Archives of Public Health最新文献

Background: Studying the spatial pattern of out-of-hospital cardiac arrest (OHCA) and its environmental impactors is crucial for both providing timely medical assistance and implementing preventative measures. Existing researches have mainly focused on natural and sociodemographic environments, usually at a macro- or meso-scale, while giving less attention to understanding the association between environment and OHCA risk from the perspective of daily-life contexts.

Methods: In this study, we utilized 1843 eligible OHCA cases from core districts of Beijing in 2020 and employed modified Besag-York-Mollié (BYM2) Bayesian models to investigate the association between living environment (consisting of food environment, physical activity environment, healthcare environment and leisure environment) and adult OHCA risk, as well as its age disparities, at a 1 × 1 km² cell resolution.

Results: The results show that: (1) Fewer living environment factors are associated with the OHCA risk in the young/middle-aged group compared to the elderly group. (2) Unhealthy food destination like barbecue restaurants in living area is associated with increased OHCA risk in both age groups. (3) Facility inducing sedentary activity like chess rooms and healthcare facilities are associated with increased OHCA risk, but only among the elderly groups. (4) The decreased OHCA risk in the young/middle-aged group is related to public gathering places for socialization and relaxation in living area like coffee shops, while for the elder groups, decreased OHCA risk is associated with more green spaces in the living area.

Conclusions: The findings suggest that living environment may impact adult OHCA risk through shaping daily habits or providing access to health resources, with the underlying mechanism varying across different age groups. Future planning should fully consider and leverage the impact of living environment in order to effectively reduce OHCA risk.

Organ donation requests to families often occur during moments of profound grief and create an emotional burden that is compounded by the varying emotional responses to circumstances surrounding death. These responses, in turn, interact with the timing of the request to influence authorization decisions. Understanding the interplay between timing and circumstances of death is crucial for improving authorization rates and addressing the organ donor shortage. The Organ Retrieval and Collection of Health Information for Donation database was used to identify 3,289 potential donors with neurologic mechanisms of brain death. Multivariate logistic regression with interaction between timing and circumstance was used to estimate authorization rates. Results show no significant differences in authorization for requests made within 12 h of death, regardless of circumstance. However, significant differences in authorization were observed between requests made at the time of brain death and those made 12 or more hours later for natural causes, as well as those at 24 or more hours for homicide, motor vehicle accidents, and non-motor vehicle accidents. These findings indicate that the optimal timing for organ donation requests may depend on the emotional intensity of the situation. While quicker requests may be more effective in less emotionally charged cases, extending the time for families to grieve in highly distressing circumstances does not appear to negatively impact authorization rates. Tailoring the timing of donation requests to the circumstances of death, balancing sensitivity with the need for prompt decision-making, could reduce families' emotional burden, ease pressure in decision-making, and help address the shortage of organ donors.

Background: Gender norms shape rights, privileges, and societal roles, impacting health and well-being. In low- and middle-income countries (LMICs), while young people may reject harmful gender discrimination, they often support other norms that perpetuate gender imbalances. This study examines factors influencing young people's attitudes toward gender norms, focusing on men's rights in decision-making, education, social roles, and equity for women's empowerment in Southeast Nigeria.

Methods: A cross-sectional analytical study was conducted from October 2022 to March 2023 in six communities in Ebonyi State, Nigeria, with 1025 young people aged 15-24 selected using cluster sampling. Gender norm attitudes were assessed using a three-point Likert scale questionnaire. Mean scores exceeding 1.5 indicated favourability towards negative gender norms. Statistical analysis included univariate, bivariate, and multivariate linear regression with statistical significance set at a p < 0.05.

Results: Over 60% of participants believed that men should have more decision-making power than women, but fewer than 30% supported unequal access to education for boys. More than two-thirds endorsed women/girls' empowerment. Predictors of support for men's decision-making rights, education, and protective rights included schooling status (β = -1.896, p < 0.001), educational status (β = 5.593, p = 0.004), gender (β = 0.529, p < 0.001), mother's educational level (β = 1.993, p = 0.020), household leadership (β = 0.218, p = 0.003) and religion: β = -0.175, p = 0.008). Predictors of support for women's empowerment included gender (β = 10.299, p < 0.001), schooling status (β = -0.170, p = 0.012), and father's educational level (β = -0.212, p = 0.041).

Conclusion: Despite widespread support for gender equality for women's empowerment, young people in the Southeast still favour traditional gender norms, particularly decision-making and educational rights for men. Factors such as educational status, gender, and household leadership play a significant role in shaping these attitudes. Interventions that promote gender equity should focus on education, challenge traditional norms, and engage both young men and women in discussions about shared decision-making and equal access to opportunities.

Background: The COVID-19 pandemic has disproportionately affected socially vulnerable communities. Some individuals experience persistent symptoms and conditions of COVID-19 illness known as long COVID. As little research has examined how social vulnerability is related to long COVID, we studied this topic using Minority Health Social Vulnerability Index (MHSVI), specifically created for the COVID-19 pandemic in the U.S.

Methods: We merged county-level MHSVI data with population-based data of Michigan adults with PCR-confirmed SARS-CoV-2 infection between March 2020 and May 2022 based on respondents' county of residence. We examined the relationship between county-level MHSVI (binary: high social vulnerability ≥ 75th percentile) and two long COVID measurements, assessed a median of 18.8 months after their initial infection: (1) ongoing long COVID (yes/no) and (2) long COVID diagnosis (yes/no). We conducted modified Poisson regression models with robust standard errors to estimate prevalence ratio (PR) between associations of MHSVI and long COVID overall and by six MHSVI themes (socioeconomic status, household composition/disability, minority/language, housing type/transportation, healthcare access, medical vulnerability), adjusting for individual-level and county-level covariates.

Results: Living in high MHSVI counties was not associated with ongoing long COVID or long COVID diagnosis. However, the associations differed by theme of MHSVI: respondents in highly socially vulnerable counties assessed by medical vulnerability had 1.32 times higher prevalence of long COVID diagnosis (95% CI:1.12 - 1.57). There were no statistically significant associations in other themes after the adjustment for covariates.

Conclusions: Our findings suggest the importance of upstream social determinants of health during public health emergencies and provide evidence that medically vulnerable communities need additional public health resources to cope with long COVID among their residents.

Objective: The COVID-19 pandemic presented an unprecedented worldwide challenge to public health and the economy. However, the effect varied in different population groups and locations. This study examines how the preexisting socioeconomic conditions, income, education, access to broadband internet, and healthy foods affect people's pandemic-related health-protective behavior and lead to this differential impact in the U.S.

Methods: This study utilizes a dynamic panel-data-based regression analysis on a nationwide dataset of U.S. counties.

Results: Higher income, education level, and broadband speed reduce the probability of violating recommended preventive measures, promote health awareness among individuals, and lower COVID-19 cases. In contrast, low access to healthy foods increases the number of cases. Additionally, our study reveals several interesting findings related to people's food habits, living conditions, and the connection between education and access to broadband internet that contribute to the differential impact of countywide COVID-19 cases.

Conclusions: Insights from our data-driven analysis enable healthcare authorities to understand where resources should be allocated at the beginning of a pandemic to reduce disease spread and thus, build a greater resiliency for the next pandemic. Hence, our findings provide significant insights to government and healthcare officials to devise health awareness campaigns and develop advocacy measures and policies in conjunction with policymakers to contain future pandemics.

Background: The community health workers (CHWs)-led model is an important strategy for managing type 2 diabetes mellitus (T2DM) in China. However, existing community-based dietary and health education interventions in diabetes management are insufficient. Meanwhile, emerging mobile health (mHealth) has emerged as a promising tool for improving disease management. Current evidence on the combined efficacy of mHealth technologies and CHWs strategies remains limited.

Objective: This study evaluates the effectiveness of an online dietary and health education intervention delivered through a tertiary hospital's WeChat official account (WOA) for T2DM patients, examining its influence on glycated hemoglobin (HbA1c) levels, body mass index (BMI), serum lipid profiles, and diabetes-specific quality of life (DSQL).

Methods: This randomized clinical trial was conducted in two community health centers in China, enrolling adults diagnosed with T2DM. Participants were randomly assigned to two groups over 3 months. The control group received standard care, while the intervention group accessed online low glycaemic index (GI) dietary and lifestyle recommendations via the WOA. This group was instructed to monitor blood glucose levels, upload daily dietary photos, review health education notifications, and participate in real-time communication with the diabetes management team via the WOA.

Results: A total of 178 participants were randomized to the control group (mean [SD] age, 57.07 [10.96] years, n = 89) and the intervention group (mean [SD] age, 57.18 [10.61] years, n = 89). After 3 months, significant improvements were observed in the intervention group compared to the control group, with lower HbA1c levels (mean 7.82%, SD 0.43%; p = 0.001), BMI (mean 24.35, SD 1.25 kg/m²; p < 0.001), low-density lipoprotein cholesterol (mean 2.38, SD 0.21 mmol/L; p < 0.001), and DSQL scores (mean 43.24, SD 7.23; P < 0.001), whereas high-density lipoprotein cholesterol (mean 1.35, SD 0.37 mmol/L; p = 0.001) was significantly higher. Subgroup analysis at 3 months showed that age, education, disease duration, comorbidity, and BMI influenced the effectiveness of HbA1c reduction.

Conclusion: Overall, the WOA-based intervention effectively engages patients in community diabetes management, leading to improved glycemic control, weight reduction, lipid metabolism optimization, and better quality of life.

Trial registration: ChiCTR2400081045.

Background: The study aim was to investigate implementation of safety-related statutory information for herbal products under the pharmaceutical legislation between 1965 and 2021 in Finland. The study period covered Finland's whole marketing authorisation system divided into five periods according to changes in legislation (1965-1982, 1983-1987, 1988-1993, 1994-2004 and 2005-2021).

Methods: The study was carried out using qualitative content analysis focusing on herbal products granted marketing authorisations, registrations and licenses under the pharmaceutical legislation. Safety-related information in the summaries of product characteristics (SmPC), package leaflets (PL) and their predecessors (i.e., preliminary PLs called brochures) from 1965 to 2021 were analysed, particularly focusing on contraindications - including special warnings and precautions. The herbal product information data were searched from the archives of the Finnish Medicines Agency (Fimea). All searched information was from publicly available EU and Finnish legislations, administrative regulations, and approved product information of SmPC, PL and their predecessors.

Results: The study material consisted of 207 herbal medicinal products after excluding six products because no data was found for them. Contraindications (including special warnings and precautions) were included in product information more systematically since 2005. Within 1965-1982, only 2/13 (15%) licensed products were equipped with a brochure. During 1994-2004 of the products 64/78 (82%) were equipped with the SmPC, PL or brochure. This legislation period can be seen as a watershed in implementation of SmPC into practice in Finland before the full (100%) implementation during the period 2005-2021. Of the contraindication (including special warnings and precautions) information, hypersensitivity/allergy information was included clearly most frequently.

Conclusions: This study is based on a unique archive material covering years 1965-2021 in Finland. It shows successful national implementation of statutory product information for herbal products and how safety-related product information on contraindications (including special warnings and precautions) has improved during the study period, particularly since legislative changes in 2005. Currently, all herbal products under pharmaceutical supervision are medicinal products which are controlled like any other medicinal products for patient safety.

Emphasizing the historical exclusion of women from medical research, our letter sheds light on the double stigma of menstruation and premenstrual disorders faced by Middle Eastern women, and calls for collaborative efforts among healthcare professionals and policymakers to implement comprehensive anti-stigma strategies.

Background: The CDC National Diabetes Prevention Program (National DPP) lifestyle change program is a nationwide initiative to prevent or delay the onset of type 2 diabetes in adults with prediabetes. The CDC recognition status (i.e., pending, preliminary, full, or full-plus) signifies that a program meets specific quality, fidelity, and effectiveness standards. However, organizations-especially those serving socially vulnerable communities -often face significant challenges in achieving and maintaining this recognition. We aimed to explore the barriers and facilitators related to achieving and maintaining CDC recognition among organizations delivering the National DPP in socially vulnerable communities.

Methods: This qualitative descriptive study used a web-based questionnaire to gather insights from 27 organizations delivering the National DPP in socially vulnerable communities. Respondents shared their experiences regarding challenges in attaining and maintaining CDC recognition, strategies to overcome these challenges, and recommendations for CDC support. Thematic analysis was conducted to identify and report emerging themes.

Results: Funding availability, strong partnerships with community organizations, and flexible program delivery models were identified as key facilitators for achieving and maintaining CDC recognition. Major barriers included difficulties with participant recruitment and retention as well as insufficient funding to support program delivery costs. Respondents recommended increasing flexibility in recognition requirements, advocating for better reimbursement models, expanding training opportunities, and promoting collaboration between delivery organizations to enhance sustainability.

Conclusion: Our study highlights key factors influencing the achievement and maintenance of CDC recognition for delivering the National DPP lifestyle change program among organizations in socially vulnerable communities. Addressing these factors through flexible program requirements (e.g., risk-adjusted models), improved funding models, strengthened support from the CDC, and collaboration between organizations could improve program sustainability.