Archives of Public Health最新文献

Background: Polytrauma was defined as a severe traumatic injury and believed that it was a sudden and unpredictable incident. Is polytrauma really just a simple accident? In order to comprehensively answer this question, the study sought to determine the frequency and specific risk factors associated with polytrauma recidivism, while also comparing the initial and subsequent injury events among recidivists.

Methods: A multicenter, retrospective cohort study was conducted at four Advanced Trauma Centers' emergency surgery or traumatic intensive care units (TICUs) between August 2020 and July 2023. A total of 2490 consecutive trauma patients who met the criteria consecutively were recruited and analyzed in the study. Risk factors for recurrent polytrauma were identified through the use of logistic regression analysis. A nomogram was created using the results from a multivariate logistic regression analysis and the rms package in R.

Results: In polytrauma, the rate of recidivism was 44.6% (672/1507), then recidivists were predominantly male (80.4%) and frequently within the 45 to 54 year-old age range (51.3%). Recidivists in polytrauma patients overall had a median time to reinjury of 27 months, as measured by the interquartile range (IQR). The polytrauma patients in the recent traumatic event were often more severe than that in the initial event, as patients had higher ISS scores and lower GCS scores (P < 0.01). Moreover, polytrauma recidivism were associated with poorer prognosis and increased healthcare costs. Polytrauma patients with the specific characteristics were found to have a higher likelihood of experiencing a subsequent recurrence, including being male (OR = 3.82,95% CI: 2.21-6.83), aged 45-54 years old (OR = 2.62,95% CI: 2.13-6.32),experiencing sleep deprivation (OR = 2.38,95% CI: 1.32-4.25), working in construction (OR = 2.72,95% CI: 1.44-5.42), working as delivery staff (OR = 3.65,95% CI: 1.51-7.96) and being involved in an electric bicycle collision (OR = 2.85,95% CI: 1.31-5.64).

Conclusion: Polytrauma recidivism is associated with a high recurrence rate, poorer clinical outcomes, and elevated healthcare costs. Key predictive markers for recidivism include being male, aged 45-54 years, experiencing sleep deprivation, employment in construction or delivery roles, and involvement in electric bicycle collisions. These findings highlight polytrauma recidivists as a critical target for primary prevention efforts. Public health strategies should prioritize tailored interventions to reduce recidivism, aiming to mitigate morbidity, mortality, and associated healthcare burdens in this high-risk population.

Background: Under the background of similar geography and culture in Lancang-Mekong countries and rapid changes in the regional economy and lifestyle, this study aimed to describe and compare the prevalence, awareness, treatment, and control of hypertension and assess the hypertension care cascade in three provinces of China, Laos, and Cambodia.

Methods: A cross-sectional study was conducted between 2021 and 2023 in the three provinces of Lancang-Mekong River countries using consistent investigative procedures. We included 11,005 participants aged ≥ 18 years from three provinces, and data were collected through questionnaires, physical examinations, and biochemical tests. We analyzed the cascade of hypertension care and compared the prevalence, awareness, treatment, and control of hypertension.

Results: The hypertension care cascade indicated that 46.3%, 51.6%, and 63.1% of patients in Yunnan Province (China), Oudomxay Province (Laos), and Ratanakiri Province (Cambodia), respectively, were not diagnosed, and 10.7%, 12.8% and 21.1% of patients, respectively, did not receive treatment. After sex-age standardization, the prevalence rates of hypertension in the three provinces were 33.4%, 34.5%, and 23.6%, respectively. Higher awareness rate in Yunnan Province (53.4%) and Oudomxay Province (46.5%) than in Ratanakiri Province of Cambodia (39.7%). The treatment rate of hypertension in Yunnan Province (42.4%) was higher than that in Oudomxay Province (34.5%), and Ratanakiri Province (16.9%). In addition, less than 20% of the patients in the three provinces had their blood pressure under control. The factors associated with hypertension differed across the three provinces.

Conclusions: In the three provinces of the Lancang-Mekong River Basin countries, there is a high burden of hypertension and a significant unmet need for hypertension care. Targeted and precise intervention strategies are urgently needed to improve the awareness, treatment, and control of hypertension in low- and middle-income regions.

Background: Added sugars intake is common among individuals with Parkinson's disease (PD), yet the link between added sugars intake and PD is not well understood. Our study aims to investigate the association between added sugars intake and PD.

Methods: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from1990 to 2020. Added sugars intake was estimated based on a 24-hour dietary recall from participants. Multivariable logistic regression analysis was employed to explore the relationship between added sugars intake and the prevalence of PD. Restricted cubic spline (RCS) was used to explore the nonlinear association between added sugars intake and PD. To further observe whether the conclusions were consistent across different subgroups, we conducted subgroup analyses to investigate the association of added sugars intake with PD in different populations.

Results: The study included 12,489 participants, of which 100 had PD. When weighted, the data represented 136,959,144 participants. The study revealed a positive association between added sugars intake and the prevalence of PD. In multivariable regression models adjusted for all confounding factors, compared with the lowest quartile of added sugars intake, the third quartile (OR = 2.99; 95% CI: 1.43-6.26) and those consuming more than 25% of their calories from added sugars (OR = 3.34; 95% CI: 1.03-10.86) had the highest risk of PD. The RCS curve showed an L-shaped nonlinear association between added sugars intake and PD. Two-segment linear regression by sex revealed that PD prevalence in women was linearly related to sugar intake (nonlinear P = 0.465), while men exhibited an L-shaped nonlinear relationship (nonlinear P = 0.03). Additionally, subgroup analysis showed that alcohol consumption and diabetes significantly influenced the association between added sugars intake and the prevalence of PD.

Conclusion: These results highlight a positive association between added sugars intake and the prevalence of PD, particularly among women, heavy drinkers, and individuals with diabetes.

Background: Cost-effectiveness analyses of health technologies have become a part of the decision-making process in healthcare policies. Nevertheless, economic results are not always presented in comprehensible formats for non-technical audiences, such as the general population, healthcare professionals or decision-makers. The purpose of this study was to observe which formats best convey the key message of an economic evaluation, and which are best received by two different audiences.

Methods: The summary of a hypothetical cost-effectiveness analysis was edited in different formats: infographic, plain language text and video-abstract for the general population; executive summary and policy brief for a specialized population, i.e. clinicians, clinical and non-clinical managers, or methodologists in health-technology assessment. Participants were randomly shown one of the formats, and data on objective and subjective comprehension, and perceived usefulness/acceptability were gathered by means of online questionnaires. Statistical differences between formats within each audience were analysed.

Results: In the general population (N = 324), objective comprehension was statistically significantly better for infographic than for video-abstract (p = 0.005), and for plain text than for video-abstract (p = 0.024). There were no differences in subjective comprehension, but video-abstract was considered statistically significantly more useful to understand the information than plain text (p = 0.011). In the specialized population (N = 100), no statistically significant differences were observed for objective and subjective comprehension, although policy brief was perceived as statistically significantly more useful than executive summary (p = 0.005).

Conclusions: A balance between effectivity of conveying the message and attractivity of the format needs to be sought, to facilitate non-technical audiences' understanding of economic data and, consequently, perceive decision-making processes as more transparent and legitimate. The infographic and policy brief could be robust ways to present economic data to the general public and specialized audience, respectively.

Background: Mobile app interventions are emerging as significant tools in managing the prognosis of type 2 diabetes, demonstrating progressively greater impacts. The effectiveness of these interventions needs further evidence-based support.

Objective: This study conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the effectiveness of mobile app interventions in improving prognosis for patients with type 2 diabetes.

Methods: We searched PubMed, Cochrane, Embase, and Web of Science for relevant studies published from inception to 18 April 2024, adhering to the Cochrane Handbook guidelines. The quality of the included studies was assessed using the Cochrane risk of bias tool. Primary outcomes measured were changes in glycated hemoglobin (HbA1c) and diabetes self-management (DSM). Secondary outcomes included changes in diastolic blood pressure (DBP), systolic blood pressure (SBP), triglycerides(TG), total cholesterol(TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), lipid profiles, fasting plasma glucose (FPG), body mass index (BMI), and Steps outcomes. Subgroup analyses were performed for the primary outcomes and for high-density lipoprotein (HDL), low-density lipoprotein (LDL), diastolic blood pressure (DBP), and systolic blood pressure (SBP). Interventions with or without interactions were also used as a basis for subgrouping.

Results: A total of 15 eligible articles involving 17 studies with 2,028 subjects (1,123 in the intervention group and 1,020 in the control group) were included in the synthesis. Interactive mobile app interventions significantly reduced HbA1c levels (SMD - 0.24; 95% CI, -0.33 to -0.15; P < 0.00001) and significantly improved diabetes self-care (SMD 0.71; 95% CI, 0.21 to 1.21; P = 0.005). Secondary outcomes, including FPG, LDL, DBP, and SBP, showed varying degrees of improvement. Subgroup analyses indicated that the intervention effect was more pronounced and less heterogeneous in the short-term (≤ 3 months) for younger Asian individuals (< 55 years) who used an interactive mobile app.

Conclusion: Interactive mobile app interventions effectively improve HbA1c levels and diabetes self-care competencies in patients with type 2 diabetes. These interventions offer supportive evidence for their clinical use in managing and prognosticating type 2 diabetes.

Systematic review registration: CRD42024550643.

Background: Healthy eating patterns from sustainable food systems are crucial for population and planetary health. Primary schools are opportune settings for teaching children about food, nutrition and sustainability (FNS) though little is known about the delivery of FNS education in this sector. This study aimed to analyse current approaches to FNS education in Australian primary schools.

Methods: A cross-sectional online survey with closed- and open-ended questions collected data about (i) teacher perceptions and attributes regarding FNS education; (ii) FNS teaching practices; and (iii) factors influencing FNS education. Statistical analyses were conducted using STATA including descriptive statistics and chi-square analyses to test for associations between categorical variables. Qualitative content and thematic analyses of open-ended questions were conducted using NVivo 14.

Results: Participants were 413 Australian primary school teachers. Teachers considered FNS education as equally important to most curriculum subjects, though frequency of FNS education was low. Less than a third of teachers were trained in FNS education, had access to funding for FNS-related activities or were from schools with policies about including FNS education in the curriculum. There was a significant association between frequency of FNS education and teacher training, access to funding and presence of FNS curriculum policies (all p < 0.001). Teachers who were trained to teach nutrition, food skills or food sustainability (all p < 0.05) were more likely to teach this as both stand-alone and cross-curricular subjects. Teachers described personal factors (workload, stress, scope of practice) that influenced their FNS teaching practices, as well as factors related to students' families (family responsibility for FNS education, family food practices, family engagement in FNS activities), the curriculum (overcrowding, prioritisation, access to resources) and the broader school environment (time, facilities, funding, training).

Conclusions: Strengthening the position of FNS education in the primary school sector is an important next step for public health research, policy and practice. Researchers and policy makers should explore future opportunities for training, funding and policy approaches that prioritise FNS within the primary school curriculum and in everyday teaching practice.

Background: The weight-adjusted-waist index (WWI) is a relatively new index to obesity. This study aimed to explore the reationship between WWI and cardiovascular disease (CVD).

Methods: This cross-sectional study included 8,899 participants aged 35 to 65 from the Ravansar non-communicable diseases (RaNCD) cohort study in Ravansar, Iran. The WWI was calculated by dividing waist circumference (WC) by the square root of weight. The receiver operating characteristic (ROC) curve was utilized to assess the predictive performance of WWI in relation to CVD. The study applied multiple logistic regression to assess the association between WWI and CVD.

Results: Participants had an average age of 47.52 ± 8.29 years, with 45.30% being men and 41.13% residing in rural areas. The prevalence of CVD was found to be 17.36%. A positive correlation between WWI and CVD was obseved, with individuals in the highest WWI quartile having a 36% (OR = 1.36, 95%CI: 1.11, 1.78) greater odds of CVD compared to those in the lowest quartile (OR = 1.03, 95%CI: 0.79, 1.33) (ptrend = 0.010). Subgroup analyses indicated stronger links between WWI and CVD among participants over 50, males, urban residents, those of high socioeconomic status (SES), and passive smokers (p < 0.001). The ROC analysis revealed that WWI is a greater ability in predicting CVD (AUC: 0.64, 95%CI: 0.61, 0.64) compared to body mass index (BMI) (AUC: 0.60, 95%CI: 0.58, 0.61) and WC (AUC: 0.61, 95%CI: 0.59, 0.62).

Conclusion: The increase in WWI elevates the odds of CVD, making the management of WWI crucial for CVD prevention.

Background: High-need, high-cost (HNHC) patients are a major focus of international healthcare reform. However, research on HNHC children in China remains limited. This study aims to classify HNHC pediatric patients, analyze the differences among groups, and explore the factors influencing HNHC status.

Methods: Data were obtained from a retrospective observational cohort of hospitalized children in Shanghai, China from 2017 to 2023. K-means clustering, one of the unsupervised learning algorithms, was employed to classify patients according to their HNHC status. Descriptive statistical analysis and the Kruskal-Wallis H test were used to describe and test the differences among different groups, with the logit regression models to analyze the predictors.

Results: 688,131 hospitalized children were classified into three groups: 1,871 persistent HNHC, 32,539 episodic HNHC, and 653,721 non-HNHC. Significant differences were observed among these groups. Persistent HNHC patients have significantly higher costs and longer HNHC durations compared to episodic and non-HNHC patients, who were more likely to be aged 30 days to 1 year or 13-18 years, female with only one type of health insurance, and leukemia was the most prevalent and costly disease. They exhibited distinct healthcare utilization patterns, including emergency admissions, higher surgery rates, longer hospital stays, more frequent hospitalizations, and a preference for tertiary and specialized hospitals in city centers. Multiple influencing factors of persistent HNHC versus episodic HNHC and non-HNHC were identified.

Conclusion: This study provides valuable insights into the classification, characteristics, and influencing factors of persistent, episodic, and non-HNHC hospitalized children in China. Persistent HNHC patients warrant targeted interventions to improve health outcomes and reduce healthcare costs. Enhanced medical coverage for key diseases, high-quality healthcare services tailored to their needs, and early interventions are crucial.