Public Health最新文献

Objectives

Research shows that smoking persists in sports clubs with smoke-free policies (SFPs). It is unknown to what extent smoking occurs at such clubs and how much that may differ from clubs without SFPs. This study aimed to determine whether and to what extent smoking differs at Dutch football clubs with and without SFPs.

Study design

This cross-sectional study used a purposive sampling method to compare smoking indicators at 117 Dutch football clubs, with 49 clubs (41.8%) having an SFP.

Methods

Using a standardised checklist, three smoking indicators were observed (number of people smoking, smoking facilities, and cigarette butts) and combined in a total smoking score (scale 0–9). Multi-level linear regression analysis was used to analyse the association between club SFP, local tobacco control policies (TCPs), and smoking indicators.

Results

Significantly fewer smoking facilities were present at clubs with an SFP (−2.35, 95% confidence interval [CI]: −3.61; −1.09), but no significant associations were found between SFP and the number of people smoking and cigarette butts. The total smoking score was 1.74 points lower for clubs with an SFP (95% CI: −2.53; −0.96) and 1.85 points lower for clubs in municipalities with strong local TCPs (95% CI: −2.98; −0.72). Strong local TCPs were associated with significantly fewer people smoking at clubs (−1.79, 95% CI: −3.41; −0.17).

Conclusions

SFPs at sports clubs succeed in limiting the number of smoking facilities but do not show differences in terms of smoking rates or smoking-related litter when compared to clubs without SFPs. Our results highlight the need for enhancing implementation of comprehensive SFPs, including clear guidelines for compliance and enforcement.

Objective

To describe analgesic-related deaths in France and report trends over a 10-year period.

Study design

The DTA (“Décès Toxiques par Antalgiques”) register is a French database of analgesic-related deaths among people without a history of drug abuse, reported by forensic toxicology experts.

Methods

We included analgesic-related deaths occurring from January 2013 to December 2022 in France. Subject demographic characteristics and medical history, forensic autopsy findings, and toxicology reports were evaluated.

Results

Among the 1036 deceased individuals (mean [SD] age, 48.3 [15.6] years), there were slightly more women than men (M:F sex ratio, 0.89:1). Over the entire study period, tramadol was the leading cause of death, ahead of morphine. A relative increase in oxycodone-related mortality was observed (from 6.8% in 2013 to 21.1% in 2022) compared to a progressive decrease in tramadol, morphine, and codeine-related deaths (from 43.2%, 31.1% and 24.3% in 2013 to 37.5%, 26.6% and 20.3% in 2022, respectively). However, no statistically significant variations were found (Chi-squared tests of homogeneity). Other analgesics (buprenorphine, dihydrocodeine, fentanyl, gabapentin, ketamine, methadone, nefopam, and pregabalin) were also implicated in deaths, but with low and stable rates over the period studied.

Conclusions

In France, no increase in fentanyl-related deaths and only a non-significant increase in oxycodone-related deaths were observed over the period 2013–2022. Tramadol was the leading cause of analgesic-related deaths throughout this period. Although close monitoring is still required, particularly for oxycodone, our data do not support the hypothesis of an opioid crisis in France.

Study Design

Cross-sectional study.

Objectives

Suboptimal health status (SHS) is a third state between health and disease. Long-term being SHS will be detrimental to one's ability development. Previous studies have demonstrated the associations of lifestyle behaviors or work stress with SHS, but few studies have comprehensively analyzed the underlying factors and mechanisms between the three.

This study aimed to investigate whether lifestyle behaviors mediated the relationship between self-perceived work stress and SHS.

Methods

A total of 4238 urban workers, who participated in a cross-sectional survey conducted from December 2018 to October 2019, were included. A general linear model was used to explore the associations between lifestyle behaviors and self-perceived work stress with SHS after adjusting for demographic variables. Structural equation modeling was performed to examine the mediation by lifestyle behaviors.

Results

The mean transformed scores of physical, mental, and social SHS were 70.98, 67.17, and 61.72, respectively. Unhealthy lifestyle behaviors and high self-perceived work stress positively affected SHS (P < 0.001). Self-perceived work stress imposed negative effects on physical SHS (β = −0.228, P < 0.001), mental SHS (β = −0.237, P < 0.001), and social SHS (β = −0.092, P < 0.001). The indirect effects of self-perceived work stress on physical SHS (β = −0.139, 95% CI: −0.178 to −0.106), mental SHS (β = −0.106, 95% CI: −0.134 to −0.082), and social SHS (β = −0.121, 95% CI: −0.154 to −0.092) were statistically significant.

Conclusions

Lifestyle behaviors and self-perceived work stress were significantly associated with SHS among Chinese urban workers. The mediating effects of unhealthy lifestyle behaviors were found in the relationship between high self-perceived work stress and SHS. Future longitudinal research may verify these associations and elucidate the underlying mechanisms.

Objectives

To synthesize eye-tracking-based evidence on consumers' visual attention devoted to alcohol warning labels (AWLs) on alcohol packaging.

Study design

A systematic review was conducted and reported in accordance with the PRISMA guidelines.

Methods

Two rounds of a literature search were conducted to identify relevant peer-reviewed articles and unpublished grey literature. While the first round (July 3 to August 21, 2023) was based on three electronic databases (PubMed, Web of Science, and PsycINFO), the second round (May 20 to 28, 2024) followed a multiple-step protocol that systematically searched the grey literature. Five criteria were applied to screen eligible articles. Using established quality control tools, the identified articles were assessed for overall quality and then for quality specific to the eye-tracking method.

Results

Six published peer-reviewed articles were thus included in the current review along with one unpublished research paper from a doctoral thesis. This review paper summarizes earlier findings in terms of bottom-up (i.e., AWL design-related) factors such as size, color, surrounding border, and pictorial elements, and top-down (i.e., goal-driven) factors such as motivation to change drinking behavior and self-affirmation. The review found that people tend to pay very little attention to AWLs displayed on alcohol packaging, although there is mixed evidence as to the effectiveness of specific factors.

Conclusions

Further investigations using eye-tracking are needed to collect additional evidence on attention devoted to AWLs. Meanwhile, we put forward implications for policymakers and future avenues for research based on our review of the existing literature.

Objectives

Improving health at global and local scales is one of the 17 Sustainable Development Goals (SDGs) set by the United Nations (UN) for the period 2015–2030, specifically defined by SDG3, which includes 13 targets described by 28 indicators. In this context, the aim of the current study was to propose a protocol to infer SDG3 values at municipality level with the current openly available data.

Study design

The study incorporated a quantitative research.

Methods

To calculate the SDG3 index, defined as the average of all 13 target scores, official Italian data at five geographical granularities covering the period 2018–2022 were used, and a spatial downscaling strategy was implemented. The quality of matching between original and inferred indicators was assessed applying a specific standard (International Organisation for Standardisation [ISO]/TS 21564) that matches quality between terminology resources with regards to health care. The significance of regional/provincial differences was assessed by the Kruskal–Wallis test with Bonferroni correction, and the Moran's index with queen contiguity method was applied to evaluate clustering tendency.

Results

The geographical distribution of scores varied considerably (and with statistical significance) across the targets, with municipalities in the central part of the country achieving relatively good overall performance. Matching quality also varied consistently across targets. Clustering tendency was observed and was likely due to regional differences in data collection protocols.

Conclusions

The SDG3 index, as an internationally standardised measure of health, can be used to validate urban health indices; however, considerable improvement by official data providers in Italy is required to guarantee access to data at the municipal level.

Objectives

The objectives of the present study were to (i) re-evaluate and expand the psychometric properties of two weight stigma instruments—the Perceived Weight Stigma Scale (PWSS) and the Weight Self-Stigma Questionnaire (WSSQ) among a large sample of adolescents using advanced psychometric methods and (ii) examine how the different types of weight stigma (i.e., PWSS and WSSQ) are associated with psychological distress.

Study design

Cross-sectional study.

Methods

In September 2023, a cross-sectional survey utilising convenience sampling was used to recruit 9995 adolescents (mean age = 16.36 years [standard deviation = 0.78]; 57.8% males). They completed the PWSS, WSSQ, and a measure on psychological distress. The data were analysed using Rasch analysis, confirmatory factor analysis (CFA), structural equation modelling (SEM), and network analysis.

Results

The CFA and Rasch model results showed acceptable psychometric properties regarding factor structure, factor loading, difficulty, and infit and outfit mean squares (except Items 4 and 7 of the PWSS). There was no substantial differential item functioning for any tested items across the sex and weight categories. The CFA and SEM results showed promising validity indices with significant associations between both weight stigma scales and psychological distress (i.e., depression, anxiety, and stress). Network analysis showed inter-variable connectivity between nodes PWSS3 (“People act as if they are afraid of you”) and WSSQF7 (“I feel insecure about others’ opinions of me”).

Conclusions

Both weight stigma scales had acceptable psychometric properties and were significantly associated with psychological distress, although each assessed different types of weight stigma. This suggests that researchers and clinicians can use these scales to reliably and validly assess weight stigmas among adolescents.

Objectives

This study aimed to assess the impact of pay-for-performance (P4P) programmes on healthcare in Taiwan.

Study design

This was a systematic review and meta-analysis.

Methods

A systematic literature search was performed using the PubMed, Medline, Embase, Cochrane review, Scopus, Web of Science and PsycINFO databases up to July 2023. Meta-analysis of the available outcomes was conducted using a random-effects model.

Results

The search yielded 85 studies, of which 58 investigated the programme for diabetes mellitus (DM), eight looked at the programme for chronic kidney disease (CKD), and the remaining studies examined programmes for breast cancer, tuberculosis, schizophrenia and chronic obstructive pulmonary disease. The DM P4P programme was a cost-effective strategy associated with reduced hospitalisation and subsequent complications. The CKD P4P was associated with a lower risk of dialysis initiation. The P4P programme also improved outcomes in breast cancer, cure rates in tuberculosis, reduced admissions for schizophrenia and reduced acute exacerbation in chronic obstructive pulmonary disease. The meta-analysis revealed that the P4P programme for DM (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.48–0.73) and CKD (OR = 0.73; 95% CI = 0.67–0.81) significantly reduced mortality risk. However, participation rate in the DM P4P programme was only 19% in 2014.

Conclusions

P4P programmes in Taiwan improve quality of care. However, participation was voluntary and the participation rate was very low, raising the concern of selective enrolment of participants (i.e. ‘cherry-picking’ behaviour) by physicians. Future programme reforms should focus on well-designed features with the aim of reducing healthcare disparities.

Objective

Investigate the acute impact of COVID-19 mitigation measures implemented in March 2020 on a comprehensive range of perinatal outcomes.

Study design

National registry-based quasi-experimental study.

Methods

We obtained data from the Dutch Perinatal Registry (2010–2020) which was linked to multiple population registries containing sociodemographic variables. A difference-in-discontinuity approach was used to examine the impact of COVID-19 mitigation measures on various perinatal outcomes. We investigated preterm birth incidence across onset types, alongside other perinatal outcomes including low birth weight, small-for-gestational-age, NICU admission, low-APGAR-score, perinatal mortality, neonatal death, and stillbirths.

Results

The analysis of the national-level dataset revealed a consistent pattern of reduced preterm births after the enactment of COVID-19 mitigation measures on March 9, 2020 (OR = 0.80, 95% CI 0.68–0.96). A drop in spontaneous preterm births post-implementation was observed (OR = 0.80, 95% CI 0.62–0.98), whereas no change was observed for iatrogenic births. Regarding stillbirths (OR = 0.95, 95% CI 0.46–1.95) our analysis did not find compelling evidence of substantial changes. For the remaining outcomes, no discernible shifts were observed.

Conclusions

Our findings confirm the reduction in preterm births following COVID-19 mitigation measures in the Netherlands. No discernible changes were observed for other outcomes, including stillbirths. Our results challenge previous concerns of a potential increase in stillbirths contributing to the drop in preterm births, suggesting alternative mechanisms.

Objective

The objective of this study was to provide novel comparative insights on the contributions of injury deaths to the changes in sex gaps in life expectancy (SGLE) and sex gaps in life disparity (SGLD) across Nordic countries.

Study design

Retrospective demographic analysis of aggregated mortality data.

Methods

To compute life expectancy (LE)/life disparity (LD), annual data on age- and sex-specific causes of death from the World Health Organization mortality database were used to construct abridged life tables for two periods: 2000–2002 and 2016–2018 (2014–2016 for Norway). The contributions of injury deaths to the changes in the SGLE and SGLD between these two periods were decomposed by age and cause using a continuous-change model.

Results

Females’ LE and LD advantages due to injury deaths narrowed by 0.16–0.44 (0.06–0.35) years for LE (LD) over time. While self-inflicted injuries consistently played a predominant role in contributing to the SGLE/SGLD in all countries in both periods, in all countries but Finland, transport accidents had the greatest contributions to the narrowing SGLE/SGLD. Widening SGLE due to self-inflicted injuries in Iceland and due to falls in Sweden were unique to these countries. Accounting for >20% of total contributions of injury deaths, the age group of 20–24 years had the greatest contributions to the narrowing SGLE/SGLD. Deaths due to falls in older ages and assault in younger ages generally contributed to the widening SGLE/SGLD.

Conclusions

Injury deaths, particularly transport accidents, contributed significantly to the narrowing SGLE and SGLD across Nordic countries, with cross-country variations in age- and cause-specific patterns. The results suggest the need for injury prevention policies targeting self-inflicted injuries in younger and falls in older males.

Objectives

Climate change is intensifying heat events, and local governments are working to absorb and mitigate the associated costs. To develop effective responses, local data on the relationship between climate and health are crucial. This study investigates the impact of heat events on unexpected mortality, focusing on deaths investigated by the Medical Examiner in Los Angeles County.

Study design

A retrospective observational study.

Methods

We estimate the associations between the National Weather Service's HeatRisk index and deaths investigated by the Medical Examiner in Los Angeles County using negative binomial count models with controls for time trends and seasonality. In subgroup analyses, we explore how these effects vary for those who are homeless or living in care facilities.

Results

Compared to days with no HeatRisk, days with moderate, major, or extreme HeatRisk were associated with death increases of 6.7% [CI: 1.9–11.7%], 15.3% [CI: 2.9–29.1%], and 65.5% [CI: 34.9–102.1%], respectively. Effects were more pronounced for individuals who were homeless or in care facilities. Major or extreme heat days were associated with a 59.3% [CI: 19.8–109.4%] increase in deaths among homeless individuals and a 91.4% [CI: 19.0–198.6%] increase in deaths among those in care facilities.

Conclusions

Heat events have a significant impact on mortality investigated by the Medical Examiner, especially among vulnerable groups. Local governments may consider using the warning tools provided by the National Weather Service to focus their resources on the most intense heat events, especially to target those living in care facilities or who are homeless.