Public Health in Practice最新文献

The purpose of this commentary is to describe combinatory play as a practice for elevating creativity and well-being among public health professionals. Albert Einstein introduced combinatory play in a letter to a colleague, and, in this commentary, we define it as engagement in an intrinsically enjoyable, cognitively stimulating artistic activity that is distinct from one's job tasks and conducive to connecting ideas toward insight and creative problem-solving. Combinatory play aligns with empirical and experiential evidence demonstrating connections between art and science. We present combinatory play in the context of research on creativity and well-being, including the growing issue of work-related stress among public health professionals. To provide an example of combinatory play, we recount how Robert Frost's poem “Mending Wall” inspired email blackout periods and an intervention for health researchers. Finally, we outline concrete strategies for public health professionals to integrate combinatory play into their lives. Overall, combinatory play is a promising practice for catalyzing novel solutions to public health issues while fueling the well-being of public health professionals themselves.

Background

With the increasing prevalence of wildfire smoke in the Pacific Northwest, it is important to quantify health impacts to plan for adequate health services. The Rogue Valley region has historically faced some of the greatest wildfire threats in the state. Health impacts from smoke have been estimated in several recent studies that include Oregon's Rogue Valley, but the results between studies are conflicting.

Objective

The objective is to critically examine impacts of wildfire smoke on health in the Rogue Valley area and translate the results to support hospital staffing decisions.

Study design

The study adopts a case-crossover approach.

Methods

Apply a conditional Poisson regression to analyze time stratified counts while controlling for mean temperature.

Results

Every 10 μ/m³ increase in PM_2.5 is associated with a 2% increase in same-day hospital or emergency room admission rates for respiratory conditions during fire season after adjusting for temperature and time (OR = 1.020; 95% CI: 1.004–1.034); a 10 μ/m³ increase in PM_2.5 lasting nine days is associated with a 4% increase in admission rates (OR = 1.041; 95% CI: 1.018–1.065). In other words, for each 10 μ/m³ single day increase in pollution from smoke, an additional 0.26 respiratory patients would be expected in the area hospitals. With a single day increase from 10 μ/m³ to 150 μ/m³, hospitals could expect an additional four patients.

Conclusions

There are small but significant health impacts in the Rogue Valley. These impacts are smaller than some statewide estimates. We need further research to understand these differences.

Background

Study design

Methods

Results

Conclusions

Background

Following the decriminalization of abortion in Colombia and amidst a global health crisis due to COVID-19, Profamilia implemented a telemedicine-assisted first-trimester Medication Abortion (MAB) program. This is an opportunity to reduce inequalities in access and to promote empowerment and sexual and reproductive rights. This study aims to describe socio-demographic and clinical characteristics of users and to assess its effectiveness and safety.

Study design

A retrospective cohort study.

Methods

The study analyzed data from users who received Profamilia's telemedicine abortion services between August 2021 and August 2022 (n = 3073). A descriptive analysis of their sociodemographic and clinical characteristics was performed, grouping, and comparing them according to follow-up status and abortion outcome. Effectiveness was assessed by the percentage of complete abortions without surgical intervention, and safety by the incidence of complications, potential adverse events, and potentially dangerous signs.

Results

Most of the users were less than 8 weeks gestation at the start of treatment (88.3 %), from low socioeconomic strata (84.8 %), affiliated to the subsidized healthcare system (87.6 %), with educational levels up to secondary school (81.6 %), between 18 and 35 years (87.4 %), from urban areas (97.8 %) and singles (90,8 %). 94.9 % of users had a complete abortion using medication, and 0.3 % of cases reported complications.

Conclusions

First-trimester MAB through telemedicine in the Latin American context is an effective and safe choice. Telehealth is an important strategy to expand access to safe abortion care, especially for those with limited financial means or educational backgrounds. Rural and marginalized populations need more attention to improve access.

Objective

Telehealth and patient travel cost subsidisation are two strategies used to reduce the effects of healthcare access inequity. Despite this shared goal, these programs are usually run independently, and their effects are infrequently compared in evaluation. Understanding how these programs are used helps ensure services are delivered efficiently.

Methods

Counts of telehealth outpatient service events (TH) (n = 250171) and patient travel subsidy scheme claims (PTSS) (n = 270933) for the 2022-23 financial year were captured. Comparisons of PTSS and TH activity were made by postcode, rurality (The Accessibility/Remoteness Index of Australia (ARIA)) and health jurisdiction (Hospital and Health Service (HHS)).

Results

Correlation analysis conducted on PTSS and TH activity revealed a statistically significant, moderate positive correlation (r = 0.449, p < 0.01). TH (coefficient = 0.650, p < 0.001) and rurality (coefficient = 26.208, p = 0.686) also retained their significance.

Conclusions

This study established that increases in TH activity is correlated with increases in PTSS, with both programs reporting greater activity as rurality increases.

Objectives

To investigate the relationship between long-term condition (LTC) status and adherence to protective behaviours against infectious disease (face covering, physical distancing, hand hygiene).

Study design

Representative cross-sectional observational survey in summer 2020 in Scotland.

Methods

Independent variable is LTC status (LTC, disability, no LTC); dependent variable is adherence to protective behaviours (face covering, hand hygiene, social distancing); moderator variables are age, gender and area deprivation; mediator variables are perceived threat and psychological distress. P values of p < 0.05 were taken as statistically significant.

Results

3972 participants of whom 2696 (67.9 %) indicated not having a LTC. People with no LTC had lowest adherence to protective behaviours, perceived threat and psychological distress. Age did not moderate the relationship between LTC status and adherence; females were more adherent than males and this gender difference was greater in people with disability compared to people with no LTC; adherence was greater for people with a LTC in the more deprived areas compared to the least deprived areas whereas adherence in those with no LTC was not related to area deprivation; threat appraisal partially mediated the relationship between having a LTC or disability and adherence; psychological distress did not mediate the relationship between LTC status and adherence.

Conclusions

This study addresses a gap in evidence about protective behaviours of people with LTCs. Perceptions of threat may be useful intervention targets against winter flu and during future pandemics in order to protect people with LTCs who are one of the most vulnerable groups of the population.

Objective

To estimate the national and provincial number of excess deaths due to diabetes across Cuba in 2019.

Study design

Cross-sectional design with secondary data.

Methods

We used DISMODII, a computerized generic disease model, to assess disease burden by modelling the relationships between incidence, prevalence, and disease-specific mortality. Baseline input data included population structure, total mortality, and age- and sex-specific estimates for diabetes prevalence from the Cuban National Health Survey 2019, and available published estimates of the relative risk of death for people with diabetes compared to people without diabetes. The results were internally validated with DISMODII output for duration of diabetes (years).

Results

In 2019, we estimated an excess of mortality attributable to diabetes of 7.5 times the diabetes mortality reported by the National Death Registry, which is equivalent to 16.4 % of all deaths in Cuba. The percentages of all-cause mortality among provinces varied between 10.7 % in Villa Clara and 24.5 % in Ciego de Avila.

Conclusions

These are the first estimates of mortality attributable to diabetes in Cuba and its provinces. Diabetes is likely to be a much more prominent leading cause of death than the 9th ranking reported by the Cuban National Death Registry 2019. Disease models similar to DISMODII are important tools to validate the epidemiologic indicators used in the burden of disease calculations.

Objectives

Excessive consumption of sugar-sweetened beverages (SSBs) contributes to adverse health outcomes but is differentiated by socio-economic indicators. The study analyses the educational disparities in adults frequent consumption of sugar-sweetened beverages (SSBs) in Estonia and its temporal changes between 2006 and 2022.

Study design

Repeated cross-sectional survey.

Methods

Nationally representative data from 9 biennial cross-sectional surveys on 25–64-year-old Estonian residents (n = 20396) was used for the study. Changes in frequent (on 6–7 days per week) consumption of SSBs by study year, sex, age, and education is analysed using descriptive statistics and binomial logistic regression. Prevalence and odds ratios (OR) with 95 % confidence intervals (CIs) are presented focusing on temporal and educational patterns in frequent SSB consumption.

Results

The prevalence of frequent SSB consumption among Estonian adults declined consistently from 2006 (14.0 %) to 2018 (5.2 %), followed by statistically non-significant increases in 2020 (6.8 %) and 2022 (7.1 %). Prevalence of frequent SSB consumption was significantly (p < 0.01) higher among adults with primary or lower education (12.4 %) compared to tertiary education group (4.8 %). The educational differences in SSB consumption (12.4 % in primary or lower vs. 4.8 % in tertiary education) were nearly three-fold after adjusting for sex, age, and period effects (OR 2.84, 95 % CI 1.71–4.74) and have been consistent since 2010.

Conclusions

Although frequent consumption of SSBs has been generally decreasing among Estonian adults, the findings illustrate the persisting educational gradients in exposure that expectedly translates into socio-economic inequalities in adverse health outcomes resulting from excessive SSB consumption.