Public Health最新文献

Objectives: To map and assess the quality of guidelines developed by or in partnership with the WHO on infectious diseases with a high risk of causing public health emergencies.

Study design: Cross-sectional audit study.

Methods: A search of the WHO website and MAGICapp was conducted to identify guidelines on treatment, management, diagnosis, prevention, and surveillance of the WHO's priority list of diseases. When these sources yielded no results, the AI search engine Perplexity was used to expand the search for locally developed WHO partner guidelines. Eligible guidelines were evaluated by three to four appraisers using the Appraisal of Guidelines for Research and Evaluation (AGREE II).

Results: Of the thirty-three guidelines assessed, 73 % were developed by the WHO and 27 % were in partnership with external organisations. Guidelines scored highest in clarity of presentation (73.71 %) but were weakest in editorial independence (26.63 %) and rigour of development (30.05 %). Thirteen guidelines (40 %) were suitable for practical use, with high scores in scope, rigour, and clarity. Fourteen (42 %) were recommended for clinical use with modifications due to insufficient rigour, stakeholder involvement, or editorial independence, whilst six (18 %) were not recommended because of significant methodological flaws. Furthermore, WHO's sole-produced guidelines had higher quality than those developed with external collaborators, except for one partnership. Moreover, no WHO guidelines were found for Crimean-Congo haemorrhagic fever, Lassa fever, Rift Valley fever, Nipah and henipaviral diseases, and SARS.

Conclusions: The rigour of development and editorial independence of WHO-supported guidelines require improvement, particularly for diseases where comprehensive guidelines are lacking.

Objectives: To quantify racial/ethnic inequities in the use of harmful supplements sold with claims to aid in immune boosting, energy boosting, cleansing/detoxing, and weight loss throughout the first year of the COVID-19 pandemic.

Study design: Prospective cohort study.

Methods: Longitudinal data (April/May 2020-April 2021) were drawn from the US-based COVID-19 Substudy (N = 55,098), embedded in the Nurses' Health Studies 2 and 3 and the Growing Up Today Study. Modified Poisson models were fit to estimate sociodemographic-adjusted risk ratios (aRRs) and 95 % confidence intervals (CIs) of supplement use by racialized identity. We estimated the contribution of social stressors in driving racial/ethnic inequities in use of immune, energy, cleanse/detox, and weight-loss supplements.

Results: Non-Hispanic Black participants had up to two times higher risk of supplement use compared to Non-Hispanic White participants. Living in a county with a high COVID-19 mortality rate was associated with a slightly elevated risk of immune supplement use, and experiencing chronic high discrimination was associated with an elevated use of all supplement types.

Conclusions: There were stark racial/ethnic inequities in use of harmful supplements throughout the first year of the COVID-19 pandemic.

Objective: To investigate the association between the Weekend Warrior (WW) pattern and diabetes prevalence in American adults.

Study design: Cross-sectional analysis of data from the 2007-2016 National Health and Nutrition Examination Survey (NHANES).

Methods: We examined the relationship between four physical activity (PA) patterns-inactive, insufficiently active, WW, and regularly active-and diabetes prevalence. Multivariable logistic regression, marginal average population effects (MAPE), subgroup, and sensitivity analyses were performed to assess these associations. Odds ratios (ORs) and average marginal effects (AME), along with 95 % confidence intervals (CIs) were calculated.

Results: Individuals engaging in the WW pattern (OR = 0.60, 95 % CI: 0.40 to 0.89, p = 0.013; AME = -0.05, 95 % CI: -0.09 to -0.02, p = 0.004) and the regularly active pattern (OR = 0.69, 95 % CI: 0.60 to 0.80, p < 0.001; AME = -0.04, 95 % CI: -0.06 to -0.03, p < 0.001) showed significantly lower diabetes prevalence than those classified as inactive. Compared to individuals classified as inactive, those categorized as insufficiently active demonstrated no significant difference in diabetes prevalence. No significant difference was observed between the WW and regularly active patterns (OR = 0.86, 95 % CI: 0.56 to 1.35, p = 0.5; AME = -0.01, 95 % CI: -0.06 to 0.03, p = 0.501). Subgroup interaction analyses revealed no significant effect modification (all p for interaction >0.05), and sensitivity analyses confirmed the robustness of these findings.

Conclusion: Both the WW and regularly active patterns are associated with a lower prevalence of diabetes compared with inactive individuals.

Objectives: Worldwide in 2015, approximately 20.5 million infants were born underweight, with Sub-Saharan Africa and Asia bearing the highest burden. Numerous studies have investigated low birth weight (LBW) and its contributing factors in Ethiopia, enlightening notable variations in reported prevalence and associated factors. The goal of this study was to estimate the pooled prevalence of LBW and identify determinants using a multilevel meta-analytic approach.

Study design: A multilevel meta-analysis was conducted with R (version 4.4.0) using the metafor package.

Methods: We searched the PubMed/MedLine, Google Scholar, and Cochrane databases from January 2018 to May 2024. multilevel random effects model, with the restricted maximum likelihood method used by accounting for the nested structure of the data, with studies nested within clusters.

Results: The pooled proportion of low birth weight based on the three-level meta-analysis model was 0.36 (95%CI: 0.32-0.39; p < 0.0001). The estimated variance components were Level₃ = 5.13 % and Level₂ = 92.30 %. Subgroup analyses were done based on different factors. However, there is no significant difference between groups. maternal age (OR: 2.46; 95 % CI: 1.96 to 3.09), AnteNatal Care follow-up (OR: 3.00; 95 % CI: 1.86 to 4.84), Gestational Age (OR: 9.68; 95 % CI: 5.88 to 15.94), Birth Interval (OR: 3.97; 95 % CI: 1.13 to 13.97), Pregnancy Induced Hypertension (OR: 2.83; 95 % CI: 1.34 to 5.97), and maternal anaemic status (OR: 3.32 95 % CI: 1.14 to 9.69) were the possible factors.

Conclusions: This study found a 36 % double arcsin transformed proportion of low birth weight, with significant factors including maternal age, ANC follow-up, gestational age, birth interval, pregnancy-induced hypertension, and maternal anaemia. Interventions like promoting a good diet, sufficient antenatal care, and maintaining a clean environment are needed to meet global nutrition goals by 2025.

The rise in global life expectancy over the past century has resulted in a demographic shift leading to a significant rise in the elderly population. This gain in life expectancy however comes with a cost as ageing is often associated with an increasing burden of chronic disease conditions. In turn, this leads to greater healthcare and social care costs. The pursuit of healthy ageing is seen as the remedy, but the concept of healthy ageing is challenging to universally define. It is unclear whether populations in different regions of the world age in a similar fashion and whether they have the same healthcare needs. Health outcomes for the elderly are influenced by more than just healthcare but there is a problem of how comprehensive long-term care can be resourced. In addition, interventions targeting the elderly of today may only deliver marginal benefits for this population group. The way forward may be to get ahead of the curve and pursue anticipatory planning to deliver interventions with a long-term view to effecting health outcome change for the elderly of the future.

Objectives: Estimate the detection limits of the COVID-19 surveillance system (SS) in Chile, by estimating the SARS-CoV-2 true prevalence (TP) and the reported official positivity prevalence (OPP) gap.

Study design: Randomized cross-sectional.

Methods: Two sampling campaigns (SC) were conducted (October-November 2020 and December 2020-January 2021) in the cities of Temuco, Valdivia, and Osorno. Blood was collected from adults from randomly selected households. Sera were analyzed using a commercial later flow test (LFT). A meta-analysis was performed to estimate LFT-performance in asymptomatic-cases. Data were analyzed using a Bayesian latent class model (BLCM) to estimate TP. Finally, BLCM outputs were compared with the OPP, by calculating the TP/OPP rate.

Results: 1124 and 1017 households were visited during the 1st and 2nd SC, respectively. The BLCM rendered TP estimates of 6.5 %, 3.2 %, and 6.6 % for the cities of Temuco, Valdivia, and Osorno, respectively (1^stSC), increasing to 9.4 %, 5.0 %, and 7.5 %, 60 days later (2^ndSC). Depending on the city and SC, TP/OPP rates varied between 2.3 and 5.7.

Conclusion: The national SS was unable to detect 70-79 % of all infected cases, suggesting that mild and asymptomatic cases were scarcely detected.

Objectives: The COVID-19 pandemic has resulted in an increase of psychological distress. We hypothesized that the mental health of individuals has improved since the end of the pandemic.

Study design: 1459 population-based participants of the RESPIRA cohort study (Costa Rica) METHODS: Psychological distress was measured at 6-month intervals using the Mental Health Inventory 5 (MHI-5) during the 2-year follow-up. Visits occurred between June 2021 and November 2023. Age-sex-standardized MHI-5 mean and proportion of individuals living with psychological distress were estimated by calendar time. We evaluated both cross-sectional estimates over time among all cohort participants, and within-individual evolution among the subset of 1341 participants with repeated measures between June 2021-June 2022 and January-November 2023.

Results: Standardized prevalence of people living with psychological distress was 13.6 % [10.8-16.8] during the height of the pandemic compared to 8.8 % [6.5-11.6] post-pandemic. The standardized MHI-5 mean increased from 76.3 [74.8-77.9] to 82.9 [81.6-84.3] between the height and post-pandemic periods. 14.5 % of the participants had a much better MHI-5 score (24 points or more) in the post-pandemic period compared to the height of the pandemic, and only 5.3 % had a much worse MHI-5 score. Consistent improvements were observed among sexes and across age, except for 12-17-year-olds.

Conclusions: This study showed a decrease in the proportion of people living with psychological distress in Costa Rica since the end of the pandemic.

Objectives: To develop a more robust understanding of the relationship between increased recreational marijuana access and opioid overdose deaths. Increasing opioid-related deaths in conjunction with the rising popularity of liberalized marijuana laws make additional research examining the interrelation of both a timely and insightful question.

Study design: We use synthetic control method to assess the impact of opening recreational marijuana dispensaries via recreational marijuana legalization (RML) on opioid death rates in Colorado, Washington, and Oregon. These states were the first to introduce recreational marijuana legalization, providing a sufficiently long post-treatment period to draw fruitful policy-related insights.

Methods: We utilize state-level data collected from the Centers for Disease Control, Bureau of Labor Statistics, US Census Bureau, American Foundation for AIDS Research's Opioid and Health Indicators Database, and other data sources to construct our synthetics.

Results: Our analysis shows each synthetic control's average treatment effect is approximately -6.49 for Colorado, -2.89 for Washington, and -4.8 for Oregon. However, these findings were not statistically significant. Additional robustness checks performed on each synthetic yield a consistent negative relationship but non-significance.

Conclusions: We did not find significant relationships between recreational marijuana dispensary openings and opioid death rates.

Objective: To systematically review evidence from high income countries on health risks from cold weather exposure among people experiencing homelessness (PEH) and assess evidence on risk-reduction interventions and their effectiveness.

Study design: Narrative systematic review.

Methods: Keyword-structured searches were performed in CINAHL, Emcare, Medline, SocINDEX, Scopus, OpenGrey, Social Policy and Practice and Web of Science, and supplemented by grey literature searches in a selection of other databases, from 1973 to 2024. Articles were double-screened on title/abstract and full text. Extracted data included information on study setting and population, health risks from cold exposure, intervention characteristics and effect sizes where reported. Studies were critically appraised using Joanna Briggs Institute checklists.

Results: 24 studies were included, predominantly from the UK and US. People sleeping rough were found to be at greater risk than the general population of mortality due to hypothermia, and of hypothermic injury. Studies assessing health service utilisation indicated higher than population average admission rates due to cold exposure among PEH. Studies on interventions to reduce health risks from cold exposure in these populations all addressed multi-component programmes including shelter provision as a central component. Evidence of effectiveness was very limited.

Conclusion: PEH are at greater risk of death from hypothermia, and of hypothermic injury due to cold exposure than the general population. The use of overnight shelters and severe weather emergency plans are established approaches in high income settings for reducing risks from cold exposure among those sleeping rough, but further evidence on effectiveness is needed.

Objectives: This study aimed to develop and validate a risk prediction model for frailty in elderly using a nationally representative longitudinal survey database.

Study design: Longitudinal study based on public databases.

Methods: Three continuous cohorts of elderly aged 65 years or older from the Chinese Longitudinal Healthy Longevity Survey, with the 2008-2018 cohort as the development cohort. 2005-2014 and 2002-2011 cohort as validation sets. Frailty was assessed using the FI constructed from 46 indicators of health deficits, with FI ≥ 0.25 considered frailty. Prediction models were constructed using Cox regression model. We assessed the predictive performance of the models using the concordance statistic and calibration accuracy.

Results: 4,878 participants from the development cohort were enrolled with a median follow-up of 65 months. The prediction model contained 9 predictors: age, BMI, cognitive function, gender, ethnicity, education, natural teeth status, smoking status, and occupation. In the development cohort, the AUCs were 0.74, 0.78, and 0.80 at 36, 60, and 96 months. The AUCs were 0.68, 0.84, 0.85, and 0.70, 0.72, and 0.76 for two validation sets, respectively. Calibration performed well in the development and two validation sets, with a Brier score of <0.25. The prediction models constructed using machine learning algorithms showed similar predictive performance.

Conclusions: We developed and validated a model to predict the risk of incident frailty in elderly. The model provides insights to enable early screening and risk stratification for frailty in elderly, and to frame the development of individualized prevention of frailty.