Public Health最新文献

{"title":"Violent victimization trajectories over the life course and past year dental care use in adulthood in the United States","authors":"Alexander Testa ,&nbsp;Luis Mijares ,&nbsp;Dylan B. Jackson ,&nbsp;Daniel Semenza ,&nbsp;Richard Stansfield ,&nbsp;Ian Silver ,&nbsp;Rahma Mungia","doi":"10.1016/j.puhe.2025.105725","DOIUrl":"10.1016/j.puhe.2025.105725","url":null,"abstract":"<div><h3>Objectives</h3><div>Exposure to violence has been linked to poorer health outcomes and reduced healthcare utilization. Yet research has not assessed how patterns of violent victimization over the life course are associated with dental care use. This study aims to fill this gap by examining the relationship between violent victimization trajectories from adolescence to adulthood and dental care use in adulthood.</div></div><div><h3>Study design</h3><div>Prospective cohort study.</div></div><div><h3>Methods</h3><div>Data are from respondents who participated in Waves I-V of the National Longitudinal Study of Adolescent to Adult Health (Years 1994–2018; ages 11–43; <em>n</em> = 5847). Group-based trajectory models (GBTM) identified patterns of violent victimization from adolescence to adulthood, and multiple logistic regression explored the association between these trajectories and past year dental care use at Wave V, adjusting for demographic, socioeconomic, and health-related factors.</div></div><div><h3>Results</h3><div>Four victimization trajectories were identified: No victimization, intermediate low victimization, adolescent limited victimization, and chronic victimization. Past year dental care use was highest among those with no victimization (66.9 %) and lowest among those with chronic victimization (49.5 %). Relative to the trajectory of no violent victimization, all other victimization trajectory groups that experienced violent victimization at any point during the life course had significantly lower odds of dental care use.</div></div><div><h3>Conclusions</h3><div>Violent victimization across the life course is associated with reduced dental care utilization in adulthood.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"243 ","pages":"Article 105725"},"PeriodicalIF":3.9,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of exposure to violence and risk of hypertension: Systematic review and meta-analysis.","authors":"Nikhil Sharma, Mahalaqua Nazli Khatib, Ashok Kumar Balaraman, Roopashree R, Mandeep Kaur, Manish Srivastava, Amit Barwal, G V Siva Prasad, Pranchal Rajput, Rukshar Syed, Gajendra Sharma, Sunil Kumar, Mahendra Pratap Singh, Ganesh Bushi, Nagavalli Chilakam, Sakshi Pandey, Manvinder Brar, Rachana Mehta, Sanjit Sah, Abhay M Gaidhane, Muhammed Shabil, Shailesh Kumar Samal","doi":"10.1016/j.puhe.2025.03.034","DOIUrl":"https://doi.org/10.1016/j.puhe.2025.03.034","url":null,"abstract":"<p><strong>Objectives: </strong>Hypertension is a major global health issue contributing to cardiovascular disease, stroke, and kidney failure. While traditional risk factors like age, diet, and genetics are well-known, the role of psychosocial stressors such as exposure to violence in hypertension development is less explored. This systematic review and meta-analysis assess the association between exposure to violence and the risk of hypertension.</p><p><strong>Study design: </strong>Systematic review and meta analysis.</p><p><strong>Methods: </strong>A systematic search of Web of Science, PubMed, and Embase was conducted up to October 5, 2024. Studies reporting physical, sexual, and intimate partner violence (IPV) and their association with hypertension risk were included. A meta-analysis using random-effects models calculated pooled odds ratios (ORs) with 95 % confidence intervals (CIs), using R software (V 4.4).</p><p><strong>Results: </strong>Out of 564 articles screened, 11 studies with a total of 153,320 participants were included. The meta-analysis showed that individuals exposed to any violence had a 30.3 % increased risk of hypertension (OR: 1.303, 95 % CI: 1.200-1.416). Significant associations were found for physical violence (OR: 1.311, 95 % CI: 1.058-1.625) and sexual violence (OR: 1.412, 95 % CI: 1.239-1.609), while IPV showed a non-significant association (OR: 1.143, 95 % CI: 0.971-1.345). Heterogeneity was low (I² = 0 %), with no evidence of publication bias.</p><p><strong>Conclusions: </strong>This review provides evidence that exposure to violence increases the risk of hypertension, indicating the importance of addressing violence as a public health issue. Healthcare providers should screen for violence history in hypertension management.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":" ","pages":"105722"},"PeriodicalIF":3.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the mapping of leisure-time physical activity inequities: the use of artificial intelligence to advance estimates of small-areas in Brazil","authors":"Thania Mara Teixeira Rezende Faria ,&nbsp;Marisa Affonso Vasconcelos ,&nbsp;Regina Tomie Ivata Bernal ,&nbsp;Gregore Iven Mielke ,&nbsp;Juliana Bottoni de Souza ,&nbsp;Crizian Saar Gomes ,&nbsp;Marcos André Gonçalves ,&nbsp;Jussara Marques de Almeida ,&nbsp;Deborah Carvalho Malta","doi":"10.1016/j.puhe.2025.105727","DOIUrl":"10.1016/j.puhe.2025.105727","url":null,"abstract":"<div><h3>Objective</h3><div>We estimated the prevalence of leisure-time physical activity (LTPA) in small areas of the city of Belo Horizonte and analyzed inequities across areas and between two time periods, 2009–2013 and 2014–2018.</div></div><div><h3>Study design</h3><div>Small area estimation using clustered data.</div></div><div><h3>Methods</h3><div>Data from the Surveillance of Risk and Protective Factors for Chronic Diseases (Vigitel) between 2009 and 2018 for the city of Belo Horizonte, Brazil, were used. Firstly, interviews were georeferenced (n = 16,019) in the census tracts (3,830) of the city. Secondly, the socioeconomic and sanitation components of a Health Vulnerability Index (IVH), indicator used to classify census tracts, served as input variables for a k-means clustering technique to group the tracts in smaller areas of higher homogeneity in relation to IVS components. Lastly, direct estimation of LTPA prevalence was obtained in each cluster by applying post-stratification weights to sample. Absolute and relative differences were calculated between periods and prevalence differences between clusters to analyze inequalities.</div></div><div><h3>Results</h3><div>Nine clusters were found. LTPA prevalence ranged from 23.70 % in a very high-risk cluster to 45.55 % in a low-risk cluster during the 2009–2013 period, and from 31.44 % in a high-risk cluster to 52.81 % in a low-risk cluster from 2014 to 2018. Reducing inequities were observed among the more disadvantaged clusters, but it remained persistently large between the lowest and highest vulnerability groups.</div></div><div><h3>Conclusion</h3><div>Small area estimates are an advantage for a more accurate level of health surveillance. Different machine learning methods are encouraged to provide information for more tailored interventions at local level.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"243 ","pages":"Article 105727"},"PeriodicalIF":3.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between type of alcoholic beverage and all-cause mortality. A population-based prospective study","authors":"Julia Fontán-Vela ,&nbsp;Cristina Ortiz ,&nbsp;Teresa López-Cuadrado ,&nbsp;María Téllez-Plaza ,&nbsp;Esther García-Esquinas ,&nbsp;Rosario Ortolá ,&nbsp;Fernando Rodríguez-Artalejo ,&nbsp;Iñaki Galán","doi":"10.1016/j.puhe.2025.105728","DOIUrl":"10.1016/j.puhe.2025.105728","url":null,"abstract":"<div><h3>Objectives</h3><div>Evidence on the differential relationship between type of alcoholic beverage consumed and mortality remains inconclusive. This study aims to evaluate the association between consumption of various alcoholic beverages and all-cause mortality in the Spanish adult population.</div></div><div><h3>Study design</h3><div>Population-based <strong>c</strong>ohort study.</div></div><div><h3>Methods</h3><div>This study included 16,130 weekly alcohol drinkers aged ≥15 years who participated in the 2011 Spanish Health Survey or the 2014 European Health Survey in Spain. Data of the participants was linked to mortality data up to December 2022, with a median follow-up time of 8.4 years. A preference for wine, beer, or spirits was defined when more than 50 % of alcohol intake was obtained from such beverage. Additionally, total alcohol intake for each beverage type was categorized into four groups: 0 g/day, &gt;0–10, &gt;10–20, &gt;20g/day. Hazard Ratios (HR) were estimated using Cox regression adjusted for sociodemographic factors, lifestyle, health status, alcohol volume intake, and heavy episodic drinking.</div></div><div><h3>Results</h3><div>Compared to individuals without a beverage preference, the HR (95 % CI) for mortality among those with preference for wine, beer or spirits was 1.09 (0.88–1.35), 1.22 (0.96–1.54), and 1.16 (0.82–1.65), respectively. Among low-risk drinkers (&gt;0–20g/day), those with a preference for beer showed a higher mortality (HR: 1.35 (1.01–1.81)). Compared to participants with zero intake of wine, beer or spirits, those in the highest consumption category (&gt;20g/day) showed no significant differences in mortality by beverage preference.</div></div><div><h3>Conclusions</h3><div>Preference for wine, beer, or spirits did not show a consistently differential impact on the association between alcohol consumption and all-cause mortality.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"243 ","pages":"Article 105728"},"PeriodicalIF":3.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The spatial distribution of mortality in a large metropolis: A methodology for identifying geographical patterns and contributing factors.","authors":"Giovana Martinelli, Fabio Kon, Raphael Y de Camargo","doi":"10.1016/j.puhe.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.puhe.2025.03.017","url":null,"abstract":"<p><strong>Objective: </strong>The distribution of mortality in large urban areas, such as major metropolises, is normally highly heterogeneous. Disadvantaged populations often present distinct health patterns that might be neglected by studies that focus on privileged areas of the city. Understanding the varied causes of death across city regions can greatly aid public health management and inform evidence-based policies.</p><p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Methods: </strong>In this paper, we propose a methodology that combines statistical analysis, clustering, and geographical visualization to analyze mortality patterns in large metropolises. It determines clusters of districts based on mortality profiles and identifies deviations from expected death rates considering demographic factors like age profile and Human Development Index (HDI).</p><p><strong>Results: </strong>We applied the method to the city of São Paulo, analyzing 376,452 deaths across five years. The method could identify four clusters within the city, each with different characteristics regarding the causes of death. Unsurprisingly, these clusters are highly correlated with the district's HDI and age profile. However, the method identifies deviations from expected death rates based on HDI and age, potentially indicating deficiencies in public health services in specific regions.</p><p><strong>Conclusions: </strong>The proposed methodology provides policymakers with tools to identify regions where causes of death exceed expected values for the population demography. It also offers insights into mortality patterns and their association with socioeconomic and demographic characteristics, enabling the development of targeted healthcare strategies to improve overall public health outcomes.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":" ","pages":"105703"},"PeriodicalIF":3.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual cycling in urban green and blue vs gray spaces: The efficacy of mental health and physical activity","authors":"Hsin-Yen Yen ,&nbsp;Hao-Yun Huang","doi":"10.1016/j.puhe.2025.105723","DOIUrl":"10.1016/j.puhe.2025.105723","url":null,"abstract":"<div><h3>Objectives</h3><div>An urban environment may be stressful, potentially leading to poor mental health. Natural elements are important in urban environments with many restorative and potential health benefits compared to artificial elements. Virtual reality can simulate an urban environment in a digital world. The purpose of this study was to compare the different effects on mental health and physical activity outcomes between cycling in virtual urban green-blue and gray spaces.</div></div><div><h3>Study design</h3><div>A randomized controlled trial conducted from September 2021 to June 2022.</div></div><div><h3>Methods</h3><div>In total, 62 participants were randomly assigned to either the green-blue or gray group. All participants received a virtual cycling intervention for 30 min per session, once a week for 12 weeks. Different 360° videos of urban views were shown on head-mounted display headsets between the two groups. Virtual green and blue spaces consisted of bike trails that passed through natural elements with landscapes and waterscapes, while virtual gray spaces consisted of bike trails that passed through more-artificial elements in cities. Outcomes at the baseline and post-intervention were measured by self-reported questionnaires and objective instruments.</div></div><div><h3>Results</h3><div>Participants in the green-blue group had improved positive affect, perceived stress, and light-intensity physical activity compared to the gray group. Participants in the green-blue group had lower perceived exertion and virtual reality sickness, and higher enjoyment than those in the gray group.</div></div><div><h3>Conclusions</h3><div>Virtual reality cycling in the urban green and blue spaces is recommended for mental health and PA promotion for urban adult populations.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"243 ","pages":"Article 105723"},"PeriodicalIF":3.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between trajectories of life-course group sports participation and dementia: A 3-year longitudinal study.","authors":"M Yamakita, T Tsuji, S Kanamori, J Saito, Y Kai, Y Tani, T Fujiwara, N Kondo, K Kondo","doi":"10.1016/j.puhe.2025.03.033","DOIUrl":"https://doi.org/10.1016/j.puhe.2025.03.033","url":null,"abstract":"<p><strong>Objectives: </strong>The evidence for a causal effect of physical activity (PA) on dementia risk remains inconclusive. Group sports participation may impact dementia risk differently compared to PA. This study aimed to examine the association between long-term group sports participation trajectories across the life course and dementia onset among older Japanese adults.</p><p><strong>Study design: </strong>Cohort study.</p><p><strong>Methods: </strong>This cohort study included 8277 adults aged ≥65 years from the Japan Gerontological Evaluation Study. Life-course group sports participation was assessed through self-reported questionnaires, and Group-Based Trajectory Modelling (GBTM) was used to identify participation trajectories. Dementia onset was determined using public long-term care insurance-system registries, and Cox proportional hazards models were employed to assess associations between trajectory groups and dementia onset.</p><p><strong>Results: </strong>GBTM identified four trajectories: persistently low (n = 5164, 62.4 %), dropout after high school (n = 2150, 26.0 %), dropout after young adulthood (n = 446, 5.4 %), and increase in midlife (n = 517, 6.2 %). During a mean follow-up of 3.2 years, 311 participants developed dementia. After adjusting for confounders, the dropout after young adulthood group had a significantly higher dementia risk than did the persistently low group (hazard ratio, 95 % confidence interval, 1.85, 1.09-3.16). No significant differences were observed between the dropout after high school (1.13, 0.84-1.52) and the increase in midlife (1.36, 0.78-2.39) groups compared to the persistently low group.</p><p><strong>Conclusions: </strong>The risk of dementia may vary depending on life-course group sports participation patterns. Further studies are needed to establish these findings, including examining specific types of sports and individual PA levels.</p>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":" ","pages":"105721"},"PeriodicalIF":3.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 pandemic and COVID-19 downgrade on non-COVID-19 respiratory diseases in Japan","authors":"Satoko Yamaguchi ,&nbsp;Akira Okada ,&nbsp;Sachiko Ono ,&nbsp;Reiko Inoue ,&nbsp;Kayo Ikeda Kurakawa ,&nbsp;Shinji Sunaga ,&nbsp;Toshimasa Yamauchi ,&nbsp;Masaomi Nangaku ,&nbsp;Takashi Kadowaki","doi":"10.1016/j.puhe.2025.03.031","DOIUrl":"10.1016/j.puhe.2025.03.031","url":null,"abstract":"<div><h3>Objectives</h3><div>A worldwide decrease in the incidence of respiratory diseases during the coronavirus disease (COVID-19) pandemic has been reported, largely due to non-pharmaceutical interventions (NPIs). However, the impact of lifting NPIs remains unclear. In Japan, NPIs were lifted rather drastically when COVID-19 was downgraded on May 8, 2023. This study aimed to evaluate the impact of the COVID-19 pandemic and its downgrade on non-COVID-19 respiratory diseases using nationwide databases.</div></div><div><h3>Study design</h3><div>Retrospective cohort study.</div></div><div><h3>Methods</h3><div>Monthly hospitalisation and prescription rates between January 2017 and October 2023 were collected from the JMDC insurance claims database covering 16,485,812 insured individuals. The monthly mortality rates in Japan were collected from an open data source published by Ministry of Health, Labour and Welfare of Japan. Interrupted time series analyses using seasonal autoregressive integrated moving average models were performed.</div></div><div><h3>Results</h3><div>While hospitalisation rates for diseases such as pneumonia, asthma, and aspiration pneumonia decreased during the pandemic, a step increase in hospitalisations for these diseases and prescriptions for anti-asthma drugs was observed following the COVID-19 downgrade. The pandemic impacted all age groups; however, the impact of COVID-19 downgrade was more pronounced in children aged 0–5 years. Although mortality from non-COVID-19 respiratory diseases decreased during the pandemic, no immediate step increase in mortality was observed following the downgrade.</div></div><div><h3>Conclusions</h3><div>Although hospitalisations for pneumonia and prescriptions for anti-asthma drugs increased immediately after downgrading COVID-19, no step increase in mortality was observed presumably because older people were less affected than children.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"243 ","pages":"Article 105719"},"PeriodicalIF":3.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143829771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The potential for primary and secondary prevention of liver cancer death in Australians with alcohol-related liver disease or metabolic-associated steatotic liver disease: A modelling study","authors":"Joachim Worthington ,&nbsp;Emily He ,&nbsp;Georgia Carney ,&nbsp;Paul Grogan ,&nbsp;Megan Varlow ,&nbsp;Karen Canfell ,&nbsp;Eleonora Feletto","doi":"10.1016/j.puhe.2025.03.030","DOIUrl":"10.1016/j.puhe.2025.03.030","url":null,"abstract":"<div><h3>Objectives</h3><div>Hepatocellular carcinoma (HCC), the most common form of primary liver cancer, is increasing in incidence and mortality in Australia, and the proportion attributable to excess alcohol intake, overweight and obesity is rising. People with alcohol-related liver disease (ARLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) are at high risk, but prevention via weight loss, alcohol cessation, and routine surveillance can reduce the likelihood of HCC death. We aimed to estimate the potential for HCC prevention in Australians with ARLD and MASLD.</div></div><div><h3>Study design</h3><div>Simulation modelling study.</div></div><div><h3>Methods</h3><div>The existing <em>Policy1-Liver</em> model of liver disease was extended to capture disease progression in people with ARLD and MASLD. A weight loss intervention, alcohol cessation, and routine HCC surveillance using FIB-4, transient elastography, and ultrasound were simulated, and the impacts on HCC burden and costs were estimated.</div></div><div><h3>Results</h3><div>A once-off 10% weight loss intervention would reduce risk of MASLD-related HCC death by 25.9%. Up to 417 Australian HCC deaths would be preventable annually through this intervention. Alcohol cessation could double quality-adjusted life expectancy of people with ARLD.</div><div>Routine HCC surveillance would reduce ARLD-related HCC death risk by 18.6 % and MASLD-related HCC death risk by 18.1%, and prevent up to 254 MASLD- and ARLD-related HCC deaths in Australia annually. Surveillance would be cost-effective, except for those with early-stage MASLD.</div></div><div><h3>Conclusions</h3><div>Weight loss, alcohol cessation, and routine HCC surveillance can improve health outcomes for people with ARLD or MASLD. Modelling to support cost-effective prevention can help guide policy decisions and future investment in liver cancer control in Australia.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"243 ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"People empowerment in the healthcare system: A conceptual model and roadmap","authors":"Marzieh Zarinbal ,&nbsp;Hamidreza Izadbakhsh ,&nbsp;Nasim Ghanbar Tehrani","doi":"10.1016/j.puhe.2025.03.032","DOIUrl":"10.1016/j.puhe.2025.03.032","url":null,"abstract":"<div><h3>Objectives</h3><div>People empowerment is the process of assisting individuals in representing their activities with responsibility and self-determination, and acting on their own authority. While most studies have focused on training and informing patients, other aspects of empowerment are often overlooked. Therefore, the main objective of this paper is to present a conceptual model that empowers not only patients but all people.</div></div><div><h3>Study design</h3><div>Public health policy.</div></div><div><h3>Methods</h3><div>The conceptual model is developed based on strategies outlined in 2009 World Bank report and is extended through a two-stage field interview. In the first stage, 15 healthcare policymakers were interviewed and in the second stage, a workshop was held with one hundred healthcare experts.</div></div><div><h3>Results</h3><div>The first stage interviews confirmed the effectiveness of the five empowerment strategies provided by World Bank report. Additionally, a new group of strategies was recommended, particularly for countries with less accountable healthcare systems. These strategy groups are Information and education, accountability, advocacy, financial empowerment, local organizational capacity, and participation. The second stage of interviews confirmed the results and provids valuable insights. To operationalize this model for the country a roadmap consisting of several projects is also developed.</div></div><div><h3>Conclusions</h3><div>From an implementation perspective, not all strategies are equally important; Some are prerequisites for others. Certain strategies can be considered as fundamental strategies. Some are functional, while others could be considered as the outcomes.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"243 ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}