Risk Management and Healthcare Policy最新文献

{"title":"Vaccine Hesitancy and Immunization Patterns in Central and Eastern Europe: Sociocultural, Economic, Political, and Digital Influences Across Seven Countries.","authors":"Donata Kurpas, Dorota Stefanicka-Wojtas, Aneta Soll-Morka, Katarzyna Lomper, Bartosz Uchmanowicz, Beata Blahova, Aelita Bredelytė, Gheorghe Gindrovel Dumitra, Vladimíra Hudáčková, Katerina Javorska, Zoltán Juhász, Stanisław Manulik, András Mohos, Egidijus Skarbalius, Victoria I Tkachenko, Izabella Uchmanowicz","doi":"10.2147/RMHP.S519479","DOIUrl":"10.2147/RMHP.S519479","url":null,"abstract":"<p><strong>Background/objectives: </strong>Vaccination programs are essential for preventing infectious diseases, yet the effectiveness of these programs varies significantly across Central and Eastern European countries due to diverse socio-economic, cultural, and political influences. This study examines vaccination trends in Hungary, Slovakia, Romania, the Czech Republic, Poland, Ukraine, and Lithuania, focusing on misinformation, regional healthcare disparities, and socio-cultural factors on vaccination rates.</p><p><strong>Methods: </strong>A comprehensive review of national policies, vaccination rates, and factors influencing vaccine hesitancy was conducted across seven Central and Eastern European countries. Input from local health stakeholders and national data sources was analysed to contextualize vaccination patterns and challenges.</p><p><strong>Results: </strong>Significant cross-country variation was observed. Hungary and the Czech Republic reported consistently high coverage of mandatory childhood vaccinations, while Romania and Ukraine experienced severe declines in uptake, leading to outbreaks of measles and polio. Slovakia demonstrated low COVID-19 vaccination willingness, and Poland recorded a sharp increase in formal vaccine refusals. Conversely, Lithuania implemented successful campaigns that improved uptake, particularly for influenza and pneumococcal vaccines. Differences were influenced by healthcare system structure, public trust, exposure to misinformation, and digital communication strategies.</p><p><strong>Conclusion: </strong>Addressing vaccine hesitancy requires targeted, context-sensitive communication and digital literacy programs. Additionally, policy reforms to enhance accessibility, particularly in rural areas, and real-time monitoring systems can strengthen vaccination rates. Cross-border collaboration and tailored public health campaigns addressing cultural and socio-economic challenges are necessary to improve immunization coverage in these regions.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1911-1934"},"PeriodicalIF":2.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Factors Influencing Dietary Management in Chinese Chronic Kidney Disease Patients Based on the COM-B Model: A Qualitative Study.","authors":"Na Zhang, Siyu Fan, Shiyu Wang, Yu Zhao, Hongyuan Liu, Yaodi Wei, Zhi Li, Weiguo Wang, Fengping Liu","doi":"10.2147/RMHP.S523169","DOIUrl":"10.2147/RMHP.S523169","url":null,"abstract":"<p><strong>Background: </strong>Dietary management plays an important role in slowing the progression of chronic kidney disease, however, adherence to dietary management remains a significant challenge, particularly in culturally diverse settings like China. Currently, there is limited research on the factors influencing dietary management in Chinese patients with chronic kidney disease. Given this knowledge gap, we aimed to explore the factors influencing dietary management in patients with chronic kidney disease based on the capability, opportunity, motivation, and behavior (COM-B) model and provide culturally suitable insights for the creation of focused interventions.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted between September and November 2024 at the Department of Nephrology, Affiliated Central Hospital of Jiangnan University, with 45 participants, including 19 patients with chronic kidney disease, 10 caregivers, and 16 healthcare professionals. Interview guide themes were informed by the COM-B model. Adoption of a thematic analysis approach and mapping onto the COM-B model. The study was reported following the COREQ Checklist.</p><p><strong>Results: </strong>Fifteen factors influencing dietary management in chronic kidney disease were categorized according to the COM-B model's three domains: (1) Capability: physical dysfunction, difficulty in controlling physiological needs, knowledge mastery, willpower and self-control, low self-efficacy; (2) Opportunity: patient-to-patient influence, social support, social culture, limitations in food and advocacy resources, lack of meals for chronic kidney disease patients in hospital canteens; (3) Motivation: value orientation, dietary expectations, experience-driven (a: perceived benefits, b: perceived burden, c: stigma), nervousness, food desires.</p><p><strong>Conclusion: </strong>This study provides a novel perspective on factors influencing dietary management in chronic kidney disease, highlights the profound impact of Chinese culture on dietary management, and provides a basis for the development of targeted, culturally appropriate intervention programs based on the dimensions of competence, opportunity, and motivation.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1895-1910"},"PeriodicalIF":2.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equity and Efficiency of Medical Resource Allocation in National Central Cities, China.","authors":"Minghua Zhou","doi":"10.2147/RMHP.S510508","DOIUrl":"10.2147/RMHP.S510508","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the equity and efficiency of medical resource allocation in national central cities in China in order to promote the development of medical resources in national central cities.</p><p><strong>Methods: </strong>Data on medical resources in 9 national central cities were extracted from 2018 to 2022, descriptive analysis, health resource density index (HRDI), and health resource agglomeration degree (HRAD) were used to evaluate equity, and data envelopment analysis (DEA) was used to evaluate efficiency.</p><p><strong>Results: </strong>The HRDI of medical resources in national central cities is higher than the Chinese average from 2018 to 2022. The HRAD for the number of beds in Shanghai, Guangzhou, and Zhengzhou is greater than 14.40, and the HRAD for registered nurses, licensed (assistant) physicians, and health technicians in Shanghai, Guangzhou, and Beijing is greater than 15.80, indicating that the medical resources in these regions are highly concentrated by geographical allocation. The HRAD/PAD for licensed (assistant) physicians, registered nurses, and health technicians in Chongqing is less than 1, indicating that there is a shortage of medical resources in these regions relative to the agglomeration population. The technical efficiency, scale efficiency and overall efficiency in Shanghai, Guangzhou, and Chongqing are all 1, and the DEA is relatively effective. In Beijing in 2018-2020, Zhengzhou in 2020, and Chengdu in 2019-2021, the overall efficiency, scale efficiency, and technical efficiency are not 1, and the DEA is relatively ineffective.</p><p><strong>Conclusion: </strong>The level of medical resource allocation in national central cities is higher than the Chinese average. The medical resources allocated in the national central cities are highly concentrated by geography. Licensed (assistant) physicians, registered nurses, and health technicians in Chongqing is insufficient relative to the agglomeration population. Except for Shanghai, Guangzhou and Chongqing, the other of the cities have a relatively inefficient allocation of medical resources.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1881-1893"},"PeriodicalIF":2.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stress, Cortisol, and Lipid Profiles Among Rwandan Undergraduate Students: A Cross-Sectional Study.","authors":"Patrick Mushumba, Donatha Nsengiyumva Uwineza, Vedaste Nsanzimana, Herbert Tendayi Mapira, Elizabeth Gori, Cuthbert Musarurwa","doi":"10.2147/RMHP.S518801","DOIUrl":"10.2147/RMHP.S518801","url":null,"abstract":"<p><strong>Background: </strong>Stress negatively affects mental and physical health globally, with university students in sub-Saharan Africa facing unique challenges that exacerbate psychological distress and academic difficulties. Chronic stress contributes to cardiovascular diseases, yet its physiological effects-such as dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and altered lipid metabolism-remain understudied in this population. There is also a lack of research on the relationship between stress and its physiological impacts among university students in Rwanda. This study aimed to investigate the relationship between serum cortisol levels, lipid profiles, and stress among undergraduate students at the University of Rwanda's Huye Campus.</p><p><strong>Methods: </strong>A cross-sectional study recruited 247 undergraduate students using stratified sampling. Participants completed a researcher-administered Perceived Stress Scale questionnaire and provided sociodemographic data. Fasting blood samples were collected for cortisol and lipid profile analysis, and data was analyzed using Stata version 15.</p><p><strong>Results: </strong>The study included 247 students aged 19-25, with 56.7% males. Stress levels were categorized as low (44.9%), moderate (53.9%), and high (1.2%). Morning cortisol levels (median 13.7µg/dL, IQR 10.8-17.2) did not significantly differ by gender (p > 0.050). However, moderate stress was linked to higher morning cortisol (p < 0.001), total cholesterol (TC), and triglycerides (p = 0.004), with TC also varying significantly across stress levels (p = 0.012).</p><p><strong>Conclusion: </strong>This study found significant associations between stress categories, serum cortisol levels, and lipid profiles, particularly total cholesterol and triglycerides, emphasizing the need for stress management strategies to mitigate long-term health risks.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1869-1880"},"PeriodicalIF":2.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, Attitudes, and Practices Toward Unexplained Recurrent Pregnancy Loss Among Afflicted Women.","authors":"Zuoping Shi, Huiping Liu, Jie Han, Xueqing Wu","doi":"10.2147/RMHP.S518739","DOIUrl":"10.2147/RMHP.S518739","url":null,"abstract":"<p><strong>Background: </strong>To explore the knowledge, attitudes, and practices (KAP) regarding recurrent pregnancy loss (RPL) of women with unexplained RPL.</p><p><strong>Methods: </strong>This cross-sectional study enrolled women with unexplained RPL in the Reproductive Medicine Centre of Shanxi Maternal and Child Health Hospital between August 28^th and September 28^th, 2024. Data were collected through a self-designed questionnaire encompassing sociodemographic characteristics and three dimensions of KAP.</p><p><strong>Results: </strong>A total of 485 valid questionnaires were included, with knowledge, attitude, and practice scores of 13.05 ± 6.24, 39.30 ± 3.09, and 41.11 ± 4.37, respectively. The multivariable logistic regression analysis showed that knowledge scores (OR = 1.05, 95% CI: 1.02-1.09, P = 0.001; beneficial), attitude scores (OR = 1.30, 95% CI: 1.20-1.41, P < 0.001), and urban residence (OR = 0.64, 95% CI: 0.41-0.99, P = 0.049) were independently associated with the proactive practice. The structural equation modeling (SEM) showed that knowledge directly (β = 0.20, P = 0.001) and indirectly (β = 0.15, P < 0.001) influenced practices.</p><p><strong>Conclusion: </strong>Women with unexplained RPL demonstrated insufficient knowledge, moderate attitude, and proactive practice towards RPL. Targeted educational interventions could be needed to enhance knowledge related to RPL, which may help women form proper expectations toward pregnancy.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1857-1867"},"PeriodicalIF":2.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Serum Magnesium Levels on Mineral-Bone Metabolism in Non-Dialysis-Dependent Chronic Kidney Disease.","authors":"Yan-Ping Cao, Li-Ping Zhu, Hai-Jiang Ge, Rui-Qing Zhang, Ru-Juan Chen, Bo Yuan, Wei-Jia Shi","doi":"10.2147/RMHP.S516474","DOIUrl":"10.2147/RMHP.S516474","url":null,"abstract":"<p><strong>Background: </strong>Magnesium is one of the important minerals in the human body. The metabolic imbalance of magnesium has been found in patients with chronic kidney disease (CKD), but the research on the serum magnesium level of patients with non-dialysis-dependent CKD (NDD-CKD) and its relationship with mineral-skeletal metabolic disorder (CKD-MBD) is still relatively limited. This study aims to explore the changes in serum magnesium levels in patients with non-dialysis-dependent CKD at different stages and evaluate its relationship with mineral metabolism markers (calcium, phosphorus, iPTH and alkaline phosphatase).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on data from 156 patients with stage 3-5 CKD (G3-G5) admitted to Handan First Hospital between March 2017 and December 2019. Serum magnesium, calcium, phosphorus, intact parathyroid hormone (iPTH), and alkaline phosphatase (AKP) levels were analyzed. The patients were categorized into hypomagnesemia, normal magnesium, and hypermagnesemia groups based on serum magnesium levels. Correlations between magnesium levels and phosphorus, iPTH, and AKP levels were analyzed.</p><p><strong>Results: </strong>Serum magnesium levels displayed an upward trend across CKD stages G3 to G5, though this trend was not statistically significant. The prevalence of hypomagnesemia was 0%, 6.82%, and 15.07%, while the incidence of hypermagnesemia was 5.13%, 13.64%, and 30.14% in G3, G4, and G5 stages, respectively. Serum magnesium levels demonstrated a significant positive correlation with serum calcium and the calcium-phosphorus product, whereas no correlation was observed with serum phosphorus or iPTH levels.</p><p><strong>Conclusion: </strong>Magnesium metabolic disorders progressively increase with CKD severity, with the highest prevalence observed in stage G5. These findings indicate that changes in serum magnesium levels may influence the development and progression of CKD-MBDs.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1847-1856"},"PeriodicalIF":2.7,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Quality Control Circle Activities on Reducing the Failure Rate of Surgical Instrument Pre-Treatment.","authors":"Yandan Wang, Xiulan Zhou, Yanqiu Zhu, Yuanmei Dan, Zeping Huang, Ling Xiang","doi":"10.2147/RMHP.S520770","DOIUrl":"10.2147/RMHP.S520770","url":null,"abstract":"<p><strong>Background: </strong>The quality of surgical instrument cleaning can affect patient safety. Pre-treatment is a key step in cleaning. This study investigated the effect of quality control circle (QCC) activities on reducing the failure rate of surgical instrument pre-treatment.</p><p><strong>Methods: </strong>A QCC with a topic of reducing the failure rate of surgical instrument pre-treatment was established within the central sterile supply department of our hospital in January 2023. The failure rates of surgical instrument pre-treatment before and after the QCC activities were compared after problem investigation, target setting, critical factor analysis, root cause validation, and development and implementation of countermeasures.</p><p><strong>Results: </strong>The failure rate of surgical instrument pre-treatment decreased significantly from 2.9% (46/1568) to 1.1% (11/989) after the implementation of QCC activities, with a statistically significant difference (χ² = 2157, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>QCC activities provide a structured approach to analyzing the root causes of failures in surgical instrument pre-treatment and develop countermeasures, thereby improving the quality of instrument cleaning and ensuring patient safety. QCC activities could also improve team cohesion and develop staff's problem-solving skills.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1837-1845"},"PeriodicalIF":2.7,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12155372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Safety Risk Defense Mechanism in Operating Room Nursing on Quality and Risk Incidents.","authors":"Haiyan Liao, Lihua Lou","doi":"10.2147/RMHP.S508662","DOIUrl":"10.2147/RMHP.S508662","url":null,"abstract":"<p><strong>Objective: </strong>To explore the application effect of a nursing model based on safety risk defense mechanism management in operating room nursing and its impact on nursing quality and the occurrence of risk incidents.</p><p><strong>Methods: </strong>From November 2022 to December 2023, 200 patients who underwent surgical treatment and received nursing care in the operating room of our hospital were selected as research subjects. During this period, the nursing model in our hospital's operating room was changed. Based on the time differences, the patients were divided into a control group and an observation group, with 100 cases in each group. The control group adopted the previous conventional nursing model, while the observation group adopted the nursing model based on safety risk defense mechanism management. The nursing quality scores and the occurrence of risk incidents were compared between the two groups.</p><p><strong>Results: </strong>The nursing quality scores of the observation group were significantly higher than those of the control group, P<0.05. The management effect of the observation group was significantly better than that of the control group, with higher satisfaction and lower complaint rates, P<0.05. The occurrence rate of risk incidents in the observation group was significantly lower than that in the control group, P<0.05. The scores in various aspects of risk control in the observation group were significantly higher than those in the control group, P<0.05.</p><p><strong>Conclusion: </strong>The nursing model based on safety risk defense mechanism management can significantly improve the quality of operating room nursing, reduce the occurrence of nursing risk incidents, and enhance patient satisfaction. It is worthy of clinical promotion and application.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1827-1835"},"PeriodicalIF":2.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loneliness and Frailty Among Older Adults Receiving Home Healthcare: A Cross-Sectional Study.","authors":"Özge Tuncer, Ayça Asma Sakallı","doi":"10.2147/RMHP.S519431","DOIUrl":"10.2147/RMHP.S519431","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study is to investigate the relationship between loneliness and frailty in older people and to provide a scientific basis for improving the quality of healthcare and social services offered to older people.</p><p><strong>Patients and methods: </strong>This cross-sectional study included individuals aged 65 years and over who were receiving home healthcare services in two cities in western Turkey. Convenience sampling was used. Eligibility criteria were age ≥65 years, receiving home healthcare services, adequate cognitive function, and voluntary participation. The Loneliness Scale for the Elderly (LSE) and the Clinical Frailty Scale were administered. Statistical analyses included <i>t</i>-tests, chi-square tests, ANOVA, Kruskal-Wallis tests, and Spearman correlation analysis.</p><p><strong>Results: </strong>A total of 533 participants were included, with 288 from Center 1 and 245 from Center 2. Overall, 62.7% of participants reported experiencing loneliness. Participants in Center 2 had significantly higher loneliness scores compared to Center 1. A weak but significant positive correlation was found between frailty and loneliness scores (Spearman's rho = 0.175, p<0.001).</p><p><strong>Conclusion: </strong>This study demonstrated a weak but significant association between loneliness and frailty among older adults receiving home healthcare. Loneliness was influenced by marital status, polypharmacy, and physical independence, which also contributed to frailty.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1809-1825"},"PeriodicalIF":2.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequalities in Mild Cognitive Impairment Risk Among Chinese Middle-Aged and Older Adults: Insights from an Integrated Learning Model.","authors":"Shengxian Bi, Dandan Guo, Huawei Tan, Yingchun Chen, Gang Li","doi":"10.2147/RMHP.S519049","DOIUrl":"10.2147/RMHP.S519049","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to address inequalities in mild cognitive impairment (MCI) risk among Chinese middle-aged and older adults by developing an integrated learning framework to predict MCI risk and identify key contributing factors.</p><p><strong>Methods: </strong>Using CHARLS data of 4626 participants, we developed a convolutional neural network-bidirectional long short-term memory-attention (CNN-BiLSTM-Attention) model to capture the temporal and spatial features of MCI progression. SHAP (Shapley Additive Explanations) analysis quantified feature importance and enhanced interpretability, while mediation analysis explored causal pathways, particularly focusing on the role of education. Model performance was compared with eight other frameworks, including LSTM-based models, using Receiver Operating Characteristic (ROC) curves and classification metrics.</p><p><strong>Results: </strong>The CNN-BiLSTM-Attention model demonstrated relatively promising predictive performance (AUC: 0.7317), with moderately high sensitivity (0.6902) and a high negative predictive value (NPV) of 0.9414. Education emerged as the most critical predictor, followed by Instrumental Activities of Daily Living (IADL) and gender. Mediation analysis revealed that education influenced MCI risk indirectly through health insurance, social interaction, physical activity, and depression.</p><p><strong>Conclusion: </strong>We present an interpretable, data-driven framework for predicting MCI risk while uncovering key inequality factors, particularly the pivotal role of education. The model's robust performance and interpretability highlight its potential to inform public health strategies and interventions aimed at addressing inequalities in dementia risk.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1793-1808"},"PeriodicalIF":2.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}