BMC Public Health最新文献

Background: The impact of neighborhood-level income on community-associated methicillin-resistant S. aureus (CA-MRSA) risk remains poorly understood, despite established associations between MRSA risk and the social determinants of health. There are conflicting findings in the existing literature and no known systematic reviews based in the U.S. Our objective was to conduct a systematic review and meta-analysis of the association between neighborhood-level income and CA-MRSA in the U.S.

Methods: We searched MEDLINE (Ovid), MEDLINE Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, and Daily (Ovid), Global Health (Ovid), Embase (Elsevier), Cochrane Database of Systematic Reviews (Wiley), Cochrane Central Register of Controlled Trials (Wiley), and Web of Science Core Collection from 2017 to 10 January 2021. An updated search was completed in November 2023. Eligible studies reported stratified CA-MRSA case counts and/or effect measures by neighborhood income level, reported as a categorical or continuous variable. Relevant data were extracted using Covidence following the PRISMA guidelines. A random-effects model meta-analysis was used to estimate the pooled effect measure. Three study design-specific risk of bias assessments and a quality assessment were applied using the modified Newcastle-Ottawa Quality Assessment Scale and GRADE approach, respectively.

Results: Six publications met eligibility criteria. Five found that living in a low-income neighborhood was associated with increased CA-MRSA risk. Among the four studies eligible for the meta-analysis, the pooled odds ratio for CA-MRSA infection among low vs. high-income neighborhoods (reference group) was 1.28 (95% CI: 1.13, 1.46), with statistical heterogeneity (I² 73%). Limiting to low risk of bias studies (n = 3), there was no significant relationship between low income and CA-MRSA infection (OR: 1.13, 95% CI: 0.96, 1.33) with heterogeneity of 0%.

Conclusions: Evidence supports an association between lower neighborhood income and higher CA-MRSA infection risk, albeit with considerable heterogeneity. Future studies should consider evaluating neighborhood-level income as a continuous variable, and at the block-group level to avoid exposure misclassification. Furthermore, researchers should consider adjusting for covariates that could allow for a causal interpretation of the relationship between low neighborhood-level income and CA-MRSA risk.

Introduction: Children's health and health behaviours primarily depend on their parental socioeconomic status backgrounds. There is limited research seeking to understand in depth the health needs and challenges of low- to middle-income families in Singapore. Understanding this can help the healthcare professional identify vulnerable families at an early stage, allowing for targeted interventions and preventive measures to address socioeconomic comorbidities and their consequences during childhood.

Objectives: To explore the health needs of the low- and middle-income families with children aged 2 months to 6 years in Singapore, and their facilitators and barriers to engagement in existing health, social and education services.

Methods: An interpretive qualitative approach was adopted in this study. We conducted 34 semi-structured one-to-one interviews with purposively sampled low- and middle-income families with children aged 2 months to 6 years. In addition, four focus group discussions comprising 19 service providers were conducted to complement the findings. All interviews were transcribed verbatim. Thematic analysis was conducted to identify key themes and subthemes.

Results: The bottom two tiers of Maslow's Hierarchy of Needs (physical, safety and security needs) constituted the larger proportion of unmet needs expressed by families. Physical needs encompassed food, exercise, sleep, screen time as well as needs related to smoking and alcohol consumption, while safety and security needs included social security needs, educational needs and physical health. Themes identified as enablers of service engagement included accessibility and convenience, financial and policy support, health awareness and engagement, trust and relationship-based engagement, interagency and technological support, and holistic family and workforce support. Conversely, themes identified as barriers to service engagement consisted of access and utilisation barriers, financial and policy inequities, challenges in information management and service coordination, and service delivery and support gaps.

Conclusions: Our analysis assembled an objective picture of challenges and strengths in relation to the health status of caregivers and their children from low- and middle-income families. Good interpersonal relationships with families, improved health literacy, readily available competent healthcare professionals, better access to social services and financial assistance, and enhanced health information technology help overcome challenges faced by low- to middle-income households.

Background: Poor adolescent sleep health is a significant public health issue worldwide. In particular, multiple sleep problems disturb the lives of adolescents. It is urgent to identify the key factors (e.g., parent‒child relationships, peer relationships, and teacher‒student relationships) and influential moderators (e.g., depressive emotions) that contribute to adolescent sleep problems.

Methods: Data were derived from the China Education Panel Survey (CEPS) and collected through self-reported questionnaires. A total of 7405 students (3818 boys and 3587 girls) born between 2000 and 2001 were followed from grade 7 through grade 8. Logistic regression was applied to explore the effects of the independent variables and moderating variable on students' sleep problems.

Results: Remaining fatigued after waking up (17.97%), dreaminess (14.21%) and sleep fragmentation (13.07%) were the three most common sleep problems among the students. Peer relationships, teacher praise, and depressive emotions were related to adolescents' sleep problems (all p < 0.05). Notably, depressive emotion served as an influential moderator in the relationship between social relationships and sleep problems among students, exhibiting simultaneous and lasting effects (all p < 0.05).

Conclusions: Reducing adolescents' sleep problems is necessary, and enhancing adolescents' positive social relationships and reducing their depressive emotions should receive increased attention.

Background: Existing evidence indicates that Muslim minorities underutilize mental health services despite a pressing need. Employing the Theory of Planned Behavior (TPB), this study seeks to explore considerations that influence mental health help-seeking by Muslims residing in California and Israel.

Methods: A qualitative approach involving semi-structured interviews guided by the TPB principles was implemented with 78 Muslim participants. Thematic analysis was conducted to identify key themes.

Results: Employing both deductive and inductive approaches, four major themes were identified: attitudes (advantages, disadvantages, and the influence of religiosity), subjective norms (the impact of significant others), perceived behavioral control (facilitators and challenges), and intentions toward seeking mental health support (influenced by gender, and prior experience). Common social and cultural norms were identified in both groups within the patterns of the TPB. The family's significance as a supportive resource emerged in both groups, but the extended family had a more profound impact among Muslims in Israel. Stigma as a barrier against seeking mental health help was stronger among Muslims in Israel, while financial barriers and socio-political context were highlighted more by Californian Muslims.

Conclusions: The findings highlighted the importance of adopting a holistic approach to mental health help-seeking among Muslims due to commonalities in approaches, irrespective of geographical differences. Variance between the two groups primarily stemmed from social factors, particularly stigma and the influence of extended family. The results underscore the universality of common aspects and emphasize the importance of addressing social norms and socio-economic realities to enhance engagement among Muslims in both countries.

Background: Office workers have the highest estimated daily sedentary time (ST). The Covid-19 pandemic resulted in a switch from office-based work to home-office work or a hybrid of both. Home-office work has been shown to increase ST compared to the office, which may have deleterious health consequences.

Objective: This study explored managers perspectives on the factors influencing their employee's ability to reduce ST in a home-office context.

Design: A descriptive qualitative study.

Methods: Semi-structured interviews (n = 20), which were mapped to the COM-B model, were conducted with managers from Ireland, Spain and The Netherlands. Interviews were conducted through Zoom, recorded and transcribed verbatim. A reflexive thematic analysis approach was used.

Results: Organisational support, management engaging in physical activity (PA) during work and a social element were seen as key to increasing engagement in interventions. Creating opportunities for employees to engage in PA during work was seen as another key element. Leveraging infrastructure put in place during the Covid-19 pandemic was identified as a feasible approach to providing education and encouragement to employees. Lastly, managers feared the impact reducing ST may have on the performance of both employees and the organisation, yet, managers felt an increase in employee well-being would benefit their company long-term.

Conclusion: These results highlight the need to include organisational support and leadership from management, ensuring a top-down approach. These changes may create opportunities for employees to reduce their ST while working from home, which may benefit both the employees' and organisations.

Background: Anemia is a condition that has been affected 1.92 billion people worldwide in 2021, leading physical decline, functional limitation and cognitive impairment. However, there are currently fewer studies focusing on the relationship between anemia and dietary patterns in older adults. This study aimed to analysis the dietary patterns in older adults aged 60 and above in China and their association with anemia.

Methods: The data was obtained from the 2015 Chinese Adults Chronic Diseases and Nutrition Surveillance (2015 CACDNS), dietary information was collected using the food frequency method within the past year, exploratory factor analysis was used to extract dietary patterns, and logistic regression was used to analyze the relationship between dietary patterns and anemia.

Results: A total of 48,955 elderly people were included, and the number of anemia patients was 4,417 (9.02%). Four dietary patterns were categorized by the exploratory factor analysis, two dietary patterns have been found to have a statistically significant relationship with the prevalence of anemia. Compared to the first quintile, the fifth quintile of dietary pattern 2 (DP2), characterized by high intake of rice and flour, fresh vegetables, livestock and poultry meat, aquatic products, was associated with higher prevalence of anemia in older adults (OR = 1.412, 95%CI: 1.273-1.567, P < 0.0001), and the trend test results showed that score of this dietary pattern was associated with higher prevalence of anemia (p for trend < 0.0001). Compared to the first quintile, Dietary Pattern 4 (DP4), rich in fungi and algae, fried dough products, other grains, various beans, and rice and flour, was linked to lower prevalence of anemia of the fifth quintile (OR = 0.768, 95% CI: 0.674-0.874, P < 0.0001). And DP4 score was associated with lower prevalence of anemia (P for trend < 0.0001).

Conclusions: There were differences in dietary patterns among elderly people over 60 in China, and the prevalence of anemia in older adults was related to DP2, and DP4.

Background: The Healthy Eating Index (HEI-2015) assesses dietary quality, and lower scores may be associated with an increased risk of frailty. However, few epidemiological studies have examined the relationship between HEI-2015 and the Frailty Index (FI). This study explores the association between HEI-2015 and FI using data from the U.S. National Health and Nutrition Examination Survey (NHANES), analyzing how factors such as gender and age influence this relationship.

Methods: TNHANES data (2007-2018) were analyzed using logistic regression models to assess the HEI-2015-frailty association. Frailty diagnosis was based on physical activity, strength, fatigue, weight change, and gait speed, with FI scores ranging from 0 to 1. A threshold of 0.21 classified frailty. The R package "DALEX" was used for feature importance analysis to enhance the prediction of frailty. From this analysis, we selected 10 key factors to further improve the accuracy of frailty prediction.

Result: Of 14,300 participants, 16.2% (2,322) were classified as frail. Frail participants had lower income, higher BMI, lower physical activity, and lower HEI-2015 scores. Higher HEI-2015 scores were associated with reduced frailty risk (adjusted OR: 0.69, 95% CI: 0.56-0.87, P < 0.01). The negative association was stronger in women, higher-income groups, and those with higher education (P < 0.01). Feature importance analysis showed HEI-2015 was the top predictor of frailty.

Conclusion: Higher HEI-2015 scores are linked to lower frailty risk. Promoting healthy eating may prevent frailty, especially in high-risk groups, with education and demographic factors influencing this relationship.

Background: To meet indicator 3.7.2 in the Sustainable Development Goals (SDGs), Thailand must reduce the adolescent birth rate (ABR) to below 15 per 1,000 women aged 15-19 years by 2027, down from 20.9 per 1,000 in 2023.

Purpose: This study aims to describe ABRs geographically, identify hot and cold spots as well as spatial outliers, and determine the association between ABRs and spatial contextual factors at the district level in Thailand from 2009 to 2018.

Methods: Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) were employed to examine the spatial patterns of ABRs and the association between ABRs and spatial contextual factors, separately for the 2009-2012 and 2013-2018 periods.

Results: ABRs at the district level in Thailand during both periods were spatially random. The OLS models for both periods satisfied all OLS requirements, with no correlation issues among explanatory variables (VIF < 5.0). During the 2009-2012 period, five variables were significantly associated with an increase in ABRs: income inequality, annual per capita income, monthly per capita expenses, the percentage of female-led households, and the percentage of households led by a single parent. In the 2013-2018 period, variables associated with an increase in ABRs included income inequality, annual per capita income, the percentage of households affected by divorce, the percentage of adolescents who completed only compulsory level education and were unemployed, and the availability of Youth-Friendly Health Services and safe abortion services.

Conclusion: As there is no pronounced geographical variation in ABRs and their contextual determinants, a uniform set of policies and programs targeting the reduction of ABRs could be implemented across all districts in Thailand.

Background: Childbearing intention is a complex issue that is influenced by a number of factor. However, childbearing intention does not necessarily lead to actual behavior, and mediating factors are effective in the realization and emergence of reproductive behavior. Since childbearing intention is influenced by several factors, including the social determinants of health, a thorough understanding of the effect of health determinants on this intention will help the reproductive process. Therefore, the present study was conducted using a social support-mediated model to examine the role of social determinants of health in women's intention to pregnant.

Methods: This cross-sectional study was conducted on 500 married women of reproductive age (age range 15-49 years old) who were referred to health centers affiliated with Shahid Beheshti University of Medical Sciences during 2022-2023. Sampling was performed in a multi-stage (class-cluster) manner. Data collection tools in this study included the Demographic Information Form, the Childbearing Intention Questionnaire, social determinants of health questionnaires such as the Ghodratnama Socio-Economic Status Questionnaire, the Perceived Social Support Questionnaire, and the Depression Anxiety Stress Scales (DASS-21), and the Dyadic Adjustment Scale (Spinner questionnaire). Data analysis was performed using SPSS21 software with descriptive statistical tests and analytical statistics. Laserl 8.8 software was also used to test the model using the path analysis statistical test.

Results: The mean scores of depression, anxiety and stress were 5.03 ± 4.39, 4.49 ± 3.68 and 7.7 ± 4.67, respectively. The mean score of marital adjustment was 103.26 ± 23.49, indicating that the majority of women (60.4%) had marital adjustment. Based on the results of the path analysis, marital adjustment was the only variable that had a direct positive and significant causal relationship with the childbearing intention from only one path (B = 0.74). Moreover, based on the results of the path analysis, perceived social support had the most direct and indirect positive causal relationship with the childbearing intention to have children (B = 0.74). Among the components of DASS21, depression was the only variable that had both a direct and indirect negative causal relationship with childbearing (B=-0.12). Both stress and anxiety had a direct positive causal relationship with the childbearing intention (B = 0.11 and B = 0.15 respectively).

Conclusion: Factors such as marital adjustment, perceived social support, depression, stress, and anxiety, as structural social determinants of health, are associated with childbearing intention. Accordingly, changes in social structures depend on population planning and policies.

Background: Multiple myeloma (MM) is the second most common haematological malignancy worldwide. A comprehensive global analysis of MM based on diverse geographic locations and timeframes is lacking. This study aimed to provide the incidence, mortality rate, and disability-adjusted life years (DALYs) of MM, from 1990 to 2021, focusing on the age structure and temporal trends of the disease burden.

Methods: This study analysed the most recent MM data (1990 to 2021) from 204 countries and territories obtained from the Global Burden of Disease database. MM incidence, age-standardised mortality rate (ASMR), and DALYs were stratified by age, sex, and region to accurately reflect epidemiological trends and disease burden. The correlation between age-standardised rates and social population index was evaluated. To explore the influencing factors of MM, the annual percentage change (APC) and average APC rate (AAPC), as well as their corresponding 95% confidence intervals (UIs), were calculated.

Results: In 2021, there were approximately 35,000 cases of MM worldwide, with the highest numbers in China and Germany, with 47,003 and 32,010 cases, respectively. In 2021, Europe had the highest ASIR and ASPR, while North America had the highest ASMR and DALYs. Globally, age-standardized ASPR, ASMR, and DALYs all increased between 1990 and 2021. From 1990 to 2021, the number of cases, deaths, and disability-adjusted life-years due to MM were higher in males than in females. The higher the sociodemographic index, the higher the ASPR.

Conclusions: The global prevalence, ASIR, ASMR and DALYs of MM increased, showing significant regional disparities. These findings underscore the need for prevention in specific populations and emphasise the urgent need for new therapies to reduce ASIR and improve patient prognosis.