Public Health最新文献

Objectives: Cross-cultural care creates environments where people from diverse cultural backgrounds can access healthcare without facing discrimination based on their beliefs or identity. Humanitarian aid workers need the knowledge and skills to effectively address the needs of diverse populations. In humanitarian aid, cross-cultural care training is crucial for delivering culturally sensitive healthcare in challenging environments. The aim of this study was to explore the available scientific evidence on the inclusion of cross-cultural care training in international humanitarian aid settings.

Study design: A scoping review was conducted, following the PRISMA-ScR guidelines.

Methods: PubMed, Lilacs, ERIC, Google Scholar, and Evidence Aid, and grey literature sources were searched for studies published in English, Spanish, and Portuguese from 2003 to 2023. Data were extracted using a standardized form and analyzed according to the JBI scoping review methodology.

Results: The review included 23 publications, consisting of 13 academic articles (57 %) and 10 grey literature sources (43 %). These were categorized into Recommendations, Guidelines, Experience in Implementation, and Teaching Materials. Findings highlighted the importance of incorporating cross-cultural care training into humanitarian organizations. Various guidelines for integrating cultural aspects into training were identified. Some organizations have implemented such training and documented their experiences. Additionally, certain international humanitarian organizations have established web-based educational resources to enhance cultural knowledge and awareness among their staff.

Conclusions: Integrating cross-cultural care training into the operations of international humanitarian aid organizations is recommended to mitigate disparities in healthcare access. The limited number of records identified highlights a significant gap in research, implementation, and documentation on this topic.

Objectives: This Danish nationwide retrospective register-based cohort study investigated healthcare costs for patients with screen-detected colorectal cancer (SD-CRC) compared to non-screen-detected CRC (NSD-CRC).

Study design: Nationwide cohort study.

Methods: Quarterly healthcare costs including costs of hospital care, out-of-hospital medication, and primary sector contacts were compared between the two groups from two years before diagnosis of CRC until two years after. A quasi-experimental difference-in-differences analysis was performed to estimate the differences per patient in total quarterly healthcare costs between the groups.

Results: A total of 13,852 patients were included, 4703 with SD-CRC, 7420 with NSD-CRC, and 1,729 with interval- or post-colonoscopy CRC (I-PC-CRC). The total quarterly healthcare costs per patient were significantly higher in the NSD-CRC group than in SD-CRC. This was consistent across the total period and in 6-month analyses, accruing additional €16,600 of costs for patients with NSD-CRC over two years after diagnosis. Total healthcare costs were significantly higher for patients with NSD-CRC as compared to patients with SD-CRC across all Union for International Cancer Control (UICC) stages, except for UICC stage I. Correspondingly, total costs associated with I-PC-CRC were significantly higher than for SD-CRC.

Conclusions: Apart from improving post-treatment outcomes, higher participation rates in the CRC screening programmes present an opportunity for reducing healthcare costs related to patients diagnosed with CRC.

Objectives: Human behaviors and blood pressure (BP) are closely intertwined, affecting health. However, few studies have demonstrated their complex relationships. Using network analysis, we aimed to untangle the intricate and potential causal relationships between BP and human instinctive behaviors, identifying potential action points for hypertension prevention and control.

Study design: Cohort study.

Methods: This study is based on two-wave data from 11,277 Chinese adults in the China Multi-Ethnic Cohort (CMEC) and an independent validation cohort of 21,947 adults from the Chinese Cohort of Working Adults (CCWA). We conducted a cross-sectional network analysis to estimate the interrelationships between measured BP and self-reported physical activity (PA), diet, and sleep. The centrality of each variable within the network was estimated using strength centrality index. Additionally, we performed a longitudinal network analysis to infer the potential causal relationships between BP and human instinctive behaviors in participants with normal or above-normal BP.

Results: The network models suggested that BP exhibited negative associations with the dietary score (edge weight: -0.09) and sleep duration (-0.05). Non-sedentary behavior and dietary score were the most central variables, strongly connecting BP and other lifestyles. Higher BP predicted a poorer dietary score (β = -0.21) in participants with above-normal BP. The effect of BP on dietary score was replicated in the validation cohort and validated by linear regression analysis.

Conclusions: Non-sedentary behaviors and dietary behaviors may be the potential action points in promoting healthy behaviors and contributing to BP management. It is essential to manage individuals' BP status, non-sedentary behaviors, and dietary behaviors to disrupt malignant cycles.

Objectives: Previous studies have reported associations of noise and air pollution with breast cancer (BC) risk, but the causality remains unclear. This study aimed to explore the effects of noise and air pollution on BC from a genetic perspective.

Study design: Genetic association study.

Methods: We began our investigation by visualizing the development trends in this field through bibliometric analysis. Subsequently, we conducted Mendelian randomization analyses to assess the effects of noise (daytime and evening) and air pollution (NO₂, NO_x, PM_2.5, PM_2.5-10, and PM₁₀) on BC. Genetic variants extracted from genome-wide association studies (GWAS) robustly associated with noise and air pollution were used as instrumental variables. The GWAS data for BC in European and East Asian populations were obtained from the Breast Cancer Association Consortium and the Biobank Japan, respectively.

Results: The effects of noise and air pollution on BC are receiving increasing attention. In the European population, genetically predicted exposure to NO₂ (OR: 1.9381; 95% CI: 1.2873-2.9180; P = 0.0015) and PM₁₀ (OR: 1.4187; 95% CI: 1.0880-1.8500; P = 0.0098) were positively associated with overall BC risk. Subtype analyses showed that PM₁₀ was significantly related to the risks of both ER+ (OR: 1.6165; 95% CI: 1.1778-2.2186; P = 0.0030) and ER- (OR: 1.6228; 95% CI: 1.0175-2.5881; P = 0.0421) BC. Additionally, NO₂ only increased the risk of ER+ BC (OR: 1.7429; 95% CI: 1.0679-2.8444; P = 0.0262), but not ER- BC. In East Asians, genetically predicted NO₂ was positively related to BC risk (OR: 1.1394; 95% CI: 1.0082-1.2877; P = 0.0366).

Conclusions: Our study gave new evidence from a genetic standpoint underscoring that improving the environmental quality of residential areas is conducive to reducing BC risk.

Objectives: The associations between childhood maltreatment (CM) and mobile phone addiction (MPA), as well as non-suicidal self-injury (NSSI) have been extensively explored. However, the dose-response relationship between CM and NSSI remains inconsistent. Furthermore, there is limited understanding of the potential mediation effect of MPA on the relationship between CM and NSSI. This study aimed to explore the dose-response relationship between CM and NSSI and investigate the potential mediating role of MPA in this relationship.

Study design: Cross-sectional study. Cross-sectional study.

Methods: In the cross-sectional study, a total of 21481 adolescents were selected using a multi-stage cluster sampling method in China. CM, MPA, and NSSI were obtained via self-reports. Data were analyzed using logistic regression models, restricted cubic spline (RCS) functions, and mediation models.

Results: A total of 38.1 % of adolescents reported engaging in NSSI at least once. Compared with participants without CM, participants with more types of CM (cumulative childhood maltreatment, CCM) had a higher risk of NSSI (P-trend in all models <0.001). RCS further confirmed the dose-response relationships between the continuous change in CM (scores) and the risk of NSSI (P for non-linearity <0.001). Mediation analysis indicated that the relationship between CM (scores) and NSSI was mediated by MPA, and the indirect effect (β = 1.07 × 10^-3, 95 % CI: 9.62 × 10^-4, 1.19 × 10^-3) accounted for 22.23 % of the total effect.

Conclusions: There was a dose-response relationship between CM and the NSSI, and the relationship was mediated by MPA. Interventions targeting MPA may reduce the risk of NSSI among adolescents who have experienced CM, particularly those with CCM.

Objectives: Historic redlining grades that were assigned to US neighborhoods based largely on minority race or ethnicity by the Home Owners Loan Corporation (HOLC) during the 1930s have been linked with adverse health outcomes among neighborhood residents. This review aimed to summarize the quantitative evidence, so we could determine if any findings are replicated and otherwise identify research gaps.

Study design: Systematic review.

Methods: We conducted a systematic review by searching the PubMed® MEDLINE database for observational studies that reported on health outcomes among people who resided in neighborhoods that were assigned HOLC grades. We assessed quality by allocating points based on whether studies reported the sample size or count of people affected by outcomes (yes = 1 point, no = 2 points), and whether unadjusted magnitudes of association were reported alongside adjusted estimates (yes = 1 point, no = 2 points). The sum score was used to classify each study as high (2 points), average (3 points) or low quality (4 points).

Results: Among the 89 articles identified, 32 met inclusion criteria; 15 were deemed high-quality. The most frequently studied health conditions in order of descending frequency were: i) injury or violence (n = 8), ii) cancer (n = 7), iii) cardiometabolic (n = 6), iv) perinatal (n = 5), v) asthma (n = 2).

Conclusion: People who lived in areas with less desirable HOLC grades tended to suffer higher than expected rates of injury or violence, asthma, adverse pregnancy outcomes, and some cardiometabolic disorders; associations with cancer were mostly null. Methodological differences limited opportunities for direct comparison across studies, and there was significant heterogeneity among the few estimates that were generally comparable. While robust data are lacking, the limited existing evidence supports a possible association between historically redlined areas and heightened risk of adverse health outcomes. Why this association may exist remains unknown.

Objectives: To explore the relationships between dietary potential acid load and renal cancer (RC) incidence and mortality.

Study design: A prospective cohort study involving 97,166 U S. adults aged 55-74 years.

Methods: Data utilized in this study were drawn from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Dietary potential acid load was assessed by dietary acid load (DAL), potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores using a validated Diet History Questionnaire (DHQ). Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for RC incidence and mortality with adjustment for potential confounders. Restricted cubic spline (RCS) plots were utilized to reveal whether there were nonlinear associations between the DAL, PRAL, and NEAP scores and RC incidence and mortality.

Results: During a follow-up period of 859,907 and 1,467,573 person-years, 423 RC cases and 221 mortality cases were documented. DAL, PRAL, and NEAP scores were positively associated with RC incidence (DAL: HR 1.41; 95% CI 1.05, 1.90; P-trend = 0.010; PRAL: HR 1.45; 95% CI 1.10, 1.91; P-trend = 0.010; NEAP: HR 1.39; 95% CI 1.04, 1.85; P-trend = 0.029). Similar associations were observed between DAL, PRAL, and NEAP scores and RC mortality. The RCS plots demonstrated a nonlinear association between DAL score and RC risk, while a linear association was observed between DAL score and RC mortality. Similar linear associations were found between PRAL and NEAP scores and RC incidence and mortality.

Conclusion: A higher dietary potential acid load was associated with higher risk of RC incidence and mortality in American adults.

Objective: The precise extent to which neighborhood influences childhood overweight and obesity (O/O) remains unknown. We investigated the magnitudes of neighborhood contributions to childhood O/O and explored potential temporal, geographical and gender variations.

Study design: This was a pooled analysis using secondary survey data from six China Family Panel Studies from 2010 to 2020.

Methods: 26 262 children and adolescents aged 6-16 years residing in the low, medium and high O/O prevalence areas were included. Multilevel logistic analyses with random slopes were utilized to regress O/O on various individual and neighborhood covariates. Intraclass Correlation Coefficients were applied to quantify neighborhood contributions and 80 % Interval Odds Ratio and Proportions of Opposed Odds Ratios were used to evaluate between-neighborhood discrepancies in specific neighborhood factors.

Results: Overall, neighborhood accounted for 2%-8% of O/O variations. Temporally, neighborhood contributions declined from 2010 to 2016 but increased thereafter. Geographically, they were higher in medium/low prevalence areas than high prevalence areas (4%-10 % vs. 2%-6%). Compared to males, they were greater among females (3%-9% vs. 1%-7%). Neighborhood contributions in high prevalence areas have rapidly increased recently with those among males growing faster. Besides O/O prevalence areas, residence (OR: 1.12, CIs: 1.01-1.23)) and percentage of households with minimum living allowance (1.01, 1.00-1.01) were significant neighborhood factors with the effects of residence exhibited lower between-neighborhood variations (32%-43 % vs. 48%-50 %).

Conclusion: This study empirically suggests the importance of neighborhood and supports the potential of governmental policies aiming at curbing childhood overweight/obesity through tailored neighborhood-based interventions.

Objectives: Air quality, socioeconomic status, access to healthcare, genetic predispositions, among other factors impacted the COVID-19 pandemic burden. We explored the relationship between PM2.5 levels and sanitary vulnerability in COVID-19 pandemic health outcomes in Argentina.

Study design: Ecological study.

Methods: We used the Sanitary Vulnerability Index (SVI) to account for social determinants of health and distance to health centers. PM2.5 air concentration and human emissions were obtained from the Atmospheric Composition Analysis Group V5.GL.03 dataset and the inventory of anthropogenic gas-phase and particle emissions for Argentina (GEEA-AEIv3.0M), respectively. Finally, we extracted data from March 1, 2020, to January 1, 2021 from the official Argentinean database of COVID-19 (Argentine Ministry of Health).

Results: SVI correlated with the rate of positive COVID-19 tests per 100,000 people (r = -0.56, p < 0.01), Intensive Care Unit (ICU) admissions per 100,000 people (r = -0.52, p < 0.01), and deaths per 100,000 people (r = -0.58, p < 0.01). PM2.5 air concentration correlated with the rate of positive tests (r = -0.09, p = 0.03), ICU admissions (r = -0.16, p < 0.01), and mortality (r = -0.11, p = 0.01). PM2.5 human emissions did not show significant correlations with COVID-19 outcomes. There was a significant interaction between SVI and PM2.5 air concentration for the rate of positive COVID-19 tests and mortality. PM2.5 air quality showed a positive and significant association with the outcomes only in areas with high SVI. A machine-learning model including these variables accounted for 46 % of the variability.

Conclusions: The interplay between health vulnerability and air quality in human health is complex. Addressing the burden of COVID-19 pandemic requires the consideration of a comprehensive range of determinants.

Objectives: Electronic cigarettes (e-cigarettes) have been attracting users around the world due in part to appealing flavors. Many countries and regions have now taken action to limit the sales of flavored e-cigarettes. In 2022, China implemented a flavor ban on e-cigarettes, prohibiting all but tobacco-flavor. It is important for international tobacco control efforts to understand responses to the ban by analyzing news media content.

Study design: Articles identified through keyword searches in the HuiKe newspaper database were qualitatively examined by thematic analysis, focusing on stakeholder reactions and regulatory impacts.

Methods: Using HuiKe news database and searching between May 1, 2022, and March 1, 2023, 125 news articles were identified and coded using thematic analysis to explore the main stakeholders mentioned in relation to the e-cigarette flavor ban, actions undertaken, and perceptions expressed.

Results: Four stakeholders were identified: administrative departments, businesses, users and the public. Eight themes were developed through analysis: the purpose of the prohibition, supervision and penalties for illegal products, approaches adopted for legal sales, approaches adopted for illegal sales, shifting use habits, speculation about the impact of the prohibition, health concerns, and suggestions for reducing illegal sales.

Conclusion: The study revealed that enforcement of the policy is portrayed as a significant concern and that controlling the spread of illegal online sales remains a significant challenge. A comprehensive regulatory strategy to address youth e-cigarette use more effectively is urgently needed. Adaptive e-cigarettes control policy should co-evolve with ever-changing industries and markets.