BMC Public Health最新文献

Background: Severe mental illnesses (SMIs) have become one of the public health problems of great concern in society, which not only bring physical and mental pain to patients but also heavy burden to families. It is known that the health-related quality of life (HRQoL) of patients and caregivers' social support are correlated with caregivers' family burden of disease, but the interaction mechanism among them is not clear. The purpose of this study was to investigate the association between HRQoL in patients with SMIs and the family burden of disease and to examine the mediating role of caregivers' social support.

Methods: From January to July 2022, this cross-sectional study was conducted in 23 community health service centers in Nanjing, China. We recruited 924 patients with SMIs and their caregivers, using a random sampling method. Hayes' PROCESS macro was used to test the mediation effect of caregivers' social support in the relationship between patients' HRQoL and family burden of disease. Indirect effects were tested using bootstrapped confidence intervals (CI).

Results: The SF-36 score of patients with SMIs was 57.85 (49.59, 63.64), while the caregivers' social support was measured at 32.00 (27.00, 35.00), and the family burden of disease scored 16.00 (8.00, 24.00). Spearman correlation analysis revealed a negative correlation between the patients' HRQoL and the family burden of disease (r = -0.54, p < 0.01). Furthermore, caregivers' social support was negatively correlated with the family burden of disease (r = -0.19, p < 0.01). The mediating role of caregivers' social support between the patients' HRQoL and the family burden of disease was confirmed by the Bootstrap test (p < 0.01), with a mediating effect of 2.75% (β = -0.016, 95% CI = -0.031, -0.002).

Conclusions: This study highlights that caregivers experience a heavy family burden of disease. The patients' HRQoL not only directly affects the family burden of disease but also indirectly influences it through the caregivers' social support. Therefore, relevant departments need to prioritize improving patients' HRQoL and expanding caregivers' social support networks when developing targeted intervention programs to reduce the family burden of SMIs.

Background: Although bullying may affect students' mental health, its prevalence and impact on mental health among students in China after the lifting of COVID-19 restrictions remains unclear. This study aimed to explored the prevalence and association of traditional and cyber bullying with mental health among Chinese adolescent and youth students post-COVID-19 restrictions.

Methods: An online survey included 82,873 students from various educational levels in Sichuan Province, China, assessing traditional and cyber victimization, cyber perpetration, COVID-19 experiences, insomnia, anxiety, depression, and post-traumatic stress disorder (PTSD). Logistic regression analyses were conducted to explore the associations between bullying and mental health problems.

Results: A total of 28.3% of students reported experiencing bullying, with 23.2% traditional victimization, 17.7% cyber victimization, and 8.1% cyber perpetration. Males had significantly higher prevalence of bullying, while females had significantly higher prevalence of mental health problems. All forms of bullying significantly increased the risk of mental health problems, with traditional bullying showing the strongest association. Students who experienced all three types of bullying had significantly higher risks of insomnia (adjusted odds ratio [aOR] 4.89 [95% CI, 4.57-5.23]), anxiety (aOR 11.42, [95% CI, 10.55-12.36]), depression (aOR 11.52, [95% CI, 10.58-12.53]), and PTSD (aOR 15.48, [95% CI, 14.17-16.92]).

Conclusion: This study highlights the high prevalence of bullying, as well as its cumulative impact on mental health problems among adolescent and youth students. Addressing and preventing bullying is crucial to promote positive mental well-being in adolescent and youth students.

Background: Pesticides, polycyclic aromatic hydrocarbons (PAHs), and phthalates are recognized as potential contributors to metabolic disorders. Nevertheless, the combined effect of simultaneous exposure to these chemicals on the metabolic syndrome (MetS) remains elusive.

Objectives: To explore the impacts of simultaneous exposure to pesticides, PAHs and phthalates and identify critical chemicals on MetS.

Methods: Based on the National Health and Nutrition Examination Survey (NHANES) database from 2007-2012, our study included 4030 non-pregnant individuals aged 20 years or older. We used the weighted linear regression model, variable selection models (including LASSO regression and BMA models), as well as a mixture exposure model (WQS model) to investigate the correlation between chemicals and MetS. Additionally, stratified analyses were performed based on gender and age.

Results: The weighted generalized linear regression model revealed a positive correlation of 2-hydroxyphenanthrene (2-PHEN) with MetS (OR: 1.37, 95% CI: 1.19-1.59, P < 0.001). Both the LASSO regression and BMA models identified 2-PHEN as a significant chemical positively associated with MetS. Additionally, the WQS model showed a positive association between overall exposure to the three chemical categories and MetS, with the highest weighted chemicals being 2-PHEN. Stratified analyses demonstrated a significant correlation between 2-PHEN and MetS between different subgroups. Notably, the WQS regression model revealed a significant association in the subgroup of female (OR = 1.40, 95% CI: 1.08-1.83, P < 0.05), with 2-PHEN, 2,5-dichlorophenol (2,5-DCP), 2-hydroxynaphthalene (2-NAP), and mono-ethyl phthalate (MEP) identified as the primary contributions to MetS.

Conclusion: Combined exposure to the three chemical groups was associated with an increased risk of MetS, with the PAHs group exhibiting the most pronounced effect and 2-PHEN emerging as a key chemical, underscoring significant public health concerns regarding the potential health risks of endocrine-disrupting chemicals (EDCs) exposure to metabolic diseases.

Background: Achieving nutrition and health equity warrants understanding lived experiences of marginalisation. Yet, people with diverse lived experiences are often inadequately included in food policy advocacy, agenda setting, and development. We aimed to explore cross-sectoral perceptions of engaging people with lived experiences of marginalisation in food policymaking in Australia, specifically in terms of challenges, enablers, required actions, and potential outcomes of doing so.

Methods: In-depth semi-structured interviews were conducted with 24 people with expertise in food policy and/or community engagement from academic, government, advocacy, and community sectors. Interviews were inductively and deductively coded using the Knowledge-to-Action framework.

Results: Participants identified few food policymaking examples where people with lived experience have been meaningfully engaged. Reported barriers included the lack of time, resources, and prioritisation across sectors and the lack of political commitment to inclusive policymaking. Having access to successful examples, existing networks of actors and flexible funding were among the few enablers identified. Several actions were deemed necessary to effectively engage people with lived experience in food policymaking and improve current practice: (1) having a dedicated budget; (2) enabling true collaboration where people with lived experience are valued, effectively engaged, sufficiently represented, have the opportunity to work alongside decision-makers, and where power is equalised; (3) striving to do no harm to the people engaged; and (4) ensuring results from engaging people with lived experience are effectively disseminated.

Conclusions: We provide a list of practical recommendations to guide more inclusive, equitable and fit-for-purpose food policymaking into the future. These recommendations seek to challenge dominant systems of discrimination by demonstrating how we can tangibly shift to ways of working that value and elevate the power of people who are often excluded from many decision-making systems, specifically when it comes to food and nutrition.

Objective: Globally, approximately 2.2 billion people suffer from visual impairments or blindness. Dietary patterns are closely associated with the prevalence of multiple ocular diseases. This study aimed to explore the association between Composite Dietary Antioxidant Index (CDAI) and ocular disorders.

Methods: The data were derived from 1706 subjects aged 40 years and older who participated in the 2005-2008 National Health and Nutrition Examination Survey (NHANES), which utilized undersampling techniques. Trained staff interviewed participants to gather information about their dietary habits using the 24-h diet recall method. The CDAI, incorporating six antioxidants, was then computed using a validated method. Eye diseases were diagnosed through a combination of examinations and questionnaires. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for potential confounders.

Results: After adjusting for potential confounders, higher CDAI quartiles (Q4) were significantly associated with reduced odds of diabetic retinopathy (OR: 0.55, P = 0.041), cataracts (OR: 0.37, P < 0.001), glaucoma (OR: 0.48, P = 0.003), and macular degeneration (OR: 0.19, P < 0.001). Carotenoids showed a significant negative correlation with ocular diseases, diabetic retinopathy (OR: 0.57, P < 0.001), cataracts (OR: 0.75, P = 0.014), glaucoma (OR: 0.59, P < 0.001) and macular degeneration (OR: 0.55, P < 0.001). Compared to the lowest quartile (Q1), higher quartiles (Q4) of zinc intake were associated with lower odds of DR (OR: 0.32, P < 0.001) and glaucoma (OR: 0.73, P = 0.001). Similarly, Q4 of vitamin C intake were associated with lower odds of cataracts (OR: 0.70, P = 0.001) and glaucoma (OR: 0.71, P = 0.003) compared to the Q1.

Conclusion: Higher CDAI scores are correlated with a decreased odds of ocular diseases, suggesting that an antioxidant-rich dietary pattern may be associated with better ocular health. Understanding these correlations could contribute to the development of preventive strategies and intervention measures for ocular diseases.

Objective: Although irrational drug use is more common in underdeveloped and developing countries, it remains a significant health problem worldwide and is considered a habit that is difficult to correct. This study was conducted to determine individuals' attitudes toward rational drug use at the household level, the costs of unused drugs within households, and the methods of disposal used.

Method: The research is descriptive and cross-sectional and was conducted between March 1, 2022, and May 30, 2022. The study consists of families who reside in a district in the Black Sea region of Turkey. The research was carried out with 385 families, and data were collected through a questionnaire prepared by the researchers using face-to-face interviews. SPSS (25.0)soft ware package was used for data analysis.

Results: The average age of the participants is 47.99 ± 17.81, with 66.8% of the participants being female. 52.5% of the participants use medication without consulting healthcare professionals when they are ill, 49.4% do not take their medication as prescribed, and 56.4% store medication at home. 28.1% of individuals do not check the expiration date of their medication, and 33.5% do not read the drug prospectus. Participants dispose of unused drugs by throwing them in the trash (36.6%) or storing them at home (36.4%). The cost of medication in households is 7,398 USD, and the cost of unused medication is 1,315 USD. The average cost of unused medication per households is calculated as 3.70 USD (112. 38 TL).

Conclusion: Rational drug use is lower among those with lower education levels. Families dispose of unused drugs in inappropriate ways. 18% of the medication in households is unused, contributing to the burden on families and the national economy. Increasing public awareness of rational drug use and the sale of medications in smaller quantities at the box/bottle level can help prevent the accumulation ofmedication at home. Practical and sustainable solutions should be implemented for the disposal of unused drugs.

Background: The COVID-19 pandemic reaffirmed the importance of high-quality laboratory services in the face of elevated demand for timely COVID-19 laboratory diagnosis. We explored the scale-up experience of the laboratory system in Armenia as well as the successes and challenges it brought to the overall laboratory system with the aim to identify lessons that can serve as opportunities for improvement.

Methods: We conducted a qualitative study to explore the experiences concerning the process of scale-up of the COVID-19 testing network through in-depth interviews with policymakers/experts (n = 6), heads (n = 6) and physicians (n = 3) of private and public laboratories conducting COVID-19 testing. Eight domains of the WHO Laboratory Assessment Tool System (S-LAT) questionnaire guided the study and directed the content analysis.

Results: According to the findings, within the COVID-19 testing network, numerous advancements were documented across all essential elements of the S-LAT as a result of the COVID-19 response. The most vivid improvements were related to the newly established network of public and private laboratories for COVID-19 testing and related coordination mechanisms, new laboratory information management practices, improved compliance with biosafety measures, novel quality assurance mechanisms as well as improved technical and human resources. However, suboptimal coordination of the COVID-19 testing network and the whole laboratory system, the gap between existing and proper biosafety management and quality control practices, and insufficient training of laboratory professionals were mentioned as potential challenges for the laboratory system in the future.

Conclusion: The assessment revealed challenges and achievements of the laboratory system during the COVID-19 response. Enhancement of coordination and cooperation mechanisms within and beyond the COVID-19 testing network, continuous improvement of human resources as well as quality and biosafety control practices throughout the whole system are crucial for sustaining the achievements and for strengthening future preparedness of the laboratory system to infectious disease outbreaks.

Background: American/Black and Latine (AABL) young/emerging adults living with HIV in the United States (US) have consistently failed to meet targets for HIV care/medication engagement. Among this population, those with non-suppressed HIV viral load are understudied, along with immigrants and those with serious socioeconomic deprivation. Guided by social action theory, we took a mixed methods approach (sequential explanatory design) to describe sociodemographic, background, and contextual factors, and their relationships to HIV management, among a diverse cohort.

Methods: Participants (N = 271) received structured baseline assessments and HIV viral load testing. Primary outcomes were being well-engaged in HIV care and HIV viral suppression. A subset (N = 41) was purposively sampled for maximum variability for in-depth interviews. Quantitative data were analyzed with descriptive statistics and logistic regression, and used to develop a research question about life contexts. Qualitative data were analyzed with directed content analysis, and the joint display method was used to integrate results.

Results: Participants were 25 years old, on average (SD = 2). The majority (59%) were Latine/Hispanic and the reminder African American/Black. Almost all were assigned male sex at birth (96%) and sexual minorities (93%). Half (49%) were born outside the US and 33% spoke primarily Spanish. They were diagnosed with HIV four years prior on average (SD = 3). Most were well-engaged in HIV care (72%) and evidenced viral suppression (81%). Speaking Spanish was associated with a higher odds of care engagement, and adverse childhood experiences and income from federal benefits were associated with a lower odds. None of the factors predicted viral suppression. Qualitative results highlighted both developmentally typical (insufficient financial resources, unstable housing) and atypical challenges (struggles with large bureaucracies, HIV disclosure, daily medication use). Federal benefits and the local HIV social services administration were critical to survival. Immigrant participants came to the US to escape persecution and receive HIV care, but HIV management was often disrupted. Overall qualitative results highlighted both risk and protective factors, and resilience. Qualitative results added detail, nuance, and richness to the quantitative findings.

Conclusions: The present study advances what is known about the backgrounds and contexts of diverse and understudied AABL young/emerging adults living with HIV.

Background: Interventions targeting dementia prevention typically lack comprehensive exploration of feasibility, acceptability, and long-term translation factors prior to deployment. Our study aimed to explore the acceptability, fidelity and participants' experiences with Brain Bootcamp, a multi-domain behaviour change intervention targeting reduced dementia risk and increased dementia risk factor awareness for older adults.

Methods: Conducted in New South Wales, Australia, from January to August 2021, our concurrent single-group mixed-methods feasibility study involved post-intervention surveys and qualitative interviews with community-dwelling older adults. Descriptive statistics were used to assess acceptability of the methods, outcome measures, and fidelity to the program components. Thematic analysis of semi-structured interviews explored participant experiences, preferences, barriers, and recommendations.

Results: Out of 853 enrolled participants, only 355 completed the program (41.6%). Among these participants, 79.1% agreed that the intervention improved their awareness of dementia risk factors, and 92.4% expressed intent to continue maintaining brain healthy behaviours post- program. Participants typically set 2-4 modifiable risk factor lifestyle goals, which were most often related to physical activity (83.7%). A majority (91.5%) successfully achieved at least one brain health goal. Qualitative analyses (n = 195) identified three overarching themes on the role of education on behaviour modification (i.e., the transformative role of the program in enhancing knowledge about dementia prevention and fostering behavioral modifications), psychological considerations (e.g., intrinsic versus extrinsic motivation on their engagement and perception of the program) and future directions (e.g., sustainability concerns and the need for tailored strategies for specific demographics).

Conclusions: While Brain Bootcamp had low completion rates, those who completed the program reported high acceptability. Future refinements, incorporating targeted strategies and enhanced participant support and communication, will facilitate pragmatic initiatives.

Clinical trial number: ACTRN12621000165886.

Background: Hearing loss is highly prevalent and the third largest cause of years lived with disability. The most frequent cause of adult-onset hearing loss is older age. As the retirement age increases in many countries, a growing number of workers will experience hearing loss, which may affect work participation. Limited research has been done on the consequences of hearing loss in workers in communicative professions. The present study examines the associations of hearing loss with work ability and sick leave among teachers.

Methods: Dutch teachers were recruited via schools, educational sector organizations, and trade unions. Teachers completed a survey questionnaire and performed a valid and reliable online speech-in-noise screening test for hearing loss. The survey measured work ability with the single-item Work Ability Score (range 0-10); scores were dichotomised into poor-moderate (score 0-7) and good-excellent (score 8-10) work ability. Teachers were asked if they had been on sick leave in the past three months (no / yes; if yes: how many days). Robust Poisson regression analyses were performed to examine the cross-sectional associations of hearing loss with both work ability (poor to moderate versus good to excellent) and sick leave (yes versus no), adjusted for age, sex, level of education, type of work tasks (only teaching versus a mixture with other (e.g. management) tasks, current work hours per week, and working as a physical education teacher.

Results: A total of 737 teachers participated in the study, of whom 86 (12%) had poor and 146 (20%) insufficient hearing. Teachers with poor and insufficient hearing had a higher prevalence of poor-moderate work ability than good hearing teachers (Prevalence Ratio (PR) = 1.67, 95% CI: 1.36-2.06 and PR = 1.40, 95% CI: 1.16-1.70, respectively). Teachers with poor hearing had a higher prevalence of sick leave than good hearing teachers (PR = 1.60, 95% CI: 1.21-2.01).

Conclusions: Among teachers, hearing loss was associated with poorer work ability and more sick leave. The results highlight the need for periodic hearing screening as recommended by the WHO. Earlier detection of hearing loss could enable timely work accommodations to prevent work disability of teachers.