Public Health in Practice最新文献

Objectives

This study aims to assess cancer patients' accessibility to healthcare services and perceived barriers during the COVID-19 pandemic in Khartoum state, aiming to explore the consequent impact on cancer patients. It also aims to determine the coping strategies used by patients to overcome these barriers.

Study design

This is a retrospective analytical cross-sectional study.

Methods

Data were collected from August 2020 to March 2021, with a sample size of 316 cancer patients. Systemic random sampling and SPSS version 25 were utilized for data collection and analysis.

Results

The study found that 55.7 % of the surveyed cancer patients had experienced disruptions in accessing essential cancer healthcare services during the lockdown. The study identified the most common cancers as breast (19.7 %), gastrointestinal (19 %), and ovarian (11 %). Notable barriers included governmental travel restrictions (51.6 %), outpatient service closures (41.8 %), and high costs (27.8 %). Additionally, delayed treatment was directly associated with a 33.3 % fatality rate among the participants.

Conclusions

This study highlights the considerable negative impact of the COVID-19 lockdown on cancer care in Sudan. Recommendations include a focus on telemedicine as an alternative form of patient consultation, the expansion of health insurance schemes to encompass cancer treatments, and strengthening healthcare infrastructure to facilitate cancer care during crises.

Objective

The study set to explore the mortality causes across six years and identify potential mortality determinates at a population level in Malta.

Study design and methods

A longitudinal follow-up of a Malta based cross-sectional national representative study across 6 years (2014–2020) was carried out. The study population was cross-linked to the mortality register and causes of death obtained. Population characteristics gathered during initial examination were analysed through univariant and multivariant logistic regressions.

Results

A total of 66 adults, mostly male (65.15 % n = 43) died, with commonest cause being cancer (42.42 % CI95 %: 31.24–54.45) mostly due to malignant neoplasm of bronchus and lung. This was followed by cardiac pathologies including acute myocardial infarction, ischaemic cardiomyopathy, and cardiomegaly (25.76 % CI95 %: 16.67–37.51). Multivariant logistic regression analyses revealed positive associations between age (OR: 1.99 p = 0.02), history of coronary heart disease (OR: 11.78 p=<0.001), smoking for 31 years or more (OR: 8.22 p=<0.001) and presence of multimorbidity (OR: 1.32 p = 0.02).

Conclusion

It is evident that occurrence of cancers is a concern in Malta, and it requires targeted action including the reduction of smoking habits. Understanding the mortality causes and the associated determining factors at a population level enable the institution of preventive actions while strengthening healthcare services to safeguard the population from premature mortality and co-morbidity.

Background

Enabling, supporting and promoting positive health-related behaviours is critical in addressing the major public health challenges of our time, and the multifaceted nature of behaviours requires an evidence-based approach. This statement seeks to suggest how a much-needed enhanced use of behavioural and cultural science and insights for health could be advanced.

Study design and methods

and methods: Public health authorities of Europe and Central Asia and international partner organizations in September 2023 met in Copenhagen, Denmark, to discuss the way forward. Drawing on 1) country reporting to WHO, 2) interview study with public health authorities and 3) the meeting deliberations, this meeting statement was developed.

Results

The meeting statement presents a joint call for step-change accelerated use of evidence-based approaches for health behaviours. Actionable next steps for public health authorities and international and regional development partners in health are presented.

Conclusions

The way forward involves increased resource allocation, integration of behavioural insights into health strategies, advocacy through case and cost-effectiveness examples and capacity building.

The emergence of COVID-19 caused a significant global threat, affecting populations worldwide. Its impact extended beyond just physical health, as it inflicted severe damage and challenges to individuals' well-being, leading to a deterioration in mental health. The lived experiences of patients hold a paramount position to explore and understand their perception of care which can ultimately strengthen the health system's delivery domain. This study explores the lived experiences of patients in the isolation ward, their recovery, and the quality of care being provided in the hospital and its effects on their mental health.

Study design

A phenomenological qualitative study using in-depth interviews.

Methods

We conducted 11 in-depth interviews of COVID-19 patients admitted to the isolation ward of the public hospitals of Peshawar, Pakistan. Participants who stayed for a minimum of 10 days in an isolation ward were included in this study. Interviews were transcribed and analyzed using NVivo 12 software and generated five themes through inductive analysis.

Results

Five themes emerged from the participants' lived experiences: Heading towards the hospital, Health Care Quality, Impact on Mental Health, Recovering from COVID-19 and Back on one's feet. These included all the positive and negative lived experiences. Socio-environmental factors along with their experiences of the disease itself and with the healthcare providers guided their reaction which was important conciliators in their experiences during the pandemic.

Conclusion

Based on the findings, the environment of isolation had a major influence on the mental well-being of the individuals involved. Considering the important role of the ward environment in shaping patient experiences and outcomes prompts a reevaluation of healthcare practices and policies. By addressing these factors healthcare systems can strive for greater effectiveness, resilience, and compassion in managing the pandemic's impact on patient care.

Aim

Perinatal mortality can be used as a reference to assess health status in a country. In Indonesia, none of previous studies specifically discuss the incidence of prenatal mortality by region. The objective of this study was to analyze perinatal mortality difference by region of Indonesia.

Study design

This study used a cross-sectional approach.

Method

The sample in this study was 13,310 women of childbearing age obtained from the Indonesian Demographic Health Survey (IDHS) 2017. The perinatal mortality rate was calculated using data on stillbirths with a gestational duration of seven months or more and early neonatal deaths. Perinatal mortality was analyzed by region using a binary logistic regression statistical test to examine the relationship between perinatal mortality and its factors (socio-demographic factors, individual disease control factors, and maternal factors).

Results

This study shows that the proportion of perinatal mortality in Indonesia is 1.5 % of total births. The highest proportion of perinatal mortality (2.5 %) was in the Papua region, while the lowest proportion (1.3 %) was in the Java region. The results of this study indicated that women in the Maluku Islands had a 1.82 times higher chance of perinatal mortality compared to the Java-Bali region. The causative variable associated with perinatal mortality in the Java-Bali and Papua regions was employment status. The causative variables associated with perinatal mortality in Kalimantan were the quality of antenatal care and delivery assistance. The causative variable associated with perinatal mortality in Nusa Tenggara and Papua was the location of delivery. The causative variable associated with perinatal mortality in Kalimantan, Maluku, and Papua was the mother's age. The causative variable associated with perinatal mortality in the Java-Bali region was parity. The causative variable associated with perinatal mortality in Sumatra was the type of delivery.

Conclusion

This study show that there were disparities in the incidence of perinatal mortality between regions in Indonesia. The government needs to re-adjust the existing strategies to improve health status and focus on community empowerment for women to prevent perinatal mortality.

Objectives

This research program involves two phases to identify enablers and barriers to diabetes care for Aboriginal people on Ngarrindjeri country; and co-design a strength-based metabolic syndrome and Type 2 Diabetes (T2D) remission program with the Ngarrindjeri community.

Study design

A study protocol on qualitative research.

Methods

The study will recruit Aboriginal people living on Ngarrindjeri country above 18 years of age with a diagnosis of metabolic syndrome or T2D. Recruitment for phases one and two will occur through the Aboriginal Health Team at the Riverland Mallee Coorong Local Health Network. The lived experiences of T2D will be explored with 10–15 Aboriginal participants, through an Aboriginal conversational technique called ‘yarning’ (60–90 min) in phase 1. Elders and senior community representatives (n = 20–30) will participate in four co-design workshops (2–4 h) in phase 2. Qualitative data will be transcribed and thematically analysed (NVivo version 12). The analysis will focus on protective factors for the Cultural Determinants of Health. Ethics approval was obtained from Aboriginal Health Research Ethics Committee in South Australia (04-22-1009), and Flinders University Human Research Ethics Committee (5847).

Results

This work will be used to pilot the co-designed diabetes remission trial. Outcomes will be published in peer-reviewed journals, presented at conferences, focusing on following best practice guidelines from the Australian Institute of Aboriginal and Torres Strait Islander Studies and National Health and Medical Research Council. Research translation will occur through digital posters, manuals, and infographics.

Conclusions

The findings will be summarised to all Aboriginal organisations involved in this study, along with peak bodies, stakeholders, Aboriginal Services, and interested participants.

Objectives

This study aimed to determine the magnitude of concurrent use of herbal medicines with ART, its associated factors and effect on viral load suppression and CD4 count among people living with HIV.

Study design

This was a cross-sectional study involving 375 HIV positive patients on ART attending at care and treatment clinic (CTC).

Methods

Data were obtained through face-to-face interviews using pre-structured questionnaires and patient's files through a checklist. Adherence was assessed though pill count method while CD4 count and viral load suppression were assessed using the Tanzania National guidelines for the management of HIV and AIDS. Data were analysed using STATA version 15. Independent predictors for herbal medicine use or viral suppression were assessed using univariate and multivariate logistic regression.

Results

Out of 375 PLHIV, 37 (35%) reported to use herbal medicines concurrently with ART. Predictors for herbal medicines use were existence of chronic disease (OR = 4.53; CI = 1.87–10.95) (p = 0.001), male gender (OR = 0.57; CI = 0.35–0.93) (p = 0.02) and HIV clinical stage (OR = 1.71; CI = 0.99–2.94) (p = 005). PLHIV who used herbal medicines along with ART did not have a significantly higher chance of achieving viral suppression than PLHIV who did not use herbal medicines (OR = 1.42; CI = 0.71–2.82). There was no statistically significant difference on CD4 count (p = 0.8943) and viral load (p = 0.8612) between herbal medicines users and non-users.

Conclusion

The utilization of herbal medicine among PLHIV on ART remains notably prevalent. Nonetheless, it is worth noting that despite the prevailing herbal medicine usage, there is no substantial effect on viral suppression. The primary determinants of the adoption of herbal medicines use were having chronic medical conditions and the stage of progression of the HIV infection.

Objectives

Cross-sectional studies demonstrate a positive association between higher physical activity and serum 25-hydroxyvitamin D (25(OH)D) concentration. However, whether this association is causal is unclear. We conducted a systematic review to identify intervention studies that examined the effect of physical activity on serum 25(OH)D concentration in humans.

Study design

Systematic review and meta-analysis.

Methods

We searched PubMed, Scopus and Web of Science to identify full-text peer-reviewed articles published in English from inception until January 2023. Eligible studies were randomised controlled trials or quasi-experimental studies. We used random effects meta-analysis to calculate the weighted mean difference (WMD) in the change in 25(OH)D concentration between physical activity and control groups. We used the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) to assess the methodological quality of included studies.

Results

We included 32 articles in the systematic review and 24 in the meta-analysis. The intervention varied from resistance and weight-bearing exercises (n = 13) to aerobic exercises (n = 10), moderate and moderate-to-vigorous exercises (n = 5), aquatic exercise (n = 2), and multicomponent traditional exercises (n = 2) (Tai Chi and Yijinjing). The WMD in 25(OH)D in the physical activity and control groups was 9.51 and 4.87, respectively (between-group mean difference 4.64, p = 0.002). However, the difference was only evident in studies that implemented the intervention outdoors (n = 3; between-group mean difference 17.33, p < 0.0001); when the intervention was indoors there was no significant effect of physical activity on 25(OH)D (n = 16; between-group mean difference 1.80, p = 0.113).

Conclusions

This meta-analysis of physical activity interventions in humans showed that physical activity does not lead to increased 25(OH)D independently of time outdoors. However, most studies were under-powered, in many the exercise was low intensity, and vitamin D was not the primary outcome.

Objectives

“Anti-science” accusations are common in medicine and public health, sometimes to discredit scientists who hold opposing views. However, there is no such thing as “one science”. Epistemology recognizes that any “science” is sociologically embedded, and therefore contextual and intersubjective. In this paper, we reflect on how “science” needs to adopt various perspectives to give a comprehensive and nuanced understanding of a phenomenon.

Study design

Opinion paper.

Methods

Based on a targeted literature survey, we first clarify the known limits of traditional scientific methods and then reflect on how the scientific reporting about Covid-19 mRNA vaccines has evolved.

Results

The first reports of the Covid-19 mRNA vaccines randomised controlled trial results showed impressive efficacy. Nevertheless, an abundant literature has since depicted a far more nuanced picture of the effectiveness and safety of those vaccines over the medium-term. We organise them around five themes: (i) differentiating between relative and absolute reduction; (ii) taking account of time in reporting effectiveness; (iii) taking account of all outcomes, including adverse effects; (iv) stratifying effectiveness and considering other decision criteria (efficiency, equity, and acceptance); (v) changing the outcome of concern and assessing vaccines’ effectiveness on mortality.

Conclusions

Science offers a wide range of perspectives on a given study object. Only the process of deliberation amongst scientists and other stakeholders can result in accepted new knowledge useful to support decision-making. Unfortunately, by trying to reduce “science” to simple messages set in stone, scientists can become the worse enemies of science.

Objective

To reduce the incidence of severe illness and fatalities, and promote the awareness of protection and precaution, increased vaccination, strengthen the physical fitness, frequent ventilation, and health education should be enhanced among vulnerable populations as essential measures for the future control of COVID-19.

Study design

Systematic review.

Method

The search was done using PubMed, EMBASE and Web of Science for studies without language restrictions, published up through March 2023, since their authoritative and comprehensive literature search database. Eighty articles were included. Extraction of articles and quality assessment of included reviews was performed independently by two authors using the AMSTAR 2 score.

Results

The articles in the final data set included research on epidemiological characteristics, pathogenicity, available vaccines, treatments and epidemiological features in special populations including the elders, pregnant women, kids, people with chronic diseases concerning Omicron.

Conclusion

Although less pathogenic potential is found in Omicron, highly mutated forms have enhanced the ability of immune evasion and resistance to existing vaccines compared with former variants. Severe complications and outcomes may occur in vulnerable populations. Infected pregnant women are more likely to give birth prematurely, and fatal implications in children infected with Omicron are hyperimmune response and severe neurological disorders. In immunocompromised patients, there is a greater reported mortality and complication compared to patients with normal immune systems. Therefore, maintain social distancing, wear masks, and receive vaccinations are effective long-term measures.