Public Health最新文献

Objectives: We aimed to predict dyslipidemia risk in elderly Chinese adults using machine learning and dietary analysis for public health.

Study design: This cross-sectional study includes 13,668 Chinese adults aged 65 or older from the 2018 Chinese Longitudinal Healthy Longevity Survey.

Methods: Dyslipidemia prediction was carried out using a variety of machine learning algorithms, including Support Vector Machine (SVM), Extreme Gradient Boosting (XGBoost), Random Forest (RF), Gaussian Naive Bayes (GNB), Gradient Boosting Machine (GBM), Adaptive Boosting Classifier (AdaBoost), Light Gradient Boosting Machine (LGBM), and K-Nearest Neighbour (KNN), as well as conventional logistic regression (LR).

Results: The prevalence of dyslipidemia among eligible participants was 5.4 %. LGBM performed best in predicting dyslipidemia, followed by LR, XGBoost, SVM, GBM, AdaBoost, RF, GNB, and KNN (all AUC > 0.70). Frequency of nut product consumption, childhood water source, and housing types were key predictors for dyslipidemia.

Conclusions: Machine learning algorithms that integrated dietary behaviours accurately predicted dyslipidemia in elderly Chinese adults. Our research identified novel predictors such as the frequency of nut product consumption, the main source of drinking water during childhood, and housing types, which could potentially prevent and control dyslipidemia in elderly adults.

Objectives: Nearly 80 % of severe neonatal hyperbilirubinemia cases are identified too late for medical treatment in lower-middle-income countries. Parents' understanding of neonatal jaundice is crucial for early detection and effective treatment. This study evaluated the effectiveness of prenatal sensitization in improving maternal knowledge and attitude toward neonatal hyperbilirubinemia management in Bangladesh.

Study design: Cluster-randomized trial.

Methods: Between September 2019 and March 2021, a prospective home-based intervention trial on neonatal hyperbilirubinemia was conducted in 20 interventions and comparison clusters through community health workers (CHW). Participants were pregnant women in their second or third trimester of pregnancy. Proportion-based difference-in-difference (DID) was calculated to determine changes in the mother's knowledge and attitude towards newborn jaundice.

Results: A total of 539 pregnant women were enrolled, 273 in the intervention, and 266 in the comparison arm. Following the intervention, participant's overall knowledge level about neonatal hyperbilirubinemia increased significantly (DID: 24.9, 95%CI: 19.2, 30.7) from baseline (33.2 %) to endline (70.5 %). Knowledge of newborn jaundice management showed the most improvement (DID: 60), followed by danger signs detection (DID: 40.0). The intervention also enhanced participants' positive attitudes regarding neonatal hyperbilirubinemia (DID: 13.1, 95%CI: 8.1, 18.0). Mothers with improved knowledge of neonatal hyperbilirubinemia were nearly five times more likely to have a favorable attitude toward it than those with counterparts.

Conclusions: CHW-led home-based prenatal sensitization interventions substantially improved mothers' awareness and attitudes toward neonatal hyperbilirubinemia detection and management. Integrating such sensitization into prenatal care of the existing health system could be a practical approach to improve neonatal health outcomes in Bangladesh.

Objectives: Little is known about the burden and the clinical presentation and prognosis of individuals with Influenza and SARS-CoV-2 during concurrent outbreaks. We aimed to describe the burden, clinical characteristics and outcomes of hospitalized adults during the Influenza A/H3N2 and Omicron outbreaks in Brazil.

Study design: Cross-sectional analysis of national surveillance data.

Methods: We described the health system burden and clinical features of confirmed cases of Influenza and/or SARS-CoV-2 reported in the national surveillance system during the Influenza A H3N2 out-of-season outbreak and the first Omicron surge between November 2021 and March 2022 in Brazil. A multilevel mixed-effects logistic regression model adjusted by a priori defined confounders was used to evaluate the association between the infection type and resource use and mortality.

Results: The outbreaks occurred simultaneously across all Brazilian regions. Coinfected patients had clinical features from both infections. Influenza coinfected cases had similar odds for requiring ICU admission (adjusted odds ratio, aOR 0.96, 95 % CI, 0.80-1.15, p = 0.634), mechanical ventilation (aOR 0.88, 95 % CI, 0.70-1.11, p = 0.290), and in-hospital mortality (aOR 1.02, 95 % CI, 0.84-1.23, p = 0.847) compared to COVID-19 only. Influenza had lower odds for requiring ICU admission, mechanical ventilation and in-hospital mortality compared to COVID-19 only.

Conclusions: Simultaneous surges of Influenza and SARS-CoV-2 increased the pressure on the health system of Brazil. Coinfection was not associated with higher resource use or death; Influenza was associated with better outcomes, compared to COVID-19.

Objectives: Cervical cancer is the most prevalent cancer in Uganda, posing a significant burden with high mortality rates. Early detection through screening is crucial to reduce cervical cancer mortality. This study aimed to investigate the awareness, knowledge, and attitudes toward cervical cancer and its screening among residents in the central and western regions of Uganda.

Study design: Cross-sectional study.

Methods: A cross-sectional study was conducted through face-to-face interviews using a structured questionnaire, during October and November 2023 in Kampala City, Mbarara City, and Mbarara District. A total of 2000 men and women aged ≥20 years participated in the study.

Results: Among the respondents, 95 % were aware of cervical cancer, 85.1 % knew about cervical cancer screening, 37.8 % had heard of the human papillomavirus (HPV), and only 18.9 % recognized HPV as a major risk factor. Among females, 35 % had undergone cervical cancer screening. The most significant barrier preventing access to screening was a lack of knowledge (74.1 %). More than half of the respondents considered cervical cancer to be a fatal disease (52.9 %), and 93.7 % of females expressed willingness to undergo screening if provided for free.

Conclusion: While awareness of cervical cancer and its screening was high, knowledge of HPV and actual cervical cancer screening rates were low, despite a high willingness to undergo screening. Increased investment in education and awareness campaigns, along with an organized cervical cancer screening program, is warranted to promote screening and reduce the cervical cancer burden in Uganda.

Objective: To described how general practitioners (GPs) personalize interventions for patients with chronic diseases and compare practice with the corresponding guidelines.

Study design: Scoping review followed by a multicentre cross-sectional study in French general practices.

Methods: We identified elements of personalization described in guidelines related to diabetes, hypertension, dyslipidaemia, insomnia and depression. Then, GPs completed questionnaires for pharmacological (PI) and non-pharmacological interventions (NPI) after any consultation for these diseases to collect: when, on which the variables (clinical, biological characteristics, etc.), how and by whom the interventions were personalized, and what was personalized in the interventions. Agreement between GPs' practices and guidelines was analyzed using Cohen's Kappa.

Results: We extracted 204 elements of personalization in 10 guidelines, and GPs described 1512 elements of personalization in 161 PI and 1313 elements in 131 NPI. Personalization was mainly based on patients' general characteristics (20.6 % of PT; 24.8 % of NPI) and treatments characteristics (14.5 % of PI; 9.8 % of NPI). GPs accounted for patients' preferences in 64.6 % of PI and 79.4 % of NPI. For PI, the agreement between GPs and guidelines was globally low (kappa = 0.21[0.11; 0.31]) but moderate for treatment characteristics (kappa = 0.48 [0.09; 0.87]) and high for disease characteristics (kappa = 1.00[1.00; 1.00]). For NPI, agreement was globally very low (kappa = 0.16[0.10; 0.25]) but moderate for treatment characteristics (kappa = 0.59[0.19; 1.00]) and disease characteristics (kappa = 0.48[0.12; 0.87]).

Conclusions: Guidelines insufficiently described the tailoring variables and the subsequent modifications of the interventions. They need to be better described to promote a medicine that is both personalized to each patient and homogeneous between physicians.

Objective: Children under five years old have a high rate of SARS-CoV-2 (COVID-19) infection, yet rates of vaccination are relatively low. Our qualitative study investigated reasons why caregivers of children ages six months to four years old may be hesitant to vaccinate their children against COVID-19.

Study design: Qualitative study.

Methods: We enrolled a convenience sample of caregivers of patients aged six months to four years who presented for care at a pediatric Emergency Department in southern California. We conducted face-to-face semi-structured interviews with caregivers to probe for themes regarding any hesitations they may have regarding vaccinating their children against COVID-19. Interviews were recorded, transcribed, translated if necessary, and coded. When thematic saturation was achieved, we applied grounded theory methodology to assess for themes and adapted the World Health Organization Strategic Advisory Group of Experts model of vaccine hesitancy determinants matrix to provide a framework for the identified themes.

Results: We conducted 20 interviews, two in Spanish, and achieved thematic saturation at 17 interviews. We categorized themes surrounding vaccine hesitancies into external, patient-centric, and vaccine-centric factors. External factors included sources of information and family/community influence. Patient-centric factors included the perceived risk versus benefit ratio, caregiver beliefs, and caregiver knowledge and awareness. Vaccine-centric factors included vaccine safety, vaccine efficacy, vaccine information, and barriers to vaccination.

Conclusions: Using qualitative methodology, we gained important insights into caregiver thoughts regarding the COVID-19 vaccine in children under five years old. We identified themes not previously published in the literature that may be specific to the COVID-19 vaccine in the young pediatric population.

Objectives: Influenza-like illness (ILI) refers to the set of symptoms associated with seasonal influenza infection. In Italy, the syndromic surveillance system RespiVirNet uses both epidemiological and virological data to monitor ILI incidence with a weekly cadence. To estimate ILI incidence in real time, several countries adopted surveillance systems which include data from the emergency-urgency (E-U) system. The aim of this study was to evaluate the relationship between the number of calls for respiratory symptoms to the E-U system and the regional incidence of ILI cases identified by the Italian syndromic surveillance system.

Study design: Retrospective observational cohort study METHODS: We analyzed data in the Lombardy region for the flu season from 2014 to 2024, excluding the COVID-19 pandemic period (from 2020 to 2022). We performed a linear regression analysis considering ILI incidence as the dependent variable and the percentage of respiratory calls to the E-U system as the independent variable.

Results: Statistical analysis showed a positive correlation (r = 0.70), with a statistically significant coefficient of 1.34 (p-value <0.001) and R² of 0.50.

Conclusions: The observed correlation highlights the potential use of prehospital E-U system data in the surveillance systems of infectious diseases by using real-time data, encouraging future research to explore the limits and possibilities of an integrated surveillance system.

Objectives: Human Papillomavirus (HPV) vaccination is a recognised preventive measure against HPV-related cancers. Despite the availability of vaccines, challenges persist, including limited awareness and gender disparities in vaccination. Addressing the challenges necessitates a comprehensive approach involving knowledge advancements, understanding societal needs and cultural beliefs, and improving vaccine communication. This study aimed to determine young people's information needs, facilitators and barriers, influential messages, and thoughts on improving vaccine communication between youth & healthcare professionals (HCPs) and parents regarding HPV vaccination.

Study design: Qualitative SWOT analysis.

Methods: This report is part of Work Package 2.1 within the EU4Health project PROTECT-EUROPE. A multi-methodological approach involved data collection through open-ended questionnaires disseminated to European youth organisations. The data underwent content and SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis.

Results: The SWOT analysis of HPV vaccination communication efforts highlighted strengths, such as using educational institutions to disseminate information and vaccination. Primary obstacles to HPV vaccination include a lack of awareness among key demographics and logistical challenges for youth accessing vaccination services. Weaknesses included barriers created by the use of technical jargon. Opportunities were seen in HCPs engaging directly with students in educational settings and open dialogue, ensuring confidentiality to the target population. Threats encompassed cultural sensitivities to HPV.

Conclusions: These insights underscore the importance of developing communication strategies that are effective and sensitive to cultural contexts and of creating accessible and adaptable vaccination programs. The findings suggest that targeted education and active engagement strategies can mitigate these issues. Moreover, prioritising open communication between HCPs and young individuals is critical for increasing vaccination uptake.

Objectives: This study aims to assess the effectiveness of an intervention based on the goal attainment theory to levels of physical activity, body composition, and motivational variables of emerging adults with physical inactivity.

Study design: A randomized, controlled trial.

Methods: A total of 157 emerging adults with physical inactivity were randomized into the control group (n = 77) or the intervention group (n = 80). The control group received routine health education for a period of 3 months, and the intervention group used a physical activity promotion intervention model based on King's attainment theory on the basis of the control group. The primary outcome was the body composition. Secondary outcomes were examined included levels of physical activity, motivation, and self-efficacy.

Results: The results indicate that the visceral fat area was significantly lower in the intervention group (Z = -6.79, P < 0.001), along with reductions in body fat mass (Z = -2.85, P < 0.05) and body fat percentage (F = -2.78, P < 0.05). The intervention group also demonstrated higher introjected motivation (Z = 2.70, P < 0.05) and self-efficacy (Z = 4.06, P < 0.001) than the control group. Physical activity levels were significantly higher in the intervention group, with increases observed in vigorous activity (Z = 60.51, P < 0.001), moderate activity (Z = 104.90, P < 0.001), walking activity (Z = 7.37, P < 0.001), and total physical activity (Z = 91.40, P < 0.001) compared to the control group.

Conclusions: Physical activity interventions based on King's Attainment Theory can improve body composition, increase physical activity levels, improve exercise self-efficacy, and promote maintenance of healthy behaviours in emerging adults.

Trial registration: This study was registered on ClinicalTrials (NCT05697679).

Objectives: To investigate the prevalence and the factors associated with experimentation and use of e-cigarettes.

Study design: Cross-sectional study.

Methods: Cross-sectional analysis of data from the National School Health Survey (PeNSE 2019), with students attending elementary school and high school in Brazil. Two outcomes were investigated: experimentation and last 30-day use of e-cigarettes. Potential exposures included family and adolescents' socio-demographic, mental health, and behavioral characteristics. Adjusted prevalence ratios (PR) were obtained by Poisson regression with robust variance.

Results: 133,237 adolescents aged ≥13 years were included. Prevalence of experimentation and last 30-day use was higher in males (20.7 % and 4.1 %, respectively) than in females (15.4 % and 2.6 %, respectively). The higher PR were with ever use of hookah in males (PR = 3.34 for e-cigarettes experimentation and PR = 4.05 for last 30-day use) and females (PR = 3.26 for experimentation and PR = 4.14 for last 30-day use). For males who ever used alcoholic beverages, the PR for e-cigarettes experimentation ranged from 2.86 to 3.18, and the PR for last 30-day use ranged from 3.09 to 3.39, depending upon the age of first alcoholic beverage experimentation. Among the females who ever used alcoholic beverages, PR for experimentation ranged from 3.46 to 4.31 and PR for last 30-day use ranged from 2.44 to 4.09.

Conclusion: About a quarter of school age adolescents had already tried e-cigarettes and 3.4 % used e-cigarettes in the prior 30 days. There were sex differences in the prevalence and in factors associated with experimentation and last 30-day use of e-cigarettes.