Archives of Public Health最新文献

Background: During the initial phase of the COVID-19 pandemic, there was an intensive debate on which strategies would be most effective to minimize the negative societal impact of the pandemic. This study aimed to provide an overview of key epidemiological outcome measures of the disease in the Nordic countries and the subsequent policy implementation that were undertaken to curb the outbreak.

Methods: Time trends in test-positive infections, hospitalizations, and intensive care unit (ICU) admissions due to COVID-19 as well as COVID-19 mortality and excess mortality were compared between Denmark, Finland, Iceland, Norway, and Sweden. The epidemiological patterns were presented in relation to 13 different policies implemented to a different degree in the countries, eight of which were related to containment and five to health systems policy. A stringency index summarized the intensity of the policies. Data were collected from Our World in Data, the Oxford COVID-19 Government Response Tracker and Eurostat. The investigated time period was 1 January 2020 to 30 April 2022.

Results: Overall, Sweden had more infections, deaths, hospitalizations, and ICU admissions than the other Nordic countries during the first three waves of the pandemic. However, in the fourth wave, Denmark exceeded Sweden in all outcomes. The overall stringency among the Nordic countries varied broadly. The lowest average stringency index was observed in Iceland and the highest in Sweden. Excess mortality over the whole study period was lowest in Iceland while Norway had very few ICU admissions.

Conclusions: The Nordic countries took vastly different approaches to contain the spread of the pandemic, but the long-term impact on excess mortality was similar. The variety in policy responses and epidemiological measures bring many opportunities for learning across the countries.

Background: Armed conflict severely impacts children's health, leading to malnutrition and increased child mortality. The republic of South Sudan gained independence from Sudan in 2011 and suffered from seven-years civil war between December 2013-2021. The war led to mass population displacement both internally and externally and worsened the health status of the population, especially the children.

Aim: To investigate the effect of conflict intensity on global acute malnutrition and under-five crude mortality rate in South Sudan during the civil war between 2014-2021.

Methods: The study used an ecological panel data analysis of armed conflict data from Uppsala Conflict Data Program (UCDP) and child health data from Standardized Monitoring and Assessment of Relief and Transitions surveys conducted in 2014-2021. Child health is evaluated as global acute malnutrition (GAM) and under-five crude mortality rate (U5CMR). The study analyzed the correlation between the intensity of conflict and the prevalence of malnutrition and under-five crude mortality on a state level. Internal displacement and food prices were used as indirect effects of conflict. One year lag effect regressions were used to estimate potential correlation between child health and armed conflict.

Results: Total number of conflict related deaths between 2014-2021 was on best estimate (9,577), and on high estimate (13,178). The average GAM rate for the same period was (15.29%), and U5CMR was (0.77). Data analysis showed a significant correlation between the high estimate of conflict intensity with GAM (.047), and with U5CMR (.043). Internal displacement and food prices had a significant correlation with GAM (P = .048, P = .016), but no significant correlation was noticed with U5CMR. Best estimate of conflict intensity did not show a significant effect on children health variables.

Conclusion: The effect of conflict on children's health outcome is complex and multifactorial. The high estimate of conflict intensity from UCDP showed significant correlation with the health outcome, while best estimate did not have significant correlation, this could be due to limited child health data, underreporting of conflict-related deaths, and a small sample size. The study suggests that other factors such as food prices and displacement might play an additional factor that increases the effect of conflict intensity on child health outcomes. The study underscores the challenge of data scarcity in researching health determinants in South Sudan.

Background: The Medical Informatics Initiative (MII) introduced a broad consent form (MII-BC) encompassing clinical, insurance, and biomaterial data, along with re-contacting options. In the emergency department (ED), outpatient and inpatient patients of all illnesses and severity could be reached early in their treatment course. The BC-ED (Broad Consent in the Emergency Department) project uniquely investigated the implementation of MII-BC in EDs, exploring feasibility, selection bias and patients' perceptions of voluntariness, information recall, motivation, and satisfaction.

Methods: The BC-ED project involving four university hospital EDs in Germany, is part of CODEX+ (Collaborative Data Exchange and Usage), an initiative within the Network University Medicine (NUM). To minimize selection bias, a systematic sampling approach (every 5th/30th patient) was applied, with patient recruitment and consent processes adapted to local conditions and therefore varying among sites. Data collection included patient questionnaires, surveys completed by study nurses, and routine clinical data. Analysis was conducted descriptively using SPSS.

Results: Of 1,138 patients approached, 553 (48.6%) were capable of giving consent. Of 353 patients who could not consent, primary reasons included language barriers (35.4%) and inability to grasp study details (21.5%). Of all eligible patients, 3.3% could not be contacted. Of 535 (47.0%) patients able to consent and contacted, 313 consented to the MII-BC. Resulting in a consent rate of 27.5% corresponding to the baseline population and 58.5% of those contacted. Motivations for consenting were general support for research (85.3%) and the desire to help future patients (78.2%). Patients generally reported a high level of understanding and satisfaction with the consent process, reporting comprehensive understanding of scientific data use (89.8%) and associated risks (82.2%). However, discrepancies were noted between consented options and patient recall.

Conclusions: This study is the first to investigate the implementation of the MII-BC in the challenging ED environment. With a consent rate of 27.5% total baseline population and 58.5% of those contacted, it demonstrates that patients were able and willing to participate in research. Reasons for non-consent were barriers like language and medical conditions. Strategies to address these barriers are crucial for inclusivity. Although patients generally understood the consent process, discrepancies in recall highlight the need for improved comprehension strategies.

Trial registration: German Clinical Trials Register on 25 October 2022 (DRKS0003054).

Background: This study aimed to estimate temporal trends in the burden of vertebral fractures (VFs) caused by falls by gender and age in China and globally from 1990 to 2021.

Methods: Data concerning the characteristics of VFs caused by falls in China and worldwide, with a focus on metrics in incidence, prevalence and years lived with disability (YLDs) and their age-standardised rates, were sourced from the Global Burden of Disease (GBD) Study 2021. Joinpoint regression analysis was used to identify periods with significant changes. The average annual percentage change (AAPC) was calculated to reflect the temporal trends from 1990 to 2021. We utilised the age-period-cohort (APC) model to assess the effects of age, period, and cohort on the burden of VFs in China.

Results: From 1990 to 2021, the age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR) and age-standardised YLD rate (ASYR) of VFs caused by falls exhibited an overall increase in China, whereas a general decline was observed globally. Furthermore, the ASIR, ASPR and ASYR were higher for males than females in China and worldwide. In 2021, across all age groups, the disease burden of VFs was primarily observed among the elderly population, particularly in the older female population, both in China and globally. The impact of age, period, and cohort on the incidence, prevalence, and YLDs exhibited variations in China.

Conclusion: The burden of VFs in China remains significant, particularly among older females. Given the considerable size of the elderly population and the ageing of the Chinese population, VFs remain critical public issues. Therefore, continued efforts must be made to address the health consequences of VFs caused by falls.

Background: The amount of physical activity, sleep, and sedentary behaviour affect several age-related diseases. However, no relevant study about their associations with cardiovascular and musculoskeletal diseases from European older adults is known.

Methods: We investigated the associations of the volumes of physical activity, sleep, and sedentary behaviour with low handgrip strength (HGS), heart attack, hip fracture, rheumatoid arthritis, stroke, and osteoarthritis among European older adults (age ≥ 50 years, n = 819) from ten countries using cross-sectional data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) conducted between 2019 and 2021. We used iso-temporal regression analysis to investigate the associations of lifestyle factors with age-related diseases.

Results: The participants who met the weekly recommendation for 150 min of moderate-to-vigorous physical activity (MVPA) had lower prevalence of low HGS, difficulty lifting 5 kg of weight, heart attack, hip fracture, rheumatoid arthritis, stroke, and osteoarthritis. The iso-temporal regression analysis revealed that more light physical activity or MVPA was associated with lower prevalence of difficulty lifting 5 kg of weight and stroke. Lastly, longer sleep or less MVPA was associated with higher prevalence of stroke and difficulty lifting 5 kg of weight.

Conclusions: Collectively, our data shows the associations of several age-related diseases and optimal LPA, MVPA, and an optimal sleep. Our observations may be useful in optimizing lifestyle to combat age-related disorders in European older adults.

Background: Individuals with diabetes mellitus (DM) have high tuberculosis (TB) prevalence. Currently, the incidence of DM is increasing in low and middle-income countries including Ethiopia where TB is also endemic, which may complicate TB prevention and control efforts. In this context, the prevalence and associated factors of TB among DM patients are not well understood in Ethiopia. This study assessed the prevalence of TB and associated factors among DM patients attending public health facilities in Ethiopia.

Methods: A multicenter cross-sectional study was employed from January to December 2023 among DM patients attending selected public health facilities in five regions of Ethiopia. The consecutive DM patients ≥ 15 years of age were screened for TB and those with signs and symptoms suggestive of TB were enrolled. Patient-related socio-demographic, behavioral, and clinical data were collected. Morning sputum and urine specimens were collected from each participant. Smear microscopy, culture, and Xpert MTB/RIF Ultra assay were conducted. Data were analyzed using SPSS version 27. Descriptive summary measures were computed to characterize the study variables. A logistic regression model was conducted to assess the statistical association between variables.

Results: In total,14,119 DM patients were screened for TB. Of them, 652 (4.62%) were found to have presumptive TB and were enrolled in the study. The mean age of enrolled participants was 55.47 years and 88.3% (576) had type II DM. Among them, 73 (11.2%, 95%CI = 8.7-13.5%) had TB which yielded a point prevalence of 517/100,000 among all screened DM patients. Bacteriological confirmation of TB occurred in 56 cases (8.6%, 95%CI = 6.4-10.6%). The independently associated factors were being younger age group (15-24 years; aOR; 10.98, 95%CI = 1.90-63.56, 25-34 years; aOR; 4.74, 95%CI = 1.12-20.13, 35-44 years; aOR; 5.70, 95%CI = 2.09-15.55, and 45-54 years; aOR; 2.68, 95%CI = 1.22-5.92), cough lasting ≥ two weeks (aOR; 2.73, 95%CI = 1.25-5.60), cigarette smoking (aOR; 7.50, 95%CI = 2.54-22.19), contact with a known TB case (aOR; 9.16, 95%CI = 2.83-29.70), HIV seropositivity (aOR; 4.40, 95%CI = 1.36-14.46), more than 10 years of DM follow-up (aOR; 4.87, 95%CI = 2.06-11.52), insulin medication (aOR; 3.00, 95%CI = 1.16-7.81), and FBS level > 126 mg/dl (aOR; 2.72, 95%CI = 1.26-5.89).

Conclusion: Diabetic patients attending public health facilities in Ethiopia had high TB prevalence. The prevalence of TB was higher among certain DM groups which implies the need for regular TB screening among those groups. The authors recommend the integration of TB screening practice into routine diabetic care.

Background: The COVID-19 pandemic has placed significant emotional and ethical burdens on healthcare workers (HCWs), leading to the emergence of moral injury (MI). Understanding the pooled mean and factors associated with MI is crucial for developing interventions and support systems for HCWs. This meta-analysis aims to examine the extent of MI among HCWs during the COVID-19 pandemic and identify potential contributing factors.

Methods: A systematic literature search was conducted, and relevant studies reporting on MI in HCWs during the COVID-19 pandemic were included. Pooled means were calculated using random-effects or fixed effect models. Subgroup analyses were conducted based on demographic variables, such as gender, profession, and geographical region. Further, Sensitivity analysis was run to assess the individual study effect.

Results: A total of 36 studies met the inclusion criteria and were included in the meta-analysis. The pooled mean of MI among HCWs during the COVID-19 pandemic was ranged from 3.06 (CI95%: 2.35-3.77) to 119.17 (CI95%: 103.04-135.30), based on the instrument types. Further analyses revealed that females (P = 0.21), younger HCWs (P = 0.13), nurses (P = 0.55), and those in developing countries (P = 0.02) experienced higher levels of MI.

Conclusion: This meta-analysis highlights the substantial MI experienced by healthcare workers (HCWs) during the COVID-19 pandemic, with nurses, younger HCWs, and those in developing countries being particularly affected. Although statistical significance was not observed in subgroup differences, trends suggest a heightened vulnerability among specific groups. These findings underscore the urgent need for targeted interventions and policies to support HCWs, particularly in high-risk demographics, and emphasize the importance of standardized MI assessment tools for future research.

Aim: Dengue cases are on the rise in Thailand, coinciding with increases in flooding events. Studies pertaining to public knowledge, attitudes, and practices (KAP) of dengue prevention have frequently been used to better understand the public's needs towards dengue. While these studies were conducted in different settings, it is necessary to initiate a systematic review and meta-analysis of relevant studies.

Subjects and method: We conducted a systematic review and meta-analysis of prior studies in Thailand that assessed the KAP towards dengue. Eligibility criteria were established and independently used by reviewers to select nine studies for the systematic review and three for the meta-analysis. Collectively, the nine studies included 3,058 individuals and 2,519 households.

Results: The overall estimate of the proportion of participants with good knowledge of dengue prevention is 35% (95% CI: 14-59%), suggesting the majority of the population in Thailand had low levels of knowledge towards dengue. The poor levels of practice in Thailand were also observed and confirmed for the majority of the population by meta-analysis, with the pooled estimate of the proportion of participants with good practice of dengue prevention being 25% (95% CI: 22-27%). In contrast, most of the studies included in the systematic review reported positive attitudes towards dengue prevention, and this finding was also affirmed by the meta-analysis, as the pooled estimate of the proportion of positive attitudes towards dengue prevention is 61% (95% CI: 43-77%).

Conclusion: Despite good attitudes towards dengue prevention, poor knowledge and poor practices predominate, highlighting the need for enhanced public health campaigns to educate the public on dengue risks and prevention methods.

Background: When seeking advice on allergy prevention in early childhood (Early Childhood Allergy Prevention, ECAP), parents often turn to health and social care providers, such as paediatricians, midwives, and family centres. However, these actors fulfil various, often care-related, roles, and cannot be considered 'health information providers' by default. In addition, although the scientific evidence for ECAP is often known by health professionals, it is not actively communicated. In this study protocol, we describe the planned procedure for the development and implementation of a process to communicate ECAP information to parents, with a focus on reaching out to those from migrant communities. Thereby, we also aim to contribute to the understanding of how to design more robust approaches to deliver health information.

Methods: We have chosen the Implementation Research Logic Model as our framework for a multi-stage process. Firstly, we will map regional and local health and social care providers to find potential providers of ECAP information. We will then approach actors from each mapping category for qualitative interviews to assess facilitators and barriers to implementation. Next, we will define actions to ease the implementation process, develop exemplary ECAP information materials for parents, and deliver these to pre-selected health and social care individuals and organizations. Each step will be adapted to meet the needs and preferences of culturally and linguistically diverse populations. Finally, the process will be evaluated for key implementation outcomes (e.g., acceptability, feasibility, effectiveness) by interviewing information providers and surveying information recipients.

Discussion: From a Public Health perspective, studies seem warranted that investigate how evidence from health research may be effectively communicated to the public, rather than merely focusing on, e.g., intervention development. Also, it has often been highlighted that the dissemination of health information needs to better target those who face the greatest difficulties when seeking advice, i.e. individuals/parents who recently migrated. ECAP is a good use case, as scientific evidence is constantly evolving, and the communication of information is hampered by low awareness of high quality sources.