Preventive Medicine Reports最新文献

Objectives

Methods

Results

Conclusions

Purpose

To examine the association between offline healthcare barriers and emotional well-being and assess the mediation roles of online patient–provider communication (OPPC) and perceived quality of care. This study also investigates the trends in offline healthcare barriers, OPPC, perceived quality of care, and emotional well-being over four years among the old population in the U.S.

Methods

Data from the Health Information National Trends Survey (HINTS) 5 Cycles 1, 2, and 4 were used. Mediation analysis and comparison analysis were employed.

Results

The results indicated an increment in OPPC and a decline in patient’s perceived quality of care between 2017 and 2020. Across the three years, offline healthcare barriers were consistently negatively associated with emotional well-being, and perceived quality of care remained a mediator in such a relationship. Moreover, the serial mediating roles of OPPC and perceived quality of care between offline healthcare barriers and emotional well-being turned from statistically non-significant (2017) to significant (2018, 2020).

Conclusion

Our results witness the growing adoption of OPPC among older adults and the evolution of OPPC as a complementary communication modality. The findings can support interventions to augment OPPC utilization and enhance the perception of quality care of older adults, contributing to their increased emotional well-being.

Background and Objective

Adverse Childhood Experiences(ACEs) have a powerful influence on mental health, physical health, and life expectancy. Screening for ACEs and the clinician response to ACEs are critical to addressing the health and well-being of children; however, little is known about the actions clinicians take in response to ACE screening. Therefore, we aimed to examine clinician responses to ACE screening at five California pediatric clinics in a large public health care system.

Methods

Patient demographics, indicators of social and behavioral determinants of health (e.g., housing insecurity), the number of ACEs endorsed on a screening instrument, and the actions clinicians took in response to each ACE screen were collected. Data was collected from May to October 2021. These data were used to examine the association between number of ACEs reported and clinician response, controlling for patient demographics and their social and behavioral determinants of health using multiple logistic regression.

Results

Five participating pediatric clinics conducted 2,652 ACE screens in six-months. Clinicians documented an action twice as often when ACEs were present, after controlling for patient demographics and their social and behavioral determinants of health (odds ratio(OR) = 2.2, 95 % confidence interval(CI): 1.5–3.3, p-value < 0.0001). Clinicians were three times more likely to record referrals to mental health clinicians, social workers, and community organizations relative to anticipatory guidance when the number of ACEs increased from one to three to four or more (OR=3.2, 95 %CI: 1.6–6.5, p < 0.0001).

Conclusion

Findings provide early information that ACE screening results are associated with patient care.

Background

Blunts (i.e., cannabis rolled in cigar paper with or without tobacco) are a popular way of consuming cannabis. Little survey research has examined knowledge and beliefs about blunts, especially among youth who use cigars or are susceptible to cigar use.

Methods

Participants were a convenience sample of N = 506 youth (ages 15–20) from the United States (US) recruited April-June 2023 who reported ever using little cigars or cigarillos (LCCs), past 30-day use of LCCs, or susceptibility to using LCCs. We used adjusted logistic and ordinal regression models to examine correlates of knowledge that blunts contain nicotine and, separately, relative addiction/harm perceptions for blunts vs. unmodified cigars containing only tobacco.

Results

One-third of youth (32.1 %) thought that blunts do not contain nicotine. Around half of youth thought that blunts were “much less” or “slightly less” addictive (45.0 %) and “much less” or “slightly less” harmful (51.5 %) than unmodified cigars. Youth who identified as Black/African American (vs. white) had lower odds of knowledge that blunts contain nicotine (aOR = 0.51, 95 % CI: 0.30, 0.87). Youth who frequently used blunts were less likely to report that blunts were more addictive (aOR = 0.39; 95 % CI: 0.24, 0.63) and harmful (aOR = 0.31; 95 % CI: 0.19, 0.50 (vs. unmodified cigars) compared with youth who never used blunts.

Conclusions

Our study with a sample of US youth—who have used or are susceptible to using LCCs—found that about 1 in 3 participants thought that blunts do not contain nicotine, and many believed blunts were less harmful and addictive than unmodified cigars.

Objective

Methods

Results

Conclusions

Introduction

Region-specific data on individual factors associated with uptake of breast and cervical cancer screening or early testing in diverse Indian populations are limited.

Aim

To assess the prevalence and individual determinants of uptake of breast and/or cervical cancer screening or testing among women aged 30–69 years in regionally representative populations of two large Indian cities: New Delhi and Chennai.

Methods

We conducted an analysis of the cross-sectional data (2016–2017) nested within the Centre for Cardiometabolic Risk Reduction in South Asia cohort, established in 2010–2011 with 12,271 participants (5365 in New Delhi; 6906 in Chennai). Among 3310 women participants, we evaluated the associations of demographic, socioeconomic, lifestyle, medical, psychosocial, and reproductive factors with breast and/or cervical cancer screening or testing using multivariable logistic regression models with results expressed as adjusted odds ratios (OR) and 95% confidence intervals (CI).

Results

At any point prior to 2016–2017, 193 women self-reported having undergone evaluations for breast and/or cervical cancer. The reasons for evaluation were ‘general examination’ or ‘physician’s advice’ (i.e., screening) or ‘being symptomatic’ (i.e., early testing). The overall prevalence was 5.8% for screening or testing and 2.5% for screening alone. Formal education (OR:1.88; 95% CI:1.12–3.15), high monthly household income (OR:2.27; 95% CI:1.59–3.25) and less ‘fear-of-judgement’ (OR:1.65; 95% CI:1.05–2.58) were positively associated with screening or testing uptake. When screening uptake was analysed separately, the results were generally similar.

Conclusion

Our findings may have important implications for interventions at community-level (e.g., reducing ‘fear-of-judgement’, increasing awareness to screening programs and early symptoms) and health-system level (e.g., opportunistic screening).

Background

The α-klotho (αKl) is widely accepted as an anti-aging and anti-inflammatory protein. However, it is rarely reported on the function and mechanism of αKl in the overall population (including healthy people and those with history of chronic disease). The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are established as predictors of systemic inflammation. This study aims to investigate the relationship between NLR, PLR, and αKl levels in the overall population.

Methods

Data from 10,124 adults aged 40 years old and above, collected from NHANES 2007–2016, were analyzed. Associations between NLR, PLR, and αKl levels were assessed by weighted multivariate linear regression analyses, adjusting for potential confounders. Subgroup analysis was conducted by gender, age, diabetes, cardiovascular disease, and chronic kidney disease.

Results

Weighted linear regression models showed that a significant negative correlation was observed between both NLR and PLR with αKl levels. Subgroup analysis revealed that the negative correlation between NLR and serum αKl levels was not significant in individuals aged 40–59 years and males, while this relationship remained stable across most other subgroups. The negative correlation between PLR and serum αKl levels was consistent across most subgroups but not significant in individuals with cardiovascular disease.

Conclusion

Our study revealed a significant negative relationship between inflammatory markers (NLR and PLR) and serum αKl levels, suggesting systemic inflammation may be linked to reduced αKl expression. Subgroup analyses showed that the relationship varies across different demographic and health-related factors. We provided insight into the significance of managing inflammation and preserving αKl levels.

Objective

We aim to study the “golden youth” hypothesis, which suggests that risky behaviors might be prevalent among affluent adolescents in post-Communist countries of Europe (PCCE) with high income inequality.

Methods

We included 71,119 adolescents aged 11–15 from 14 PCCE participating in the Health Behavior in School-aged Children survey 2017/18. A K-means cluster analysis was conducted to group adolescents based on risky behavior. Generalized linear mixed models were fitted.

Results

The proportion of high-SEP adolescents in Cluster 2, characterized by frequent alcohol consumption but moderate frequency of drunkenness, was greater than that of low-SEP adolescents (14.3 % vs. 10.7 %). The prevalence of risky behaviors was similar for high and low-SEP adolescents in Cluster 3 (high smoking, frequent alcohol use, drunkenness, and moderate bullying) (8.0 % vs. 8.2 %) and Cluster 4 (high bullying perpetration) (6.7 % vs. 7.2 %). Countries with higher Gini index were at greater risk of reporting risky behaviors. High-SEP adolescents were more likely to engage in risky behaviors in countries with high income inequality. The odds ratios comparing high- vs. low-SEP adolescents ranged from 0.89 in the least unequal to 1.67 in the most unequal countries for multiple risky behaviors (Cluster 3: P-interaction = 0.042) and from 0.61 to 1.19 for bullying perpetration (Cluster 4: P-interaction = 0.030).

Conclusions

High-SEP adolescents in PCCE might be at increased risk for unhealthy and vicious behaviors, especially in countries with high income inequality. Redistributive policies decreasing the gap between rich and poor are needed to ensure the health and well-being of adolescents in PCCE.