrations are in the post-prandial, physiological range. There were obesity, but not sex differences in the regulation of splanchnic FFA release and sex differences in the regulation of leg FFA release. Reversing the defects in insulin-regulated UBNS adipose tissue FFA release would have the greatest impact on systemic FFA abnormalities in UBO. (not applicable)Funding: These studies were supported by grants DK45343 and DK40484 from the U.S. Public Health Service, and the Novo Nordic Foundation (grant numbers NNF18OC0031804 and NNF16OC0021406) and the Independent Research Fund Denmark (grant number 8020-00420B).

Patients' Experiences With Digitalization in the Health Care System: Qualitative Interview Study.

The digitalization of public and health sectors worldwide is fundamentally changing health systems. With the implementation of digital health services in health institutions, a focus on digital health literacy and the use of digital health services have become more evident. In Denmark, public institutions use digital tools for different purposes, aiming to create a universal public digital sector for everyone. However, this digitalization risks reducing equity in health and further marginalizing citizens who are disadvantaged. Therefore, more knowledge is needed regarding patients' digital practices and experiences with digital health services. This study aims to examine digital practices and experiences with public digital health services and digital tools from the perspective of patients in the neurology field and address the following research questions: (1) How do patients use digital services and digital tools? (2) How do they experience them? We used a qualitative design with a hermeneutic approach. We conducted 31 semistructured interviews with patients who were hospitalized or formerly hospitalized at the department of neurology in a hospital in Denmark. The interviews were audio recorded and subsequently transcribed. The text from each transcribed interview was analyzed using manifest content analysis. The analysis provided insights into 4 different categories regarding digital practices and experiences of using digital tools and services in health care systems: social resources as a digital lifeline, possessing the necessary capabilities, big feelings as facilitators or barriers, and life without digital tools. Our findings show that digital tools were experienced differently, and specific conditions were important for the possibility of engaging in digital practices, including having access to social resources; possessing physical, cognitive, and communicative capabilities; and feeling motivated, secure, and comfortable. These prerequisites were necessary for participants to have positive experiences using digital tools in the health care system. Those who did not have these prerequisites experienced challenges and, in some cases, felt left out. Experiences with digital practices and digital health services are complex and multifaceted. Engagement in digital practices for the examined population requires access to continuous assistance from their social network. If patients do not meet requirements, digital health services can be experienced as exclusionary and a source of concern. Physical, cognitive, and communicative difficulties might make it impossible to use digital tools or create more challenges. To ensure that digitalization does not create inequities in health, it is necessary for developers and institutions to be aware of the differences in digital health literacy, focus on simplifying communication with patients and next of kin, and find flexible solutions for citizens who are disadvantaged.

Two-year clinical and radiographic evaluation of ACTIVA BioACTIVE versus Compomer (Dyract® eXtra) in the restoration of class-2 cavities of primary molars: a non-inferior split-mouth randomised clinical trial

ObjectivesThe trial aimed to compare the clinical performance and radiographic success of ACTIVA BioACTIVE versus Compomer in restoring class-II cavities of primary molars.Materials and methodsA non-inferior split-mouth design was considered. A pre-calculated sample size of 96 molars (48 per group) with class-2 cavities of twenty-one children whose ages ranged from 5 to 10 years were randomly included in the trial. Pre-operative Plaque Index (PI), DMFT/dmft scores and the time required to fill the cavity were recorded. Over 24 months, the teeth were clinically evaluated every six months and radiographically every 12 months by two calibrated and blinded evaluators using the United States public health service (USPHS)-Ryge criteria. The two-sided 95% confidence interval (CI) for the difference in success rate was considered to assess non-inferiority, and the margin was set at -18%. The linear mixed model and Firth’s logistic regression model were used for data analysis (P < 0.05).ResultsAfter 24 months, 86 teeth (43 per group) were evaluated. The mean PI score was 1.1(± 0.9), while DMFT/dmft was 0.35 (± 0.74) and 6.55 (± 2.25) respectively. The clinical and radiographic success rate of Dyract vs. ACTIVA was 95.3% and 88.3% vs. 93% and 86%, respectively. The two-sided 95% CI for the difference in success rate (-2.3%) was − 3.2 to 1.3% and didn’t reach the predetermined margin of -18% which had been anticipated as the non-inferiority margin. Clinically, ACTIVA had a significantly better colour match (P = 0.002) but worse marginal discolouration (P = 0.0143). There were no significant differences regarding other clinical or radiographic criteria (P > 0.05). ACTIVA took significantly less placement time than Dyract, with a mean difference of 2.37 (± 0.63) minutes (P < 0.001).ConclusionThe performance of ACTIVA was not inferior to Dyract and both materials had a comparable high clinical and radiographic performance in children with high-caries experience. ACTIVA had a significantly better colour match but more marginal discolouration. It took significantly less time to be placed in the oral cavity.Trial registrationThe study was registered at ClinicalTrials.gov on 4 May 2018 (#NCT03516838).

Comparing modified USPHS and FDI criteria for the assessment of glass ionomer restorations in primary molars utilising clinical and photographic evaluation.

To compare the applicability of modified US Public Health Service (USPHS) and FDI criteria for evaluating glass ionomer cement (GIC) restorations in primary posterior teeth through digital image analysis. This comparative analytic study was conducted at the Children's Dental Clinic RSKGM FKG UI, involving 40 GIC restorations on lower first primary molars in children aged 4-9years. After cleaning, the restorations were assessed clinically using modified USPHS and FDI criteria before taking digital images, then the collected images were re-evaluated using both sets of criteria, and the clinical assessment results were compared to the digital image assessment results. Statistical analysis revealed significant differences between the clinical evaluation of GIC restorations in primary teeth and their corresponding digital photographs when using the modified USPHS criteria, and although the use of FDI criteria yielded different results, these differences were not statistically significant. The assessment of GIC restorations through digital images aligns more closely with clinical assessments using the FDI criteria compared to the modified USPHS criteria.

The leave gap: actual versus optimal maternity leave in a sample of US breastfeeding women

ABSTRACT Access to quality parental leave is a prominent US work-family issue and crucial for supporting maternal and child health, including breastfeeding outcomes. This is even more salient given the recently updated US public health recommendation to breastfeed for up to two-plus years. Yet little prior research on work-breastfeeding conflict, has addressed breastfeeding women’s perceptions of maternity leave. How much leave do breastfeeding women want relative to what they receive? What shapes their optimal leave perceptions? Using in-depth interview data, we first examined the leave gap between optimal and actual leave duration. Most interviewees reported a leave deficit, averaging 20 weeks. We then examined perceptions of optimal leave – identifying four themes: (1) making comparisons, (2) role transition and adjustment, (3) the developing child, and (4) return-readiness. Overall, we argue that it is important to consider ideal leave and the leave gap, which may produce further strain for breastfeeding employees.

Association of healthy lifestyle score with control of hypertension among treated and untreated hypertensive patients: a large cross-sectional study.

Hypertension stands as the leading single contributor to the worldwide burden of mortality and disability. Limited evidence exists regarding the association between the combined healthy lifestyle score (HLS) and hypertension control in both treated and untreated hypertensive individuals. Therefore, we aimed to investigate the association between HLS and hypertension control among adults with treated and untreated hypertension. This cross-sectional study, including 311,994 hypertension patients, was conducted in Guangzhou using data from the National Basic Public Health Services Projects in China. The HLS was defined based on five low-risk lifestyle factors: healthy dietary habits, active physical activity, normal body mass index, never smoking, and no alcohol consumption. Controlled blood pressure was defined as systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg. A multivariable logistic regression model was used to assess the association between HLS and hypertension control after adjusting for various confounders. The HLS demonstrated an inverse association with hypertension control among hypertensive patients. In comparison to the low HLS group (scored 0-2), the adjusted odds ratios (95% confidence intervals) for hypertension were 0.76 (0.74, 0.78), 0.59 (0.57, 0.60), and 0.48 (0.46, 0.49) for the HLS groups scoring 3, 4, and 5, respectively (Ptrend < 0.001). Notably, an interaction was observed between HLS and antihypertensive medication in relation to hypertension control (Pinteraction < 0.001). When comparing the highest HLS (scored 5) with the lowest HLS (scored 0-2), adjusted odds ratios (95% confidence intervals) were 0.50 (0.48, 0.52, Ptrend < 0.001) among individuals who self-reported using antihypertensive medication and 0.41 (0.38, 0.44, Ptrend < 0.001) among those not using such medication. Hypertensive patients adhering to a healthy lifestyle without medication exhibited better blood pressure management than those using medication while following a healthy lifestyle. HLS was associated with a reduced risk of uncontrolled blood pressure.

Estimating the Cost of the COVID-19 Response for Local Health Departments: Evidence From Ohio.

This study assessed the staffing allocations and associated costs incurred by Ohio local health departments (LHDs) in response to the challenges posed by the COVID-19 pandemic. Data were extracted from the annual financial reports of Ohio LHDs for 2020 and 2021, encompassing a sample of 38 LHDs in 2020 and 60 LHDs in 2021. Descriptive analysis showed that Ohio LHDs committed substantial resources to responding to the COVID-19 pandemic. Although there was considerable variability across LHDs, median staffing and compensation collectively constituted 22% of total staffing and compensation. Multivariate regression analysis found minimal associations between the examined agency and community-level variables and the differences in staffing allocations and associated costs incurred by LHDs in response to the COVID-19 pandemic. After decades of underfunding and understaffing, securing sustainable funding will be crucial to equip LHDs across the country with the necessary resources to deliver comprehensive public health services in their communities.

Plasma ADAM10 Levels and their Association with Alzheimer's Disease Diagnosis in Older Adults with Fewer Years of Formal Education.

Low educational attainment is a potential risk factor for Alzheimer's disease (AD) development. Alpha-secretase ADAM10 plays a central role in AD pathology, attenuating the formation of beta-amyloid peptides and, therefore, their aggregation into senile plaques. This study seeks to investigate ADAM10 as a blood-based biomarker in mild cognitive impairment (MCI) and AD in a diverse group of community-dwelling older adults, focusing on those with limited educational attainment. Participants were recruited from public health services. Cognition was evaluated using MMSE and ACE-R batteries. Blood samples were collected to analyze plasma ADAM10 levels. A logistic regression was conducted to verify the influence of plasma ADAM10 on the AD diagnosis. Significant differences in age, years of education, prescribed medications, and cognitive test scores were found between the MCI and AD groups. Regarding cognitive performance, both ACE-R and MMSE scores displayed significant differences between groups, with post-hoc analyses highlighting these distinctions, particularly between AD and cognitively healthy individuals. Elevated plasma ADAM10 levels were associated with a 4.5-fold increase in the likelihood of a diagnosis of MCI and a 5.9-fold increase in the likelihood of a diagnosis of AD. These findings suggest that ADAM10 levels in plasma serve as a valuable biomarker for assessing cognitive status in older individuals with low education attainment. This study underscores the potential utility of plasma ADAM10 levels as a blood-based biomarker for cognitive status, especially in individuals with low educational backgrounds, shedding light on their relevance in AD development and diagnosis.

ESDM intervention in severe preschool autism: an Italian Case report, psychological and social medicine reflections

Background The goal of our contribution is to discuss a preschool intervention based on the Early Start Denver Model and the use of the main tools for the detection of adaptive behaviour in cases of autism: Vineland, ABAS. Case presentation: the work is the presentation of a clinical case that has benefited from an intervention with the Early Start Denver Model methodology for the benefit of a child with socio-cultural and economic disadvantages. This early intervention, in a child of 36 months, which followed the diagnosis, was possible thanks to the intervention of many third-sector organizations which allowed this child, with a serious autism profile, to receive an evidence-based intervention for free. At the beginning of the intervention, the child presented a diagnosis of severe autism with absence of gaze, vocalizations and other communicative impairments. The level of motor clumsiness was also quite high, as were stereotypies. Conclusions: Research has shown the usefulness of intervening in this area with an early assessment and/or diagnosis and immediate intervention; however, public health services are not always able to maintain this pace. Our contribution therefore shows on the one hand the evidence of the improvements achieved by the child despite the low intensity of the treatment, and on the other hand, demonstrates the total versatility and adaptability of the Denver Model to the Italian context. In our conclusions, there are also some reflections on the tools used to measure adaptive behavior which seem to have a number of limitations and criticalities.

Changes in mentalization in patients with personality disorders during sequential brief-Adlerian psychodynamic psychotherapy: The role of therapists' technique and countertransference.

The aim of the present work was to study the relationship between therapists' technique, therapists' CT, and patients' mentalization, in a sample of patients with PDs undergoing a 40-session program of sequential brief-adlerian psychodynamic psychotherapy, a psychodynamic therapeutic model specifically developed for the treatment of PDs in public mental health services. Eighty-seven patients with PD and their therapists completed ratings of mentalization (mentalization imbalances scale and reflective functioning questionnaire), CT (therapist response questionnaire), and therapists' intervention (comparative psychotherapy process scale) at five different time points (Sessions 5, 10, 20, 30, and 40). Results showed that patients' mentalizing problematics decreased over time. Moreover, we found a reduction of therapists' disengaged CT, and an increase in positive CT over time. Regarding therapists' techniques, psychodynamic-interpersonal interventions were on average higher than cognitive-behavioral, but both techniques were used increasingly over time. Our results also showed significant and clinically coherent interactions between therapist's CT and techniques and between patient's mentalization imbalance and therapist's response. Our results highlighted the importance of early stages in therapy, since the most significant relationships between the various process variables (patient's mentalizing imbalances, therapist's techniques, and emotional responses) are observed between t₁ and t₂, corresponding to the initial phases of the treatments. Clinical implications will be discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perceptions about the COVID-19 disease and the vaccination of those arriving at a vaccination center are correlated with medical public health services management

&lt;b&gt;Background:&lt;/b&gt; Perceptions of COVID-19 and vaccination depend on personal beliefs, experiences, and trust in health authorities’ information. Cultural and social factors also influence perceptions. Effective government messaging can minimize barriers to vaccination.&lt;br /&gt; &lt;b&gt;Methodology:&lt;/b&gt; This cross-sectional research examines socio-demographic parameters related to risk factors, conducted using questionnaires at the vaccination center of Hippokrateio General Hospital of Athens, Greece (n=167), in the last quarter of 2022. Participants were asked to answer questions regarding the impact of the COVID-19 pandemic, a measurement tool for assessing good health status developed by the World Health Organization. The data were analyzed using IBM SPSS v26.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; The study found that women perceive vaccines to cause more harm than men, with younger individuals viewing the infection as harmless. Educational level also influences vaccine side effects and long-term harm. Perceptions of COVID-19 differ based on vaccination status.&lt;br /&gt; &lt;b&gt;Conclusions:&lt;/b&gt; This research confirms the link between socio-demographic variables and pandemic severity perception, emphasizing the importance of correlated with medical public health services management in enhancing communication strategies and creating effective vaccination campaigns.

An innovative and collaborative method to develop a model care and service trajectory for the assessment, diagnosis, and support of children with developmental disabilities

This paper documents an innovative research approach undertaken to co-develop an integrated assessment, diagnosis, and support service trajectory for children suspected of having a developmental disability. It employed data-driven practices and involved multiple stakeholders such as parents, professionals, managers, and researchers. It emphasized the importance of incorporating experiential knowledge adopting an integrated care and service trajectory perspective, and using an implementation science framework. The first part of this article presents the theoretical roots and the collaborative method used to co-construct the model trajectory. The second part of this article presents the results of a survey in which participating stakeholders shared their point of view on the value and impact of this approach Overall, this article provides a step-by-step operationalization of participative research in the context of public health and social services. This may help guide future initiatives to improve services for developmental disabilities in partnership with those directly concerned by these services.

Measuring moral distress in health professionals using the MMD-HP-SPA scale

BackgroundMoral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes.MethodsA regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice.ResultsThe mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9).ConclusionsFemale, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals.

Disparities in awareness and utilisation of National Essential Public Health Services between the floating population and the registered residents: a cross-sectional study in China

ObjectiveThere are differences between the floating population and the registered population in the awareness and use of the National Essential Public Health Services (NEPHS) due to the influence of China’s...