Public Health最新文献

Objectives: Alcohol consumption and its associated harms pose a significant challenge to public health in the UK. To address this issue, Wales implemented a Minimum Unit Price policy (MUP) in February 2020, setting a minimum price of 50p per UK unit of alcohol (10 ml/8 g). In this study we evaluate the policy's impact on alcohol sales metrics to gauge its effectiveness in improving public health outcomes.

Study design: Controlled interrupted time series study.

Methods: Analysis was conducted on alcohol sales data from February 2016 to February 2022, using the Kantar WorldPanel dataset, which tracks household alcohol purchases. The study employed a difference-in-difference and dynamic differences approach with controls for year fixed effects and a control for COVID-19, comparing the impact of the MUP in Wales to England, where no policy was introduced. Key outcomes included mean spend on alcohol per shopping trip, mean price per litre, proportion of households purchasing each type of alcohol (penetration), and average volume of alcohol purchased (average weekly purchase in volume and spend).

Results: MUP was associated with reduced alcohol purchases, notably among drinkers under 28 favouring cheap high-strength alcohol like cider. Effects varied by demographics and alcohol type. Those aged under 28 decreased cider consumption by 50 % compared to England, possibly switching to lager, which saw a 33 % spending increase. Older consumers exhibit short-term price insensitivity. Additionally, there was a 1.33 percentage point rise in wine consumption among lower socioeconomic groups.

Conclusions: MUP in Wales changed purchasing behaviour, which should lead to public health benefits in the longer term. There were some interesting effects by age group and alcohol type.

Objectives: This study investigated how socio-economic and environmental factors contribute to suicidal ideation in South Korea.

Study design: This was a cross-sectional study.

Methods: Using a Bayesian multilevel analysis, the study highlights the impact of housing insecurity, financial burden, and subjective health perceptions on mental health. Data from the 2018 Korea Health Panel and regional statistics were used to analyze variables at the individual, household, and regional levels.

Results: The results suggest that poor subjective health perception, depression, and a precarious financial situation increase suicidal ideation. Regions with high housing vacancies exhibit lower suicide ideation rates, implying that reduced housing competition may alleviate mental stress.

Conclusions: Targeted mental health interventions and improved housing policies are required to help vulnerable populations.

Objective: To develop and validate a county deprivation index (CDI) that assesses socio-economic disparities and their impact on health outcomes at the county level.

Study design: A retrospective, cross-sectional study using publicly available county-level data.

Methods: Hierarchical cluster analysis was used to group 18 county-level socio-economic indicators into three clusters: economic well-being and technical connectivity, socio-economic disadvantage and vulnerability, and housing affordability and quality of life. The CDI was derived from model coefficients and validated by comparing its performance to established county deprivation measures, including the Social Deprivation Index (SDI) and the Multidimensional Deprivation Index (MDI), in predicting disease-specific mortality rates. We also assessed the CDI's ability to explain variability in Robert Wood Johnson Foundation (RWJF) county health scores across eight randomly selected states.

Results: The analysis included 3107 counties from the contiguous US. The CDI explained 45 % of the variance in age-adjusted avoidable heart disease and stroke death rates, 20 % in cancer mortality rates, 19 % in lung cancer mortality rates, and 52 % in all-cause mortality rates, outperforming the SDI and MDI. It also accounted for 63-91 % of the variance in RWJF health outcome and factor scores across selected states.

Conclusions: The CDI demonstrates superior predictive accuracy compared to existing indices, making it a valuable tool for identifying health disparities and guiding targeted public health interventions. Regular updates of the CDI will be necessary to maintain its relevance and effectiveness in capturing evolving socio-economic conditions.

Objectives: Vaccine hesitancy is often conceptualized as negative perceptions regarding vaccines, but recent authors have increasingly argued that the construct should instead be conceptualized as indecision in the vaccination decision-making process. This has caused authors to reevaluate the placement of vaccine hesitancy in associated models and frameworks, and it has caused uncertainty regarding how these two conceptualizations relate to each other. In the current article, we argue that the relation between these two conceptualizations of vaccine hesitancy is best understood via nonlinear effects. Specifically, we argue that this relation takes an inverted U-shape.

Study design: We utilized a cross-sectional survey design.

Methods: We recruited 273 participants from Prolific who completed two measures of vaccine hesitancy: an eight-dimension measure reflecting negative perceptions of vaccines and a unidimensional measure reflecting indecision in the vaccine decision-making process.

Results: We performed eight quadratic regression analyses (one for each dimension) to assess our proposed nonlinear relation. The quadratic term was significant in all eight regression analyses (all p < .01), supporting our proposed inverted U-shape relation.

Conclusions: Our results provide reasoning for future authors to test whether vaccine hesitancy as negative perceptions impacts vaccination via vaccine hesitancy as indecision, and researchers must now recognize their nonlinear relation in any developed models and frameworks.

Objectives: A key element in ensuring appropriate balance of harms and benefits in cancer screening is to develop a priority set of performance and outcome indicators to be used in screening data evaluation systems. These indicators need to be equity-focused, aligned to new screening approaches and broad-based to cover possible opportunistic screening, but at the same time as limited as possible.

Study design: Indicators for breast, colorectal and cervical cancer screening programs were chosen through a consensus building Delphi methodology involving a panel of cancer screening experts.

Methods: The list of indicators was developed using a multistage process. First, a systematic search was performed along with an extensive grey literature search to identify all potential existing indicators. Next, these indicators were refined by two expert groups, definitions and calculations were agreed upon, redundant indicators removed. A final list of 38 indicators was put forward into a Delphi study. 33 cancer screening experts were invited to take part. The Delphi study consisted of two rounds of an online survey and an online facilitated discussion between the cancer screening experts.

Results: 23 indicators were chosen covering 10 predefined indicator categories with detection rate, examination coverage and interval cancer rate deemed most important. Outcome indicators such as crude incidence rate and time from screen to result notification, while ultimately reaching consensus were deemed of less importance.

Conclusion: 23 priority indicators cover the entire screening pathway including harms, barriers and inequalities. These indicators have been piloted by the CanScreen-ECIS project.

Objective: The topic of brain health across the life-course is currently receiving exponential attention. Alongside this, exposure to lifestyle-related risk factors for Alzheimer's disease and related dementias accumulates across the life-course. This study aimed to explore young adults' (18-39 years) perceptions and understanding of brain health and dementia risk.

Study design: This study employed a phenomenological descriptive qualitative methodology to examine the lived experiences and perceptions of participants.

Methods: Focus groups were conducted with 39 young adults (18 female, 2 non-binary) from North America (n = 20) and Europe (n = 19), conducted via video conference.

Results: Participants' awareness and understanding of brain health and dementia risk factors varied, influenced by factors such as general health, family history of dementia, and personal experiences with brain health issues (e.g., traumatic brain injury). The data revealed rich insights into how participants connected (or did not connect) lifestyle factors to brain health and dementia risk.

Conclusion: This study is among the first to explore young adults' perceptions of brain health across diverse populations. While participants demonstrated moderate awareness of factors affecting brain health, they often struggled to link these factors directly to dementia risk or protective measures.

Objectives: Health and social service research impact analysis play a pivotal role in demonstrating research value. Impact analysis of programs, interventions, or policies in real-world settings is complex. There are many implementation evaluation theories, models, and frameworks (TMF) and researchers find choosing one challenging. Our objective was to systematically scope TMFs, review and chart key components of the process of implementation impact analysis to identify gaps.

Study design: A scoping review was undertaken and reported using PRISMA-ScR guidelines.

Methods: Systematic literature searches were conducted for impact analysis and impact assessment TMFs in MEDLINE, SCOPUS databases, hand searches, and expert directed search (2010-2024). Peer-reviewed articles were eligible for inclusion if they described an implementation evaluation TMF in English and used in the real world. Data extracted by the study team was charted in an Excel spreadsheet.

Results: The review identified 71 relevant papers which included a theory (n = 6), model (n = 14), or framework (n = 51). Most considered resources and/or results, whereas only 25 % considered implementation process components. Ten frameworks were deemed comprehensive and covered at least two phases of implementation and five components. Most frameworks had not developed or tested practical tools to facilitate use of the framework.

Conclusions: No frameworks were identified that incorporated all phases of implementation, nor key components of the process in each phase of implementation research. The findings highlight the need to identify key components and develop a taxonomy, glossary and tools to assess the process components of implementation in real world settings.

Objectives: Mumps (infectious parotitis) is an acute respiratory illness caused by the mumps virus in humans. While numerous studies have explored the impact of climate variability on mumps incidence in specific cities or regions, few have analyzed nationwide associations across multiple locations. This study aims to systematically assess the short-term effects of meteorological factors on mumps incidence across Japan over a 15-year period.

Study design: Weekly time-series of mumps cases and meteorological factors in the period 2005-2019 were collated from the 47 Japanese prefectures.

Methods: A two-stage time-series design was employed. The exposure-response relationships between incidence of mumps, mean temperature, and relative humidity were quantified using a quasi-Poisson regression with a distributed lag non-linear model for each prefecture and the estimates from all the prefectures were then pooled using a multivariate mete-regression model to derive nationwide average associations.

Results: Between 2005 and 2019, 1,455,583 mumps cases were reported. Our results indicate that increased mean temperature and relative humidity are positively associated with increased mumps incidence in Japan. Specifically, using -1.3 °C as the reference temperature, the relative risk (RR) of mumps peaked at 19.4 °C, with an RR of 1.16 (95 % confidence interval [CI]: 1.08-1.24). For humidity, using 45.5 % as the reference, the RR peaked at 68.3 %, with an RR of 1.05 (95 % CI: 1.02-1.09).

Conclusions: Our findings demonstrate the influence of heat and humidity on mumps incidence in Japan and underscore the need for preventive measures to mitigate the impact of climate variability on mumps transmission.

Objectives: The aim of this study was to explore the association of fruit, vegetable, and pulses consumption with all-cause, cardiovascular, and cancer mortality.

Study design: This prospective study included 66,933 individuals from three Spanish health surveys linked to the national death registry up to December 2022.

Methods: Adjusted Poisson regression models were used to analyze the data, categorizing fruit, vegetable and pulses intake according to Spanish dietary recommendations and using splines to examine non-linear relationships.

Results: No clear association was found between pulses intake and mortality. Consuming fruits and vegetables ≥2 times/day reduced all-cause mortality risk by 20 % (95%CI = 10%-29 %) and 17 % (95%CI = 7%-26 %) respectively, compared with <3 times/week. Combined intake of fruits and vegetables from 1 to 1.99 to ≥5 times/day showed reductions in all-cause and CVD mortality ranging from 16 % (95%CI = 5%-26 %) to 30 % (95%CI = 20%-39 %), and from 25 % (95%CI = 5%-41 %) to 35 % (95%CI = 14%-50 %), respectively, compared with <1 time/day. No additional benefits against all-cause and CVD mortality for intakes of fruits over 2-3 times/day, but gradual reductions in mortality risk for vegetable intake of 2-5 times/day were observed. Combined intake showed protection up to intakes of 10 times/day, notably for CVD mortality. Associations were similar but weaker for cancer mortality.

Conclusions: This study suggests that significant benefits of fruits and, specially, vegetables intake might go beyond the recommended five servings a day. Confirmation of these results could lead to specific dietary recommendations to prevent chronic diseases.

Objectives: This study aimed to assess the preferences of breast cancer patients in China for screening services using a discrete choice experiment (DCE) and latent class modeling (LCM). The findings are intended to inform the development of more patient-centered screening programs.

Study design: A cross-sectional, hospital-based survey employing discrete choice experiment methodology.

Methods: A total of 278 breast cancer patients were recruited from the Department of Thyroid and Breast Surgery at a tertiary hospital in Guizhou Province. The study evaluated key attributes of screening services, including screening frequency, medical staff experience, referral sources, and out-of-pocket costs, through a DCE questionnaire. A mixed logit model was applied to assess overall patient preferences, while LCM was used to explore heterogeneity among patient subgroups. The development of the DCE questionnaire involved focus group discussions to ensure the relevance of attributes.

Results: The analysis revealed that screening frequency, medical staff experience, and out-of-pocket costs were the most significant factors influencing patient preferences. Patients exhibited a strong preference for annual screenings (β = -1.622, p < 0.001) and for screening by experienced medical staff (β = 2.216, p < 0.001). Additionally, lower out-of-pocket costs significantly enhanced willingness to participate (β = -0.211, p < 0.05). LCM analysis identified two distinct patient subgroups: "process-driven" patients, who prioritized lower costs and multi-channel referral options, and "efficiency-driven" patients, who valued timely service and experienced staff.

Conclusion: This study emphasizes the diverse preferences of breast cancer patients for screening services and suggests that personalized screening programs could better meet the needs of different patient subgroups. Developing flexible, patient-centered screening programs will be essential to improving participation and satisfaction with breast cancer screening in China. Practical challenges in implementing such personalized approaches should be considered in future policy development.