Public Health in Practice最新文献

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.

Background

In England and Wales coroners have a duty to write a report, called a Prevention of Future Deaths report or PFD, when they believe that actions should be taken to prevent future deaths. Coroners send PFDs to individuals and organisations who are required to respond within 56 days. Despite the increase in mental health concerns and growing use of medicines, deaths reported by coroners that have involved medicine-related suicides had not yet been explored. Therefore, this study aimed to systematically assess coroners’ PFD reports involving suicides in which a medicine caused or contributed to the death to identify lessons for suicide prevention.

Methods

Using the Preventable Deaths Tracker database (https://preventabledeathstracker.net/), 3037 coroners' PFD reports in England and Wales were screened for eligibility between July 2013 and December 2019. Reports were included if they involved suicide or intentional self-harm and prescribed or over-the-counter medication; illicit drugs were excluded. Following data extraction, descriptive statistics, document and content analysis were performed to assess coroners’ concerns and the recipients of reports.

Results

There were 734 suicide-related coroner reports, with 100 (14%) reporting a medicine. Opioids (40%) were the most common class involved, followed by antidepressants (30%). There was wide geographical variation in the writing of reports; coroners in Manchester wrote the most (18%). Coroners expressed 237 concerns; the most common were procedural inadequacies (14%, n = 32), inadequate documentation and communication (10%, n = 22), and inappropriate prescription access (9%, n = 21). 203 recipients received the PFDs, with most sent to NHS trusts (31%), clinical commissioning groups (10%), and general practices (10%), of which only 58% responded to the coroner.

Conclusions

One in four coroner reports in England and Wales involved suicides, with one in seven suicide-related deaths involving a medicine. Concerns raised by coroners highlighted gaps in care that require action from the Government, health services, and prescribers to aid suicide prevention. Coroner reports should be routinely used and monitored to inform public health policy, disseminated nationally, and responses to coroners should be transparently enforced so that actions are taken to prevent future suicides.

Background

It has been previously reported in the literature that the COVID-19 pandemic resulted in overall excess deaths and an increase in non-COVID deaths during the pandemic period.

Specifically, our research elucidates the impact of the COVID-19 pandemic on non-COVID associated mortality.

Study aim

To compare mortality rates in non-COVID conditions before and after the onset of the COVID-19 pandemic in England and Wales.

Study design

Annual mortality data for the years 2011–2019 (pre-pandemic) and 2020 (pandemic) in England and Wales were retrieved from the Office for National Statistics (ONS). These data were filtered by ICD-10 codes for nine conditions with high associated mortality. We calculated mortality numbers – overall and age stratified (20–64 and 65+ years) and rates per 100 000, using annual mid-year population estimates.

Methods

Interrupted time series analyses were conducted using segmented quasi-Poisson regression to identify whether there was a statistically significant change (p < 0.05) in condition-specific death rates following the pandemic onset.

Results

Eight of the nine conditions investigated in this study had significant changes in mortality rate during the pandemic period (2020). All-age mortality rate was significantly increased in: ‘Symptoms Signs and Ill-defined conditions’, ‘Cirrhosis and Other Diseases of the Liver’, and ‘Malignant Neoplasm of the Breast’, whereas ‘Chronic Lower Respiratory Disorders’ saw a significant decrease. Age-stratified analyses also revealed significant increases in the 20–64 age-group in: ‘Cerebrovascular Disorders’, ‘Dementia and Alzheimer's Disease’, and ‘Ischaemic Heart Diseases’.

Conclusion

Trends in non-COVID condition-specific mortality rates from 2011 to 2020 revealed that some non-COVID conditions were disproportionately affected during the pandemic. This may be due to the direct impact COVID-19 had on these conditions or the effect the public health response had on non-COVID risk factor development and condition-related management. Further work is required to understand the reasons behind these disproportionate changes.

Objectives

This study aims to assess factors influencing public trust in the National Health Service (NHS) in England, focusing on the impact of waiting times in Accident & Emergency (A&E) departments and for GP-to-specialist cancer referrals.

Study design

A cross-sectional survey-based research design was employed, covering the period from July 2022 to July 2023.

Methods

Data were collected through YouGov surveys, yielding 7415 responses. Our analysis is based on 6952 of these responses which we were able to aggregate to 42 NHS Integrated Care Boards (ICBs) for A&E waiting times and 106 ICB sub-units for cancer referral times. Multiple regression analysis was conducted, with the dependent variable being trust in the NHS.

Results

Waiting times for A&E and cancer referrals did not significantly affect trust in the NHS. However, other sociopolitical factors displayed significant influence. Specifically, being a member of an ethnic minority group, or having voted Conservative in the 2019 general election were associated with lower trust scores. Other variables such as age and local unemployment rate were also significant predictors.

Conclusions

Our findings suggest that waiting times for healthcare services have no effect on public trust in the NHS. Instead, trust appears to be largely shaped by sociopolitical factors. Policymakers should therefore look beyond operational efficiency when seeking to bolster trust in the healthcare system.

Objective

Tribal population in India (8.6% of the total population) have a greater prevalence of tuberculosis compared to the national average. The article aims to study out-of-pocket expenditure (OOPE), hardship financing, and impoverishment effects of TB hospitalisation treatment among tribal populations in India.

Methods

Data of three rounds of National Sample Surveys (NSS) 60th (2004–05), 71st (2013–14) and 75th (2017–18) rounds were analyzed. Descriptive statistics, bivariate estimates and multivariate models were performed to calculate the OOPE, healthcare burden (HCB), catastrophic health expenditure (CHE), hardship financing and impoverishment effects using standard definitions at February 2023 price values. Propensity score matching (PSM) was used to examine the effect of health insurance coverage on catastrophic health expenditure, and impoverishment.

Results

Over two-thirds of the TB cases are seen in the economically productive age group (14–59 years). Substantial OOPE and its impact on HCB, CHE, and poverty impact observed among 15–35 age group across all three rounds. Illiterate patients and those availing private hospitals for TB treatment had higher OOPE, HCB, hardship financing, CHE, and poverty impact. 38.5% (2014) and 33.2% (2018) are covered with any kind of public healthcare coverage, PSM analysis shows households with health insurance have lower incidence of CHE and impoverishment effects due to TB hospitalisation expenditure.

Conclusions

The current study aids in comprehending the patterns in the financial burden of TB on tribal households during the previous 15 years and gives policy makers information for efficient resource allocation management for TB among Indian tribal communities.