Frontiers in Public Health最新文献

Objectives: This study aims to analyze differences between lesbian, gay, bisexual, transgender, and queer (LGBTQ+) and non-LGBTQ+ Veterans with post-traumatic stress disorder (PTSD) in terms of demographics, comorbidities, and medical care usage, including differences by sex of record, including separate analyses for transgender and non-transgender Veterans.

Methods: Chi-square, t-test, ANOVA Welch one-way testing, and absolute standardized difference analyses were conducted on a cohort of 277,539 Veterans diagnosed with PTSD.

Results: The study found significant differences, particularly concerning positive LGBTQ+ status and sex of record. There were significant differences found in age, marital status, and medical care usage, as well as pain, mental health, and substance use disorder diagnoses. Differences in having experienced military sexual trauma, crime, or maltreatment were especially significant, with increased percentages among LGBTQ+ individuals, and sex of record females. In separate analyses, there were similar differences among transgender and non-transgender Veterans, with similar increased risks for sex of record females.

Conclusion: Our findings suggest an intersectionality of LGBTQ+ status and sex of record in the context of PTSD. These findings may help guide future research, policy, and interventions.

The burden of disease and death attributable to environmental pollution is a growing public health challenge worldwide, particularly in developing countries. While the adverse effects of environmental pollution on oral health have garnered increasing attention, a comprehensive and systematic assessment remains lacking. This article delves into the intricate relationship between environmental pollution and oral health, highlighting significant impacts on various aspects such as dental caries, periodontal diseases, oral facial clefts, cancer, as well as other oral diseases. Our results suggested that secondhand smoke, particulate matters (PM) and heavy metals are the most important risk factors affecting oral health. Additional contributors, such as radiation pollutants, electronic cigarette, phthalates, gaseous air pollutants, pesticides, solvents, wood dust, formaldehyde and excessive fluoride were investigated, though evidence for their impacts remains limited and often inconclusive. The review also explores potential mechanisms underlying these impacts, including microorganism, inflammation, oxidative stress, genetic influences, and toxicant exposures from heavy metals and other pollutants. For instance, PM2.5 may contribute to dental caries by disrupting oral pH balance and absorbing heavy metals such as lead and cadmium which have been considered as caries promoting elements. It is also associated with adverse inflammatory responses and tissue damage in periodontal tissues by causing oxidative stress, potentially leading to periodontitis. Drawing on current evidence, it provides a comprehensive analysis of these associations, offering critical insights to guide the development of preventive strategies and public health interventions. The findings highlight the pressing need for future research to validate the causal links between environmental pollution and oral diseases and to unravel the underlying biological mechanisms. Ultimately, greater attention must be directed toward addressing the relationship between environmental pollution and oral diseases, with a focus on pollution control and the reduction of preventable environmental risks to safeguard oral health on a broader scale.

Purpose: Musculoskeletal disorders (MSDs) are one of the main causes of health-related absenteeism. MSDs were a known problem among healthcare workers (HCWs) even before COVID-19. The pandemic, with its associated stresses and changes in working conditions, may have influenced the incidence and duration of MSDs-related sick leave (SL) among HCWs. The aim of this study was to compare the incidence and duration of MSDs-related SL among HCWs before and during the COVID-19 pandemic, with a focus on differences between age and gender groups.

Methods: A retrospective analysis was conducted using Slovenian national SL data on work-related MSDs within NACE Rev. 2 "Human health activities" for 2019, 2020, and 2021, categorized by gender and age.

Results: The study found that older HCWs, particularly women, consistently had a higher incidence of work-related MSDs SL than their younger counterparts. However, during the pandemic, MSDs were more common among younger men, while the average duration of SL was longer among younger women. On the other hand, in older HCWs, the average SL incidence decreased during the pandemic, while the SL duration substantially increased.

Conclusion: The dynamics of MSDs related SL among HCWs are complex and influenced by several factors, including the challenges posed by the COVID-19 pandemic. Healthcare managers should implement tailored strategies to address MSDs-related absenteeism among specific groups of HCWs to promote a healthier workforce and ensure a resilient healthcare system during health crises.

Introduction: Enteric pathogens are a leading causes of diarrheal deaths in low-and middle-income countries. The Exposure Assessment of Campylobacter Infections in Rural Ethiopia (EXCAM) project, aims to identify potential sources of bacteria in the genus Campylobacter and, more generally, fecal contamination of infants during the first 1.5 years of life using Escherichia coli as indicator.

Methods: A total of 1,310 samples (i.e., hand rinses from the infant, sibling and mother, drinking and bathing water, food and fomite provided to or touched by the infants, areola swabs, breast milk and soil) were collected from 76 households between May 2021 and June 2022. Samples were assigned to two groups by infant age: TP1 (time point 1), infants between 4 and 8 months of age, and TP2, infants between 11 and 15 months of age. Fluorometric and semi-selective colorimetric approaches were used to quantify E. coli in the field samples.

Results: Overall, E. coli was ubiquitous within selected households (56.8% across the study). E. coli was more frequently detected than average (>53%) with high concentration (>2-log CFU) in soil (g) and per pair of hand, while the opposite trend (<33%; <1.5-log CFU) was observed in food provided to the infants (g or mL), per areola, and breast milk (mL; p < 0.01). E. coli was frequently detected in fomites touched by the infants, drinking and bathing water (>51%), but at low concentration (<1.5-log CFU). Correlation analysis between E. coli concentration in different sample types suggested that the mother's hands and fomites might play a key role in the transmission of E. coli to the infants (p < 0.01; r ² > 0.3).

Discussion: Using E. coli as surrogate, our study identified mother (hands and areola) as reservoirs likely to be involved in frequent transmission of fecal contaminants to infants within rural Ethiopian households.

[This corrects the article DOI: 10.3389/fpubh.2024.1343300.].

Background: Malaria and anemia are significant public health concerns that contribute to child mortality in African. Despite global efforts to control the two diseases, their prevalence in high-risk regions like Nigeria remains high. Understanding socioeconomic, demographic, and geographical factors associated with malaria and anemia, is critical for effective intervention strategies.

Objective: The study aims to assess the risk factors for malaria and anemia in children under 5 years using the joint generalized linear mixed model (JGLMM).

Methods: The Nigeria Malaria Indicator Survey (NMIS) 2021 dataset was used, with a sample of 10,120 children aged 6-59 months. A two-stage sampling method was applied. Descriptive statistics and chi-square tests examined factors associated with malaria and anemia prevalence. Missing data were handled using multiple imputations with chained equations (MICE). Lastly, the adjusted odds ratio was interpreted for the current study. SAS was used in analyzing the data and statistical significance was set at 5% significance level.

Results: The prevalence of malaria and anemia was 36.81 and 67.66%, respectively, in children between 6 and 59 months old in Nigeria. The JGLMM was used to examine malaria RDT and anemia findings in conjunction with demographic, geographic, and socioeconomic covariates. The following underlying risk factors for malaria and anemia in children were discovered in the study: region, altitude, age of child in months, toilet facility of the household, main wall material used for the house, main roof material used for the house, children under five who slept under a mosquito net, whether the child had fever in last 2 weeks before the survey took place, place of residence where the child resides, household wealth index, sex of child, and mother's education level. However, whether the mother knew of ways to prevent malaria was not statistically significant regarding anemia.

Conclusion: This study highlights the importance of addressing fever as a key factor for anemia and improving housing conditions to reduce malaria and anemia prevalence. Policymakers should prioritize mosquito net distribution and healthcare access, particularly in rural areas. The study's novelty lies in its handling of missing data through imputation techniques, enhancing the reliability of findings.

Background: Frontline medical staff's psychological symptoms deserve persistent attention after 3 years of high-pressure and high-intensity work during the pandemic. In addition, the meaning of burnout and its relationship with depression and anxiety have long been debated. This study aimed to identify profiles of these symptoms among Chinese medical staff with frontline anti-epidemic experience, along with their distinguishing characteristics.

Methods: Psychological symptoms of burnout (exhaustion, cynicism, and inefficacy), depression, and anxiety from 989 doctors and 1,105 nurses were explored with latent profile analysis. The R3step method was conducted to analyze the predictive factors of those medical staff's symptoms.

Results: Three symptom profiles were identified for medical staff, with high-level (62.1%), moderate-level (28.9%), and low-level symptoms (9.0%). In the low-level and moderate-level profiles, symptom variables considered had a consistent trend. However, within the high-level profile, the inefficacy of burnout remained at a lower level, and anxiety performed as the most prominent symptom. Variables of gender, age, salary satisfaction, work hours, and work intensity predicted medical staff profiles (p < 0.05).

Conclusion: In the post-COVID-19 era, former frontline Chinese medical staff's psychological symptoms were divided into three latent profiles. Symptoms of burnout, depression, and anxiety did not move in lock-step, indicating that they are different and robust constructs. Targeted intervention strategies should be developed for different subgroups.

To examine the relationship between socioeconomic deprivation and complex needs, defined as mental and physical comorbidities, we conducted a cross-sectional retrospective cohort analysis of adult Utah Medicaid beneficiaries. Our analysis included Medicaid beneficiaries with geocoded addresses aged ≥18 years in Utah (N = 157,739). We geocoded beneficiary addresses and assigned them to census block groups. We compared the socioeconomic status of block groups (Singh's area deprivation index) with the proportion of complex needs, defined based on cluster analysis as 1 physical condition with depression or ≥ 2 physical with ≥1 mental health condition. Spatial mapping was performed of prevalence quantiles grouped by count overlaid with Medicaid-covered mental health facilities. Prevalence of complex needs was 18.9% (n = 29,742); beneficiaries with >3 emergency department visits had 12.8 odds of having complex needs; 39.7% of beneficiaries with >$5,000 in annual costs had complex needs. Common comorbid conditions among beneficiaries with complex needs were hypertension (56.0%), hyperlipidemia (35.5%), depression (68.8%), anxiety (56.2%), drug use (16.0%), and alcohol use disorders (15.2%). Census block groups with higher deprivation had a higher proportion of complex needs (ρ = 0.21, p < 0.001). There was a statistically significant spatial autocorrelation of the prevalence of complex needs (Moran's I index: 0.65; p < 0.001). Six high-count census blocks had no mental health facilities. Areas with increased socioeconomic deprivation had a greater proportion of complex needs and fewer mental health facilities. Integrated programs addressing both physical and mental health conditions with a focus on socioeconomically deprived areas might benefit Medicaid recipients in populations such as those in Utah.

Background: Taiwan implemented global hospital budgeting with a floating-point value, which created a prisoner's dilemma. As a result, hospitals increased service volume, which caused the floating-point value to drop to less than one New Taiwan Dollar (NTD). The recent increase in the number of hospital beds and the call to enhance the floating-point value to one NTD raise concerns about the potential for increased financial burden without adding value to patient care if hospitals expand their bed capacity for volume-based competition. The present study aimed to examine the relationship between the supply of hospital beds and hospitalizations following an emergency department (ED) visit (called ED hospitalizations) by using diabetes-related ambulatory care sensitive conditions (ACSCs) that are preventable and discretionary as an example.

Methods: The study was a pooled cross-sectional design analyzing 2011-2015 population-based claims data in Taiwan. The dependent variable was a dummy variable representing an ED hospitalization, with a treat-and-leave ED visit as the reference group. The key independent variable is the number of hospital beds per 1,000 populations. Multivariate logistic regression models with and without a clustering function were used for the analyses.

Results: Approximately 59.26% of diabetes-related ACSCs ED visits resulted in ED hospitalizations. The relationship between the supply of hospital beds and ED hospitalizations was statistically significant (OR = 1.12; 95% CI: 1.09-1.14; P < 0.001) in the model without clustering but was statistically insignificant in the model with clustering (OR = 1.03; 95% CI: 0.94-1.12; P > 0.05). Several social risk factors were positively associated with the likelihood of ED hospitalizations, such as low income and the percentage of the population without a high school diploma. In contrast, other factors, such as female patients and the Charlson comorbidity index, were negatively associated with the likelihood of ED hospitalizations.

Conclusion: Under hospital global budgeting with a floating-point value mechanism, increases in hospital beds likely motivate hospitals to admit ED patients with preventable and discretionary conditions. Our study emphasizes the urgent need to add value-based incentive mechanisms to the current global budget payment. The value-based incentive mechanisms may encourage providers to focus on quality of patient care by addressing social risk factors rather than engage in volume-based competition, which would improve population health while reducing preventable ED visits and hospitalizations.