Archives of Public Health最新文献

Background: Previous research has indicated a low tuberculin skin tests (TST) strong positive rate in school tuberculosis (TB) screening implemented by community-level medical and health care institutions in China. The research objective was to evaluate the latent tuberculosis infection (LTBI) detection gap in school contact investigation in China.

Methods: In this cross-sectional study, school contacts were investigated by Chongqing Municipal Institute of Tuberculosis between January 2022 and April 2024 in Chongqing, China. TST, creation tuberculin skin test (C-TST), or Interferon-gamma release assays (IGRA) were conducted for immunological diagnostic methods. The LTBI detection gap among school contacts was assessed by comparing with the data implemented by community-level medical and health care institutions from 2021 to 2022.

Results: In 6063 participants, 4233 were tested using TST, 1799 were tested using C-TST, and 31 were tested using IGRA. Seven students were confirmed to have active TB. The LTBI prevalence rate using TST and C-TST was 15.2% (95%CI, 14.1-16.3%) and 3.6% (95%CI, 2.7-4.4%) respectively. A LTBI detection gap of 10.3% was identified when comparing with TST results implemented by community-level medical and health care institutions (χ² = 636, P < 0.001).

Conclusions: TB school contact investigation plays an important role in controlling TB epidemic. However, there may be a LTBI detection gap, likely due to poor quality control of TST implemented by community-level medical and health care institutions.

Introduction: Contraception discontinuation is a concern, especially if it occurs in breastfeeding women, thereby exposing them to a high risk of close and unwanted pregnancies. Our study aimed to measure the prevalence and identify the individual and community-level factors associated with the discontinuation of modern contraceptives among breastfeeding women.

Methods: This was a secondary analysis of retrospective data of the most recent Demographic and Health Surveys (DHS) data from nine high-fertility rate countries, conducted mostly between 2018-2021. We reported weighted frequencies of modern contraceptives discontinuation (binary variable, coded 1 and 0). The independent variables included individual-level variables, including sociodemographic characteristics, female reproduction and family planning history, the women and their households exposure to media, and community-level ones such as place of residence (urban and rural) and country. Multilevel-modified Poisson regression was used to identify associated factors at the 5% threshold.

Results: The overall prevalence of modern contraceptives discontinuation was 13.1% among 5,599 lactating mothers, with wide variations between countries (prevalence ranging from 8.2% in Sierra Leone to 33.6% in Guinea). Women were more likely to discontinue contraception if they were the head of the household (adjusted prevalence ratio (aPR) = 1.71; 95% CI [1.17-2.50]; p = 0.006). In addition, compared to implant users, women using pills (aPR = 3.06; 95% CI [2.24-4.16]; p < 0.001), those using injectables (aPR = 2.80; 95% CI [2.16-3.62]; p < 0.001), and women whose partners used condoms (aPR = 2.30; 95% CI [1.47-3.59]; p < 0.001) were more likely to discontinue contraception. Moreover, women who were not sexually active (aPR = 2.11; 95% CI [1.75-2.54]; p < 0.001) and those who wanted children within two subsequent years (aPR = 1.84; 95% CI [1.36-2.48]; p < 0.001) were more likely to discontinue contraception. Finally, method discontinuation varied by country, with women in Gambia, Guinea, Mauritania, and Mali more likely to discontinue a modern contraceptive method than those living in Burkina Faso.

Conclusion: To improve the retention of women using contraceptive, high-fertility rate countries need to focus on contraceptive education, communication about side effects, dissemination of family planning messages through the media, and regular monitoring of women taking contraceptives.

Background: Readiness of healthcare facilities is essential for delivering quality healthcare services. There is limited evidence on the antenatal care (ANC) readiness of healthcare facilities in Ethiopia. This study aimed to assess the readiness of ANC services and its influencing factors in Ethiopian healthcare facilities.

Methods: A secondary data analysis was performed using data from the Ethiopian Service Provision Assessment conducted from 11th August 2021 to 4th February 2022. A total of 905 healthcare facilities from nine regions and two city administrations in Ethiopia that provided ANC were included. Healthcare facilities' ANC readiness was evaluated using 22 indicators across five domains: trained staff and ANC guidelines (3), basic medical equipment (4), medicines and commodities (4), infection prevention tools (6), and diagnostic tests (5). A higher score in each domain indicated greater readiness to deliver recommended ANC. A Generalized Poisson regression model identified factors influencing each domain of ANC readiness indicators. Data analysis was conducted using Stata software version 16.

Results: The total number of ANC readiness indicators in healthcare facilities ranged from two to seventeen. The mean score for each indicator of ANC readiness in healthcare facilities was as follows: trained staff and guidelines (1.36/3, SD = 0.96), basic medical equipment (3.20/4, SD = 0.99), medicines and commodities (1.95/4, SD = 1.36), infection prevention tools (4.33/6, SD = 1.51), and diagnostic tests (2.22/5, SD = 1.80), based on the included indicators in each domain. Regression results showed lower availability of medicines and commodities, infection prevention tools, and diagnostic tests in clinics and rural facilities. Trained staff and ANC guidelines were less available in private healthcare institutions, health posts, and clinics. Conversely, medicines and commodities were more available in healthcare facilities in the Afar, Amhara, and Somali regions.

Conclusion: Most healthcare facilities in Ethiopia lacked key ANC readiness indicators, which are crucial for comprehensive ANC and achieving maternal and child health Sustainable Development Goals. Strategic interventions are needed to ensure ANC readiness indicators are available in healthcare facilities and to address disparities by facility type, managing authority, location and region.

Background: In 2018, a nationwide survey carried out in 387 acute care hospitals from 16 out of 21 Italian regions, allowed defining an extended checklist for the participatory evaluation of person-centredness in hospital care. We aimed to validate a reduced set of core items for continuous use across the country.

Methods: Factor analysis was used to validate the construct of the checklist. Varimax rotation with eigenvalues > 1 was used to optimize factor structure. Items with an item-total correlation > 0.30 and factor loadings > 0.4 were attributed to individual factors. Items with inter-item correlation coefficient > 0.70 were submitted to expert opinion for final decision. Overall internal consistency was assessed through Cronbach's alpha.

Results: A total of 183 out of 243 items in the original checklist were submitted to factor analysis. A subgroup of 67 items was retained in 4 main areas, allocated as follows: 16 items in 4 sub-areas of "Person-oriented organizational and care processes", 16 items in 4 sub-areas of "Physical accessibility, liveability and comfort of the facilities", 15 items in 3 sub-areas of "Access to information, streamlining and transparency", and 20 items in 4 sub-areas of "Taking care of the relationship with patients and citizens". Overall values of Cronbach's alpha ranged between 0.77 and 0.90, showing high consistency.

Conclusions: This study validated a "core" checklist that can be routinely used to monitor the implementation of person-centred care in Italian hospitals. The tool can be applied more widely by multiple stakeholders as a measurement instrument for the participatory evaluation of person-centredness.

Background: A preterm neonate is defined by the World Health Organization as a child delivered before 37 weeks of gestation. In low- and middle-income countries, including Ethiopia, preterm-related complications are serious health problems due to increases in the mortality and morbidity of newborns and children under 5 years of age. The aim of this study was to assess the time to neonatal mortality and its predictors among preterm neonates admitted to the neonatal intensive care unit in northern Ethiopia, 2023/2024.

Methods: An institution-based retrospective cohort study was conducted among 495 randomly selected preterm neonates in six out of the fourteen general hospitals of Tigray, Ethiopia from October 2023 to June 2024. Epi Data version 4.6 and STATA version 14 were used for data entry and analysis, respectively. Descriptive statistics were carried out to determine the distribution. Kaplan-Meier analysis, life table, and log rank were computed. Cox proportional hazards models were fitted to identify independent predictors of preterm mortality.

Results: The proportion of preterm neonatal mortality was 109 (22.7%). The overall median survival time was 21 (95% CI: 20, 28) days. Initiation of breast milk (AHR = 0.38 (95% CI: 0.24, 0.61)), respiratory distress syndrome (AHR = 1.9 (95% CI: 1.07,3.63)), perinatal asphyxia (AHR = 2.05 (95% CI: 1.05, 4.00)), receiving kangaroo mother care practice (AHR = 0.5 (95% CI: 0.34, 0.83)), and gestational age (AHR = 1.6 (95% CI 1.07, 2.59) were the predictors of time to death.

Conclusion: Respiratory distress syndrome, gestational age less than 32 weeks, and perinatal asphyxia at admission were found to be independent risk factors for preterm neonatal mortality. Breastfeeding and receiving kangaroo-mother care were independent preventive predictors of preterm neonatal mortality. It is better to give full emphasis and close follow-up to preterm neonates, especially during the early neonatal period.

Background: Our understanding of the global burden distribution of inflammatory cardiomyopathy and myocarditis is very limited.

Objective: To comprehensively assess the global burden distribution and attributable risk factors of inflammatory cardiomyopathy and myocarditis from 1990 to 2019.

Methods: We extracted the data on death, disability-adjusted life years (DALY), and age-standardized rate (ASR) of inflammatory cardiomyopathy and myocarditis from the 2019 Global Burden of Disease (GBD) study, including the comprehensive data and the data classified by age/sex. Evaluate the epidemic trend by calculating the estimated annual percentage change (EAPC) of the above variables. This paper discusses the spatial differences from four aspects: global, five socio-demographic index regions, 21 GBD regions, and 204 countries and regions. We also estimated the risk factors attributable to inflammatory cardiomyopathy and myocarditis-related deaths.

Results: In 2019, the global death toll from inflammatory cardiomyopathy and myocarditis was 340,349, and the age-standardized mortality rate (ASDR) was 4.40/100,000, of which the elderly and men were the majority. Although ASR has decreased in developed areas, inflammatory cardiomyopathy and myocarditis are still important health problems in those relatively underdeveloped areas. Similar DALYs burden pattern of inflammatory cardiomyopathy and myocarditis was also observed during the study period. Globally, among men over 60 and women over 65, the proportion of deaths caused by high systolic blood pressure in 2019 was higher than that in 1990.

Conclusions: Inflammatory cardiomyopathy and myocarditis are still important global public health problems. The changing pattern of the burden of inflammatory cardiomyopathy and myocarditis varies with location, age, and sex, so it is essential to improve resource allocation to formulate more effective and targeted prevention strategies. In addition, the control of blood pressure should be emphasized.

Background: Breastfeeding has numerous health benefits but social inequality in breastfeeding is documented in many high-income countries. The evidence for improving breastfeeding support through prenatal encounters is conflicting, but points towards a mechanism activated through a positive relationship between the families and their health care providers. A Danish intervention included a home visit by a health visitor during pregnancy to prolong breastfeeding and reduce social inequality in its rates. The purpose of this study was to investigate how this home visit affected breastfeeding support across socioeconomic groups with attention to how, and for whom, it activated a mechanism of improved relationship and trust between the health visitor and the family.

Methods: Our study used a realist evaluation approach and was embedded in a cluster randomized trial carried out in 20 municipalities. In the intervention arm, we observed 35 home visits delivered by the health visitors, interviewed 16 mothers and conducted 6 focus groups with a total of 34 health visitors to examine the intervention mechanisms and contextual factors that influence the generation of outcomes. The analysis applied Luhmann's, and Brown and Meyers' concepts of trust as middle-range theories.

Results: The pregnancy home visit helped early establishment of trust which enhanced the subsequent breastfeeding support postpartum in numerous ways. In realist terms, our central mechanism of change, the establishment of trust, had optimal conditions for success in the contextual setting of the pregnancy home visit where there was time, peace, undisturbed conversations, mental capacity to reflection, and a perceived more even power balance between the family and the health visitor which resulted in a range of positive outcomes. The mechanism resulted in improved tailored breastfeeding support postpartum, families reaching out to the health visitor sooner when experiencing breastfeeding difficulties, and families expressing a more positive experience of breastfeeding. The mechanism was activated across the different socioeconomic groups.

Conclusions: The circumstances of the pregnancy home visit helped to establish trust between the health visitor and the family. Especially for families in vulnerable positions, the pregnancy home visit seems to be a potent driver for enhancing the gains from breastfeeding support.

Background: Non-specific symptoms, such as headaches and sleep problems, are more common after disasters. They can become chronic, and impact emotional and physical functioning. However, limited research has focused on such symptoms in the context of a pandemic. This study investigated the association between perceived impact of the COVID-19 pandemic, and prevalence, duration, and severity of health symptoms.

Methods: A cross-sectional survey using validated questionnaires was conducted shortly after the first COVID-19 wave in 2020, with nearly 46,000 adult participants from Utrecht, the Netherlands. Negative binomial regression analyses were performed to assess the relationship between pandemic-related factors and symptom reports, adjusting for demographics, chronic conditions, lifestyle, and socio-economic status.

Results: Perceived impact of the pandemic on stress levels, loneliness, anxiety and depression was consistently and significantly associated with symptom report, duration, and perceived severity. Incidence rate ratio's (IRR) varied from 1.17 to 1.29. Delayed care during the pandemic was associated with severity of symptoms (IRR = 1.63; 99% confidence intervals (CI): 1.20-2.20). People that (suspected) got COVID-19 infected were at higher risk of symptom report, duration, and perceived severity (IRR around 1.20-1.28).

Conclusion: As with other disasters, the perceived impact of an immediate threat such as a pandemic can influence health symptoms, independent of health or socio-demographic factors. Understanding symptom patterns and risk factors can assist healthcare professionals and policymakers in identifying vulnerable groups, symptoms profiles, and improving care and support during and after pandemics.

Background: 24-h movement behaviors have a close relationship with children and adolescents' cognition, gray matter volume, and academic performance. This systematic review aims to precisely explore the associations between meeting different combinations of guidelines and the aforementioned indicators, in order to better serve public health policy.

Methods: Computer retrieval was conducted on CNKI, Web of Science, PubMed, SPORT Discus and Cochrane library databases. The screening and data extraction processes were conducted by two researchers. This study used the Joanna Briggs Institute checklist for methodological quality assessment and the Grading of Recommendations Assessment, Development, and Evaluation system for the evaluation of the level of evidence. Descriptive statistical analysis is performed using frequency and percentage on the extracted data and key findings, primarily to assess the consistency of the positive benefits associated with meeting different guidelines and outcome variables.

Results: A total of 10 studies were included (with 16 correlation analyses conducted), involving 51,566 children and adolescents aged between 4.2 and 15.9 years old. The included studies generally agreed upon the following associations: adherence to the screen time (ST) guidelines is positively linked to fluid intelligence; adherence to the sleep duration (SD) guidelines is positively linked to literacy; adherence to both ST and SD guidelines is associated with increased fluid intelligence and gray matter volume; and overall adherence to all guidelines is positively correlated with fluid intelligence. The included studies reported low certainty of evidence. Additionally, the included studies have provided clear evidence, but some studies did not strictly control confounding factors, and it is also unclear whether there is a larger effect size, hence the level of evidence is relatively low.

Conclusion: There are varying degrees of associations between different combinations of guidelines and cognition, gray matter volume, and academic performance, but further research is needed to confirm these findings, especially the relatively limited role of meeting physical activity guidelines.

Background: The association of workload and performance with physical functioning is recognised among the ageing public sector workforce. The characteristics of working conditions and social- and health-related factors associated with physical functioning after statutory retirement are still unknown. Also, previous studies on changes in physical functioning have not used a person-oriented approach. We examined physical functioning trajectories over statutory retirement and how social- and health-related factors are associated with them. Our aim was to identify distinct developmental trajectories of physical functioning over statutory retirement and to examine how social- (age, gender, marital status, education) and health-related (physical workload, self-reported sleep problems, alcohol consumption, smoking, fruit and vegetable (F&V) consumption, leisure-time physical activity (LTPA), and body mass index (BMI)) factors before retirement were associated with the identified trajectories.

Methods: We used data from the Helsinki Health Study cohort. Participants consisted of 2736 employees of the City of Helsinki, Finland who retired during the follow-up. Growth mixture modelling was used to identify physical functioning trajectories and multinominal regression analyses to examine associations of social- and health-related factors with them.

Results: Three distinct developmental patterns in physical functioning before and after retirement were found among ageing and retired employees. Lower educational level, sleep problems, physical inactivity, and obesity were associated with the trajectory groups of 'fast decreasing' and 'slowly increasing', compared to the 'stable high' trajectory.

Conclusion: The results suggest that poor social- and health-related factors are key risk factors associated with declining and lower-level physical functioning over the retirement period. Supporting healthy lifestyles among older employees might maintaining good physical functioning until retirement and beyond.