Design of a RCT evaluating the (cost-) effectiveness of a lifestyle intervention for male construction workers at risk for cardiovascular disease: the health under construction study

Adverse childhood experiences of Korean mothers with young children: a latent class analysis

Background: Adverse childhood experiences (ACEs) have negative impacts on women with children, including psychosocial and general health problems. However, there is limited research investigating ACEs identifying the characteristics of distinct subgroups according to the frequency of ACEs.Objective: Utilizing the national dataset of the Family with Children Life Experience 2017, this study aimed to classify patterns of ACEs based on the total number of types of ACEs and the types of predominant events, and to examine differences in general and psychological characteristics, as well as experiences of violence in adulthood among the classes identified.Method: A total of 460 Korean mothers raising infants or toddlers participated. Latent class analysis was performed to classify the patterns of ACEs, while t-tests and Chi-square tests were used to examine differences in general and psychological characteristics and experiences of violence between the ACEs subgroups.Results: The participants were classified into two subgroups: the 'high-ACEs group' and the 'low-ACEs group'. The high-ACEs group exhibited higher rates of child abuse, workplace violence perpetration and victimization, as well as lower self-esteem, higher depression levels, and increased suicidal thoughts compared to those of the low-ACEs group.Conclusion: The findings highlight the significant role of ACEs on the formation of an individual's psychological characteristics and their propensity to experience additional violence even into adulthood, as perpetrators and as victims. It is noteworthy how the influence of ACEs extends across generations through child abuse. These findings offer insights for developing interventions aimed at mitigating the negative effects of experiences of violence on mothers raising young children.

A qualitative study of maternal and paternal parenting knowledge and practices in rural Mozambique

BACKGROUND

Providing nurturing care for young children is essential for promoting early child development (ECD). However, there is limited knowledge about how mothers and fathers across diverse contexts in sub-Saharan Africa care for their children and from whom they receive guidance and support in their caregiving roles. We aimed to examine caregivers' nurturing care practices and sources of parenting knowledge in rural Mozambique.

METHODS

This is a secondary analysis using data from a qualitative evaluation of a pilot intervention to improve nurturing care for early child health and development within existing health systems. The evaluation was conducted across three primary care health facilities and their catchment areas in Nampula province, Mozambique. For this study, we analyzed data from in-depth interviews conducted with 36 caregivers (32 mothers and 4 fathers) to investigate mothers' and fathers' daily caregiving experiences. Data were analyzed using thematic content analysis.

RESULTS

Caregivers described various caregiving roles relating to general caregiving of young children (e.g., feeding, bathing, caring for child's health) and stimulation (e.g., play and communication) activities. Mothers more commonly engaged in general caregiving activities than fathers, whereas both mothers and fathers engaged in stimulation activities. Other family members, including siblings, grandparents, and aunts/uncles, were also actively engaged in general caregiving activities. With respect to sources of parenting knowledge, caregivers received parenting guidance and support primarily from their own mothers/parents and facility-based health providers.

CONCLUSIONS

These findings highlight the importance of adopting a holistic approach involving caregivers and their context and reveal potential strategies to promote caregiving and ECD in rural Mozambique and similar contexts.

10-year multimorbidity patterns among people with and without rheumatic and musculoskeletal diseases: an observational cohort study using linked electronic health records from Wales, UK

OBJECTIVES

To compare the patterns of multimorbidity between people with and without rheumatic and musculoskeletal diseases (RMDs) and to describe how these patterns change by age and sex over time, between 2010 and 2019.

PARTICIPANTS

103 426 people with RMDs and 2.9 million comparators registered in 395 Wales general practices (GPs). Each patient with an RMD aged 0-100 years between January 2010 and December 2019 registered in Clinical Practice Research Welsh practices was matched with up to five comparators without an RMD, based on age, gender and GP code.

PRIMARY OUTCOME MEASURES

The prevalence of 29 Elixhauser-defined comorbidities in people with RMDs and comparators categorised by age, gender and GP practices. Conditional logistic regression models were fitted to calculate differences (OR, 95% CI) in associations with comorbidities between cohorts.

RESULTS

The most prevalent comorbidities were cardiovascular risk factors, hypertension and diabetes. Having an RMD diagnosis was associated with a significantly higher odds for many conditions including deficiency anaemia (OR 1.39, 95% CI (1.32 to 1.46)), hypothyroidism (OR 1.34, 95% CI (1.19 to 1.50)), pulmonary circulation disorders (OR 1.39, 95% CI 1.12 to 1.73) diabetes (OR 1.17, 95% CI (1.11 to 1.23)) and fluid and electrolyte disorders (OR 1.27, 95% CI (1.17 to 1.38)). RMDs have a higher proportion of multimorbidity (two or more conditions in addition to the RMD) compared with non-RMD group (81% and 73%, respectively in 2019) and the mean number of comorbidities was higher in women from the age of 25 and 50 in men than in non-RMDs group.

CONCLUSION

People with RMDs are approximately 1.5 times as likely to have multimorbidity as the general population and provide a high-risk group for targeted intervention studies. The individuals with RMDs experience a greater load of coexisting health conditions, which tend to manifest at earlier ages. This phenomenon is particularly pronounced among women. Additionally, there is an under-reporting of comorbidities in individuals with RMDs.

An evolution of socioeconomic inequalities in self-rated health in Korea: Evidence from Korea National Health and Nutrition Examination Survey (KNHANES) 1998-2018

Reducing socioeconomic inequalities in health has become an important health policy agenda. This study aimed to measure socioeconomic inequalities in health in Korea over the past two decades and identify the contributing factors to the observed inequalities. Data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2016/2018 were utilized. The concentration index (CI) was calculated to measure health inequalities, and decomposition analysis was applied to identify and quantify the contributing factors to the observed inequalities in health. The results indicated that health inequalities exist, suggesting that poor health was consistently more concentrated among Korean adults with lower income (1998: -0.154; 2016/2018: -0.152). Gender-stratified analyses also showed that poor health was more concentrated in lower income women and men, with the degree of inequalities slightly more pronounced among women. The decomposition approach revealed that income and educational attainment were the largest contributors to the observed health inequalities as higher income and education associated with better self-rated health. These findings suggest the importance of considering socioeconomic determinants, such as income and education, in efforts to tackling health inequalities, particularly considering that self-rated health is a predictor of future mortality and morbidity. Furthermore, it is essential to implement more egalitarian social, labour market, and health policies in order to eliminate the existing socioeconomic inequalities in health in Korea.

Consumption and adverse reaction reporting of herbal medicines among people living with HIV at University teaching hospitals in Blantyre, Malawi and Ibadan, Nigeria

Background

Consumption of herbal medicines among people living with HIV is a common practice in Sub-Saharan Africa. The utilization of herbal medicines was at 17.5% and 67.9% in Malawi and Nigeria, respectively. There is inadequate data on use and adverse reactions (ADRs) reporting of herbal medicines among people living with HIV (PLWHIV). This study was designed to investigate use and ADRs reporting of herbal medicines among PLWHIV at the University Teaching Hospitals in Blantyre, Malawi and Ibadan, Nigeria.

Methodology

A cross-sectional study was conducted among PLWHIV attending Antiretroviral Therapy (ART) clinic at Queen Elizabeth Central Hospital, Blantyre, Malawi and University College Hospital, Ibadan, Nigeria. A structured questionnaire was administered to 360 and 370 participants in Blantyre and Ibadan respectively, through face-to-face interviews after obtaining their informed consent.

Results

The prevalence of herbal medicines use among PLWHIV in Malawi and Nigeria was at 80.6% and 55.7% (p<0.001), respectively. The most frequently used herbal medicines in Malawi were Aloe vera (14.0%), Moringa oleifera (14.0%), Zingiber officinale (13.0%) and Allium sativum (7.0%). Likewise, in Nigeria, the most commonly used herbal medicines were Zingiber officinale (15.0%), Vernonia amygdalina (14.0%), Moringa oleifera (9.0%), and Allium sativum (11.0%). The major reason for herbal medicines' use in Malawi was ready availability (42.1%) and perception that it boosts immunity (44.6%) in Nigeria. The PLWHIV reported experiencing suspected herbal medicine ADRs in Malawi (3.9%) and in Nigeria (8.0%).

Conclusion

A higher percentage of people living with HIV are using herbal medicines in Malawi as well as in Nigeria. In both countries, a few participants reported experiencing suspected ADRs related to herbal medicines.

Dental Caries among the Elderly in Iran: A Meta-analysis

Background

The prevalence of dental caries among the elderly is high worldwide, and dental caries cause the major burden of oral diseases. This meta-analysis aimed to determine the dental caries experience among the elderly in Iran.

Methods

A systematic review of the published and grey literature on Iranians aged 65 years or older was performed. Six international and local databases provided the most comprehensive population-based studies. National oral health surveys and national disease and health surveys were considered other primary data sources. The quality of remained studies was assessed by a modified tool designed based on the STROBE statement checklist to evaluate the cross-sectional studies. R Version 3.6.0 was used for statistical analysis. Heterogeneity was assessed using Cochran's Q and F statistics. Subgroup analysis was performed to detect the source of heterogeneity. Funnel plots and Egger's regression intercept test were used to assess publication bias and selective reporting.

Results

Overall, 3099 sources were found. After excluding ineligible studies, 46 data points with 10411 people ≥65 years were included in the meta-analysis. The mean pooled decayed, missing, and filled teeth (DMFT) among older people was 26.84 (range, 26.41-27.28). The DMFT was 26.78 (range, 26.12-27.43) in women and 26.91 (range, 26.32-27.50) in men. The mean number of decayed teeth was 1.48 (range, 1.32-1.65). The mean pooled missing teeth was 24.83 (range, 24.20-25.46), and the mean pooled filled teeth was 0.14 (range, 0.12-0.17). The majority (92%) of the DMFT was related to missing teeth.

Conclusion

Iranian elderly have almost 5 sound teeth in their mouth on average. The Iranian oral health policymakers should address this considerable burden of dental caries in designing and implementing better oral health policies for the population, especially older Iranian adults.

Factors associated with intentions to quit tobacco use in Lebanon: A cross-sectional survey

Introduction

The prevalence of tobacco smoking in Lebanon is among the highest globally. This study aims to determine past attempts to quit smoking among adults and identify factors associated with intentions to quit.

Methods

A nationally representative telephone survey was conducted between June and August 2022. Eligibility criteria included people aged >=18 years residing in Lebanon. The questionnaire was divided into three components: socio-demographic characteristics, cigarette and waterpipe tobacco use behaviours. Binary logistic regression was used to examine factors associated with intention to quit cigarette and waterpipe tobacco use.

Results

A total of 2003 respondents were included in the study. The prevalence of any tobacco product use was 41%, the prevalence of current cigarette smoking was 41% and the prevalence of current waterpipe tobacco use was 20%. Approximately 24% of adults who smoke cigarettes and 26% of those who use waterpipe tobacco had previous quit attempts mainly due to health concerns. Intentions to quit smoking within the next 6 months were reported among 12% of survey respondents. Among adults who smoke, past quit attempts increased the likelihood of intentions to quit cigarette smoking by 5-fold (OR: 5.11; 95% CI: 1.80-14.47, p = 0.002) and waterpipe tobacco use by 7-fold (OR: 6.98, 95% CI: 2.63-18.51, p = <0.001). Age and income were associated with intentions to quit cigarette but not waterpipe tobacco use.

Conclusion

Intention to quit smoking was strongly associated with past quitting attempts. Understanding factors associated with intentions to quit can help inform the development of context specific smoking cessation interventions.

Potential risk zones and climatic factors influencing the occurrence and persistence of avian influenza viruses in the environment of live bird markets in Bangladesh

Live bird markets (LBMs) are critical for poultry trade in many developing countries that are regarded as hotspots for the prevalence and contamination of avian influenza viruses (AIV). Therefore, we conducted weekly longitudinal environmental surveillance in LBMs to determine annual cyclic patterns of AIV subtypes, environmental risk zones, and the role of climatic factors on the AIV presence and persistence in the environment of LBM in Bangladesh. From January 2018 to March 2020, we collected weekly fecal and offal swab samples from each LBM and tested using rRT-PCR for the M gene and subtyped for H5, H7, and H9. We used Generalized Estimating Equations (GEE) approaches to account for repeated observations over time to correlate the AIV prevalence and potential risk factors and the negative binomial and Poisson model to investigate the role of climatic factors on environmental contamination of AIV at the LBM. Over the study period, 37.8% of samples tested AIV positive, 18.8% for A/H5, and A/H9 was, for 15.4%. We found the circulation of H5, H9, and co-circulation of H5 and H9 in the environmental surfaces year-round. The Generalized Estimating Equations (GEE) model reveals a distinct seasonal pattern in transmitting AIV and H5. Specifically, certain summer months exhibited a substantial reduction of risk up to 70-90% and 93-94% for AIV and H5 contamination, respectively. The slaughtering zone showed a significantly higher risk of contamination with H5, with a three-fold increase in risk compared to bird-holding zones. From the negative binomial model, we found that climatic factors like temperature and relative humidity were also significantly associated with weekly AIV circulation. An increase in temperature and relative humidity decreases the risk of AIV circulation. Our study underscores the significance of longitudinal environmental surveillance for identifying potential risk zones to detect H5 and H9 virus co-circulation and seasonal transmission, as well as the imperative for immediate interventions to reduce AIV at LBMs in Bangladesh. We recommend adopting a One Health approach to integrated AIV surveillance across animal, human, and environmental interfaces in order to prevent the epidemic and pandemic of AIV.

Measurement invariance of the Center for Epidemiologic Studies Scale-Depression within and across six diverse intervention trials

Depression, a major contributor to the global burden of disease, is an outcome of interest in clinical trials. Researchers and clinicians note that depression often presents differently across cultures, posing challenges in the accurate measurement of depressive symptoms across populations. A commonly used self-administered screening tool to measure depressive symptoms, the Center for Epidemiologic Studies Scale-Depression (CES-D), has been translated into dozens of languages and used in thousands of studies, yet gaps remain in our understanding of its factor structure and invariance across studies and over time in the context of interventions. In this secondary analysis, we sampled six recent trials from lower- and middle-income countries to (a) establish the factor structure of the CES-D, (b) assess measurement invariance of the CES-D across treatment versus control arms and over time, (c) examine cross-study invariance, and (d) identify items that may be driving potential noninvariance. We performed exploratory/confirmatory factor analysis to establish the factor structure of the CES-D within each trial and used multiple group confirmatory analysis to assess within-study cross-arm/cross-time and cross-study invariance. After removal of positive affect items, a unidimensional model performed equivalently over time and across arms within trials, but exhibited noninvariance across trials, supporting prior literature describing differences in factor structure of the scale across populations. While our findings suggest that the CES-D without positive affect items is a valid measure of depressive symptoms within trials in our sample, caution is warranted in interpreting the findings of meta-analyses and multisite/multicountry studies using the CES-D as an outcome measure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Geographic distribution and predictors of diagnostic delays among possible TB patients in Uganda

BACKGROUND

Understanding the geographic distribution and factors associated with delayed TB diagnosis may help target interventions to reduce delays and improve patient outcomes.

METHODS

We conducted a secondary analysis of adults undergoing TB evaluation within a public health demonstration project in Uganda. Using Global Moran's I (GMI) and Getis-Ord GI* statistics, we evaluated for residential clustering and hotspots associated with patient-related and health system-related delays. We performed multivariate logistic regression to identify individual predictors of both types of delays.

RESULTS

Of 996 adults undergoing TB evaluation (median age: 37 years, IQR 28-49), 333 (33%) experienced patient delays, and 568 (57%) experienced health system delays. Participants were clustered (GMI 0.47-0.64, P ⩽ 0.001) at the sub-county level, but there were no statistically significant hotspots for patient or health system delays. Married individuals were less likely to experience patient delays (OR 0.6, 95% CI 0.48-0.75; P < 0.001). Those aged 38-57 years (OR 1.2, 95% CI 1.07-1.38; P = 0.002) were more likely than those aged ⩾58 years to experience patient delays. Knowledge about TB (OR 0.8, 95% CI 0.63-0.98; P = 0.03) protected against health system delays.

CONCLUSIONS

We did not identify geographic hotspots for TB diagnostic delays. Instead, delays were associated with individual factors such as age, marital status and TB knowledge.

The road to recovery: Financial resilience and mental health in post-apartheid South Africa

Following the post-apartheid era in South Africa, global economic hardships and financial shocks have forced most households to endure various mental and psychological stresses.. This has hindered the achievement of Sustainable Development Goal 3 (SDG-3)-good health and wellbeing-prompting policymakers and academics to search for remedies to mitigate such stresses. Highlighting resilience as a means of improving wellbeing, this paper focuses on financial resilience and constructs an index using a multidimensional framework to investigate its association with mental health disorders. Using the South Africa National Income Dynamic Study alongside several robust estimation techniques, we uncover a negative association between financial resilience and mental health disorders among South Africans. More specifically, financial resilience is associated with an approximately 37% decrease in the occurrence of mental health disorders. The results also reveal disparities in the correlation between financial resilience and mental health disorders across different subgroups. Non-Whites (especially Blacks), urban dwellers, and male household heads are shown to most strongly experience the depression-reducing effect of financial resilience. This paper also shows that life satisfaction and household expenditure mediate the relationship between financial resilience and mental wellbeing. Toward the end of this paper, we discuss the implications of our results and offer some policy recommendations.

The impact of neighborhood disadvantage on colorectal cancer screening among African Americans in Chicago

Historically, colorectal cancer (CRC) screening rates have been lower among African Americans. Previous studies that have examined the relationship between community characteristics and adherence to CRC screening have generally focused on a single community parameter, making it challenging to evaluate the overall impact of the social and built environment. In this study, we will estimate the overall effect of social and built environment and identify the most important community factors relevant to CRC screening. Data are from the Multiethnic Prevention and Surveillance Study (COMPASS), a longitudinal study among adults in Chicago, collected between May 2013 to March 2020. A total 2,836 African Americans completed the survey. Participants' addresses were geocoded and linked to seven community characteristics (i.e., community safety, community crime, household poverty, community unemployment, housing cost burden, housing vacancies, low food access). A structured questionnaire measured adherence to CRC screening. Weighted quantile sum (WQS) regression was used to evaluate the impact of community disadvantages on CRC screening. When analyzing all community characteristics as a mixture, overall community disadvantage was associated with less adherence to CRC screening even after controlling for individual-level factors. In the adjusted WQS model, unemployment was the most important community characteristic (37.6%), followed by community insecurity (26.1%) and severe housing cost burden (16.3%). Results from this study indicate that successful efforts to improve adherence to CRC screening rates should prioritize individuals living in communities with high rates of insecurity and low socioeconomic status.

Predictors of fear control related to COVID-19 among older population: an investigation on COVID-19 risk perception and health related quality of life during the pandemic

BACKGROUND

The aim of this study was to examine the role of demographic characteristics, general health and health related quality of life on the fear control. Also, the aim of study was to explore how older people percept the COVID-19 pandemic by using the component of the expanded parallel process model (EPPM), and how the possible perception may contribute to probable behavior responses to prevention and control of COVID-19.

METHODS

The present study is a cross-sectional study that was conducted in Tabriz, a city in north of Iran from February to April 2021, the period that correspond with the fourth wave of COVID-19. To collect information, the Covid-19 risk perception questionnaire (based on EPPM model including efficacy, defensive responses, and perceived threat) and health related quality of life (HQOL) Short Form-36 questionnaire were used. Discriminate value was calculated to estimate fear control and danger control. Univariate and multivariable logistic regression were calculated to examine the effect of demographic characteristics, general health and health-related quality of life on the fear control.

RESULTS

The mean age of the 350 participants was 67.9 (6.4) years. A total of 83.1% of participants were engaged in danger control processes and 16.9% in fear control processes. According to the multivariable results, significant predictors for fear control were: gender 1.57 (95% CI 1.05-2.34, 0.025), education 7.38 (1.42-38.35, p = 0.017), economic status 1.31 (0.4-0.63, p = 0.029), and significant protective factors for fear control were: body pain 0.97 (0.94-0.99, p = 0.041), general health 0.96 (0.93-0.98, p = 0.032), physical health 0.94 (0.90-0.98) and total quality of life 0.024 (0.89-0.98).

CONCLUSIONS

Strong associations of fear control were found with being female, being illiterate, and having a good economic status and also body pain, general health, physical health and total HQOL were significantly associated with danger control. Since, most of elderly populations have adequately higher perceptions of efficacy to counteract their threat perceptions to continue motivating these older people to engage in COVID-19 self-protective behaviors, it is necessary to emphasis on the susceptibility of target population and the severity of the COVID-19 threats.

Migration intent among Jordanian medical students: a nationwide cross-sectional investigation

PURPOSE OF THE STUDY

To investigate postgraduation emigration intents of medical students throughout different years and different universities in Jordan.

STUDY DESIGN

This cross-sectional study was conducted via an online self-administered questionnaire from medical students in six schools of medicine in Jordan. Our questionnaire included two sections with questions regarding sociodemographic, intentions and reasons behind residency and fellowship abroad, and views on Jordanian residency programmes.

RESULTS

Of a sample of 1006, 55.7% were females, and 90.7% were holding Jordanian citizenship. 85% and 63% of respondents intended to pursue residency and fellowship abroad, respectively. Intention to continue residency abroad was associated with males, expatriates and those living in urban areas. The main three destinations were the USA (37.4%), UK (22.3%) and Germany (16.6%). 30% of respondents intended to leave the country permanently, because of low salaries, poor education and lower ranking of Jordan residency programmes. When asked about ranking Jordanian residency programmes, it was found that on average, students ranked military hospitals first and government hospitals last with university hospitals being in second place and private hospitals in third.

CONCLUSION

Unfortunately, a striking number of Jordanian medical students intended to leave the country postgraduation, which points towards the necessity for Ministry of health to take immediate actions to reduce the loss of our best students.

Relapse during opioid use disorder treatment: A pilot study to understand the reasons for opioid use during treatment

Background

Opioid use is a cause of concern in many parts of the world. About 2.1% Indians use opioids. Opioids are also the most common drugs used by injection drug users in India. Despite various treatment strategies used to manage opioid use disorders (OUDs), relapse is common. A good treatment program would make efforts to address lapses and prevent relapse. Hence, there is a need to understand the factors associated with relapse in OUD.

Method

One hundred and twenty patients completed a baseline assessment that included socio-demographic details and the Maudsley Addiction Profile (MAP). They were followed up for three months and assessed using telephonic interview for opioid use. All those who relapsed were assessed using the Reasons for Relapse Questionnaire (RRQ). The patients who relapsed were compared with the patients who were abstinent. Relapse was defined as any use of opioid during follow-up.

Results

Forty participants relapsed during the 90 days of the study period. Relapsed patients had a greater number of conflict days with family members, used a higher amount of heroin and cannabis at baseline, were less likely to be discharged on buprenorphine, and were more likely to drop out. Participants cited mood and social reasons more often than cue/craving and unwell domains of RRQ.

Conclusion

Baseline treatment and prospective factors are associated with relapse in OUD. Addressing these factors can help in reducing relapse in OUD patients.

Culturally supported health promotion to See, Treat, Prevent (SToP) skin infections in Aboriginal children living in the Kimberley region of Western Australia: a qualitative analysis

Background

While there are many skin infections, reducing the burden of scabies and impetigo for remote living Aboriginal people, particularly children remains challenging. Aboriginal children living in remote communities have experienced the highest reported rate of impetigo in the world and are 15 times more likely to be admitted to hospital with a skin infection compared to non-Aboriginal children. Untreated impetigo can develop into serious disease and may contribute to the development of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). As the largest organ protecting the body and visible to everyone, skin infections are often unsightly and very painful, therefore maintaining healthy skin and reducing the burden of skin infections is important for overall physical and cultural health and well-being. Biomedical treatments alone will not address these factors; therefore, a holistic, strengths-based approach that aligns with the Aboriginal world view of wellness is required to help reduce the prevalence of skin infections and their downstream consequences.

Methods

Culturally appropriate yarning sessions with community members were conducted between May 2019 and November 2020. Yarning sessions have been identified as a valid method for story sharing and collecting information. Semi-structured, face-to-face interviews and focus groups with school and clinic staff were conducted. When consent was provided, interviews were audio-recorded and saved as a digital recording in a de-identified format; for those yarning sessions not recorded, handwritten notes were scribed. Audio recordings and handwritten notes were uploaded into NVivo software prior to a thematic analysis being conducted.

Findings

Overall, there was a strong knowledge of recognition, treatment, and prevention of skin infections. However, this did not extend to the role skin infections play in causing ARF, RHD or kidney failure. Our study has confirmed three main findings: 1. The biomedical model of treatment of skin infections remained strong in interviews with staff living in the communities; 2. Community members have a reliance and belief in traditional remedies for skin infections; and 3. Ongoing education for skin infections using culturally appropriate health promotion resources.

Interpretation

While this study revealed ongoing challenges with service practices and protocols associated with treating and preventing skin infections in a remote setting, it also provides unique insights requiring further investigation. Bush medicines are not currently practiced in a clinic setting, however, using traditional medicines alongside biomedical treatment procedures facilitates cultural security for Aboriginal people. Further investigation, and advocacy to establish these into practice, procedures and protocols is warranted. Establishing protocols and practice procedures focused on improving collaborations between service providers and community members in remote communities is also recommended.

Funding

Funding was received from the National Health and Medical Research Council [NHMRC] (GNT1128950), Health Outcomes in the Tropical NORTH [HOT NORTH 113932] (Indigenous Capacity Building Grant), and WA Health Department and Healthway grants contributed to this research. A.C.B. receives a NHMRC investigator Award (GNT1175509). T.M. receives a PhD scholarship from the Australian Centre for Elimination of Neglected Tropical Diseases (ACE-NTD), an NHMRC centre of excellence (APP1153727).

Factors influencing tuberculosis preventive practices among people living with HIV/AIDS enrolled in secondary health facilities in Lagos, Nigeria

Background information

Tuberculosis is the most potent opportunistic infection leading to deaths among patients with Human Immunodeficiency Virus (HIV). Therefore, knowledge, attitude and practices regarding tuberculosis preventive strategy among People Living with HIV/AIDS (PLWHA) is vital in minimizing the risk of developing TB infection which forms the objective of this study.

Methodology

A descriptive cross-sectional study carried out using multi-stage sampling technique in selecting 606 respondents. Data was collected using a semi-structured questionnaire and analysed with SPSS version 23.

Result

Of all the respondents, 245 (40.4%) were within 28-37 years, 386 (63.7%) were females and 219 (36.1%) had secondary education. Majority of the respondents 500 (82.5%), 423(69.8%) and 411(67.8%) had positive attitude, good practices and good knowledge respectively. Associated factors were age, marital status, religion, educational status, knowledge and attitude with tuberculosis practices. Respondents between 18-27 years were twice less likely to engage in good TB preventive practices (OR-0.44, 95% CI- 0.25-0.78, p = 0.004).

Conclusion

Over half of respondents had good tuberculosis preventive practices, influenced by their socio-demographic characteristics, knowledge and attitude towards TB infection. Preventive efforts need to be strengthened among individuals between 18-27 years of age, non-Christians and those with lower educational status.

Traditional male circumcision and the risk for HIV transmission among men: a systematic review

OBJECTIVES

To synthesise evidence to determine whether, in contrast to medical male circumcision, traditional male circumcision (TMC) practices may contribute to HIV transmission and what the impacts of TMC are on the initiates, their families and societies.

DESIGN

Systematic review.

DATA SOURCE

PubMed, CINHAL, SCOPUS, ProQuest, Cochrane database and Medline were searched between 15 and 30 October 2022.

ELIGIBILITY CRITERIA

(1) Studies involving young men, young male adults, male adults and mixed male and female participants; (2) studies on TMC involving men living with HIV (married and non-married); (3) studies on TMC, HIV transmission and impact in low-income and middle-income countries; (4) qualitative, quantitative and mixed-method studies and (5) studies aimed at exploring TMC and how it contributes to HIV transmission and the impacts of HIV on circumcised men and their families.

DATA EXTRACTION

Data were extracted based on study details, study design, characteristics of participants and results.

RESULT

A total of 18 studies were included: 11 were qualitative studies, five were quantitative studies and two were mixed-method studies. All the studies included were conducted in areas where TMC was performed (17 in Africa and one in Papua New Guinea). The review's findings were categorised into themes: TMC as a cultural practice, consequences of not being traditionally circumcised on men and their families and TMC-related risk of HIV transmission.

CONCLUSION

This systematic review highlights that TMC practice and HIV risk could negatively impact men and their families. Existing evidence suggests that little attention has been paid to men and their families experiencing the impacts of TMC and HIV risk factors. The findings recommend the need for health intervention programmes such as safe circumcision and safe sexual behaviours following TMC and efforts to address psychological and social challenges in communities practising TMC.

PROSPERO REGISTRATION NUMBER

CRD42022357788.

Factors associated with academic burnout and its prevalence among university students: a cross-sectional study

BACKGROUND

This study aimed to evaluate the current state of academic burnout among Chinese college students and its influencing factors.

METHODS

A cross-sectional study of 22,983 students was conducted using structured questionnaires and the Maslach Burnout Inventory General Survey on sociodemographic characteristics, educational process, and personal aspects. Multiple variables were statistically evaluated using logistic regression analysis.

RESULTS

The total score of the students' academic burnout was 40.73 (± 10.12) points. The scores for the reduced personal accomplishment, emotional exhaustion, and cynicism were 23.63 (± 6.55), 11.20 (± 6.05), and 5.91 (± 5.31), respectively. Students with academic burnout accounted for 59.9% (13,753/22,983). Male students had higher burnout scores than female students, upper-grade students had higher burnout scores than lower-grade students, and students who smoked had higher burnout than non-smokers during the school day.

CONCLUSIONS

More than half of students experienced academic burnout. Gender, grade, monthly living expenses, smoking, parents' education level, study and life pressures, and the current degree of professional knowledge interest significantly impacted academic burnout. An effective wellness program and an annual long-term burnout assessment may sufficiently reduce student burnout.

Prevalence and determinants of early neonatal mortality in Ethiopia: findings from the Ethiopian Demographic and Health Survey 2016

BACKGROUND

Early neonatal death accounts for a significant number of under-5 mortality worldwide. However, the problem is under-researched and under-reported in low-income and middle-income countries, particularly in Ethiopia. The magnitude of mortality during the early neonatal period and associated factors should be studied for designing appropriate policies, and strategies that could help tackle the problem. Hence, this study aimed to determine the prevalence and identify factors associated with early neonatal mortality in Ethiopia.

METHODS

This study was conducted by using data from Ethiopian Demographic and Health Survey 2016. A total of 10 525 live births were enrolled in the study. A multilevel logistic regression model was used to identify determinants of early neonatal mortality. Adjusted OR (AOR) at a 95% CI was computed to assess the strength and significance of the association between outcome and explanatory variables. Factors with a p<0.05 were declared statistically significant.

RESULTS

The national prevalence of early neonatal mortality in Ethiopia was 41.8 (95% CI 38.1 to 45.8) early neonatal deaths per 1000 live births. The extreme ages of pregnancy (under 20 years (AOR 2.7, 95% CI 1.3 to 5.5) and above 35 years (AOR 2.4, 95% CI 1.5 to 4)), home delivery (AOR 2.4, 95% CI 1.3 to 4.3), low birth weight (AOR 3.3, 95% CI 1.4 to 8.2) and multiple pregnancies (AOR 5.3, 95% CI 4.1 to 9.9) were significantly associated early neonatal mortality.

CONCLUSIONS

This study revealed a higher prevalence of early neonatal mortality as compared with prevalence in other low-income and middle-income countries. Thus, it is determined to be essential to design maternal and child health policies and initiatives with a priority on the prevention of early neonatal deaths. Emphasis should be given to babies born to mothers at extreme ages of pregnancy, to those born of multiple pregnancies delivered at home and to low birthweight babies.

Associations between socioeconomic status and risk of obesity and overweight among Chinese children and adolescents

BACKGROUND

In China, the threat of obesity and overweight in children and adolescents is developing quickly. It may be possible to lower the risk of obesity and overweight in children and adolescents by understanding the factors that drive these conditions. Therefore, this study aimed to investigate the association between SES and risk of obesity and overweight among children and adolesecnts in China's provinces of Jiangsu, Anhui, Zhejiang, and Shanghai.

METHODS

Chinese children and adolescents (n = 2,746; 46.3% boys) were recruited using multistage sampling. SES was measured using self-reported questionnaires, the specific indicators were parental education, perceived family wealth, and Family Affluence Scale II. Height and weight were measured and used to calculate body mass index (BMI, categorized into obesity or overweight). The definition of obesity or overweight was based on the Chinese standard "Screening for obesity and overweight among school-age children and adolescents". Descriptive statistics, independent sample t-tests, and a Chi-square test were used to report the sample characteristics and analyse BMI differences across different sociodemographic groups. A binary logistic regression was then applied to analyse the association of SES indicators with BMI in children and adolescents.

RESULTS

Overall, 22.5% of children and adolescents were obese or overweight. Participants with medium and high maternal education levels were 1.48 [95% CI 1.15-1.91] and 1.47 [95% CI 1.03-2.11] times more likely to be obese/overweight. Girls with medium maternal education levels were 1.70[95% CI 1.21-2.40] times more likely to be obese/overweight. For boys, no association was observed. Junior middle school students with medium maternal education levels were 1.51[95% CI 1.10-2.07] times more likely to be obese/overweight. Participants with medium or high FAS, perceived family wealth, or paternal education levels were not associated with obesity/overweight.

CONCLUSIONS

The findings of this study indicated a positive association between SES and risk of overweight/obesity in girls, suggesting that maternal education level may have a substantial impact on future prevention efforts for these conditions in girls. To increase the effectiveness of interventions, longitudinal studies are necessary to better understand the causal association between SES and obesity/overweight.

Genomic landscape of virus-associated cancers

It has been estimated that 15%-20% of human cancers are attributable to infections, mostly by carcinogenic viruses. The incidence varies worldwide, with a majority affecting developing countries. Here, we present a comparative analysis of virus-positive and virus-negative tumors in nine cancers linked to five viruses. We find that virus-positive tumors occur more frequently in males and show geographical disparities in incidence. Genomic analysis of 1,658 tumors reveals virus-positive tumors exhibit distinct mutation signatures and driver gene mutations and possess a lower somatic mutation burden compared to virus-negative tumors of the same cancer type. For example, compared to the respective virus-negative counterparts, virus-positive cases across different cancer histologies had less often mutations of TP53 and deletions of 9p21.3/ CDKN2 A- CDKN1A ; Epstein-Barr virus-positive (EBV+) gastric cancer had more frequent mutations of EIF4A1 and ARID1A and less marked mismatch repair deficiency signatures; and EBV-positive cHL had fewer somatic genetic lesions of JAK-STAT, NF-κB, PI3K-AKT and HLA-I genes and a less pronounced activity of the aberrant somatic hypermutation signature. In cHL, we also identify germline homozygosity in HLA class I as a potential risk factor for the development of EBV-positive Hodgkin lymphoma. Finally, an analysis of clinical trials of PD-(L)1 inhibitors in four virus-associated cancers suggested an association of viral infection with higher response rate in patients receiving such treatments, which was particularly evident in gastric cancer and head and neck squamous cell carcinoma. These results illustrate the epidemiological, genetic, prognostic, and therapeutic trends across virus-associated malignancies.

Missed opportunities for immunization among children 0 to 11 months of age that were attended to at debre tabor comprehensive specialized hospital, south gondar zone, Ethiopia

Background

The World Health Organization's Expanded Immunization Program was established in 1974 and aimed to provide vaccines to children all over the world. Since the inception of this program, numerous initiatives and campaigns have been launched, and millions of children around the world have been saved from death. Many vaccine-preventable diseases, however, remain prevalent in developing countries. This is because most of those countries have low immunization coverage for an unknown number of reasons. As a result, the goal of this study was to examine missed opportunities for immunization among children aged 0 to 11 months.

Methods

A cross-sectional survey was carried out from May to August 2022. A structured questionnaire was used to collect data, and the sample was chosen using a simple random sampling technique. Before being entered into the Epidata and exported to the Statistical Package for Social Science for analysis, the data were checked for consistency and completeness. The statistical significance was determined using binary and multiple logistic regression analyses. The statistical level of significance was established at p ≤ 0.05.

Result

In this study, 49.1% of immunization opportunities were missed. Education status [AOR = 2.45, 95% CI = 2.14, 4.22], rural residence [AOR = 4.32, 95% CI = 3.11, 6.38], and perception of caretakers [AOR = 2.13, 95% CI = 1.89, 4.07] were associated with the missed opportunity of immunization.

Conclusion

When compared to previous studies, the proportion of missed immunization opportunities was high in this study. The healthcare staff should be applying the multi-dose vial policy, which is recommended by the World Health Organization to increase the services. The doses for BCG and measles should be minimized to lower doses per vial in order to conduct immunization without having to wait for enough children and without worrying about vaccine waste. All infants who visit the hospital should be linked to immunization services.

Designing an optimal sequence of non-pharmaceutical interventions for controlling COVID-19

The COVID-19 pandemic has had an unprecedented impact on global health and the economy since its inception in December, 2019 in Wuhan, China. Non-pharmaceutical interventions (NPI) like lockdowns and curfews have been deployed by affected countries for controlling the spread of infections. In this paper, we develop a Mixed Integer Non-Linear Programming (MINLP) epidemic model for computing the optimal sequence of NPIs over a planning horizon, considering shortages in doctors and hospital beds, under three different lockdown scenarios. We analyse two strategies - centralised (homogeneous decisions at the national level) and decentralised (decisions differentiated across regions), for two objectives separately - minimization of infections and deaths, using actual pandemic data of France. We linearize the quadratic constraints and objective functions in the MINLP model and convert it to a Mixed Integer Linear Programming (MILP) model. A major result that we show analytically is that under the epidemic model used, the optimal sequence of NPIs always follows a decreasing severity pattern. Using this property, we further simplify the MILP model into an Integer Linear Programming (ILP) model, reducing computational time up to 99%. Our numerical results show that a decentralised strategy is more effective in controlling infections for a given severity budget, yielding up to 20% lesser infections, 15% lesser deaths and 60% lesser shortages in healthcare resources. These results hold without considering logistics aspects and for a given level of compliance of the population.

Factors associated with anti-retroviral therapy (ART) adherence among adult people living with HIV (PLWH): A 5-year retrospective multi-centre study in Kumasi, Ghana

Background

Combined antiretroviral therapy (cART) is the recommended treatment regimen for people living with HIV (PLWH). Long-term HIV treatment of over 95% adherence inhibits increase in viral load and boosts immune system performance. On the contrary, non-adherence results in treatment failure, accelerated development of HIV drug-resistance and increased mortality. However, there is paucity of data on the prevalence of antiretroviral therapy (ART) adherence and its associated factors in Ghana. We assessed the prevalence, sociodemographic and clinical factors associated with ART adherence among registered PLWH.

Methods

In a multi-centre hospital-based retrospective study, we collected data on 720 registered PLWH 18 years and above, who attend the HIV clinic at the University Hospital (KNUST), Komfo Anokye Teaching Hospital (KATH), and the Bomso Clinic, on ART and with up-to-date medical records. They were enrolled using a multistage sampling technique. Adherence was assessed retrospectively using missed doses and prescriptions renewal. All analysis were done using SPSS Version 26.0 and GraphPad prism version 8.0.

Results

Of 720 registered PLWH, 51.8% had good ART adherence, 35.3% had fair ART adherence and 12.9% had poor ART adherence. Those diagnosed at WHO stage II (aOR = 0.45, 95% CI: (0.30-0.68); p < 0.0001) and stage III (aOR = 0.40, 95% CI: (0.27-0.59) < 0.0001) were independently associated with lower chances of good adherence to ART. Moreover, those treated with AZT/3TC/EFV (aOR = 0.33, 95% CI: (0.16-0.68); p = 0.0030), and AZT/3TC/NVP (aOR = 0.50, 95% CI: (0.26-0.98); p = 0.0410) were independently associated with lower likelihood of good ART adherence. On the contrary, PLWH who have been on treatment for 4 years (aOR = 3.56, 95% CI: (1.10-11.54); p = 0.0340) was an independent predictor of good ART adherence.

Conclusion

About half of PLWH on treatment have good adherence to ART. Being diagnosed at WHO stage II and stage III, being treated with AZT/3TC/EFV, and AZT/3TC/NVP ART combination are associated with lesser chances of good ART adherence. However, increased duration of ART among PLWH influence good ART adherence. PLWH on ART should be monitored to achieve over 95% ART adherence for effective management of HIV/AIDS.

Spatial distribution of rotavirus immunization coverage in Ethiopia: a geospatial analysis using the Bayesian approach

Introduction

Rotavirus causes substantial morbidity and mortality every year, particularly among under-five children. Despite Rotavirus immunization preventing severe diarrheal disease in children, the vaccination coverage remains inadequate in many African countries including Ethiopia. Measuring rotavirus immunization coverage in a lower geographic area can provide information for designing and implementing a targeted immunization campaign. This study aimed to investigate the spatial distributions of rotavirus immunization coverage in Ethiopia.

Methods

Rotavirus immunization coverage data were obtained from the recent Ethiopian Demographic and Health Survey (EDHS 2019). Covariate data were assembled from different publicly available sources. A Bayesian geostatistics model was used to estimate the national rotavirus immunization coverage at a pixel level and to identify factors associated with the spatial clustering of immunization coverages.

Result

The national rotavirus immunization coverage in Ethiopia was 52.3% (95% CI: 50.3, 54.3). The immunization coverage varied substantially at the sub-national level with spatial clustering of low immunization coverage observed in the Eastern, Southeastern, and Northeastern parts of Ethiopia. The spatial clustering of the rotavirus immunization coverage was positively associated with altitude of the area [mean regression coefficient (β): 0.38; 95% credible interval (95% CrI): 0.18, 0.58] and negatively associated with travel time to the nearest cities in minutes [mean regression coefficient (β): − 0.45; 95% credible interval (95% CrI): (− 0.73, − 0.18)] and distance to the nearest health facilities [mean regression coefficient (β): − 0.71908; 95% credible interval (95% CrI): (− 1.07, − 0.37)].

Conclusions

This study found that the rotavirus immunization coverage varied substantially at sub-national and local levels in Ethiopia. The spatial clustering of rotavirus immunization coverage was associated with geographic and healthcare access factors such as altitude, distance to health facilities, and travel time to the nearest cities. The immunization program should be strengthened in Ethiopia, especially in the Eastern, Southeastern, and Northeastern parts of the Country. Outreach immunization services should be also implemented in areas with low coverage.

Prevalence of prediabetes, diabetes, diabetes awareness, treatment, and its socioeconomic inequality in west of Iran

We aim to estimate the prevalence of prediabetes, and diabetes mellitus (DM). We estimated awareness, treatment, plasma glucose control, and associated factors in diabetes, as well as, socioeconomic-related inequality in the prevalence of diabetes and prediabetes. Data for adults aged 35-70 years were obtained from the baseline phase of the Dehgolan prospective cohort study (DehPCS). Diabetes status was determined as fasting plasma glucose (FPG) of ≥ 126 mg/dl and/or taking glucose lowering medication confirmed by a medical practitioner. Prediabetes was considered as 100 ≤ FPG ≤ 125 mg/dl. The relative concentration index (RCI) was used to exhibit socioeconomic inequality in the prevalence of prediabetes and DM. Prevalence of prediabetes and DM, diabetes awareness and treatment, and glycemic control of DM 18.22%, 10.00%, 78.50%, 68.91% and, 28.50%, respectively. Increasing age (p < 0.001), Increasing body mass index (BMI) (p < 0.05), ex-smoker (p < 0.01), family history of diabetes (FHD) (p < 0.001), and comorbidity (p < 0.001) were independent risk factors for DM. Age group of 46-60 (p < 0.05), ex-smoker (p < 0.05), FHD (p < 0.05) were increased chance of awareness. Current smokers (p < 0.05), and higher education increase the chance of glycemic control in DM. Both DM (RCI =  - 0.234) and prediabetes (RCI =  - 0.122) were concentrated significantly among less-educated participants. DM was concentrated significantly among poor (RCI =  - 0.094) people. A significant proportion of DM awareness and treatment can be due to the integration of diabetes into the primary health care system. The high prevalence of prediabetes and diabetes, which is affected by socioeconomic inequality and combined with low levels of glycemic control may place a greater burden on the health system. Therefore, awareness, receiving treatment, and glycemic control in people with diabetes, and the socioeconomic status of people have become increasingly important in the near future.

The mental health of Farsi-Dari speaking asylum-seeking children and parents facing insecure residency in Australia

BACKGROUND

This research examined the mental health of a cohort of asylum-seeking children, adolescents and their primary caregiver affected by insecure residency while living in the community, compared to refugees and immigrants.

METHODS

The project investigated the prevalence of psychosocial problems among Iranian and Afghani asylum seeker, refugee and immigrant children and adolescents, and their caregivers who arrived in Australia from 2010. In total, n=196 children and adolescents aged 5-18 years, and their primary caregiver were asked about family visa status, country of origin, level of education, parent symptoms of posttraumatic stress disorder (Harvard Trauma Questionnaire) and child wellbeing (Strengths and Difficulties Questionnaire). An additional n=362 Farsi and Dari speaking children, recruited through the Building a New Life in Australia (BNLA) study, a national comparison sample of families with permanent refugee visas, were included.

FINDINGS

Asylum seeker children and adolescents displayed significantly more psychosocial problems compared to those with full refugee protection and immigrant background within the current sample and when benchmarked against a national sample of Farsi-Dari speaking refugee children. Higher parental posttraumatic stress disorder symptoms was associated with poorer child and adolescent psychosocial functioning. This effect was more marked in families with insecure residency.

INTERPRETATION

Insecure visa status is associated with higher rates of children's mental health problems and a stronger association with parental PTSD symptoms compared to children with secure residency. This raises important questions about Australia's restrictive immigration policies.

FUNDING

This project was supported by an Australian Rotary Health Research Fund / Mental Health of Young Australians Research Grant and by the Australian Research Council (DP160104378).

Inequalities in children's exposure to alcohol outlets in Scotland: a GPS study

BACKGROUND

Alcohol use is a leading cause of harm in young people and increases the risk of alcohol dependence in adulthood. Alcohol use is also a key driver of rising health inequalities. Quantifying inequalities in exposure to alcohol outlets within the activity spaces of pre-adolescent children-a vulnerable, formative development stage-may help understand alcohol use in later life.

METHODS

GPS data were collected from a nationally representative sample of 10-and-11-year-old children (n = 688, 55% female). The proportion of children, and the proportion of each child's GPS, exposed to alcohol outlets was compared across area-level income-deprivation quintiles, along with the relative proportion of exposure occurring within 500 m of each child's home and school.

RESULTS

Off-sales alcohol outlets accounted for 47% of children's exposure, which was higher than expected given their availability (31% of alcohol outlets). The proportion of children exposed to alcohol outlets did not differ by area deprivation. However, the proportion of time children were exposed showed stark inequalities. Children living in the most deprived areas were almost five times more likely to be exposed to off-sales alcohol outlets than children in the least deprived areas (OR 4.83, 3.04-7.66; P < 0.001), and almost three times more likely to be exposed to on-sales alcohol outlets (OR 2.86, 1.11-7.43; P = 0.03). Children in deprived areas experienced 31% of their exposure to off-sales outlets within 500 m of their homes compared to 7% for children from less deprived areas. Children from all areas received 22-32% of their exposure within 500 m of schools, but the proportion of this from off-sales outlets increased with area deprivation.

CONCLUSIONS

Children have little control over what they are exposed to, so policies that reduce inequities in alcohol availability should be prioritised to ensure that all children have the opportunity to lead healthy lives.

Associations between cohort study participation and self-reported health and well-being: the Northern Finland Birth Cohort 1966 Study

Aim

The aim of this study was to explore whether active participation in a longitudinal birth cohort study is associated with study participants’ health behaviour and well-being.

Methods

The subjects of this study were part of the Northern Finland Birth Cohort 1966. The follow-up data were collected through clinical examinations and questionnaires when the cohort members were 1, 14, 31 and 46 years old. In this study, cohort participation activity was divided into three categories: active, semiactive and least active.

Results

The total number of study participants who participated in the 46-year follow-up on both the survey and clinical trials was 6392, of which 66.5% (n=4268) participated actively in the cohort study. A total of 67.6% were female (p<0.001). Of the participants, 23.7% (n=1519) were semiactive and 9.5% (n=605) were the least active. Women who participated least actively experienced statistically significantly more depressive symptoms and poorer health, were more dissatisfied with their lives and had more addiction problems. In men, there was not a statistically significant association between participation activity and these well-being variables other than addiction problems and mental health.

Conclusions

The findings indicate that participation activity is associated with better self-reported health and well-being, especially among women. With this knowledge, people can be encouraged to participate in longitudinal health research and, at the same time, may improve their own health and quality of life.

Acceptance of Index Case HIV Testing and Its Associated Factors Among HIV/AIDS Clients on ART Follow-Up in West Ethiopia: A Multi-Centered Facility-Based Cross-Sectional Study

Background

Index case HIV/AIDS testing (ICHT) is a good approach for addressing and improving the efficiency and yield of testing among high-risk populations. Partners and families of people living with HIV/AIDS are among the high-risk populations for contracting HIV/AIDS. However, there is limited study on index case HIV testing among HIV patients attending Anti-Retroviral Therapy (ART). Hence, this study was aimed at assessing the magnitude and factors associated with ICHT among HIV patients attending ART in Nekemte town public health facilities.

Methods

An institution-based cross-sectional study was conducted at Nekemte town public health facilities from May 20 to July 21, 2020. A systematic random sampling method was used to select the study participants. Multivariable logistic regression analysis was used to determine the predictors of acceptance of ICHT among HIV patients.

Results

The ICHT acceptance was 85.2% (95% CI=84.9–91.1%). Disclosure of their HIV status (AOR=9.74, 95% CI=4.11–23.06), having good knowledge of ICHT (AOR=4.70, 95% CI=1.92–11.61), believing HIV index case testing has benefits (AOR=3.43, 95% CI=1.27–9.29), and being on ART for more than 1 year (AOR=4.78, 95% CI=2.13–10.76) were significantly associated with index case HIV test acceptance.

Conclusion and Recommendation

This study revealed a significant proportion of index case HIV testing acceptance. HIV status disclosure of index cases, knowledge of ICHT, the perceived benefit of ICHT, and long duration on ART were found to be significantly associated with acceptance of ICHT. Hence, it is essential to give attention to counseling on the importance of ICHT, enhance people living with HIV (PLWHIV) to have positive belief on the advantage of ICHT, strengthen disclosure counseling, and assist HIV status disclosure in health facilities.

The effects of magnesium supplementation on abnormal uterine bleeding, alopecia, quality of life, and acne in women with polycystic ovary syndrome: a randomized clinical trial

BACKGROUND

Abnormal uterine bleeding (AUB), alopecia, low quality of life, and acne are considered as complications of polycystic ovary syndrome (PCOS). We hypothesized that magnesium supplementation would yield beneficial effects on PCOS related complications.

OBJECTIVE

To examine the effects of magnesium supplementation on AUB, alopecia, quality of life, and acne.

METHODS

In this parallel randomized clinical trial, we randomly assigned 64 women with PCOS to the magnesium group (n = 32) or placebo group (n = 32) for 10 weeks. AUB, alopecia, quality of life, and acne were assessed by the International Federation of Gynecology and Obstetrics criterion, the Sinclair Scale, the Health Survey Quality of Life Questionnaire, and the Global Acne Grading System, respectively. This randomized clinical trial was registered at IRCT.ir (IRCT20130903014551N9).

RESULTS

Magnesium supplementation significantly improved the components of quality of life including physical functioning (p = 0.011), role limitations due to physical health (p = 0.012), role limitations due to emotional problems (p < 0.001), energy/fatigue (p = 0.005), emotional wellbeing (p < 0.001), social functioning (p = 0.002), general health (p = 0.013), and total quality of life (p < 0.001), compared with placebo. No significant effect was observed on acne, alopecia, and AUB.

CONCLUSION

Magnesium supplementation in women with PCOS had a significant positive effect on improving total quality of life.

TRIAL REGISTRATION

This randomized clinical trial was registered at IRCT.ir on 2020-10-18 (Registration Code: IRCT20130903014551N9 ).

Australian children's foot, ankle and leg problems in primary care: a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) data

OBJECTIVES

To explore children's foot, ankle and leg consultation patterns and management practices in Australian primary care.

DESIGN

Cross-sectional, retrospective study.

SETTING

Australia Bettering the Evaluation and Care of Health program dataset.

PARTICIPANTS

Data were extracted for general practitioners (GPs) and patients <18 years from April 2000 to March 2016 inclusive.

MAIN OUTCOME MEASURES

Demographic characteristics: sex, GP age groups (ie, <45, 45-54, 55+ years), GP country of training, patient age grouping (0-4, 5-9, 10-14, 15-18 years), postcode, concession card status, indigenous status, up to three patient encounter reasons, up to four encounter problems/diagnoses and the clinical management actioned by the GP.

RESULTS

Children's foot, ankle or leg problems were managed at a rate of 2.05 (95% CI 1.99 to 2.11) per 100 encounters during 229 137 GP encounters with children. There was a significant increase in the rate of foot, ankle and leg problems managed per 100 children in the population, from 6.1 (95% CI 5.3 to 6.8) in 2005-2006 to 9.0 (95% CI 7.9 to 10.1) in 2015-2016. Management of children's foot, ankle and leg problems were independently associated with male patients (30% more than female), older children (15-18 years were 7.1 times more than <1 years), male GPs (13% more) and younger GPs (<45 years of age 13% more than 55+). The top four most frequently managed problems were injuries (755.9 per 100 000 encounters), infections (458.2), dermatological conditions (299.4) and unspecified pain (176.3). The most frequently managed problems differed according to age grouping.

CONCLUSIONS

Children commonly present to GPs for foot, ankle and leg problems. Presentation frequencies varied according to age. Unexpectedly, conditions presenting commonly in adults, but rarely in children, were also frequently recorded. This data highlights the importance of initiatives supporting contemporary primary care knowledge of diagnoses and management of paediatric lower limb problems to minimise childhood burden of disease.

Mapping BCG vaccination coverage in Ethiopia between 2000 and 2019

Introduction

The Bacille-Calmette–Guerin (BCG) vaccination remains the primary strategy to prevent severe disseminated TB in young children, particularly in high TB-burden countries such as Ethiopia. Accurate knowledge of vaccination coverage in small geographical areas is critically important to developing targeted immunization campaigns. Thus, this study aimed to investigate the spatiotemporal distributions and ecological level determinants of BCG vaccination coverage in Ethiopia.

Method

Bacille-Calmette–Guerin immunization coverage and geographical information data were obtained from five different Demographic and Health Surveys, conducted in Ethiopia between 2000 and 2019. Data for independent variables were obtained from publicly available sources. Bayesian geostatistical models were used to predict the spatial distribution of BCG vaccination coverage in Ethiopia.

Result

The overall national BCG vaccination coverage between 2000 and 2019 was 65.5%. The BCG vaccine coverage was 53.5% in 2000, 56.9% in 2005, 64.4% in 2011, 79.6% in 2016, and 79.0% in 2019. BCG vaccination coverage increased by 47.6% in Ethiopia from 2000 to 2019, but substantial geographical inequalities in BCG coverage remained at sub-national and local levels. High vaccination coverage was observed in northern, western, and central parts of Ethiopia. Climatic and demographic factors such as temperature, altitude, and population density were positively associated with BCG vaccination coverage. Whereas, healthcare access factors such as distance to health facilities and travel time to the nearest cities were negatively associated with BCG vaccine coverage in Ethiopia.

Conclusion

Despite substantial progress in national BCG vaccination coverage, marked spatial variation in BCG coverage persists throughout the country at sub-national and local levels. Healthcare access and climatic and demographic factors determined the spatial distribution of BCG vaccination coverage. Maintaining a high level of vaccination coverage across geographical areas is important to prevent TB in Ethiopia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07547-4.

Aetiological research on the health of migrants living in Germany: a systematic literature review

BACKGROUND

Germany has become an important immigration country and health services need to adopt to meet the needs of an increasingly multicultural population. For public health planning, it is essential to understand the aetiology of health problems among migrant populations. The main objective was to systematically identify, evaluate and synthesise population-based studies that investigated exposure-outcome relationships among migrant groups in Germany.

METHODS

In November 2019, we searched PubMed and LIVIVO, and updated this search in November 2020, to identify peer-reviewed publications that fulfilled our eligibility criteria: English or German language; study on disease aetiology among major migrant groups in Germany, according to the latest microcensus; publication date from inception to 01 November 2020 and observational or experimental study designs. For quality appraisal, we used the Critical Appraisal Skills Programme checklists. Outcomes under investigation were categorised according to the WHO major disease groups, and their associations with risk factors were synthesised as a heat map.

RESULTS

Out of 2407 articles retrieved, we included 68 publications with a total number of 864 518 participants. These publications reported on cross-sectional data (n=56), cohort studies (n=11) and one intervention study. The population groups most frequently studied were from the Middle East (n=28), Turkey (n=24), sub-Saharan Africa (n=24), Eastern Europe (n=15) and the former Soviet Union (n=11). The outcomes under study were population group specific. There were consistent associations of demographic and socioeconomic factors with ill health among migrants in Germany.

DISCUSSION

In this systematic review, we observed low risk of bias in two-thirds of the studies. There is an increasing body of evidence for aetiological research on migrants' health in Germany. Still, the directions of associations between a wide range of risk factors and major disease groups seem only partially understood.

PROSPERO REGISTRATION NUMBER

CRD42018085074.

Factors associated with sexual and reproductive health service utilisation in high migration communities in six Southern African countries

BACKGROUND

Migration among women has significant health consequences on their access to and utilisation of health services, particularly sexual and reproductive health services. Despite the large quantity of research on migrant health, there is a paucity of research on the factors associated with utilization of modern methods of contraception, intimate partner violence services and sexual and reproductive health (SRH) referral services among non-migrants, internal and international migrant women. Consequently, understanding the factors associated with utilisation of SRH services among women in Southern Africa motivates this study.

METHODS

The study uses secondary data from a cross sectional survey conducted in 2018. Logistic regression models were fitted to investigate the factors associated with utilisation of sexual and reproductive health services among 2070 women aged 15-49 years in high migrant communities in six Southern African countries.

RESULTS

Factors found to be associated with current non-use of modern contraceptive methods were country, employment status, educational level, comprehensive knowledge about SRH, comprehensive knowledge about HIV, desire for another child, partner's age and partner's educational level. Regarding utilisation of SRH services, important factors were ever denied access to a public healthcare facility, country, marital status and comprehensive knowledge about HIV. Factors associated with utilising IPV services were migration status, age and attitude towards wife beating.

CONCLUSION

The findings highlight that migration status is associated with utilisation of IPV services. Comprehensive knowledge about SRH and partner characteristic variables were associated with current non-use of modern contraceptive methods. There is a need for SRH programs that can disseminate accurate information about SRH and encourage male involvement in SRH related issues. In addition, the SRH programs should target all women regardless of their migration status, age, educational level and marital status.

Health-Related Quality of Life According to Sociodemographic Characteristics in the South Korean Population

Health-related quality of life (HRQoL) concerns satisfaction with life and happiness with regard to physical, mental, and social factors. RAND-36 is a publicly available, self-administered questionnaire that examines eight health dimensions. This study evaluated the HRQoL of the South Korean population using the RAND-36 questionnaire and compared HRQoL across sociodemographic characteristics. From May 2015 to May 2019, South Koreans who visited public places aged 19−80 years were recruited and the RAND-36 questionnaire was administered. Overall, 1002 participants were recruited (mean age 45.34 years, 52% men). Men scored better than women in both physical and mental health (p < 0.05). There were significant differences in bodily pain (p < 0.05), general health perception (p < 0.05), and energy/fatigue (p < 0.05) dimensions according to the participants’ health condition. The HRQoL of South Koreans was lower than average in most dimensions compared with other countries. As the first study to assess this, its data can be used in future studies that apply RAND-36 to evaluate the HRQoL of diseased individuals, as they can compare their findings with those of our study population.

Covid-19 Preventive Behaviors in Iranian People: Applying Health Belief Model

Covid-19 disease, as a common infectious disease, has caused infection and death. Preventive behaviors are among the most important essential strategies of the Covid-19 disease prevention and control program. The health belief model (HBM) is one of the models that have been used to investigate the effective motivational factors and ultimately the protective behavior of the individual. Therefore, this study was conducted to define the factors related with Covid-19 protection behaviors among patients referred to comprehensive health service centers in Tuyserkan city using the HBM. A total of 800 patients referred to the comprehensive health service centers of Tuyserkan city during November 2021 were selected as the statistical population of this descriptive-analytical study. Clients were selected by multi-stage cluster random sampling from 21 comprehensive health service centers and health bases and then entered the study through simple random sampling. Data collection was online and based on a questionnaire. The questionnaire consisted of two parts: demographic information and HBM structure. The analysis was performed using SPSS24 software after data collection. The mean age of the subjects was 48.80 years and the income of the majority of the subjects was low (86.5%). People who washed their hands frequently kept a social distance, avoided losing others, used masks and gloves were 54.2%, 72.5%, 79.8%, 53.9%, 7.9% respectively. The results showed that with one unit increase in self-efficacy score and practice guide, the average behavior score increased by 0.27 and 0.31. The results show that the importance of prevention of Covid-19 infection among the population is necessary due to the high prevalence of infection and mortality. It seems that in intervention and prevention programs, the factors of prevention of Covid-19 transmission should be fully identified and proper interventions should be planned and implemented based on affective factors.

Psychiatric consequences of a father's leave policy by nativity: a quasi-experimental study in Sweden

BACKGROUND

Parental leave use has been found to promote maternal and child health, with limited evidence of mental health impacts on fathers. How these effects vary for minority populations with poorer mental health and lower leave uptake, such as migrants, remains under-investigated. This study assessed the effects of a Swedish policy to encourage fathers' leave, the 1995 Father's quota, on Swedish-born and migrant fathers' psychiatric hospitalisations.

METHODS

We conducted an interrupted time series analysis using Swedish total population register data for first-time fathers of children born before (1992-1994) and after (1995-1997) the reform (n=198 589). Swedish-born and migrant fathers' 3-year psychiatric hospitalisation rates were modelled using segmented negative binomial regression, adjusting for seasonality and autocorrelation, with stratified analyses by region of origin, duration of residence, and partners' nativity.

RESULTS

From immediately pre-reform to post-reform, the proportion of fathers using parental leave increased from 63.6% to 86.4% of native-born and 37.1% to 51.2% of migrants. Swedish-born fathers exhibited no changes in psychiatric hospitalisation rates post-reform, whereas migrants showed 36% decreased rates (incidence rate ratio (IRR) 0.64, 95% CI 0.47 to 0.86). Migrants from regions not predominantly consisting of Organisation for Economic Cooperation and Development countries (IRR 0.50, 95% CI 0.19 to 1.33), and those with migrant partners (IRR 0.23, 95% CI 0.14 to 0.38), experienced the greatest decreases in psychiatric hospitalisation rates.

CONCLUSION

The findings of this study suggest that policies oriented towards promoting father's use of parental leave may help to reduce native-migrant health inequalities, with broader benefits for family well-being and child development.

Evaluation of health-related quality of life before and after total hip arthroplasty in the elderly in Iran: a prospective cohort study

Background

Owing to the direct impact of total hip arthroplasty (THA) on health-related quality of life (HRQOL) and the higher prevalence of THA in the elderly, this study aimed to compare HRQOL before, and after THA in the Iranian elderly.

Methods

The present prospective cohort study was performed on 161 THA candidates. Demographic data were extracted from records of patients. Before, 6, and 12 months after THA, a Short Form 36 health survey (SF-36) was used to assess HRQOL. Before THA, 6 and 12 months after THA, Physical (PCS), and mental component scores (MCS) were obtained from a hundred separately for each subscale of the questionnaire. The Paired t-test was used to compare HRQOL before and after THA.

Results

Both 6 and 12 months after THA, HRQOL was significantly increased compared to previous THA (P = 0.001). In the first half-year after THA, vitality and emotional state were not different from pre-surgery. However, 12 months after THA, these two subscales also were significantly improved. Although, 6 months after THA, the PCS has dramatically gone up compared to the previous THA (P = 0.012), despite MCS was remained steady. Nonetheless, by comparison with the before surgery, 12 months after THA, MSC notably improved (P = 0.048).

Conclusion

HRQOL was appreciably improved by the THA in the elderly after 12 months. The improvement in HRQoL in the first 6 months after THA is related to the promotion in the physical aspect (PCS score), and in the second 6 months after THA is related to the promotion in the psychological aspect (MCS score).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00762-3.

Impact of COVID-19 Pandemic on Mental Health and Quality of Life. An Exploratory Study During the First Outbreak in Italy

The coronavirus pandemic has been sweeping the world for more than a year. As physical health begins to stabilize in the western world, an increasing concern is related to the impact of the virus and its containment measures on people's mental health. This work aimed to explore the effect of demographic factors (age, gender, level of education, and socioeconomic status) and variables such as fear of COVID-19 and social support in predicting the quality of life and mental health of adults during the first wave of the pandemic in Italy. Through an online survey with 1087 Italian adults (M = 39.7, SD = 16.39; 74.4% women), gender and socioeconomic status emerged as crucial factors in determining differences regarding people's responses and reactions to the pandemic. In addition, the results highlighted the importance of perceived social support and a moderate fear of COVID-19 in predicting people's quality of life and mental health. The study suggests important guidelines for the development of interventions to support the population's well-being and mental health.

Trauma-Informed Intervention with Children: Integrating the CANS Assessment with the ARC Framework in a Clinical Setting

Ongoing trauma-focused assessment is critical to developing trauma-informed treatment plans. The current study examines the clinical benefits of utilizing the Child and Adolescent Needs and Strengths (CANS) assessment to guide intervention based on the Attachment, Self-Regulation, and Competency (ARC) model to address children's trauma related symptoms in a rural state. WV CANS was developed by adapting the language of original CANS to be culturally specific to the state's unique situation and culture in consultation with the original CANS developer. This study included the data from children who received mental health services under WV CANS-ARC mapping from 2017 to 2019. Children's trauma-related symptoms are assessed using the WV CANS at intake and every 90 days to identify any changes in their symptoms. In order to examine the changes of traumatic symptoms over time, the study was limited to children who have at least three time points, with a total of 362 children used for the current analyses using Multilevel modeling with SAS PROC MIXED. The study found that children's trauma related symptoms significantly decreased in all ARC outcome domains over time after adjusting for basic demographic variables. The current study contributes to the evidence on treatment for children's trauma-related symptoms, especially with the application of the CANS-ARC mapping in a real-world clinical setting. The findings have significant implications for clinicians in integrating the assessment and treatment process using CANS-ARC mapping and for cross-system collaboration with continuity of care serving children who have experienced trauma.

Inequalities in full vaccination coverage based on maternal education and wealth quintiles among children aged 12-23 months: further analysis of national cross-sectional surveys of six South Asian countries

OBJECTIVE

This study was conducted to compare full vaccination coverage and its inequalities (by maternal education and household wealth quintile).

DESIGN

This further analysis was based on the data from national-level cross-sectional Demographic and Health Survey (DHS) from six countries in South Asia.

SETTING

We used most recent DHS data from six South Asian countries: Nepal, India, Pakistan, Bangladesh, Afghanistan and the Maldives. The sample size of children aged 12-23 months ranged from 6697 in the Maldives to 628 900 in India.

PRIMARY AND SECONDARY OUTCOME MEASURES

To measure absolute and relative inequalities of vaccination coverage, we used regression-based inequality measures, slope index of inequality (SII) and the relative index of inequality (RII), respectively, by maternal education and wealth quintile.

RESULTS

Full vaccination coverage was the highest in Bangladesh (84%) and the lowest in Afghanistan (46%), with an average of 61.5% for six countries. Pakistan had the largest inequalities in coverage both by maternal education (SII: -50.0, RII: 0.4) and household wealth quintile (SII: -47.1, RII: 0.5). Absolute inequalities were larger by maternal education compared with wealth quintile in four of the six countries. The relative index of inequality by maternal education was lower in Pakistan (0.5) and Afghanistan (0.5) compared with Nepal (0.7), India (0.7) and Bangladesh (0.7) compared with rest of the countries. By wealth quintiles, RII was lower in Pakistan (0.5) and Afghanistan (0.6) and higher in Nepal (0.9) and Maldives (0.9).

CONCLUSIONS

The full vaccination coverage in 12-23 months old children was below 85% in all six countries. Inequalities by maternal education were more profound than household wealth-based inequalities in four of six countries studied, supporting the benefits of maternal education to improve child health outcome.

Impact of health system strengthening on delivery strategies to improve child immunisation coverage and inequalities in rural Madagascar

Background

To reach global immunisation goals, national programmes need to balance routine immunisation at health facilities with vaccination campaigns and other outreach activities (eg, vaccination weeks), which boost coverage at particular times and help reduce geographical inequalities. However, where routine immunisation is weak, an over-reliance on vaccination campaigns may lead to heterogeneous coverage. Here, we assessed the impact of a health system strengthening (HSS) intervention on the relative contribution of routine immunisation and outreach activities to reach immunisation goals in rural Madagascar.

Methods

We obtained data from health centres in Ifanadiana district on the monthly number of recommended vaccines (BCG, measles, diphtheria, tetanus and pertussis (DTP) and polio) delivered to children, during 2014–2018. We also analysed data from a district-representative cohort carried out every 2 years in over 1500 households in 2014–2018. We compared changes inside and outside the HSS catchment in the delivery of recommended vaccines, population-level vaccination coverage, geographical and economic inequalities in coverage, and timeliness of vaccination. The impact of HSS was quantified via mixed-effects logistic regressions.

Results

The HSS intervention was associated with a significant increase in immunisation rates (OR between 1.22 for measles and 1.49 for DTP), which diminished over time. Outreach activities were associated with a doubling in immunisation rates, but their effect was smaller in the HSS catchment. Analysis of cohort data revealed that HSS was associated with higher vaccination coverage (OR between 1.18 per year of HSS for measles and 1.43 for BCG), a reduction in economic inequality, and a higher proportion of timely vaccinations. Yet, the lower contribution of outreach activities in the HSS catchment was associated with persistent inequalities in geographical coverage, which prevented achieving international coverage targets.

Conclusion

Investment in stronger primary care systems can improve vaccination coverage, reduce inequalities and improve the timeliness of vaccination via increases in routine immunisations.

Validation of the EQ-5D in Taiwan using item response theory

Background

Our study aims to provide validity evidence for the EuroQol five dimensions questionnaire (EQ-5D) in the National Health Interview Survey of Taiwan in the 2013 wave and further interpret the EQ-5D scores for patients with chronic diseases. Another goal of the study was to use item response theory (IRT) to identify items that are informative for assessing quality of life using EQ-5D.

Methods

There were 17,260 participants, aged 12-64, who completed the interviews in our study. Psychometric methods, including factor analysis and the IRT model known as the Graded Response Model (GRM), were used to assess the unidimensionality of EQ-5D and its item properties. Correlation analysis was used to assess whether EQ-5D scores are associated with scores from the 36-Item Short Form Survey (SF-36).

Results

The EQ-5D scores have moderate internal consistency (Cronbach’s alpha: 0.60) and a scree plot suggests that the EQ-5D measure is unidimensional. The item information function analysis from the IRT model demonstrates that the first 3 items, “mobility,” “self-care,” and “usual activities” are the most informative items for patients who have chronic diseases and health-related quality of life below the 10th percentile. The EQ-5D scores have a moderate correlation (r: 0.61) with SF-36 scores.

Conclusions

The EQ-5D scale shows promise for use in the general population. The IRT model informs our interpretation of the EQ-5D scores. Given the time constraints in clinical settings, we suggest using the first three items in EQ-5D to measure the health-related quality of life for patients with chronic diseases.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12334-y.

Adding Family Digital Supports to Classroom-Based Physical Activity Interventions to Target In- and Out-of-School Activity: An Evaluation of the Stay Active Intervention during the COVID-19 Pandemic

Remotely delivered interventions are promising for reaching large numbers of people, though few have targeted multiple levels of influence such as schools and families. This study evaluated two versions (arms) of a remotely delivered classroom-based physical activity (CBPA) intervention. One arm solely included remote CBPA; the other included remote CBPA and mobile health (mHealth) family supports. Six schools were randomized to CBPA or CBPA+Family. Both arms were remotely delivered for seven weeks. CBPA+Family added behavior change tools delivered via text messages and newsletters to caregiver/child dyads. Garmin devices measured moderate-to-vigorous activity (MVPA) in both arms and were used for goal setting/monitoring in the CBPA+Family arm (integrated with the text messages). Caregivers completed surveys evaluating intervention acceptability. 53 participants (CBPA n=35; CBPA+Family n=18; 9.7±0.7 years) were included. Increases in MVPA were similar between arms, showing a pre-post effect of the CBPA but no additional effect of family supports. MVPA was low at baseline and during the first 3 weeks (CBPA 7.5±3.1 minutes/day; CBPA+Family 7.9±2.7 minutes/day) and increased by Weeks 6-8 (CBPA 56.8±34.2 minutes/day; CBPA+Family 49.2±18.7 minutes/day). Approximately 90% of caregivers reported high satisfaction with the added family support content. CBPA+Family participants wore the Garmin later into the study period. Remote delivery of CBPA appears feasible and effective for supporting increases in children's MVPA. Adding family supports to school-based interventions appears acceptable and may support engagement, demonstrating promise for more multilevel/multi-setting interventions, though the multilevel intervention was not more effective than the single-level intervention in increasing children's MVPA.

Fear of COVID-19 changes economic preferences: evidence from a repeated cross-sectional MTurk survey

The personal experience of events such as financial crises and natural disasters can alter economic preferences. We administered a repeated cross-sectional preference survey during the early stages of the COVID-19 outbreak, collecting three bi-weekly samples from participants recruited through Amazon Mechanical Turk. The survey elicits economic preferences, self-reported fear of the pandemic, and beliefs about economic and health consequences. Preferences varied over time and across regions, and self-reported fear of the pandemic explains this variation. These findings suggest caution about the generalizability of some types of experimental work during times of heightened fear.

Healthcare waste management in the Tamale Central Hospital, northern Ghana. An assessment before the emergence of the COVID-19 pandemic in Ghana

Healthcare waste (HCW) poses several environmental and public health challenges. However, much attention has not been given to its management. The present study sought to assess the healthcare waste management (HCWM) practices in the Tamale Central Hospital (TCH) by characterizing and measuring the quantities of waste generated and the associated implications. Observation of the value chain of healthcare waste management, waste quantification using a weighing scale (Top-pan-spring balance), and semi-structured interviews were used in the data collection. The study revealed that, except for sharps, there was no segregation of infectious and non-infectious waste, and healthcare waste was not treated before final disposal. The study showed that a daily record of 5.1 kg of sharps, 24.46 kg of infectious waste and 59.45 kg of general waste was generated. The maternity ward produced more general waste (14 kg), whereas the theatre generated the highest infectious waste (5.70 kg) and sharps (0.8 kg) daily. Generally, the maternity ward recorded the highest daily waste generation of 17.9 kg. The waste treatment method available in the hospital was incineration. However, the incinerator was found to be dysfunctional. Thus, an improvised method (dug pit) was used irrespective of the associated health and environmental implications. The study also revealed that the hospital did not quantify the amount of solid waste that was generated. Inadequate finance and lack of supervision were linked to the problem of poor healthcare waste management in the study area. Also, 82% of the workers mentioned that there was poor HCW segregation at the departments whereas 76% of the patients who received healthcare at the facility were unsatisfied with the HCWM practices. A strong linear relationship in the responses made was recorded. The healthcare waste management index showed that the HCWM practice at the facility was unsatisfactory as it was medium-ranked. The study, therefore, recommends that the hospital considers constructing an on-site waste treatment facility, segregate and quantify waste for effective allocation of resources for treating healthcare waste.

Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention

OBJECTIVE

Psychosocial and economic (socioeconomic) barriers, including poverty, stigma and catastrophic costs, impede access to tuberculosis (TB) services in low-income countries. We aimed to characterise the socioeconomic barriers and facilitators of accessing TB services in Nepal to inform the design of a locally appropriate socioeconomic support intervention for TB-affected households.

DESIGN

From August 2018 to July 2019, we conducted an exploratory qualitative study consisting of semistructured focus group discussions (FGDs) with purposively selected multisectoral stakeholders. The data were managed in NVivo V.12, coded by consensus and analysed thematically.

SETTING

The study was conducted in four districts, Makwanpur, Chitwan, Dhanusha and Mahottari, which have a high prevalence of poverty and TB.

PARTICIPANTS

Seven FGDs were conducted with 54 in-country stakeholders, grouped by stakeholders, including people with TB (n=21), community stakeholders (n=13) and multidisciplinary TB healthcare professionals (n=20) from the National TB Programme.

RESULTS

The perceived socioeconomic barriers to accessing TB services were: inadequate TB knowledge and advocacy; high food and transportation costs; income loss and stigma. The perceived facilitators to accessing TB care and services were: enhanced championing and awareness-raising about TB and TB services; social protection including health insurance; cash, vouchers and/or nutritional allowance to cover food and travel costs; and psychosocial support and counselling integrated with existing adherence counselling from the National TB Programme.

CONCLUSION

These results suggest that support interventions that integrate TB education, psychosocial counselling and expand on existing cash transfer schemes would be locally appropriate and could address the socioeconomic barriers to accessing and engaging with TB services faced by TB-affected households in Nepal. The findings have been used to inform the design of a socioeconomic support intervention for TB-affected households. The acceptability, feasibility and impact of this intervention on TB-related costs, stigma and TB treatment outcomes, is now being evaluated in a pilot implementation study in Nepal.

Genetic Prion Disease: Insight from the Features and Experience of China National Surveillance for Creutzfeldt-Jakob Disease

Human genetic prion diseases (gPrDs) are directly associated with mutations and insertions in the PRNP (Prion Protein) gene. We collected and analyzed the data of 218 Chinese gPrD patients identified between Jan 2006 and June 2020. Nineteen different subtypes were identified and gPrDs accounted for 10.9% of all diagnosed PrDs within the same period. Some subtypes of gPrDs showed a degree of geographic association. The age at onset of Chinese gPrDs peaked in the 50-59 year group. Gerstmann-Sträussler-Scheinker syndrome (GSS) and fatal familial insomnia (FFI) cases usually displayed clinical symptoms earlier than genetic Creutzfeldt-Jakob disease (gCJD) patients with point mutations. A family history was more frequently recalled in P105L GSS and D178N FFI patients than T188K and E200K patients. None of the E196A gCJD patients reported a family history. The gCJD cases with point mutations always developed clinical manifestations typical of sporadic CJD (sCJD). EEG examination was not sensitive for gPrDs. sCJD-associated abnormalities on MRI were found in high proportions of GSS and gCJD patients. CSF 14-3-3 positivity was frequently detected in gCJD patients. Increased CSF tau was found in more than half of FFI and T188K gCJD cases, and an even higher proportion of E196A and E200K gCJD patients. 63.6% of P105L GSS cases showed a positive reaction in cerebrospinal fluid RT-QuIC. GSS and FFI cases had longer durations than most subtypes of gCJD. This is one of the largest studies of gPrDs in East Asians, and the illness profile of Chinese gPrDs is clearly distinct. Extremely high proportions of T188K and E196A occur among Chinese gPrDs; these mutations are rarely reported in Caucasians and Japanese.