Epidemiolgia (Basel, Switzerland)最新文献

{"title":"NT-proBNP for Heart Failure Screening in Primary Care in an Eastern European Country: What We Know and Proposed Steps.","authors":"Ioana Camelia Teleanu, Anca Mîrșu-Păun, Cristian Gabriel Bejan, Ana-Maria Alexandra Stănescu","doi":"10.3390/epidemiologia6010002","DOIUrl":"10.3390/epidemiologia6010002","url":null,"abstract":"<p><p>Epidemiological studies indicate that heart failure (HF) prevalence and associated mortality are significantly higher among Eastern European countries as compared to their Western European counterparts. The significant financial burden on the healthcare system matches these sobering data. Thus, efficient programs for patients with HF have been called for. N-terminal prohormone of brain natriuretic peptide (NT-proBNP) represents a widely used, cost-effective, and readily available test that can be used to evaluate HF risk. However, it should not be used as a universal assessment, given the existing variability in proposed cut-off scores for various subgroups of patients. Thus, the clinical context needs to always be considered, and alternative diagnoses need to be ruled out. Based upon evidence from the literature for the above assumptions, the advantages and limitations of using NT-proBNP in primary care settings, along with other HF diagnostic modalities, are discussed in this paper. Also, this paper argues that an effective primary care network, in collaboration with specialist providers, may avoid a delay in HF diagnoses, may help provide on-time treatments, and may ultimately cut unnecessary healthcare expenditures associated with HF hospitalizations. Therefore, the present paper proposes an algorithm for diagnosing HF in primary care settings and discusses specific knowledge and skills that family physicians should be well equipped with in order to successfully respond to the needs of their patients with HF.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Role of Irisin in Longevity and Aging: A Narrative Review.","authors":"Ana I Plácido, Daniela Azevedo, Maria Teresa Herdeiro, Manuel Morgado, Fátima Roque","doi":"10.3390/epidemiologia6010001","DOIUrl":"10.3390/epidemiologia6010001","url":null,"abstract":"<p><p>Irisin is a protein resulting from a proteolytic cleavage of fibronectin type III domain-containing protein 5 (FND5). The ability of irisin to modulate adipocyte and control glucose metabolism in human metabolic diseases gave rise to the hypothesis that irisin could have a pivotal role in aging-related diseases. Although in animal models, increased levels of irisin have been positively associated with better health outcomes, in humans, its role remains controversial. To provide an overview of the main finding on irisin in older adults, a comprehensive search was performed through the MEDLINE-PubMed, Web of Science, Scopus, and Cochrane databases for studies conducted in older adults (≥60 years) published since 2012. After grouping and analyzing the articles based on diseases associated with older adults, the main conclusion of this narrative review is that the included studies did not yield consistent evidence regarding the association between irisin and health or disease in older adults. Further studies are necessary to clarify the effective role of this protein in promoting health and longevity.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining South Tyrol's Experience: Digital Health Adoption and Workforce Issues in Implementing Italy's Primary Care Reform Under Ministerial Decree No. 77/2022.","authors":"Christian J Wiedermann, Angelika Mahlknecht, Verena Barbieri, Dietmar Ausserhofer, Barbara Plagg, Carla Felderer, Pasqualina Marino, Adolf Engl, Giuliano Piccoliori","doi":"10.3390/epidemiologia5040057","DOIUrl":"10.3390/epidemiologia5040057","url":null,"abstract":"<p><p><b>Background:</b> Ministerial Decree (D.M.) 77/2022 aims to reform Italy's primary care system by establishing community health centres and integrating digital tools to address healthcare access disparities and workforce shortages. This review focuses on frailty assessment tools, digital health innovations, and workforce challenges in the Autonomous Province of Bolzano, South Tyrol, emphasising interprofessional trust and collaboration issues. <b>Methods:</b> Using a narrative custom review approach guided by the SANRA checklist, this study synthesised findings from PubMed, official health websites, and regional surveys on frailty, workforce dynamics, interprofessional collaboration, and digital infrastructure in South Tyrol. <b>Results:</b> General practitioners (GPs) exhibited high professional motivation but expressed concerns about autonomy and administrative burdens in collaborative care models. Trust issues between GPs and specialists hinder workforce cohesion and care coordination, highlighting the need for structured inter-professional communication. Frailty assessments, such as the PRISMA-7 tool, identify over 33% of community-dwelling individuals aged 75 years and older as frail, necessitating targeted interventions. Digital health adoption, particularly electronic health records and telemedicine, is slow because of workforce shortages and infrastructure limitations. <b>Conclusions:</b> The successful implementation of D.M. 77/2022 in South Tyrol requires addressing workforce challenges, improving interprofessional trust, expanding digital infrastructure, and integrating frailty assessment findings into care strategies. These measures are critical for achieving a more resilient, equitable, and effective primary healthcare system.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"5 4","pages":"838-853"},"PeriodicalIF":0.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11675674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Interplay Between Vitamin D Deficiency, Iron Status, and Anemia Risk in Moroccan Women of Reproductive Age: A Cross-Sectional Analysis.","authors":"Noura Zouine, Ilham Lhilali, Lode Godderis, Adil El Midaoui, Samir El Jaafari, Younes Filali-Zegzouti","doi":"10.3390/epidemiologia5040055","DOIUrl":"10.3390/epidemiologia5040055","url":null,"abstract":"<p><p><b>Background:</b> Vitamin D and iron deficiencies are prevalent among Moroccan women of reproductive age (WRA). Research suggests that Vitamin D deficiency (VDD) may impair iron bioavailability, potentially leading to iron deficiency (ID) and anemia. Objectives: This study investigates associations between vitamin D status, iron levels, and anemia risk in WRA, aged 18-49, from Meknes, Morocco. <b>Methods:</b> A cross-sectional study was conducted among 463 participants, measuring serum 25(OH)D, blood count parameters, iron, ferritin, C-reactive protein, and creatinine. Lifestyle factors, including dietary intake, sun exposure, and physical activity, were assessed through validated questionnaires, and anthropometric data were collected. Linear and logistic regression models analyzed associations, while ROC analysis evaluated VDD's predictive accuracy for ID and anemia. <b>Results:</b> VDD (25(OH)D < 20 ng/mL) was significantly associated with reduced hemoglobin, hematocrit, red blood cells, and ferritin (all <i>p</i> < 0.01), indicating vitamin D's role in erythropoiesis and iron storage. Multivariate logistic regression showed that VDD increased the risk of anemia (OR: 7.17, 95% CI: 3.19-19.28, <i>p</i> < 0.001), ID (OR: 2.20, 95% CI: 1.32-3.77, <i>p</i> = 0.007), and IDA (OR: 4.10, 95% CI: 1.73-12.08, <i>p</i> = 0.004). Dietary iron intake was inadequate, showing minimal protective effects against anemia and ID (β(SE): -0.08(0.03), <i>p</i> = 0.030 and β(SE): -0.05(0.02), <i>p</i> = 0.037). <b>Conclusions</b>: VDD is a significant risk factor for impaired iron status and anemia in Moroccan WRA, highlighting the need for targeted nutritional interventions and further research.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"5 4","pages":"805-827"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11675096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Bovine Neosporosis in Relation to Socioeconomic, Demographic, and Transmissibility Factors in Dual-Purpose Production Systems in Colombia.","authors":"Cesar A Murcia-Mono, Sergio Falla-Tapias, Britney K Cabrera-Ospina, Jahir O Vargas-Domínguez, William O Burgos-Paz","doi":"10.3390/epidemiologia5040056","DOIUrl":"10.3390/epidemiologia5040056","url":null,"abstract":"<p><strong>Introduction: </strong>Bovine neosporosis represents a significant threat to reproduction and production in livestock systems worldwide. This disease is caused by the protozoan <i>Neospora caninum</i>, resulting in abortions of cows and neurological signs in newborn calves. This leads to significant economic losses, decreasing meat and milk production, especially in tropical regions. The infection has an endogenous and exogenous cycle of transmission involving dogs that shed the oocysts, with the highest transmission successes in humid areas. Similarly, there is a lack of knowledge about the epidemiological risk factors and management practices involved in the transmission success in tropical humid regions.</p><p><strong>Methods: </strong>In this sense, a cross-sectional epidemiological survey was conducted on 150 farms from 24 municipalities of the Huila area. A total of 360 cattle were sampled, and information about the production system was collected using a structured poll with 128 questions.</p><p><strong>Results: </strong>In these cattle, 53% (191/360) were positive for antibodies against <i>Neospora caninum</i> using ELISA. The logistic regression analysis using the information collected from the poll identified the presence of flooring type, water access, production systems, and feed management as risk factors. Among the protective factors were identified the geographical area, molasses supplementation, and biosecurity practices such as animal separation and access control.</p><p><strong>Discussion: </strong>This study identified for the first time the epidemiological risk factors associated mainly with the exogenous cycle of neosporosis. The present study contributes to the design of intervention strategies oriented to minimize the impact of parasitism in Colombian herds.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"5 4","pages":"828-837"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11675348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-Mode Face-to-Face and Telephone Approach to Data Collection in Health Surveys: A Scoping Review.","authors":"Paulo Henrique Guerra, Letícia Aparecida Calderão Sposito, Daniel Umpierre, Alex Antonio Florindo","doi":"10.3390/epidemiologia5040054","DOIUrl":"10.3390/epidemiologia5040054","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The present study aims to identify information from health research studies that have used a mixed-methods data collection approach, considering the combination of face-to-face and telephone interviews (referred to as the MMFT approach), specifically focusing on identifying themes, objectives, designs, populations involved, and implementation processes. <b>Methods</b>: A scoping review was developed, with systematic searches performed in March 2024 across five databases, namely, PubMed; SciELO; Scopus; Web of Science; as well as Google Scholar and reference lists. The inclusion criteria were defined under the following categories: \"Participants\" (observational epidemiological studies, with no restrictions as to where they were carried out, sampling techniques, or sample profiles); \"Concept\" (use of MMFT in data collection), and \"Context\" (studies carried out in the health area, with no restrictions on the theme/subject). The review process was carried out by three researchers who worked independently. <b>Results</b>: From the initial 1515 potential references, the synthesis of this review included data from seven original studies, highlighting cross-sectional designs, involvement of adults and/or elderly people without specific health conditions, variability between data collection strategies, and complementary use of online approaches. <b>Conclusions</b>: Based on the evidence generated, it is recommended that future studies assess aspects of the MMFT approach in terms of response rate, cost reduction, and increasing the speed of conducting health surveys.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"5 4","pages":"796-804"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11675162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Voluntary Blood Donation in Modern Healthcare: Trends, Challenges, and Opportunities.","authors":"Svjetlana Gasparovic Babic, Antea Krsek, Lara Baticic","doi":"10.3390/epidemiologia5040052","DOIUrl":"10.3390/epidemiologia5040052","url":null,"abstract":"<p><p>Voluntary blood donation plays a crucial role in public health by ensuring a stable supply of blood and its components, essential for medical treatments including surgeries, trauma care, and chronic disease management. Voluntary donors, often healthier individuals, enhance the safety of the blood supply and play a vital role in emergency preparedness. Beyond its societal benefits, regular blood donation may offer health advantages for donors, including improved cardiovascular health due to reduced iron levels and psychological benefits stemming from altruism and a sense of social responsibility. Public health initiatives are instrumental in fostering blood donation through education, awareness campaigns, and targeted donor recruitment strategies. These efforts encourage a culture of social responsibility, inspiring community participation and improving overall healthcare system sustainability. Despite these efforts, challenges such as fluctuating donation rates, aging populations, and shifting demographics underscore the need for ongoing initiatives to ensure a sufficient blood supply. As a public health priority, voluntary blood donation demands continuous promotion and innovation to meet the growing demand for blood products and maintain healthcare system resilience. This review highlights the public health significance of voluntary blood donation, with particular focus on its benefits for donors and its role in supporting healthcare systems.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"5 4","pages":"770-784"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11675880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, Regional, and National Burden of Tracheal, Bronchus, and Lung Cancer in 2022: Evidence from the GLOBOCAN Study.","authors":"Rajesh Sharma, Jagdish Khubchandani","doi":"10.3390/epidemiologia5040053","DOIUrl":"10.3390/epidemiologia5040053","url":null,"abstract":"<p><strong>Background: </strong>Tracheal Bronchus and Lung cancers (TBL) represent one of the leading causes of cancer deaths worldwide. This study aimed to examine the disease and economic burden of TBL cancers in 185 countries worldwide in 2022.</p><p><strong>Methods: </strong>The estimates of TBL cancer incidence and mortality (counts and age-standardized rates) were obtained from the GLOBOCAN 2022 data produced by the International Agency for Research on Cancer. Mortality-to-incidence ratios (MIR) were utilized as a proxy of 5-year survival rates. Multivariate regression was utilized to examine the association between TBL cancer burden and tobacco use prevalence.</p><p><strong>Results: </strong>Globally, there were 2.48 million incident cases and 1.82 million deaths due to TBL cancers in 2022. Males accounted for 63.4% of incident cases (1.57 million) and 67.85% of TBL deaths (1.23 million) in 2022. For both sexes combined, the age-standardized rate was 23.1 per 100,000, and the age-standardized mortality rate was 16.8/100,000. The Mortality-to-incidence ratio (MIR) at the global level stood at 0.71. Eastern Asia had the largest burden of TBL cancers among the 21 UN-defined regions, with around 51% of incident cases (1.24 million) and 46.9% of global deaths (851,876), followed by Northern America (incidence: 257,284; deaths: 150,675) and Eastern Europe (incidence: 158,141; deaths: 126,840). At the country level, human development index (HDI) and adult tobacco use prevalence could explain 67% and 64% variation in ASIR and ASMR, respectively. HDI was statistically significantly related to MIR, explaining a 48% variation in MIR.</p><p><strong>Conclusions: </strong>With 1.9 million deaths in 2022, TBL cancer is a significant global cause of mortality. Despite the knowledge and awareness of smoking and lung cancer, adult smoking rates remain high in many countries, including the United States and China. Renewed and sustained global efforts are needed to reduce smoking prevalence and PM2.5 levels, particularly in China and low- and middle-income countries.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"5 4","pages":"785-795"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11675692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Maturation of the International Health Crisis Response: The Polish Typhus Epidemic of 1916-1923 Compared to the African Ebola Virus Disease Epidemic of 2013-2016: Part I, the Polish Epidemic.","authors":"Gregory M Anstead","doi":"10.3390/epidemiologia5040051","DOIUrl":"10.3390/epidemiologia5040051","url":null,"abstract":"<p><p>Poland suffered an epidemic of louse-borne typhus from 1916-1923, with 400,000 cases and more than 130,000 deaths. The causative factors were depressed economic conditions and a refugee crisis that engulfed Poland after World War I. The recognition of the epidemic in 1919 stimulated the creation of the League of Red Cross Societies (LRCS). However, the LCRS had limited resources, and the Poles requested help from other governments and the League of Nations (LoN). The United States sent the American-Polish Relief Expedition to conduct delousing. However, the Polish-Soviet War of 1920 disrupted typhus control and exacerbated the refugee situation. The LoN belatedly organized an underfunded Epidemic Commission. The LCRS sent a research team that did groundbreaking work on the pathology of typhus. Into 1921, the epidemic continued, driven by refugees from typhus-stricken Russia. By 1924, typhus cases were finally approaching pre-World War I levels. Multiple factors lead to the amelioration of the epidemic. The repatriation of prisoners of war and displaced civilians had concluded by 1923. Also, there had been a steady influx of sanitary, food, economic, and medical aid from various organizations into Poland since 1919. Administratively, within Poland, the anti-typhus campaign was also conducted more effectively by the Extraordinary Epidemic Commissariat.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"5 4","pages":"728-769"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11675154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Physician-Insurance Contracting Contributes to the Medical Exodus and Access to Ophthalmic Care in Puerto Rico.","authors":"Luma Al-Attar, Rafael A Ocasio Diaz, Andrea N Ponce, Hossein Zare","doi":"10.3390/epidemiologia5040050","DOIUrl":"10.3390/epidemiologia5040050","url":null,"abstract":"<p><strong>Background: </strong>Puerto Rico (PR) has experienced significant demographic changes, characterized primarily by an aging population and an unprecedented exodus of medical doctors. Ophthalmologists are of particular concern as they commonly serve older populations, and the island has high rates of some age-related eye diseases in the United States (US). Our research aims to investigate the factors driving ophthalmologists in PR to emigrate to the mainland US.</p><p><strong>Methods: </strong>This is a cross-sectional study among ophthalmologists in PR, using survey data collected from May to June 2023. This study recruited a convenient sample of all ophthalmologists practicing in PR via outreach in person and online communities. The survey covered various types of challenges faced by ophthalmologists, their demographics, and practice details. STATA/BE 18 statistical software was used for data analysis. Statistical tests, such as chi-square and proportion tests, were performed, stratifying results by age, gender, subspecialty, geographic health districts, experience, and practice type.</p><p><strong>Results: </strong>Among 130 of the estimated 218 ophthalmologists in PR, insurance/billing issues were identified as the primary challenge to practicing in PR and the primary reason to leave PR. The challenges that were identified included required authorizations for patient care, unjustified claim rejections, and threats of contract cancellation. We found that new ophthalmologists (≤15 years of practice) faced more specific challenges than experienced ophthalmologists (>15 years of practice), such as difficulty in obtaining insurance contracts.</p><p><strong>Conclusions: </strong>Insurance/billing issues are a pervasive concern for ophthalmologists in PR. New ophthalmologists are disproportionately affected by these challenges, potentially leading some to find employment outside of PR. There is a need for targeted policies-regulation of insurance contracting and increased reimbursement from private insurance plans-to reduce insurance contracting barriers for keeping a sustainable physician workforce in PR.</p>","PeriodicalId":72944,"journal":{"name":"Epidemiolgia (Basel, Switzerland)","volume":"5 4","pages":"715-727"},"PeriodicalIF":0.0,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11587007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}