Frontiers in Public Health最新文献

Background: Falls are a leading cause of injury and injury-related deaths in older adults. A variety of community-delivered, evidence-based, fall risk-reduction programs have been developed and proven effective. These evidence-based fall prevention programs (EBFPP) have been classified along a fall-risk continuum, indicating the target fall-risk level of participants. The congruency between the program's targeted and enrolled fall-risk level of participants is unknown. This study creates a fall-risk classification index, places participants into one of three fall risk categories, and then examines congruency of actual vs. recommended fall-risk of participants, by program.

Methods: Data came from the Healthy Aging Programs Integrated Database, created by the National Council on Aging (NCOA) funded by the Administration for Community Living (ACL) for use by ACL falls prevention program grantees. Using data from a pre-participation survey designed by the ACDL for their grantees, a fall risk index was created. The fall risk levels of the participants were then compared to the fall risk profile of the EBFPPs as identified in NCOA's Evidence-based Falls Prevention Programs Risk Continuum Guidance for Program Selection in which they were enrolled.

Results: Between July 2016 and June 2022, 105,323 older adults participated in one of eight EBFPPs. Participant characteristics varied among programs. Applying the fall risk index to the fall risk sample (31,064 older adults), 29% of participants were identified as being at high risk, 41% at moderate risk, and 30% at low risk. When the fall risk level of participants, by program, was compared to the target risk profile of the associated EBFPP, programs that had a risk profile targeting individuals at moderate to low risk were found to enroll a larger percentage of adults at high risk than expected. All programs enrolled at least some participants at each of the three risk levels.

Conclusion: All eight EBFPPs enrolled participants across all three fall-risk levels with most programs being at least somewhat congruent with the fall-risk program continuum recommendations. More research is needed to better understand inconsistencies between risk-levels of program, target risk-levels, and actual participant risk-level, to guide either adaptations in the risk-level classification or program modifications to accommodate different risk-levels.

Objective: To investigate the mediating effect of life satisfaction between physical exercise behavior and depressive symptoms among middle-aged and elderly individuals, providing a reference for improving depressive conditions in this demographic group.

Methods: Data from 11,101 middle-aged and elderly individuals from the 2020 China Family Panel Studies (CFPS) were collected. STATA 17.0 was used for data cleaning, organization, and statistical analysis which includes univariate analysis, stepwise regression analysis, and mediation effect testing.

Results: Among 11,101 individuals aged 45 years and above, 2,272 participated in physical exercise, accounting for 20.47%; 2,052 exhibited depressive symptoms, representing 18.48%. Physical exercise was positively correlated with life satisfaction and negatively correlated with depression. Depression scores also showed a negative correlation with life satisfaction. According to the results of the mediation effect study, life satisfaction accounted for 16.60% of the overall effect and had a mediating effect value of -0.099 on depression symptoms.

Conclusion: Physical exercise and life satisfaction are factors influencing depressive symptoms, and life satisfaction acts as a partial mediator between physical exercise participation and depression among middle-aged and elderly adults.

Introduction: As part of building a platform for epidemiological research on diagnostic errors and problems that centers on patients and equity, this paper summarizes the development and analysis of data collected from fielding a survey in a nationally representative U.S. population to explore the prevalence and harm consequences of diagnostic problems or mistakes (referred to here as "diagnostic P&Ms") by respondent-reported sociodemographic characteristics.

Methods: We applied narrative elicitation methods to enhance the rigor of implementing a novel survey about diagnostic experiences. We conducted a U.S. population-based survey of a nationally representative sample in 2022-2023, drawn from the NORC AmeriSpeak® panel. We conducted multivariate regression analysis at the household level and in a patient subsample to explore sociodemographic predictors of diagnostic P&Ms and related outcomes in the aftermath.

Results: The comparative analysis by sociodemographic characteristics estimates prevalence of diagnostic P&Ms, prevalence of persisting harms, rate of respondent-reported perceptions of personal attribute adversely affecting diagnosis, and concern about future diagnostic P&Ms. Outcome estimates ranged from about 4% (concern about future diagnostic P&M) to 38% (at least one P&M in households during the past 4 years). Several sociodemographic groups experienced statistically significant higher levels of risk for these outcomes, with some at greater than twice the odds compared to reference groups-transgender and gender independent individuals (e.g., 5 + -fold odds of expectation of future P&M compared to cis-males), cis-females (e.g., greater than 1.5 odds of persistent physical and emotional harms compared to cis-males), low household income (e.g., twice the likelihood of multiple P&Ms for incomes under $60 K compared to $100 K+ households), younger age (3-fold odds of at least one diagnostic P&M for those under 25 years old compared to those aged 45-54), multiracial individuals (about twice the odds of diagnostic P&Ms compared to non-Hispanic White), and disabled and unable to work full-time (more than twice the likelihood of perceiving that a personal attribute impaired diagnosis compared to those with other work status designations).

Discussion: This new survey and accompanying data source facilitate an enriched exploration of the patterns of diagnostic disparities and points of leverage through which diagnostic experiences can be made more equitable.

Introduction: Hearing loss is the most commonly recognized occupational disease in Germany. Musicians are also affected, as playing classical music can expose them to high or very high sound volumes. With this scoping review, we aimed to assess the prevalence of noise-induced hearing loss among professional musicians and evaluate its characteristics.

Methods: The databases such as MEDLINE, Embase, Cochrane Library, and Google Scholar were searched using the terms (hearing loss OR hearing impairment OR hearing difficulties OR acoustic trauma) AND (musician) on 14 August 2023 and 2 January 2025. Only original studies with audiometric examination results were included.

Results: A total of 79 studies were retrieved for descriptive analysis. The median number of participants was 52 (IQR 30-109). The majority of the retrieved studies included participants with at least 5 years of experience as practicing musicians. The proportion of men was significantly higher than that of women, with the median_{men portion} of 69% (IQR 53-83%). Students were a common study population, indicating that the data on older and retired musicians were either rare or missing. As a result, the lifetime prevalence of hearing loss in musicians could not be determined. The data analysis showed an increased risk of hearing loss >15-20 dB in the frequency range of 4,000-6,000 Hz among participants in the classical genre group. Studies with participants having normal hearing were also found within that genre. Rock, pop, and jazz musicians had an increased risk of hearing loss >20 dB in the frequency range of 3,000-8,000 Hz. The data for military and marching band music and traditional music genres were limited. The retrieved studies indicated a higher risk of hearing loss >20 dB in the frequency range of 4,000-6,000 Hz. A total of 17 studies adjusted the audiogram results for age, 2 did not, and 59 had no report. Data extraction yielded a prevalence of notch configurations in 20-50% of the classical musicians, with hearing loss affecting 5-70% of them. Up to 40% of rock, pop, and jazz musicians showed notch configurations, with 20-60% experiencing hearing loss.

Conclusion: Overall, a definitive assessment of the prevalence of musicians' hearing loss cannot be drawn from the available data. Prospective, longitudinal studies with reliable sample sizes and representative populations are essential. A multicenter study would also be valuable.

Introduction: Waste management represents an occupational setting where fungi are significant contaminants. This study aimed to assess the exposure of waste workers to mycotoxins through a human biomonitoring study.

Methods: A total of 33 workers and 19 controls provided spot urine samples to determine 10 mycotoxins' urinary biomarkers using liquid chromatography coupled with mass spectrometry. Risk characterization was performed using hazard quotient and margin of exposure assessments.

Results: The results indicated that workers were exposed to six out of the 10 mycotoxins tested, with the following detection rates: deoxynivalenol (91%, 30/33), ochratoxin A (33%, 11/33), zearalenone (17%, 5/33), α-zearalenol (12%, 4/33), β-zearalenol (12%, 4/33), and HT-2 toxin (3%, 1/33). Within controls and outwith controls, were exposed to 5/10 and 2/10 mycotoxins, respectively. All participants exhibited hazard quotients for deoxynivalenol and zearalenone below one, indicating that the exposure is unlikely to pose a health risk. However, when considering the margin of exposure determined for ochratoxin A, 18% of the total participants presented results below 200 for non-neoplastic effects, and 100% of the total participants presented values below 10,000 for neoplastic effects, suggesting potential health concerns that require further assessment.

Discussion: This study highlights the need for future research on occupational exposure to mycotoxins in waste management settings.

Objectives: To investigate the association between meteorological factors and common uropathogens in children with urinary tract infections (UTIs) and assesses the potential influence of weather conditions on pediatric UTIs.

Study design: Analyze the demographic and uropathogen characteristics from children with culture-proven UTIs and its correlation with meteorological factors.

Methods: 2,411 data from infants and children with UTIs in a children's hospital from 2016 to 2021 were retrospectively analyzed. A correlation analysis was conducted to investigate the relationship between the monthly detection number of uropathogens and meteorological factors.

Results: Multiple linear stepwise regression analyses showed a positive correlation between monthly average temperature, precipitation volume, sunshine hours, monthly total number of uropathogens, and the number of E. coli and E. faecalis. E. faecium was predominant in <12-month-old children, while E. coli was dominant in the 3-18-year age category. E. faecium showed a higher prevalence in girls, while E. faecalis was more prevalent in boys. E. coli exhibited resistance rates of >40% to second-or third-generation cephalosporins in multiple age groups. E. faecium showed high resistance rates to tetracyclines, fluoroquinolones, erythromycin, ampicillin, and penicillin, while K. pneumoniae displayed higher sensitivity to cephalosporin-sulbactam and amikacin, but higher resistance rates to cefazolin and ceftazidime.

Conclusion: This study reveals the association between meteorological factors and uropathogens in children with UTIs, as well as the distribution, age-related characteristics, gender differences and antibiotic resistance profiles of pathogenic bacteria. These findings inform the development of targeted strategies for UTI prevention and treatment based on uropathogenic characteristics and meteorological conditions.

Background: Suicide represents a critical public health concern and one of the most devastating forms of death. Based on a report from the World Health Organization, around 700,000 deaths by suicide occur globally each year. In 2019, the worldwide suicide mortality rate was 9.0 per 100,000 people, while in Iran, this rate has been reported to be an average of 5.2 per 100,000. Suicide is influenced by various factors spanning individual, relational, community, and social domains, all of which may elevate the risk of suicide and related death. One significant factor potentially impacting this issue was the COVID-19 pandemic, which may have affected these trends by disrupting individuals' social interactions and gatherings. To explore this further, the present study was carried out to investigate the impact of the COVID-19 pandemic on the changes in suicide rates leading to death in Iran.

Methods: This study was designed using an Interrupted Time Series approach combined with negative binomial regression. Seasonal variations were adjusted for using the harmonic method. The research sample comprised 63,514 suicide-related deaths recorded between April 20, 2009, and March 20, 2023. Suicide mortality data were sourced from the National Legal Medicine Organization, while population statistics were obtained from the official website of the Statistical Center of Iran. The study analyzed trends in suicide incidence both prior to and during the COVID-19 pandemic. The period used to evaluate pandemic-related changes in Iran began in May 2020, following the World Health Organization's declaration of COVID-19 as a global public health emergency. Descriptive analyses were performed using Stata software, and trend assessments through the Interrupted Time Series (ITS) method were conducted using R software and the "lmtest" statistical package.

Results: The changes in the incidence of suicide during the study increased by 1.003 monthly (p < 0.001). This rate increased by 1.1 (p < 0.001) compared to the times before the onset of the pandemic after entering the effect of the COVID-19 pandemic in the model. When the interaction effect of time with the COVID-19 pandemic was added to the base model, no significant relationship was observed.

Conclusion: Before the COVID-19 pandemic, suicides in Iran had a proportional increasing trend. However, three months after the pandemic, an increasing trend in the level of suicide deaths was observed. Most likely, the COVID-19 pandemic phenomenon had an impact on the occurrence of suicide.

In 2019, a community collaborative of nearly 30 health care, social service, philanthropic, and government organizations came together to construct a community-wide plan to reduce older adult isolation in Lackawanna County, Pennsylvania. Although such collaborations have been pursued before, the current one has exceeded expectations, launched a promising pilot, and formed exciting ripple effects throughout the region's aging services landscape. Among the implementation strategies informing the initiative are the use of an interorganizational shared screening tool to identify isolation risk, a team of older adult peer navigators to provide one-on-one assistance and foster connections for those who are isolated, and a major public awareness campaign to educate residents on the negative health impacts of isolation and reduce the stigma felt by many living socially disconnected lives. This article will summarize the methodological process used in developing a cohesive, multi-sector collective impact coalition, as well as examine the limitations and future directions for this initiative.

Background: This study explores the longitudinal relationship between the Weight-Adjusted Waist Index (WWI), an innovative obesity metric, and stroke incidence in aged 45 and older Chinese adults.

Methods: Data from 9,725 individuals aged 45 years and older were analyzed from the China Health and Retirement Longitudinal Study (2011-2020). Baseline characteristics were analyzed across different quartiles of the WWI. Stroke incidents were determined through self-reported doctor diagnoses. Multivariate logistic regression analyses and curve fitting assessed the WWI-stroke risk relationship, adjusting for various demographic, lifestyle, and health-related factors.

Results: Higher WWI quartiles were associated with older age and higher prevalence of stroke and adverse health conditions. In the fully adjusted model, participants in the highest WWI quartile had an odds ratio of 1.52 (95% CI: 1.19, 1.92) for stroke compared to the lowest quartile. Curve fitting revealed a linear relationship between WWI and stroke risk, consistent across various demographic and clinical subgroups.

Conclusion: Higher WWI is linked to an increased risk of stroke in aged 45 and older Chinese adults over an eight-year period. WWI may serve as an effective tool for predicting long-term stroke risk within this population. However, the study is limited by the reliance on self-reported stroke diagnoses and the presence of potential residual confounding factors.

Background: Access to high-quality medical oxygen has been a long-standing challenge in Liberia due to barriers that span across the health system, which were amplified during the COVID-19 pandemic. The surge in cases requiring oxygen therapy necessitated rapid capacity-building for healthcare workers. In response, an emergency oxygen training package was adapted and implemented by the Liberia Ministry of Health and the National Incidence Management System. This manuscript evaluates the implementation of a short-term respiratory care training package to rapidly build healthcare worker capacity during the COVID-19 response and its adaptation for routine in-service training post-response.

Methods: The emergency training used the "hot and cold" simulation approach from the 2014 Ebola response, consisting of a cold phase (3-days) with didactic lectures and practical sessions, and mock COVID treatment unit simulations (2-days); and a hot phase within an active CTU. Participants were doctors, physician assistants, nurses, or midwives, deployed to COVID treatment units at major health centers and hospitals across all counties in Liberia. Training assessments consisted of a paper-based knowledge test pre- and post-training, and Objective Structured Clinical Examinations post-training.

Results: The emergency training as part of COVID response included 123 health care workers from 43 health facilities and saw a significant increase in knowledge (median score of 46% pre-training vs. 84% post-training, p < 0.001). Adaptation and piloting of the package for routine in-service training was also effective at increasing knowledge amongst 81 health care workers (median score of 41% pre-training vs. 78% post-training, p < 0.001). High post-training Objective Structured Clinical Examination scores demonstrated clinical competency achievement in both cohorts. For emergency training, median scores were 92% (pulse oximetry), 81% (oxygen cylinders), and 83% (oxygen concentrators). For routine in-service training, scores were 88, 82, and 84%, respectively.

Conclusion: We demonstrate that the implementation of a healthcare worker training package in oxygen therapy during the COVID response in Liberia and its eventual integration into a routine in-service training program was able to achieve significant improvements in health care worker knowledge and skills. This highlights the feasibility of using rapid and short-term training to enhance clinical capacity within both emergency and post-response settings in a resource-limited country.