AJPM focus最新文献

Introduction

Despite being almost entirely preventable, cervical cancer is the fourth most frequently diagnosed cancer among women worldwide. Cervical cancer incidence suggests missed opportunities for prevention. Geospatial analysis could strategically guide public health interventions. This study aimed to identify geographic clusters of cervical cancer incidence in Texas, a state with higher than national rates of cervical cancer incidence and mortality.

Methods

In this population-based cross-sectional study, the authors analyzed incident cervical cancer data among Texas women aged 30–64 years, from 2014 to 2018. The authors conducted a purely spatial Poisson-based analysis function in SaTScan to examine geographic clusters of higher-than-expected proportions of cervical cancer incidence (i.e., hot spots) and adjusted for age.

Results

A total of 5,060 women aged 30–64 years with incident cervical cancer diagnosis (mean age: 45.7 years, SD=9.6), including 1,840 (36.4%) Hispanic, 591 (11.7%) non-Hispanic Black, 2,397 (47.4%) non-Hispanic White, and 232 (4.6%) other races, were analyzed. Spatial scan analysis detected 7 significant hot spots of cervical cancer incidence. Hot spots were identified in the South Texas Plains (near Mexico border), Gulf Coast (Houston), Prairies and Lakes (North Texas), Panhandle Plains (Northwest Texas), and Piney Woods (Southeast Texas) regions of Texas. Hot spots, compared with the rest of Texas, had higher proportions of Hispanic population and individuals with socioeconomic disadvantages.

Conclusions

This study found spatial variation in cervical cancer incidence in Texas. The hot spot areas can benefit from targeted, novel, scalable, and cost-effective interventions to increase human papillomavirus vaccination and screening and early detection and treatment of precancerous cervical lesions.

Introduction

The COVID-19 pandemic has increased the global experience of anxiety and depression owing to social isolation and government-mandated quarantine for transmission reduction. To date, literature surrounding the mental health effects of COVID-19 for the U.S. population is limited.

Methods

This is a retrospective study from a large metropolitan Detroit health system. Patient encounters between December 23, 2018 and June 22, 2021, with March 23, 2020 being the start of Michigan state-wide lockdown, were used to define pre– and post–COVID-19 encounters, respectively. The data were divided into Detroit and non-Detroit on the basis of patient ZIP code. All patients aged ≥13 years with a visit with a family medicine provider were included. Outcome variables included Patient Health Questionnaires-2 and -9 and General Anxiety Disorder-7 scores; diagnoses of depression, anxiety, adjustment, and grief disorders; antidepressant prescriptions; and behavioral health referrals. Logistic regression was used to determine the incidence of composite mood disorder, depression, and anxiety.

Results

A total of 20,970 individuals were included in this study: 10,613 in the Detroit subgroup and 10,357 in the non-Detroit subgroup. A total of 88.2% of the Detroit population were Black, and 70% were female. Logistic regression shows that the incidence of composite mood disorder decreased with increasing age (OR=0.787, 0.608, 0.422, and 0.392; p<0.001). Male sex is a protective factor (OR=0.646, p<0.001). Federal insurance is the only factor presenting a statistically significant increased risk (OR=1.395, p<0.001). There was no statistical difference between residing in urban and suburban areas in the incidence of composite mood disorder (OR=0.996, p=0.953).

Conclusions

This research demonstrates that residing in an urban setting did not increase the risk of developing a mental health disorder during the COVID-19 period.

Introduction

Law enforcement professionals who investigate crimes involving child sexual abuse material face increased risk of mental health challenges, including burnout. This study aims to develop a data-driven self-assessment tool for law enforcement personnel exposed to child sexual abuse material. The tool assesses burnout symptoms and related mental health issues, offering a proactive approach to identifying and supporting individuals at risk.

Methods

A mixed-methods investigation involved 500 police investigators and forensic examiners across the U.S. The study utilized a convenience sample recruited through various channels connected with the National Criminal Justice Training Center.

Results

Twenty percent of participants exhibited high burnout. The Burnout Self-Assessment Tool demonstrated a sensitivity of 69.6% and specificity of 74.6% at a cut-off point ≥2, correctly classifying 73.6% of the sample. Individuals with scores ≥2 were 3.47 times more likely to be experiencing high burnout than peers with a score of zero, with increasing odds with each additional score. High burnout was associated with longer tenure in current positions.

Conclusions

The Burnout Self-Assessment Tool offers a short and simple self-assessment tool for law enforcement professionals exposed to child sexual abuse material, aiding in the early identification of burnout symptoms. A cut-off point ≥2 provides a data-driven strategy for identifying individuals at increased risk, promoting timely intervention and support to mitigate burnout's adverse effects on mental well-being and professional performance. The Burnout Self-Assessment Tool's sensitivity and specificity balance enhances its utility, providing a proactive approach to address the unique mental health challenges faced by law enforcement personnel combating crimes involving child sexual abuse material.

Introduction

Patient education is an effective modality to reinforce self-care practices for chronic disease management. The purpose of this study was twofold: (1) to assess the health impact of a phone-delivered diabetes intervention and (2) to identify predictors of telehealth message use among adults aged 18–65 years with diabetes in a primary care setting using the Technology Acceptance Model theoretical framework.

Methods

A pretest–posttest experimental study design was employed. Participants were randomized to receive 7 weeks of telehealth self-care messages or to the routine care group. Outcome measures included (1) telehealth use among patients who received weekly telehealth messages, (2) self-care behavior management derived from the Behavior Score Instrument, and (3) clinical outcomes measures.

Results

The study team enrolled 150 patients, and of these, 138 (aged 18–65 years) completed the study. Participants aged 53±9.6 (mean±SD) years were mainly females (n=93; 76%), and the majority received government-sponsored health insurance (n=75; 54%). Age was a strong predictor of telehealth use (p<0.001). Among patients who received telehealth messages, systolic and diastolic blood pressure measures (140/78 mmHg vs 134/74 mmHg) were statistically significant at follow-up (p=0.001 and p=0.007, respectively).

Conclusions

Digital support tools can play a valuable role in supporting lifestyle modification changes and reinforcing good diabetes self-care practices in older adults. Providing accessible tools and resources empowers adults to take an active role in their own health.

Introduction

Methods

Results

Conclusions

Introduction

Indoor tanning is a major modifiable risk factor in the development of both melanoma and nonmelanoma skin cancers. Investigation of behavior-altering interventions is an area of active research. As with other preventive measures, screening of high-risk populations can be an important aspect of a multimodality public health intervention. This study sought to further the limited understanding of indoor tanning screening practices in the primary care setting.

Methods

Physicians practicing within the scope of primary care in the northeast were surveyed in 2022 on practice patterns around the frequency of indoor tanning screening, barriers encountered with implementing screening, and actions taken with a positive screen. Research methodology adhered to the Joanna Briggs Institute critical appraisal checklist.

Results

Of 26 primary care physicians, only 7.7% routinely screened for indoor tanning. Barriers identified included time limitations (76.9%) and prioritization of other health concerns (96.2%). All primary care physicians (100%) reacted to reports of indoor tanning with an intervention, most commonly counseling on the risks of indoor tanning (92.6%).

Conclusions

This data suggest that screening for indoor tanning use could be improved. The authors recommend the incorporation of a standardized screening question regarding indoor tanning in intake forms.

Introduction

Veterans commonly experience both poor health and employment difficulty. However, the research examining potential relationships between chronic physical and mental health conditions and employment in veterans has important limitations. This study examines those potential relationships using large-scale, nationally representative data. The authors' hypothesis was that veterans experiencing these conditions would be less likely to be employed than veterans without the conditions and, further, that there may be differences in these relationships when comparing male veterans with female veterans.

Methods

The study team conducted a pooled cross-sectional analysis of nationally representative data from the 2004–2019 administrations of the Medical Expenditures Panel Survey, which had items addressing health conditions, employment, and military experience. The authors assessed the relationship between health conditions and employment using multivariate logistic regression. Control variables included demographics, SES, family size, and survey year.

Results

Veterans experiencing diabetes, high blood pressure, stroke, emphysema, arthritis, serious hearing loss, poor self-reported mental health, poor self-reported health, depression, or psychological distress were less likely to be employed than veterans without those conditions, even after adjusting for potential confounding factors. Veterans with diabetes had 25% lesser odds of being employed than veterans without the condition (95% CI=0.65, 0.85). Veterans with increased likelihood of depression had 35% lesser odds of being employed than veterans without depression (95% CI=0.52, 0.81).

Conclusions

This study adds evidence to the understanding of the role of chronic health conditions in employment status of veterans. The results support arguments for programs that aid veterans with both their health and their employment.

Introduction

Pregnancy complications, including high maternal BMI, are associated with altered early development and child health outcomes. A growing body of work links the prenatal environment, specifically maternal BMI, with respiratory infections in offspring. In this rapid review, the authors review the literature supporting the hypothesis that high maternal BMI during pregnancy is associated with childhood respiratory infection incidence.

Methods

The authors employed systematic search criteria in known databases—EMBASE, EMCARE, MEDLINE, CINAHL, and PsychINFO—searching from inception to January 2023. Included were primary research studies that involved (1) human pregnancy, (2) pregravid or gestational overweight or obesity, and (3) childhood respiratory infection with or without hospitalization.

Results

Only 7 population-based cohort studies met the criteria, investigating maternal BMI as an exposure and childhood respiratory infection as an outcome (age 6 months to 18 years). Therefore, the authors conducted a qualitative analysis, and outcomes were reported. The authors found that >85% of the albeit few published studies support the hypothesis that maternal BMI may have independent and profound consequences on respiratory infection risk across childhood.

Discussion

This area of research needs large-scale, well-controlled studies to better understand the relationship between maternal BMI and childhood respiratory infection. Possible resources such as cohort catalogs and combined databases are discussed. These findings add to the growing evidence that early environmental factors influence lifelong respiratory health. By incorporating a life course approach to infectious disease risk, policy makers can put this research to work and target health vulnerabilities before they arise.

Introduction

This study aimed to clarify the relationship between psychological factors (goal orientation and desire for approval from others) and the severity of sports injuries experienced by young Japanese athletes.

Methods

A total of 560 young Japanese athletes (328 males and 232 females) aged 18–24 years completed an online survey in 2022–2023. A web questionnaire was used to investigate participants’ task and ego orientations, desire for approval from others (e.g., coaches and friends/families), and history of injury. The samples were then split into 3 groups on the basis of the rest duration due to the injury: noninjury group (0 days), mild-to-moderate injury group (1–27 days), and severe injury group (>28 days). Spearman's test examined a correlation between task and ego orientation scores among all samples. The Mann–Whitney U test was used to compare the scores between the severe injury and noninjury groups.

Result

A significant positive correlation was found between task and ego orientation scores from all samples (ρ=0.27, p<0.001). The severe injury group had significantly higher task orientation scores and desire for approval scores than the noninjury group (ρ=0.001, p<0.001).

Conclusions

Japanese young athletes with high task orientation and approval desire may be at risk of severe sports injuries requiring >4 weeks to return to sports. The goal orientation profiles should be interpreted with caution. Future research should examine contextual effects such as the perceived motivational climate, in addition to the goal orientation profiles.