Higher Education Institutions (HEIs) are acknowledged as key drivers in realizing health-related Sustainable Development Goals (SDGs). The University of the Philippines Manila, College of Public Health (UP CPH) together with the Asia-Pacific Academic Consortium for Public Health (APACPH), hosted the 53rd APACPH International Conference last 21-23 September 2022. The conference discussed current issues relating to the attainment of SDGs and promoted collaboration of leading academic institutions and other stakeholders in addressing various public health challenges. The conference revolved around the challenges and opportunities in attaining health-related SDGs, and the good practices and roles of HEIs in addressing health disparities. The lack of certificati on framework of public health tertiary programs, pedagogy and infrastructure, and ambiguous roles and network of public health professionals were discussed. The conference served as a platform for discussing potential resolutions and ways forward in addressing these challenges. Opportunities for improvement such as updating of policies and curricula, strengthening of internship and community engagement programs, establishment of capacity-building partnerships and programs, and developing multidisciplinary-competent faculty and students were identified. This paper providesthe highlights of the conference focusing on the good practices and roles of HEIs in addressing health disparities, the impact of COVID-19 pandemic, and other issues and challenges in attaining SDGs.

Clinical grading diagnosis of disorder of consciousness (DOC) patients relies on behavioral assessment, which has certain limitations. Combining multi-modal technologies and brain-computer interface (BCI) paradigms can assist in identifying patients with minimally conscious state (MCS) and vegetative state (VS). This study collected electroencephalogram (EEG) and functional near-infrared spectroscopy (fNIRS) signals under motor BCI paradigms from 14 DOC patients, who were divided into two groups based on clinical scores: 7 in the MCS group and 7 in the VS group. We calculated event-related desynchronization (ERD) and motor decoding accuracy to analyze the effectiveness of motor BCI paradigms in detecting consciousness states. The results showed that the classification accuracies for left-hand and right-hand movement tasks using EEG were 93.28% and 76.19% for the MCS and VS groups, respectively; the classification precisions using fNIRS were 53.72% and 49.11% for these groups. When combining EEG and fNIRS features, the classification accuracies for left-hand and right-hand movement tasks in the MCS and VS groups were 95.56% and 87.38%, respectively. Although there was no statistically significant difference in motor decoding accuracy between the two groups, significant differences in ERD were observed between different consciousness states during left-hand movement tasks ( P < 0.001). This study demonstrates that motor BCI paradigms can assist in assessing the level of consciousness, with EEG being more sensitive for evaluating residual motor intention intensity. Moreover, the ERD feature of motor intention intensity is more sensitive than BCI classification accuracy.
Humans ; Brain-Computer Interfaces ; Spectroscopy, Near-Infrared/methods* ; Electroencephalography/methods* ; Consciousness Disorders/diagnosis* ; Male ; Movement ; Adult ; Female ; Intention ; Persistent Vegetative State/diagnosis*

OBJECTIVES: Older adults in rural areas with multiple chronic conditions (MCC) generally exhibit poorer medication adherence than the general elderly population. Considering individual heterogeneity helps to design precise subgroup-based interventions. This study aims to identify latent profile types of medication adherence mechanisms among rural older adults with MCC based on the capability-opportunity-motivation-behavior (COM-B) model, and to explore factors influencing medication adherence. METHODS: A multistage sampling method was used to recruit 349 rural older adults with MCC from 10 administrative villages in Jianghua County, Yongzhou City, Hunan Province, between July and September, 2024. Participants were surveyed using a general information questionnaire, the Health Literacy Scale for Chronic Patients, the Beliefs about Medicines Questionnaire-Specific, the Multidimensional Scale of Perceived Social Support, and the Morisky Medication Adherence Scale. Latent profile analysis based on the COM-B model was conducted to identify subgroups of medication adherence mechanisms. Univariate and Logistic regression analyses were used to identify influencing factors associated with different latent profiles and adherence levels. RESULTS: Among the participants, 33.5% demonstrated good medication adherence. The 5 most prevalent chronic diseases were hypertension (86.5%), diabetes (36.7%), arthritis or rheumatism (34.4%), stroke (21.8%), and heart disease (17.5%). Overall, rural older adults with MCC exhibited relatively good medication capability, opportunity, and motivation. Their medication adherence mechanisms were classified into 3 latent profiles: "family-support restrained type" (5.2%), "family-support driven type" (52.1%), and "comprehensive advantage type" (42.7%). Significant differences were observed among the three profiles in terms of education level, marital status, living arrangement, and per capita monthly household income (all P<0.05). Multivariate Logistic regression revealed that higher education level was a protective factor for belonging to the "comprehensive advantage type" rather than the "family-support driven type" [OR=0.277, 95% CI (PL) 0.126 to 0.614, P=0.002]. Furthermore, significant differences in education level, self-rated health status, and latent profile type were found between participants with good and poor adherence (P<0.05). Binary Logistic regression indicated that with each one-level increase in self-rated health status, the risk of poor adherence increased by 293.9% [OR=3.939, 95% CI (PL) 1.610 to 9.636, P=0.003]. Compared with the "family-support restrained type", individuals classified as the "comprehensive advantage type" had a 96.8% [OR=0.032, 95% CI (PL) 0.008 to 0.123, P<0.001] lower risk of poor medication adherence. CONCLUSIONS The mechanisms underlying medication adherence among rural older adults with MCC show clear heterogeneity. Primary healthcare providers should focus on the "family-support restrained type" subgroup, strengthen social support networks, and implement targeted interventions to improve medication adherence.
Humans ; Aged ; Rural Population ; Male ; Female ; China ; Medication Adherence/psychology* ; Surveys and Questionnaires ; Chronic Disease/drug therapy* ; Multiple Chronic Conditions/drug therapy* ; Social Support ; Motivation ; Middle Aged ; Health Literacy ; Aged, 80 and over

OBJECTIVES: To investigate the neural mechanisms of rhythmic activity in the hippocampal CA1 region and orbitofrontal cortex (OFC) during a spatial goal-directed task. METHODS: Four long-Evans rats were trained to perform a spatial goal-directed task in a land-based water maze (Cheese-board maze). The task was divided into 5 periods: Pre-test, Pre-sleep, Learning, Post-sleep, and Post-test. During the Learning phase, the task was split into two goal navigation and two reward acquisition processes with a total of 8 learning stages. Local field potentials (LFP) from the CA1 and the OFC were recorded, and power spectral density analysis was performed on Theta (6-12 Hz), Beta (15-30 Hz), Low gamma (30-60 Hz), and High gamma (60-90 Hz) bands. Coherence, phase-locking value (PLV), and phase-amplitude cross coupling (PAC) were used to assess the interactions between the CA1 and the OFC during learning and memory. RESULTS: During the task training, the rats showed consistent rhythms of OFC neural activity across the task states (P>0.05) while exhibiting significant changes in Beta and High gamma rhythms in the CA1 region (P<0.05). Coherence and PLV between the CA1 and the OFC were higher during goal navigation, especially in the stable learning phase (Stage 8 vs Stage 1, P<0.01). The rats showed stronger cross-frequency coupling between CA1-Theta and OFC-Low gamma in the Post-test phase than in the Pre-test phase (P<0.05). CONCLUSIONS Learning and memory consolidation in goal-directed tasks involve synchronized activity between the CA1 region and the OFC, and cross-frequency coupling plays a key role in maintaining short-term memory of reward locations in rats.
Animals ; Rats ; Rats, Long-Evans ; CA1 Region, Hippocampal/physiology* ; Memory Consolidation/physiology* ; Prefrontal Cortex/physiology* ; Maze Learning/physiology* ; Goals ; Male ; Memory/physiology* ; Learning/physiology*

The Healthy China 2030 Plan set the goal of reducing premature deaths from diabetes by 30% by 2030. However, there has been a lack of assessment of premature mortality for diabetes since the action plan was issued. This study used data from the Global Burden of Disease Study 2021, calculated the premature deaths for diabetes by sex, provinces, and subtypes from 1990 to 2021. We explored the temporal trend of premature mortality using the average annual percent change (AAPC) for different sexes, provinces, and subtypes from 1990 to 2021. Furthermore, we predicted premature mortality for diabetes through 2030 for China and its provinces according to the average annual change rate from 2010 to 2021. There was a first slow upward trend in premature mortality for diabetes from 0.5% in 1990 to 0.6% in 2004, and then a decline until 2021 with premature mortality of 0.4%. By 2030, only Fujian (30.3%) will achieve the desired level of reduction, with only seven provinces meeting the target for females and none for males. There is a large range in the degree of decline between inland and coastal regions, showing obvious geographic differences, and there should be a focus on balancing medical resources.
Humans ; China/epidemiology* ; Female ; Male ; Mortality, Premature/trends* ; Diabetes Mellitus/mortality* ; Goals ; Middle Aged ; Adult

OBJECTIVE: This study explored the job choice preferences of Center for Disease Prevention and Control (CDC) workers to provide CDC management information and recommendations for optimizing employee retention and motivation policies. METHODS: A discrete choice experiment was conducted in nine provinces across China. Seven key attributes were identified to analyze the job preferences of CDC workers. Mixed logit models, latent class models, and policy simulation tools were used. RESULTS: A valid sample of 5,944 cases was included in the analysis. All seven attributes significantly influenced the job choices of CDC workers. Heterogeneity analyses identified two main groups based on different levels of preference for attribute utility. Income-prioritizers were concerned with income and opportunities for career development, whereas bianzhi-prioritizers were concerned with bianzhi and welfare benefits. The policy simulation analysis revealed that income-prioritizers had a relatively higher sensitivity to multiple job preference incentives. CONCLUSION Income and bianzhi were the two key attributes influencing the job choices and retention preferences of CDC workers. Heterogeneity in job preferences was also identified. Based on the preference characteristics of different subgroups, policy content should be skewed to differentiate the importance of incentives.
China ; Humans ; Male ; Female ; Adult ; Centers for Disease Control and Prevention, U.S. ; Middle Aged ; Choice Behavior ; Career Choice ; Motivation

PURPOSE

Reflective practice is widely recognized as a fundamental component of nursing education and professional development that had the potential to enhance critical thinking skills. This study intended to evaluate the effect of reflective practice interventions on the critical thinking capability of student nurses.

The quantitative, meta-analysis design was employed. CINAHL, Medline, PubMed, Health Sources and Google Scholar databases weresearched forpublications in English until December 2020.The studies were subjected to quality assessment with the JBI checklist, systematic data extraction and statistical analysis using Comprehensive Meta-analysis version 3.0.

A total of four studies satisfied the inclusion criteria. Reflective practice strategies such as journaling/journal writing and self-regulated learning had effectively enhance critical thinking skills of student nurses (summary effect=0.24; 95% CI [0.13-0.44]; p-value= 0.00004). Sensitivity analysis confirmed the strength of the findings and the publication bias was assessed and found to be minimal.

Reflective practice interventions had positive impact on the improvement of critical thinking capacity of nursing students. With the practical implications for nursing education and professional development, this study had recommended to integrate reflective practice strategies into the curriculum and training programs.

BACKGROUND

According to the World Health Organization, in 2016, there were more than 1.9 billion adults who were overweight. Of these, over 650 million were obese. Physical inactivity is one of the major risk factors for several non-communicable diseases. Healthcare workers who have direct contact with patients often influence their behaviors. However, health care workers who educate their patients but they themselves do not practice what they recommend, may be one of the barriers that can affect patient education and influence.

This research paper aimed to investigate the motivation to participate in physical activity among healthcare workers and to determine the association between the profile of respondents with the different types of motivation.

There was a total of 250 randomly selected respondents who were included in the study. Data were gathered through a self-administered questionnaire utilizing the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Behavioral Regulation in Exercise Questionnaire (BREQ-2). Descriptive statistics was used to summarize sociodemographic information, physical activity levels and BREQ-2 profiles. T-test was used to analyze differences in gender while analysis of variance (ANOVA) was used for levels of physical activity and professional category.

Female healthcare professionals have a higher average in amotivation (mean=0.56) while males have a higher average in intrinsic (mean=2.82) motivation. Nurses and ancillary services have higher average amotivation scores than physicians.

Health care workers who have high classification in physical activity have the highest average scores in terms of relative autonomy index, introjected, identified, and intrinsic scores. This demonstrates a positive association between motivation from internal regulation and increased physical activity.

BACKGROUND AND OBJECTIVE

Midwives play a vital role in the attainment of Sustainable Development Goals related to the health and well-being of mothers and newborns. Strengthening the leadership and management capacities of midwives is pivotal to the fulfillment of their mandate beyond assisting in birth and delivery. The study explores the perspectives of midwives about professional education and practice, which are aimed to serve as bases for developing a leadership course for midwives to enhance their roles in public health.

The study employed a descriptive-qualitative design. Using a semi-structured questionnaire, online focus group discussions (FGDs) with midwives from the academe, professional organization, and clinical practice were conducted. Through directed content analysis, the gathered information was analyzed to include the participants’ insights on midwifery competencies, teaching methods and assessment strategies, supplementary courses and training, and factors affecting midwifery practice.

A total of eleven (11) participants contributed to the FGDs, which included midwives from the academe (dean, faculty), professional organization (board member of the Professional Regulation Commission), and clinical practice (public and private institutions). Notably, participants shared their perspectives regarding the similarities/differences in the terminal competencies of midwifery programs. The demands of outcomes-based education, coupled by the shift to online learning due to the pandemic, pushed the need for modifications in program delivery for the students. Results highlighted the need for supplementary courses and capacity building on leadership and management, research, and interprofessional collaboration. Midwives shared factors that affect their professional practice, which include insufficient training, inadequate manpower, and differences in expectations/standards in task performance.

The findings indicate the need to develop capacity-building courses for midwives to enhance their contribution towards universal health care. The results of this study also highlight the importance of understanding and improving the competencies of midwives across the building blocks of the health system, which include health service delivery, human resources for health, health information systems, health financing, health governance, and health regulation. Notably, key concepts recommended for the Leadership Development Course for Midwives include: leadership and management, research, and interprofessional collaboration.

OBJECTIVES: Reforming medical insurance payment methods is a key part of deepening the healthcare system reform. Understanding the influencing factors and underlying mechanisms of physicians' strategic behaviors under the diagnosis-related groups (DRG) payment system is crucial for reducing medical resource waste and improving the efficiency of health insurance fund utilization. METHODS: Based on the Theory of Planned Behavior, this study used grounded theory to construct a questionnaire encompassing belief, behavioral attitude, subjective norm, perceived behavioral control, behavioral intention, and behavior measurement items. Structural equation modeling was then used for empirical analysis. RESULTS: Physicians' behavioral intention had the most significant impact on their strategic behavior (β=0.606, P<0.001). Physician's attitude toward strategic behavior (β=-0.159, P<0.01), subjective norm (β=-0.093, P<0.05), and perceived behavioral control (β=-0.120, P<0.05) were major influencing factors of behavioral intention. Physicians' behavioral beliefs, normative beliefs, and control beliefs were significantly correlated with behavioral attitude (β=0.554, P<0.001), subjective norm (β=0.383, P<0.001), and perceived behavioral control (β=0.274, P<0.001), respectively. CONCLUSIONS Behavioral intention is the primary predictor driving physicians to engage in strategic behavior. Attitudes toward the behavior, subjective norms, and perceived behavioral control all significantly affect physicians' behavioral intentions.
Humans ; Physicians/psychology* ; Surveys and Questionnaires ; Attitude of Health Personnel ; Diagnosis-Related Groups/economics* ; Intention ; Female ; Male ; Adult