The burden of headache disorders in the adult general population of the Kingdom of Saudi Arabia: estimates from a cross-sectional population-based study including a health-care needs assessment

BACKGROUND

We have previously shown headache to be highly prevalent among adults in Saudi Arabia. Here we estimate associated symptom burden and impaired participation (impaired use of time, lost productivity and disengagement from social activity), and use these estimates to assess headache-related health-care needs in Saudi Arabia.

METHODS

A randomised cross-sectional survey included 2,316 adults (18-65 years) from all 13 regions of the country. It used the standardised methodology of the Global Campaign against Headache with a culturally mandated modification: engagement by cellphone using random digit-dialling rather than door-to-door visits. Enquiry used the HARDSHIP questionnaire, with diagnostic questions based on ICHD-3 beta, questions on symptom burden, enquiries into impaired participation using the HALT index and questions about activity yesterday in those reporting headache yesterday (HY). Health-care "need" was defined in terms of likelihood of benefit. We counted all those with headache on ≥ 15 days/month, with migraine on ≥ 3 days/month, or with migraine or TTH and meeting either of two criteria: a) proportion of time in ictal state (pTIS) > 3.3% and intensity ≥ 2 (moderate-severe); b) ≥ 3 lost days from paid work and/or household chores during 3 months.

RESULTS

For all headache, mean frequency was 4.3 days/month, mean duration 8.4 h, mean intensity 2.3 (moderate). Mean pTIS was 3.6%. Mean lost days from work were 3.9, from household chores 6.6, from social/leisure activities 2.0. Of participants reporting HY, 37.3% could do less than half their expected activity, 19.8% could do nothing. At population-level (i.e., for every adult), 2.5 workdays (potentially translating into lost GDP), 3.6 household days and 1.3 social/leisure days were lost to headache. According to HY data, mean total impaired participation (not distinguishing between work, household and social/leisure) was 6.8%. A total of 830 individuals (35.8%) fulfilled one or more of our needs assessment criteria.

CONCLUSION

A very high symptom burden is associated with a commensurately high burden of impaired participation. The economic cost appears to be enormous. Over a third of the adult population are revealed to require headache-related health care on the basis of being likely to benefit, demanding highly efficient organization of care.

Disparities in COVID-19 Hospitalization at the Intersection of Race and Ethnicity and Income

BACKGROUND

Existing studies have elucidated racial and ethnic disparities in COVID-19 hospitalizations, but few have examined disparities at the intersection of race and ethnicity and income.

METHODS

We used a population-based probability survey of non-institutionalized adults in Michigan with a polymerase chain reaction-positive SARS-CoV-2 test before November 16, 2020. We categorized respondents by race and ethnicity and annual household income: low-income (< $50,000) Non-Hispanic (NH) Black, high-income (≥ $50,000) NH Black, low-income Hispanic, high-income Hispanic, low-income NH White, and high-income NH White. We used modified Poisson regression models, adjusting for sex, age group, survey mode, and sample wave, to estimate COVID-19 hospitalization prevalence ratios by race and ethnicity and income.

RESULTS

Over half of the analytic sample (n = 1593) was female (54.9%) and age 45 or older (52.5%), with 14.5% hospitalized for COVID-19. Hospitalization was most prevalent among low-income (32.9%) and high-income (31.2%) Non-Hispanic (NH) Black adults, followed by low-income NH White (15.3%), low-income Hispanic (12.9%), high-income NH White (9.6%), and high-income Hispanic adults (8.8%). In adjusted models, NH Black adults, regardless of income (low-income prevalence ratio [PR]: 1.86, 95% CI: 1.36-2.54; high-income PR: 1.57, 95% CI: 1.07-2.31), and low-income NH White adults (PR: 1.52, 95% CI: 1.12-2.07), had higher prevalence of hospitalization compared to high-income NH White adults. We observed no significant difference in the prevalence of hospitalization among Hispanic adults relative to high-income NH White adults.

CONCLUSIONS

We observed disparities in COVID-19 hospitalization at the intersection of race and ethnicity and income for NH Black adults and low-income NH White adults relative to high-income NH White adults, but not for Hispanic adults.

Intersectional analysis of social disparities in type 2 diabetes risk among adults in Germany: results from a nationwide population-based survey

BACKGROUND

Differences in type 2 diabetes risk have been reported for several sociodemographic determinants including sex/gender or socioeconomic status. From an intersectional perspective, it is important to not only consider the role of social dimensions individually, but also their intersections. This allows for a deeper understanding of diabetes risk and preventive needs among diverse population groups.

METHODS

As an intersectionality-informed approach, multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was used in a population-based sample of adults without known diabetes in Germany from the cross-sectional survey "Disease knowledge and information needs- Diabetes mellitus (2017)". Diabetes risk was assessed by the German Diabetes Risk Score (GDRS, range 0-122 points), estimating the individual risk of developing type 2 diabetes within the next 5 years based on established self-reported risk factors. Nesting individuals in 12 intersectional strata defined by combining sex/gender, educational level, and history of migration, we calculated measures to quantify the extent to which individual differences in diabetes risk were explained at strata level, and how much this was due to additive or multiplicative intersectional effects of social determinants.

RESULTS

Drawing on data of 2,253 participants, we found good discriminatory accuracy of intersectional strata (variance partition coefficient = 14.00% in the simple intersectional model). Model-predicted GDRS means varied between 29.97 (corresponding to a "low risk" of < 2%) in women with high educational level and a history of migration, and 52.73 ("still low risk" of 2-5%) in men with low educational level without a history of migration. Variance in GDRS between strata was mainly explained by additive effects of social determinants (proportional change in variance to intersectional interaction model = 77.95%) with being male and having low educational level being associated with higher GDRS. There was no evidence of multiplicative effects in individual strata.

CONCLUSIONS

Type 2 diabetes risk differed between intersectional strata and can to some extent be explained at strata level. The role of intersectional effects was minor and needs to be further investigated. Findings suggest a need for specific preventive measures targeted at large groups with increased diabetes risk, such as men and persons with low educational level.

Assessing the population's correct knowledge of malaria in Malaysia: a vital component for malaria elimination certification

BACKGROUND

Malaria remains a public health problem in Malaysia despite a decline in the number of cases in recent years. Public knowledge of malaria is essential to achieving and maintaining malaria elimination. Therefore, this survey assessed the prevalence of people who had ever heard of malaria, had correct knowledge of malaria transmission, symptoms, risk activities, and prevention measures in the Malaysian population, and identified the associated factors involved.

METHODS

The data were obtained from the National Health and Morbidity Survey (NHMS) which was conducted from September to October 2020. A cross-sectional survey with five structured questionnaires using the method of computer-assisted telephone interviews (CATI) was used to collect data. The socio-demographic characteristics such as age, gender, ethnicity, nationality, marital status, educational level, and occupation were recorded. Data were analysed using STATA SE Version 16. Associations between variables were tested using chi-square and logistic regression, with the level of statistical significance set at p < 0.05.

RESULTS

Out of 3085 respondents who participated in this survey, 2491 had ever heard of malaria with a prevalence of 76.1% (95% CI 70.5, 80.9). The prevalence of correct knowledge of malaria transmission was 53.9% (95% CI 50.2, 57.7), symptoms 24.1% (95% CI 21.2, 27.2), risk activities 34.0% (95% CI 29.3, 39.1) and prevention measures 59.7% (95% CI 55.5, 63.7). Multivariate analysis showed that age, ethnicity, and educational level were significantly associated with correct malaria transmission and risk activities. In addition, age and educational level were significantly associated with correct malaria symptoms. Subsequently, only the variable ethnicity showed a significant association with the correct malaria prevention measures.

CONCLUSION

In general, the prevalence of ever heard of malaria was considered high since the survey was performed based on a non-specific malaria population. However, the prevalence of correct knowledge of malaria symptoms and risk activities were considered low. It is concluded that educational level is one of the major factors associated with correct malaria knowledge, along with age and ethnicity. Therefore, based on these findings, targeted intervention and innovation should be planned by malaria programme managers to sustain malaria elimination in Malaysia.

Ante-, Peri-, and Neonatal Factors Associated with Autism Spectrum Disorders in Vietnam: A Population-Based Cross-Sectional Survey

Background

Autism Spectrum Disorders (ASDs) are common behavioral syndromes but limited critical evidence in Vietnam. This study aimed to identify ante-, peri- and neonatal factors for ASDs amongst children in Vietnam.

Methods

This population-based study applied the cross-sectional design with a multistage sampling in 21 urban and rural districts in seven cities/provinces in Vietnam during 2017-2018. Overall, 42,551 children age 18 to 30 months were enrolled in the study. Two phases of assessment using Modified Checklist for Autism in Toddlers (M-CHAT) for screening and diagnostic assessment using Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for confirmation. We employed univariate and binary logistic regression to identify.

Results

Our study showed a fast-growing trend of ASDs amongst children age 18 and 30 months (75.8 per 10,000 individuals). Nine ante-, peri-, and neonatal factors were associated with ASDs: five factors of antenatal period (history of miscarriage/abortion or stillbirth, children conceived by assisted reproduction technologies, having cold, flu or acquiring virus during pregnancy, having gestational diabetes, toxemia, high blood pressure or pre-eclampsia during pregnancy, and having stress or mental disorders during pregnancy); one factors of perinatal period (mode of delivery); and three factors of neonatal period (jaundice, respiratory distress, and newborn seizures).

Conclusion

This first large-scale survey in Vietnam confirms some prenatal, perinatal, and postnatal factors with ASDs amongst children age 18 and 30 months. Future interventions should focus on these factors to early diagnosis and intervention to improve functional outcomes for risky children.

Characterizing the adult exposome in men and women from the general population: Results from the EHES-LUX study

Throughout life individuals are exposed to a large array of diverse environmental exposures (exposome). Hair analyses can assess chronic exposure to a large number of chemicals with less intra-variability than urine and blood. This is essential for studies that aim to achieve a global vision of the exposome. We aimed at characterizing the adult exposome by describing 175 environmental exposures and correlation patterns between and within exposure groups. A subsample of participants of the European Health Examination Survey, covering information on exposure to chemical pollutants in hair samples, were included in the present analysis (N = 442). Concentrations of micronutrients, lifestyle, home environment and socioeconomic information completed the exposome description and were obtained through blood analyses and questionnaires. We detected 29 persistent and non-persistent chemical pollutants in more than 70% of hair samples. Compared to women, men had higher concentrations of pesticides, lower concentrations of micronutrients (with the exception of vitamin A), and presented higher alcohol consumption. Across all exposures, a low median absolute correlation was found, 0.05 (5th - 95th centiles = 0.10, 0.20). We observed higher correlations and median correlations within exposure groups than between groups of exposure. The highest median correlation was observed between plasticizers (bisphenol A and S) in both men (0.50) and women (0.31). A 70% and 95% of cumulative variance was explained by 37 and 73 principal components respectively. We found a wide range of chemical exposures in hair samples of men and women. The adult exposome was complex and multidimensional. Future exposome studies should include hair as a matrix for characterizing exposure to multiple environmental chemicals.

Is elevated ALT associated with lifestyle risk factors? A population-based survey

Purpose

Given the high prevalence of non-alcoholic fatty liver disease (NAFLD) and the role of Alanine aminotransferase (ALT) in diagnosing liver injury along with the increasing prevalence of lifestyle risk factors, we aimed to evaluate the association between serum ALT level and lifestyle risk factors in a population-based survey.

Methods

This was a population-based study conducted in rural and urban areas of Iran in 2016. Cluster sampling method was applied to enroll a total of 31,050 participants aged ≥ 18. Demographic data, anthropometric measures, and laboratory samples were gathered. Multivariate logistic regression analyses were performed using three different cut-off levels for elevated ALT to assess the relationship between elevated ALT and lifestyle risk factors.

Results

The prevalence of elevated ALT was significantly higher in men with elevated body mass index (BMI), waist-to-hip ratio (WTH), hip circumference, and salt consumption, likewise, in women with higher BMI and WTH. In the multivariate logistic model adjusted for age and sex, high WTH (adjusted odds ratio: 1.73; 95% CI 1.52-1.96), BMI > 25 (1.51; 95% CI 1.29-1.76), hip circumference (1.26; 95% CI 1-1.58), and current smoking (0.67; 95% CI 0.56-0.8) were associated with elevated ALT levels using American cut-off (ALT > 33U/L for male and ALT > 25U/L for female). Only physical measurements (BMI, WTH) but not lifestyle risk factors were related to the increased ALT regardless of the selected cut-offs.

Conclusion

As elevated ALT was associated with several lifestyle risk factors, stewardship programs should be established to modify lifestyle risk factors, such as abdominal obesity and physical inactivity.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-022-01137-6.

Who is trying to lose weight? Trends and prevalence in past-year weight loss attempts among US adults 1999-2018 at the intersection of race/ethnicity, gender, and weight status

Common stereotypes of those who desire or attempt to lose weight often center on the experience of White, thin women. However, prior studies have neglected how systems of oppression at intersection of race/ethnicity, gender, and weight status may interact to place certain subpopulations at elevated risk. Repeated cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 (n = 53,528), a population-representative sample of US adults, were used to 1) assess trends in past-year weight loss attempts using the Kendall-Mann trend test stratifying by race/ethnicity, gender, and weight status, and 2) estimate the adjusted prevalence of weight loss attempts over the combined 20-year period for combinations of race/ethnicity, gender, and weight status using logistic regression. There were significant monotonic trends from 1999 to 2018 for non-Hispanic Black men (43.8% to 67.8%, FDR adjusted p = .022) with an obese BMI, but not for any other groups. After adjusting for covariates, weight loss attempt prevalence was positively associated with BMI category for all race/ethnicity-gender combinations, although the degree of association differed. These findings underscore the need to use an intersectional lens in weight-related research. Despite limited long-term beneficial health impact, certain population subgroups, particularly Black men with an obese BMI, are increasingly trying to lose weight.

Seroprevalence of anti-SARS-CoV-2 antibodies in Senegal: a national population-based cross-sectional survey, between October and November 2020

Objectives

A nationwide cross-sectional epidemiological survey was conducted to capture the true extent of coronavirus disease 2019 (COVID-19) exposure in Senegal.

Methods

Multi-stage random cluster sampling of households was performed between October and November 2020, at the end of the first wave of COVID-19 transmission. Anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies were screened using three distinct ELISA assays. Adjusted prevalence rates for the survey design were calculated for each test separately, and thereafter combined. Crude and adjusted prevalence rates based on test performance were estimated to assess the seroprevalence. As some samples were collected in high malaria endemic areas, the relationship between SARS-CoV-2 seroreactivity and antimalarial humoral immunity was also investigated.

Results

Of the 1463 participants included in this study, 58.8% were female and 41.2% were male; their mean age was 29.2 years (range 0.20-84.8.0 years). The national seroprevalence was estimated at 28.4% (95% confidence interval 26.1-30.8%). There was substantial regional variability. All age groups were impacted, and the prevalence of SARS-CoV-2 was comparable in the symptomatic and asymptomatic groups. An estimated 4 744 392 (95% confidence interval 4 360 164-5 145 327) were potentially infected with SARS-CoV-2 in Senegal, while 16 089 COVID-19 RT-PCR laboratory-confirmed cases were reported by the national surveillance. No correlation was found between SARS-CoV-2 and Plasmodium seroreactivity.

Conclusions

These results provide a better estimate of SARS-CoV-2 dissemination in the Senegalese population. Preventive and control measures need to be reinforced in the country and especially in the south border regions.

SARS-CoV-2 seroprevalence and associated risk factors in periurban Zambia: a population-based study

BACKGROUND

We nested a seroprevalence survey within the TREATS (Tuberculosis Reduction through Expanded Antiretroviral Treatment and Screening) project. We aimed to measure the seroprevalence of SARS-CoV-2 infection and investigate associated risk factors in one community (population ∼27,000) with high prevalence of TB/HIV in Zambia.

METHODS

The study design was cross-sectional. A random sample of 3592 individuals aged ≥15 years enrolled in the TREATS TB-prevalence survey were selected for antibody testing. Randomly selected blocks of residence were visited between October 2020 and March 2021. Antibodies against SARS-CoV-2 were detected using Abbott- ARCHITECT SARS-CoV-2 IgG assay.

RESULTS

A total of 3035/3526 (86.1%) individuals had a blood sample taken. Antibody testing results were available for 2917/3035 (96.1%) participants. Overall, 401/2977 (13.5%) individuals tested positive for IgG antibodies. Seroprevalence was similar by sex (12.7% men vs 14.0% women) and was lowest in the youngest age group 15-19 years (9.7%) and similar in ages 20 years and older (∼15%). We found no evidence of an association between seroprevalence and HIV-status or TB. There was strong evidence (p <0.001) of variation by time of enrollment, with prevalence varying from 2.8% (95% CI 0.8-4.9) among those recruited in December 2020 to 33.7% (95% CI 27.7-39.7) among those recruited in mid-February 2021.

CONCLUSION

Seroprevalence was 13.5% but there was substantial variation over time, with a sharp increase to approximately 35% toward the end of the second epidemic wave.

Health information-seeking behavior associated with linguistic group membership: latent class analysis of a population-based cross-sectional survey in Italy, August to September 2014

Background

Evidence suggests an increasing demand for culturally and linguistically responsive disease prevention programs and health interventions. It is important to understand how individuals seek health information to address the potential needs of the health care system.

Methods

Latent classes of health information-seeking behaviors in a linguistically mixed region of Italy were explored through a population-based telephone survey of ten health information sources. Data were collected in August and September 2014 from 504 adults in South Tyrol, Italy (primary language German, 68%; Italian, 28%), and analyzed using latent class analysis and latent class multinomial logistic regression models.

Results

Three classes of health information-seeking behaviors emerged: “multidimensional” (23.3%), “interpersonal” (38.6%) and “technical/online” (38.1%). Compared to the “technical/online” class, “interpersonal” class members were older, had lower education than high school, and were less likely to be of Italian ethnicity. “Multidimensional” class members were more likely to be female, older, and of German ethnicity than those in the “technical/online” class.

Conclusions

Linguistic ethnicity explains membership in classes on health information-seeking behavior. Policymakers and healthcare providers should consider the health information-seeking behaviors of population subgroups to promote health and medical care in linguistic minority groups.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00847-w.

Prevalence of SARS-Cov-2 antibodies and living conditions: the French national random population-based EPICOV cohort

BACKGROUND

We aimed to estimate the seroprevalence of SARS-CoV-2 infection in France and to identify the populations most exposed during the first epidemic wave.

METHODS

Random selection of individuals aged 15 years or over, from the national tax register (96% coverage). Socio-economic data, migration history, and living conditions were collected via self-computer-assisted-web or computer-assisted-telephone interviews. Home self-sampling was performed for a random subsample, to detect IgG antibodies against spike protein (Euroimmun), and neutralizing antibodies with in-house assays, in dried blood spots (DBS).

RESULTS

The questionnaire was completed by 134,391 participants from May 2nd to June 2st, 2020, including 17,441 eligible for DBS 12,114 of whom were tested. ELISA-S seroprevalence was 4.5% [95% CI 3.9-5.0] overall, reaching up to 10% in the two most affected areas. High-density residences, larger household size, having reported a suspected COVID-19 case in the household, working in healthcare, being of intermediate age and non-daily tobacco smoking were independently associated with seropositivity, whereas living with children or adolescents did not remain associated after adjustment for household size. Adjustment for both residential density and household size accounted for much of the higher seroprevalence in immigrants born outside Europe, twice that in French natives in univariate analysis.

CONCLUSION

The EPICOV cohort is one of the largest national representative population-based seroprevalence surveys for COVID-19. It shows the major role of contextual living conditions in the initial spread of COVID-19 in France, during which the availability of masks and virological tests was limited.

A Validation Study of the National Database of Health Insurance Claims and Specific Health Checkups of Japan Regarding the Annual Number of Tooth Extractions Performed Across the Entire Japanese Population

This report describes a validation study of data in the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) obtained by nationwide surveys on tooth extractions. The following 3 data sources on tooth extractions in Japan were compared: (1) the Nationwide Survey of the Reasons for Permanent Tooth Extractions in Japan (a previous survey conducted by the present authors); (2) the Statistics on Medical Care Activities in Public Health Insurance; and (3) the 4th NDB Open Data Japan. Source 1 was a nationwide survey conducted in 2018; sources 2 and 3 comprised data that are freely available for use by the public. In Source 1, 2,345 of 5,250 dentists approached responded to the questionnaire (recovery rate: 44.8%). The number of extracted teeth among younger age groups (aged 25-50 years) reported in Source 1 was lower than that in the other two sources. In contrast, the number of extracted teeth among older age groups reported in Source 1 was higher than that reported in the other two sources. However, when stratified by age group, all differences across the 3 sources regarding the mean annual number of tooth extractions were <0.05 teeth/year. The present results suggest that the NDB is a reliable resource for data on tooth extractions performed across the entire Japanese population.

Weight Stigma and Disease and Disability Concepts of Obesity: A Survey of the German Population

INTRODUCTION

Recent years have witnessed a medicalization of obesity, promoting a classification as a disease or disability in order to reduce or protect against weight stigma and discrimination. This study sought to investigate the public understanding of the disability and disease concepts in obesity, their acceptance, and association with weight stigma.

METHODS

In a representative German population sample (n = 2,524), public views of obesity as a disease or disability were assessed via a self-report questionnaire. For the assessment of weight stigma, the Weight Control/Blame subscale from the Antifat Attitudes Test was used.

RESULTS

A significantly greater acceptance of the disease than the disability concept was found (37.1 vs. 15.4%). Both disease and disability were mainly viewed as physical conditions, although one-third also viewed obesity as a mental disease. While agreement with the disease concept - especially of physical and genetic disease - significantly predicted lower weight stigma; agreement with the disability concept - especially of mental or intellectual disability - predicted higher weight stigma.

CONCLUSIONS

These results suggest a careful use of the disease and disability terms and precise definitions. The disability concept in particular carries notions that are publicly devalued.

The mediating role of vaccine hesitancy between maternal engagement with anti- and pro-vaccine social media posts and adolescent HPV-vaccine uptake rates in the US: The perspective of loss aversion in emotion-laden decision circumstances

While Human Papillomavirus (HPV) is a prominent cause of cervical cancer and mortality among underserved women, HPV vaccine completion rates remain stagnant (54%) among US adolescents. Our objective is to identify how adolescents' mothers' engagement with anti-vaccine versus pro-vaccine social media content is associated with their children's HPV vaccination rates via increased vaccine hesitancy. We employ the notion of loss aversion escalated in an emotion-laden circumstance in consumer behavior literature given that HPV vaccination decisions directly affect children's well-being. Based on this escalated loss aversion tendency for an emotion-laden decision, we explain why anti-vaccine content disproportionately increases mothers' overarching vaccine hesitancy, while pro-vaccine content does not decrease vaccine hesitancy. We conducted a population-based survey among 426 mothers of US adolescents aged 13-18. Our sample closely mimics the socioeconomic and demographic factors of the population group of mothers of adolescents in the US census. Our results show that anti-vaccine social media posts are associated with increases in mothers' overarching vaccine hesitancy and with decreases in their children's HPV vaccination rates, while pro-vaccine content has no significant association with either.

The Prevalence of Overactive Bladder Symptoms in Women in Algeria, Egypt, Jordan and Lebanon: A Cross-Sectional Population-Based Survey

Aims

Estimate the prevalence of symptoms suggestive of overactive bladder (OAB) in women living in the Middle East to describe their demographic characteristics and explore treatment-seeking behavior.

Methods

Cross-sectional, population-based survey of women aged ≥ 40 years resident in Algeria, Jordan, Lebanon or Egypt. Respondents were recruited using computer-assisted telephone interview over approximately 4 months. Eligible respondents were asked to complete the OAB-V8, a validated questionnaire that explores the extent of bother from the key symptoms of OAB without clinical investigations. In addition, information regarding demographics, comorbidities and treatment behavior was collected, and respondents were stratified by age.

Results

A total of 2297 eligible women agreed to participate. Mean age was 54 ± 10 years; over half (59.3%) were aged 40–55 years. Overall, 53.8% of eligible women had symptoms suggestive of OAB (Jordan 58.5%; Egypt 57.5%; Algeria 49.9%; Lebanon 49.0%), with over 90% also reporting symptoms of urinary incontinence. Only 13.0% of women with symptoms suggestive of OAB were currently receiving treatment, while most (74.3%) had never been treated; these data were consistent across country and age categories. Among the untreated subgroup, almost half (48.7%) reported they were ‘not bothered by symptoms,’ while 8.4% considered OAB to be ‘part of normal aging’ and 4.7% did not know it was treatable.

Conclusion

A high prevalence of symptoms suggestive of OAB was observed, and the majority had symptoms of urinary incontinence. Despite the high prevalence, most women had never received treatment. Considering the potential significant impact of OAB symptoms on health, quality of life and productivity, these findings highlight an unmet medical need in the population studied. Strategies to improve treatment-seeking behavior (e.g., through education and tackling the stigma associated with OAB symptoms) may improve the diagnosis, management and health outcomes of women with OAB in the Middle East.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12325-020-01588-4.

Population-based seroprevalence surveys of anti-SARS-CoV-2 antibody: An up-to-date review

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has led to a global pandemic. However, the majority of currently available data are restricted to laboratory-confirmed cases for symptomatic patients, and the SARS-CoV-2 infection can manifest as an asymptomatic or mild disease. Therefore, the true extent of the burden of COVID-19 may be underestimated. Improved serological detection of specific antibodies against SARS-CoV-2 could help estimate the true numbers of infections. This article comprehensively reviews the associated literature and provides updated information regarding the seroprevalence of the anti-SARS-CoV-2 antibody. The seroprevalence can vary across different sites and the seroprevalence can increase with time during longitudinal follow-up. Although healthcare workers (HCWs), especially those caring for COVID-19 patients, are considered as a high-risk group, the seroprevalence in HCWs wearing adequate personal protective equipment is thought to be no higher than that in other groups. With regard to sex, no statistically significant difference has been found between male and female subjects. Some, but not all, studies have shown that children have a lower risk than other age groups. Finally, seroprevalence can vary according to different populations, such as pregnant women and hemodialysis patients; however, limited studies have examined these associations. Furthermore, the continued surveillance of seroprevalence is warranted to estimate and monitor the growing burden of COVID-19.

Psychometric validation of a Saudi Arabian version of the sf-36v2 health survey and norm data for Saudi Arabia

Background

Adaptation of a patient-reported outcomes survey into a new language requires careful translation procedures as well as qualitative and quantitative psychometric testing. This study aimed to evaluate the basic psychometric properties of the new Saudi Arabian SF-36v2 and establish norm data for Saudi Arabia.

Methods

Translation and adaptation of the SF-36v2 used standard methodology. Psychometric validation included two stages: 1) A qualitative study (n = 100) explored the components of health and health-related quality of life considered important in Saudi Arabia and evaluated the content validity of the SF-36v2 in Saudi Arabia, and 2) A quantitative study (n = 6166) evaluated the basic psychometric properties of the Saudi SF-36v2 and established norm data for Saudi Arabia. Comparison with US general population data (n = 4040) evaluated differential item function (DIF) and cross-national differences.

Results

The qualitative study supported the content validity of the Saudi SF-36v2. Cognitive debriefing identified only few and minor problems. Psychometric analyses supported item convergence within scales and differentiation across scales of the SF-36v2. Scale level exploratory factor analyses did not support the typical distinction between physical health and mental health components. Internal consistency reliability was satisfactory for all scales except the social function scale (alpha = 0.67). Cross-national DIF was identified for 9 items. In the Saudi general population, the average vitality score was lower for women (− 2.71 points) compared to men. For men, older age groups scored lower on the physical function scale (− 3.31) and the physical health component (− 3.06). For women, older age groups scored lower on the role physical (− 3.72), bodily pain (− 3.66), and vitality (− 2.32) scales as well as the physical health component (− 3.52). Compared to the 2009 United States general population, and after adjusting for age, gender, and differential item function, persons in Saudi Arabia had lower average scores for the physical function (− 3.10), role physical (− 4.75), social function (− 4.23), role emotional (− 5.67), and mental health (− 4.82) scales, as well as the mental health component (− 4.57).

Conclusion

This Saudi normative study of patient reported outcomes supported the validity and reliability of the new Saudi SF-36v2 and found cross-national differences with the USA.

The declining trend of HIV-Infection among pregnant women in Cameroon infers an epidemic decline in the general population

Background

HIV remains a generalised epidemic in Cameroon, with regular sentinel surveillance surveys (SSS) conducted among pregnant women to monitor the epidemiological dynamics, and for strategic policy making. Our main objective was to actualise data on HIV epidemiology, and compare the trends overtime among pregnant women versus data from the general population in Cameroon.

Methods

Sentinel surveillance was conducted in 2016 among pregnant women in the 10 regions (60 sites) of Cameroon, targeting 7,000 first antenatal care (ANC-1) attendees (4,000 in urban; 3,000 in rural). HIV testing was done following the serial national algorithm at the National Public Health Laboratory. Results of 2016 were compared with 2009 and 2012 dataset, alongside reports from the general population; with p < 0.05 considered statistical significant.

Findings

A total of 6,859 ANC-1 (97.99% sampling) were enrolled in 2016, with 99.19% (6,513/6,566) acceptability for HIV testing; similar to performances in 2009 and 2012 (>99%). National prevalence of HIV was 5.70% (389/6,819), similar between urban (5.58%) and rural (5.87%) settings. HIV prevalence among pregnant women declined significantly from 2009 (7.6%), 2012 (7.8%) to 2016 (5.7%), p < 0.0001; with a similar declining trend in the general population: from 2004 (5.5%), 2011 (4.3%) to 2017 (3.4%), p < 0.0001. Difference between SSS and the population-based survey was non-significant (r = 0.6; p = 0.285). Following geographical settings, HIV prevalence was higher in urban vs. rural settings from 2009-2012 (p < 0.0001), followed by similar rates in 2016. Early-age infection (15–24 years) decreased from 6.7% in 2009 to 3.4% in 2016, with remarkable declines in new infections within the age ranges 15–19 years (5.1%–1.57%) and 20–24 years (7.8%–4.39%).

Interpretation

With high acceptability in HIV testing, the prevalence of HIV-infection through SSS indicates a declining but generalised epidemic among pregnant women in Cameroon. Of note, as the declining prevalence among pregnant women also reflects an epidemic reduction in the general population, SSS represents an efficient strategy to understand the dynamics of HIV epidemics in the general Cameroonian population, pending validation by periodic population surveys.

Knowledge and stigma of latent tuberculosis infection in Brazil: implications for tuberculosis prevention strategies

Background

Tuberculosis (TB) elimination requires treatment of millions of persons with latent M. tuberculosis infection (LTBI). LTBI treatment acceptance depends on population-wide TB knowledge and low stigma, but limited data are available on the relationship between stigma and knowledge. We assessed knowledge of TB disease and LTBI throughout Brazil and examined their association with TB stigma and incidence.

Methods

We performed a nationwide survey with multi-stage probability design through AmericasBarometer from April–May 2017; the sample was representative of Brazil at regional and national levels. Knowledge of and stigma toward TB were assessed by validated survey questions.

Results

Survey-weighted responses of 1532 individuals suggest that 57% of the population knew LTBI can occur, and 90% would seek treatment for it. Regarding active TB, 85% knew TB symptoms, 70% reported they should avoid contact with someone with active TB, and 24% had stigma toward persons with TB (i.e., thought persons with tuberculosis should feel ashamed, or deserved their illness). In regression models adjusting for clinical and demographic variables, knowledge of LTBI was associated with increased stigma toward persons with TB (adjusted odds ratio [OR] = 2.13, 95% confidence interval [CI]: 1·25–3.63, for “should feel ashamed”; OR = 1·82, 95% CI: 1·15–2·89, for “deserve illness”). Adjusting for regional TB incidence did not affect this association.

Conclusions

High proportions of this representative Brazilian population had knowledge of LTBI and were willing to seek treatment for it. However, such knowledge was associated with TB-specific stigma. Strategies to educate and implement treatment of latent tuberculosis must include efforts to decrease TB stigma.

Use and awareness of and willingness to self-test for HIV: an analysis of cross-sectional population-based surveys in Malawi and Zimbabwe

BACKGROUND

Many southern African countries are nearing the global goal of diagnosing 90% of people with HIV by 2020. In 2016, 84 and 86% of people with HIV knew their status in Malawi and Zimbabwe, respectively. However, gaps remain, particularly among men. We investigated awareness and use of, and willingness to self-test for HIV and explored sociodemographic associations before large-scale implementation.

METHODS

We pooled responses from two of the first cross-sectional Demographic and Health Surveys to include HIV self-testing (HIVST) questions in Malawi and Zimbabwe in 2015-16. We investigated sociodemographic factors and sexual risk behaviours associated with previously testing for HIV, and past use, awareness of, and future willingness to self-test using univariable and multivariable logistic regression, adjusting for the sample design and limiting analysis to participants with a completed questionnaire and valid HIV test result. We restricted analysis of willingness to self-test to Zimbabwean men, as women and Malawians were not systematically asked this question.

RESULTS

Of 31,385 individuals, 31.2% of men had never tested compared with 16.5% of women (p < 0.001). For men, the likelihood of having ever tested increased with age. Past use and awareness of HIVST was very low, 1.2 and 12.6%, respectively. Awareness was lower among women than men (9.1% vs 15.3%, adjusted odds ratio [aOR] = 1.55; 95% confidence interval [CI]: 1.37-1.75), and at younger ages, and lower education and literacy levels. Willingness to self-test among Zimbabwean men was high (84.5%), with greater willingness associated with having previously tested for HIV, being at high sexual risk (highest willingness [aOR = 3.74; 95%CI: 1.39-10.03, p < 0.009]), and being ≥25 years old. Wealthier men had greater awareness of HIVST than poorer men (p < 0.001). The highest willingness to self-test (aOR = 3.74; 95%CI: 1.39-10.03, p < 0.009) was among men at high HIV-related sexual risk.

CONCLUSIONS

In 2015-16, many Malawian and Zimbabwean men had never tested for HIV. Despite low awareness and minimal HIVST experience, willingness to self-test was high among Zimbabwean men, especially older men with moderate-to-high HIV-related sexual risk. These data provide a valuable baseline against which to investigate population-level uptake of HIVST as programmes scale up. Programmes introducing, or planning to introduce, HIVST should consider including relevant questions in population-based surveys.

Field-testing of a rapid survey method to assess the prevalence and causes of hearing loss in Gao'an, Jiangxi province, China

BACKGROUND

The Rapid Assessment of Hearing Loss (RAHL) survey protocol aims to measure the prevalence and causes of hearing loss in a low cost and rapid manner, to inform planning of ear and hearing services. This paper reports on the first field-test of the RAHL in Gao'an County, Jiangxi Province, China. This study aimed to 1) To report on the feasibility of RAHL; 2) report on the estimated prevalence and causes of hearing loss in Gao'an.

METHODS

A cross-sectional population-based survey was conducted in September-October 2018. Forty-seven clusters in Gao'an County were selected using probability-proportionate-to-size sampling. Within clusters, compact segment sampling was conducted to select 30 people aged 50+. A questionnaire was completed covering sociodemographics, hearing health, and risk factors. Automated pure-tone audiometry was completed for all participants, using smartphone-based audiometry (hearTest), at 0.5, 1, 2, 4 kHz (kHz). All participants had their ears examined by an Ear Nose and Throat (ENT) doctor, using otoscopy, and probable causes of hearing loss assigned. Prevalence estimates were age and sex standardised to the Jiangxi population. Feasibility of a cluster size of 30 was examined by assessing the response rate, and the proportion of clusters completed in 1 day.

RESULTS

1344 of 1421 eligible participants completed the survey (94.6%). 100% of clusters were completed in 1 day. The survey was completed in 4.5 weeks. The prevalence of moderate or greater hearing loss (pure-tone average of 0.5, 1, 2, 4 kHz of > = 41dBHL in the better ear) was 16.3% (95% CI = 14.3, 18.5) and for any level of hearing loss (pure-tone average of > = 26dBHL in the better ear) the prevalence was 53.2% (95% CI = 49.2, 57.1). The majority of hearing loss was due to acquired sensorineural causes (91.7% left; 92.1% right). Overall 54.0% of the population aged 50+ (108,000 people) are in need of diagnostic audiology services, 3.4% were in need of wax removal (7000 people), and 4.8% were in need of surgical services (9500 people). Hearing aid coverage was 0.4%.

CONCLUSION

The RAHL survey protocol is feasible, demonstrated through the number of people examined per day, and the high response rate. The survey was completed in a much shorter period than previous all-age surveys in China. Some remaining challenges included assignment of causes of probable sensorineural loss. The data obtained from this survey can be used to scale-up hearing services in Gao'an.

Factors associated with local herb use during pregnancy and labor among women in Kigoma region, Tanzania, 2014-2016

Background

Despite research suggesting an association between certain herb use during pregnancy and delivery and postnatal complications, herbs are still commonly used among pregnant women in sub-Sahara Africa (SSA). This study examines the factors and characteristics of women using local herbs during pregnancy and/or labor, and the associations between local herb use and postnatal complications in Kigoma, Tanzania.

Methods

We analyzed data from the 2016 Kigoma Tanzania Reproductive Health Survey (RHS), a regionally representative, population-based survey of reproductive age women (15–49 years). We included information on each woman’s most recent pregnancy resulting in a live birth during January 2014–September 2016. We calculated weighted prevalence estimates and used multivariable logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with use of local herbs during pregnancy and/or labor, as well as factors associated with postnatal complications.

Results

Of 3530 women, 10.9% (CI: 9.0–13.1) used local herbs during their last pregnancy and/or labor resulting in live birth. The most common reasons for taking local herbs included stomach pain (42.9%) and for the health of the child (25.5%). Adjusted odds of local herb use was higher for women reporting a home versus facility-based delivery (aOR: 1.6, CI: 1.1–2.2), having one versus three or more prior live births (aOR: 1.8, CI: 1.4–2.4), and having a household income in the lowest versus the highest wealth tercile (aOR: 1.4, CI: 1.1–1.9). Adjusted odds of postnatal complications were higher among women who used local herbs versus those who did not (aOR: 1.5, CI: 1.2–1.9), had four or more antenatal care visits versus fewer (aOR: 1.4, CI: 1.2–1.2), and were aged 25–34 (aOR: 1.1, CI: 1.0–1.3) and 35–49 (aOR: 1.3, CI: 1.0–1.6) versus < 25 years.

Conclusions

About one in ten women in Kigoma used local herbs during their most recent pregnancy and/or labor and had a high risk of postnatal complications. Health providers may consider screening pregnant women for herb use during antenatal and delivery care as well as provide information about any known risks of complications from herb use.

Psychometric properties of a nationwide survey for adults with and without diabetes: the "disease knowledge and information needs - diabetes mellitus (2017)" survey

BACKGROUND

In order to close existing information gaps on diabetes-related health perceptions, diabetes knowledge, and information-seeking behaviors among adults in Germany, a representative population-based survey targeting the German-speaking population 18 years and older with and without diabetes was conducted. The aim of the present work was to analyze the psychometric properties of the multi-item scales, applied in the survey in order to provide guidance for decisions on the use of these measurements for future research.

METHODS

Based on data from participants who completed the final survey (N = 1479 with known diabetes; N = 2327 without known diabetes) reliability and unidimensionality of multi-item scales were tested using Cronbach's Alpha and confirmatory factor analysis (CFA).

RESULTS

Psychometric properties and model fit varied across scales. Cronbach's alpha values ranged from very good to unacceptable. Model fit indices suggested evidence of a single underlying factor in some but not all scales. Adequate reliability and at least mediocre model fit were found for diabetes distress and patient-provider-relationship in people with diabetes and for perceived level of information in individuals without diabetes. Scales revealing inacceptable reliability values or not suggesting unidimensionality were e.g. diabetes-related stigmatization in both individuals with and without diabetes, self-efficacy in individuals with diabetes, and perceived personal control in those without diabetes.

CONCLUSION

Based on results of the current study, some of the scales applied in the survey can be recommended for present and future analyses of the survey data and for future surveys (e.g. diabetes distress, patient-provider-relationship in people with diabetes). Other scales should be interpreted and used with caution (e.g. depressive symptoms in people with diabetes) while others should be reformulated, interpreted only as single items, or need further investigation (e.g. diabetes-related stigmatization in people with and without diabetes). Findings provide researchers the opportunity to evaluate diabetes-specific scales in population-based studies of adults with and without diabetes.

Three-year trends in dietary behaviours among mothers, teenagers and children from SNAP-Ed (Supplemental Nutrition Assistance Program-Education) eligible households across California

OBJECTIVE

To examine trends from 2015 to 2017 in dietary behaviours and diet quality among low-income mothers, teenagers and children.

DESIGN

Cross-sectional telephone surveys using a validated 24 h dietary assessment.

SETTING

Randomly sampled households with incomes ≤185 % of the US federal poverty level across California.

PARTICIPANTS

Survey participants were 13 247 mothers (≥18 years), 3293 teenagers (12-17 years) and 6043 children (5-11 years). Respondents were mostly Latino.

RESULTS

Over the 3-year study period, consumption of fruits and vegetables with and without 100 % fruit juice increased (P ≤ 0·05) by at least 0·3 cups/d for mothers, teenagers and children. Intake of water also increased (P ≤ 0·001) by more than 1 cup/d for mothers and children and 2 cups/d for teenagers. Sugar-sweetened beverage (SSB) consumption was unchanged over the 3 years. Overall diet quality, as assessed by the Healthy Eating Index-2015, improved (P ≤ 0·01) for mothers, teenagers and children. Covariates for the fifteen regression models (three age groups by five outcome variables) included race/ethnicity, age, education for mothers, and gender for teenagers and children.

CONCLUSIONS

The observed increases in fruit and vegetable intake and improvements in overall diet quality during the 3-year period suggest that low-income Californians may have lowered their risk of preventable diseases. However, more intense or strategic SSB-reduction interventions are required. Regional- or state-level, population-based surveillance of dietary behaviours is useful for public health nutrition policy and programme decision making, and can be used to assess potential trends in future negative health outcomes and related costs associated with poor dietary behaviours within at-risk populations.

[Use of psychotherapy among adults with a history of suicide attempt: Results form a large population-based study]

OBJECTIVES

The current study aims to identify the factors associated with the use of psychotherapy among adults with a history of suicide attempt.

METHODS

A large cross-sectional survey (N=22,138) was conducted in four regions of France to characterize mental health care needs in the general population. Data were collected between April and June 2005 by trained interviewers using a computer-assisted telephone interviewing system (CATI). Sociodemographics, past-year mental disorders, lifetime and 12-month history of suicide attempts, and use of psychotherapy were assessed.

RESULTS

Overall, 7.1% of adults reported having undergone psychotherapy in the course of their life, and 2.0% in the previous 12 months. While 8.3% of adults with a lifetime suicide attempt (prior to the previous 12 months) underwent a psychotherapy in the previous 12 months, 27.5% of adults with a past-year suicide attempt underwent a psychotherapy in the previous 12 months. Psychotherapy was provided by psychiatrists (49.5%), psychologists (28.2%), and psychoanalysts (10.6%). While the frequency of psychotherapy sessions was greater among those with a prior attempt as compared to those with no prior attempt [Chi² (10)=21.35, P=.019], there was no difference in therapy duration [Chi² (8)=6.71, P=.568]. Compared to adults who did not report a prior attempt, those with a prior suicide attempt were 3,3 more likely to undergo psychotherapy with a psychologist [AOR=3.31 (2.54-4.31)]. Among adults with a prior suicide attempt, increased odds of undergoing a psychotherapy in the course of their life was predicted by higher education [AOR=2.81 (1.56-5.06)], living in the Paris region [AOR=2.06 (1.32-3.23)], and being a woman [AOR=1.50 (1.08-2.09)]. Increased odds of undergoing a psychotherapy in the previous 12 months was predicted by a major depressive disorder [AOR=2.59 (1.57-4.27)], any anxiety disorder [AOR=1.79 (1.07-2.97)], higher education [AOR=3.60 (1.29-10.0)], living in a city of 20,000 to 100,000 inhabitants [AOR=2.71 (1.13-6.50)] and more [AOR=2.50 (1.12-5.57)] (outside of the Paris region), a 2000 to 3000 euros monthly income [AOR=2.37 (1.15-4.85)].

DISCUSSION

One third of adults with a lifetime suicide attempt and close to half of those with a past-year attempt have received some form of psychotherapy in the course of their life. In line with prior work, higher education and income level predicted past-year use of psychotherapy among adults with a prior suicide attempt. These findings highlight the association between major depressive disorder or anxiety disorders and increased odds of undergoing psychotherapy in the previous 12 months among adults with prior attempt. While pharmacological treatment, inpatient hospitalizations for mental health problems, visits with a general practitioner or specialized physician are free of charge in France, psychotherapy provided by psychologists or psychotherapists is currently not covered by the French Social Security health care system. As the treatment of mental disorders plays an important role in the reduction of suicide risk, supporting evidence-based psychotherapy through its reimbursement appears to be an important public health issue.

Prevalence and correlates of generalized anxiety disorder in Singapore: Results from the second Singapore Mental Health Study

The aim of this paper is to report findings on the epidemiology of generalized anxiety disorder (GAD) using data from the Singapore Mental Health Study (SMHS) 2016, and draw comparisons with results from the first SMHS in 2010. Singapore residents aged 18 years and above participated in the household survey where the WHO Composite International Diagnostic Interview 3.0 was administered to assess the prevalence of GAD and other mental health conditions. The findings revealed that the lifetime prevalence of GAD was 1.6% among the Singapore general population in 2016, an increase from the 0.9% in 2010. More lifetime GAD cases were reported across several sociodemographic groups including age and employment status. Lifetime GAD was significantly associated with higher odds of several comorbid psychiatric conditions (OR = 3.8-9.3, p < 0.05). Treatment seeking behavior did not differ significantly when compared to SMHS 2010 and there was still a considerable treatment gap among individuals with GAD. Future intervention programs to reduce anxiety and encourage help-seeking behavior could be implemented at institutes of higher learning and workplace settings to reach the targeted audience.

Thirty-eight-year trends of educational differences in smoking in Finland

Objectives

Smoking is declining, but it is unevenly distributed among population groups. Our aim was to examine the socio-economic differences in smoking during 1978–2016 in Finland, a country with a history of strict tobacco control policy.

Methods

Annual population-based random sample data of 25–64-year-olds from 1978 to 2016 (N = 104,315) were used. Response rate varied between 84 and 40%. In addition to logistic regression analysis, absolute and relative educational differences in smoking were examined.

Results

Smoking was more prevalent among the less educated but declined in all educational groups during the study period. Both absolute and relative differences in smoking between the less and highly educated were larger at the end of the study period than at the beginning. Cigarette price seemed to have a larger effect on the smoking among the less educated.

Conclusions

Socio-economic differences in smoking among the Finnish adult population have increased since the 1970s until 2016. Further actions are needed, especially focusing on lower socio-economic positions, to tackle inequalities in health. They should include support for smoking cessation and larger cigarette tax increases.

Electronic supplementary material

The online version of this article (10.1007/s00038-019-01228-x) contains supplementary material, which is available to authorized users.

Is caregiving by baby boomer women related to the presence of depressive symptoms? Evidence from eight national surveys

BACKGROUND

A common hypothesis is that caregiving is deleterious to women's mental health. International studies continue to emphasize the importance of mental health issues for women. Yet only a few researchers have used population-based surveys to explore the association between caregiving and depressive symptomatology in the context of the community, and even less is known about this aspect of Baby Boomer women in a global context.

METHODS

The present study uses eight international surveys covering nineteen nations (N = 15,100) and uses multilevel logistic models to examine possible linkages between caregiving and the likelihood of depressive symptoms among Baby Boomer women, when taking individual-level and country-level social factors into consideration.

RESULTS

The various analyses found a significant variation in the likelihood of depressive symptoms among these Boomer women across the nations investigated and across both individual-level and country-level characteristics. The significant association of caregiving by women and the likelihood of depressive symptoms is related to their social status in some nations (OR = 1.30; p < 0.001). Boomer women living in countries with high rates of female participation in managerial/professional work (OR = 1.04; p < 0.05) and living in countries where women are often in vulnerable employment (OR = 1.01; p < 0.05) are at greater risk of depressive symptomatology.

CONCLUSIONS

These findings demonstrate that the depressive consequences of caregiving by women are, to some degree, contingent upon social context and structure. Policies aimed at promoting mental health among female Baby Boomers should therefore be context specific.

Changes in the use of effective and long-acting reversible contraception in Vietnam

OBJECTIVES

To calculate the prevalence and identify correlates of unmet need for contraception and to assess whether prevalence of use of effective contraception and long-acting reversible contraception (LARC) has changed over time among married or cohabiting, reproductive-age women in Vietnam.

METHODS

Study population was drawn from nationally representative Multiple Indicator Cluster Surveys conducted in 2000, 2006, 2011 and 2014. Unmet need for contraception was defined as occurring when a fecund, married or cohabiting woman is not using any method of contraception but either does not want children or wants to delay birth for at least 1 year or until marriage. Following the ranking of method effectiveness by the Centers for Disease Control and Prevention, we defined "effective contraception" as implant, intrauterine device, male and female sterilization, injectable, pill, patch, ring or diaphragm. We used multivariable logistic regression to identify correlates of unmet need for contraception in 2014 and Cochran-Armitage trend tests to assess changes in effective contraception and LARC use from 2000 to 2014. All analyses used survey weights to account for the complex sampling design.

RESULTS

In 2014, 4.3% of married or cohabiting, reproductive-age women had unmet need for contraception. Multivariable analysis showed that age, education and number of children ever born were statistically significant correlates of unmet need for contraception. Use of effective contraception statistically significantly declined from 53.0% in 2000 to 45.7% in 2014 (p<.0001). Similarly, LARC declined from 39.6% in 2000 to 30.0% in 2014 (p<.0001). After adjusting for age, education, residence and having at least one son, these secular trends remained.

CONCLUSION

Findings indicate that effective contraception and LARC use have decreased among married or cohabiting women of reproductive age in Vietnam. Correlates of unmet need for contraception should be used to inform interventions to prevent unintended pregnancy.

IMPLICATIONS

Although the prevalence of unmet need for contraception was low (4.3%) in 2014, the use of effective contraception and long-acting reversible contraception declined among reproductive-age, married or cohabiting women in Vietnam from 2000 to 2014. This finding is particularly striking given the economic growth in the nation during this time frame.

Association of Metabolic Markers with self-reported osteoarthritis among middle-aged BMI-defined non-obese individuals: a cross-sectional study

BACKGROUND

Osteoarthritis (OA) is a chronic degenerative joint disease. While it is well-established that obesity affects OA through increased axial loading on the joint cartilage, the indirect effect of obesity through metabolic processes among the body mass index (BMI)-defined non-obese population, i.e., BMI < 30 kg/m2, is less known. Our goal was to evaluate the association of metabolic markers including body fat percentage (BF%), waist circumference, maximum weight gain during adulthood and serum creatinine with self-reported OA to establish if such measures offer additional information over BMI among the non-obese population between 40 and 65 years of age.

METHODS

Cross-sectional data from two cycles of the Canadian Health Measures Survey (CHMS) in 2007-2009 and 2009-2011 were analyzed. Sex-specific logistic regression models were developed to evaluate the association of self-reported OA with metabolic markers. Models were separately adjusted for age, BMI categories and serum creatinine, and a stratified analysis across BM categories was performed. In a secondary analysis, we evaluated the association of self-reported OA, cardiovascular diseases and hypertension across BF% categories.

RESULTS

Of 2462 individuals, 217 (8.8%) self-reported OA. After adjusting for age and BMI, those within BF%-defined overweight/obese category had 2.67 (95% CI: 1.32-3.51) and 2.11(95% CI: 1.38-3.21) times higher odds of reporting self-reported OA compared to those within BF%-defined athletic/acceptable category for females and males, respectively. BF% was also significantly associated with self-reported OA after adjusting for age and serum creatinine only among females (OR: 1.47, 95%CI: 1.12-1.84). Furthermore, among the BMI-defined overweight group, the age-adjusted odds of self-reported OA was significantly higher for overweight/obese BF% compared to athletic/acceptable BF% in both females and males. In a secondary analysis, we showed that the association of self-reported OA and hypertension/cardiovascular diseases is significantly higher among BF% overweight/obese (OR: 1.37, 95%CI: 1.19-3.09) compared to BF% athletic/acceptable (OR: 1.13, 95%CI: 0.87-2.82).

CONCLUSION

Our results provide corroborating evidence for a relationship between body fat and OA in a population-based study, while no significant independent correlates were found between other metabolic markers and OA prevalence. Future investigation on the longitudinal relationship between BF and OA among this sub-population may inform targeted prevention opportunities.

Prevalence of food allergy in Vietnam: comparison of web-based with traditional paper-based survey

Background

Web-based surveys (WBS) are increasingly applied in epidemiological studies as an appealing alternative to traditional survey methods. Rapid data collection, reduced expenditure and ease of access to large populations are some of the clear advantages of online surveys. However, WBS are still subject to limitations in terms of sample size, response rate and other additional biases compared to traditional survey methods. In the present study, we seek to validate data on food allergy (FA) in two independent sample populations collected from a WBS, and compare it to a paper-based survey (PBS).

Methods

Data collected from two survey modes were compared by hypothesis testing for independent sample population. The WBS included 1185 respondents, while the PBS included 9039 respondents.

Results

Overall, the data from the WBS were comparable to the PBS conducted over the same period of time in Vietnamese adults. There were no effects of different survey modes on the lifetime prevalence of doctor-diagnosed FA (5.7%; P = 0.7795, β = 0.05) and IgE-mediated FA (5.8%; P = 0.9590, β = 0.05). Both surveys showed the dominance of seafood allergy in this population (up to 2.6%), followed by beef allergy. Close correlation was seen in the patterns of FAs and different clinical symptoms. The contribution of family history of allergic diseases and place of residence to FA were confirmed in both surveys.

Conclusions

The consistency of the WBS results with the PBS indicates a promising application of online surveys as an economic and validated model for future epidemiological studies, specifically in developing countries.

Electronic supplementary material

The online version of this article (10.1186/s40413-018-0195-2) contains supplementary material, which is available to authorized users.

Relationship between sleep duration and self-reported health-related quality of life among US adults with or without major chronic diseases, 2014

OBJECTIVES

To assess the association between sleep duration and health-related quality of life (HRQOL) among adults with or without chronic conditions.

METHODS

Using the 2014 Behavioral Risk Factor Surveillance System, we analyzed self-reported data from adult respondents aged ≥18 years with (n=277,757, unhealthy group) and without (n=172,052. healthy group) reported history of any of nine chronic conditions (coronary heart disease, stroke, cancer, chronic obstructive pulmonary disease, diabetes, asthma, arthritis, depression, chronic kidney disease). Multivariable logistic regressions were separately constructed to assess the associations between sleep duration and four self-reported HRQOL measures after adjustment for sociodemographics, leisure-time physical activity, body mass index, and smoking status among unhealthy and healthy adults.

RESULTS

The prevalence of poor/fair health, frequent physical distress, frequent mental distress, frequent activity limitation, and short sleep duration was 27.9%, 19.3%, 17.0%, 13.6%, and 38.3% in the unhealthy group and 6.9%, 4.0%, 5.3%, 2.1%, and 31.0% in the healthy group, respectively. U-shaped relationships of sleep duration to all four HRQOL indicators were observed among the unhealthy group and to poor/fair health, frequent mental distress, and frequent activity limitation among the healthy group. The relationships further varied by sex, age, race/ethnicity, and BMI category among the healthy group.

CONCLUSIONS

Relationships between extreme sleep duration and HRQOLs were observed among both healthy and unhealthy groups. These results can help inform public awareness campaigns and physician-counseling regarding the importance of sleep for mental health and well-being.

Prevalence and determinants of disability among adults in Malaysia: results from the National Health and Morbidity Survey (NHMS) 2015

BACKGROUND

Reliable national data on disability which is internationally comparable is needed in Malaysia. This study aims to examine the prevalence of disability among adults in Malaysia and its determinants, particularly the socioeconomic factors and comorbidities.

METHODS

This study was based on the disability module, which is part of the National Health and Morbidity Survey 2015. This survey was implemented using a multi-stage stratified sampling design. A locally validated Washington Group questionnaire was used to collect data on disability.

RESULTS

Based on the definition of having at least one domain scored "a lot of difficulty or unable to do at all" or at least "some difficulty" scored in two domains, the prevalence of disability among adults in Malaysia was 11.8% (95% CI: 11.15, 12.53). Logistic regression analysis performed showed that population at risk of having disability in Malaysia were those of older people, ethnic minority, low level of education, single, obese, physically inactive and having mental health problems. Among older people, disability was significantly higher among those with no formal education, having mental health problems and physically inactive.

CONCLUSIONS

The prevalence of disability among adults in Malaysia is comparable to WHO estimates and most developing countries. Planning for healthcare services should consider at-risk population, particularly older people and those from disadvantaged background to ensure equity healthcare.

Characteristics of participants in a randomized trial of an Internet intervention for depression (EVIDENT) in comparison to a national sample (DEGS1)

BACKGROUND

While the efficacy of Internet interventions for depression has been demonstrated in numerous studies, there is concern that the participants in these studies may systematically differ from depressed subjects in the general population. The goal of this study was to compare participants in a large trial of an Internet intervention for depression with a population-based sample that reported depressive symptomatology in the same range of severity.

METHODOLOGY

The analysis is based on a sample of participants of a randomized controlled trial testing the effectiveness of an Internet intervention for depression in mild to moderate depression (EVIDENT, N = 1013) and a subsample of participants in a representative population-based sample (DEGS1, n = 1978). The DEGS1 subsample was chosen based on the score in the Patient Health Questionnaire-9 (PHQ-9, score 5-14) as this was the main inclusion criterion for the EVIDENT study. Both samples were compared with respect to a range of demographic and clinical variables.

RESULTS

Compared with the DEGS1 subsample, participants in the EVIDENT sample were significantly more often female (68.6% vs. 56.3%), slightly older (mean age 42.9 vs. 40.4 years), had more often completed highest secondary education (51.3% vs. 22.4%), were clinically more severely affected (moderate depressive symptoms in 62.6% vs. 18.3%) and reported a lower quality of life.

CONCLUSION

These findings indicate that participants in this Internet trial were not just internet savvy young males without significant impairment. Future studies should aim to recruit participants with lower educational status to increase the reach of Internet interventions.

Urine cadmium levels and albuminuria in a general population from Spain: A gene-environment interaction analysis

BACKGROUND

The interaction of cadmium with genes involved in oxidative stress, cadmium metabolism and transport pathways on albuminuria can provide biological insight on the relationship between cadmium and albuminuria at low exposure levels.

OBJECTIVES

We tested the hypothesis that specific genotypes in candidate genes may confer increased susceptibility to cadmium exposure.

METHODS

Cadmium exposure was estimated by inductively coupled plasma mass spectrometry (ICPMS) in urine from 1397 men and women aged 18-85years participating in the Hortega Study, a representative sample of a general population from Spain. Urine albumin was measured by automated nephelometric immunochemistry. Abnormal albuminuria was defined as urine albumin greater than or equal to 30mg/g.

RESULTS

The weighted prevalence of abnormal albuminuria was 6.3%. The median level of urine cadmium was 0.39 (IQR, 0.23-0.65) μg/g creatinine. Multivariable-adjusted geometric mean ratios of albuminuria comparing the two highest to the lowest tertile of urine cadmium were 1.62 (95% CI, 1.43-1.84) and 2.94 (95% CI, 2.58-3.35), respectively. The corresponding odds ratios of abnormal albuminuria were 1.58 (0.83, 3.02) and 4.54 (2.58, 8.00). The association between urine cadmium and albuminuria was observed across all participant subgroups evaluated including participants without hypertension, diabetes or chronic kidney disease. We observed Bonferroni-corrected statistically significant interactions between urine cadmium levels and polymorphisms in gene SLC30A7 and RAC1.

CONCLUSIONS

Increasing urine cadmium concentrations were cross-sectionally associated with increased albuminuria in a representative sample of a general population from Spain. Genetic variation in oxidative stress and cadmium metabolism and transport genes may confer differential susceptibility to potential cadmium effects.

Illicit drug use is increasing among non-medical users of prescription drugs-Results from population-based surveys 2002-2014

BACKGROUND

Non-medical use of prescription drugs (NMUPD) is known to be associated with illicit drug use, but less is known about how illicit drug use has changed in NMUPD. We examined (1) the changes in illicit drug use among Finnish non-medical users of prescription drugs during the 2000s and (2) whether the trends of illicit drug use differ by non-medical use of prescription drugs in the general population.

METHODS

Data were derived from population-based (aged 15-69) Drug Surveys conducted in Finland in 2002, 2006, 2010 and 2014. The response rates varied between 63% and 48%. NMUPD during the last year was measured (n=252). Past-year illicit drug use among non-medical users of prescription drugs and the reference population not reporting NMUPD (n=10,967) was compared. Logistic regression was used to estimate the p-values for trends.

RESULTS

Illicit drug use has increased notably among Finnish non-medical users of prescription drugs (from 21% to 70%, p for trend<0.001). This was not explained by the respondents' gender, age, employment status or alcohol use. Among the reference population, illicit drug use also increased statistically significantly, but much more moderately (from 2.5% to 5.4%). The difference between the trends was confirmed by an interaction test (p=0.022).

CONCLUSIONS

NMUPD seems to be increasingly merging with illicit drug use. This indicates an increasing prevalence of polydrug use among non-medical users of prescription drugs, which may bring about more severe harms and worse health outcomes for users and more challenges in regard to treatment.

Addictive behaviors and healthcare renunciation for economic reasons in a French population-based sample

BACKGROUND

Healthcare renunciation for economic reasons is a major health concern, but it has been scarcely investigated among drug users, even if drug users constitute a vulnerable population in need of medical care. This study investigated associations of healthcare renunciation for economic reasons and addictive behaviors (alcohol, tobacco, cannabis, illicit drug use, and gambling) in a population-based sample of adults living in France, a country with universal health coverage.

METHODS

Data were collected using the 2014 Health Barometer, a French cross-sectional survey conducted among a random representative sample of the general population aged 18-64 (n=12,852). Measures included healthcare renunciation, substance use (alcohol, tobacco, cannabis, and other illicit drugs) and gambling. Experimental/recreational and heavy/chronic use were assessed. Logistic regressions were used to test the relationship between healthcare renunciation and addictive behaviors, controlling for relevant covariates.

RESULTS

A total of 25% of the participants had renounced care at least once in the previous twelve months. Most variables of drug use were significantly associated with increased healthcare renunciation. This was the case for heavy/hazardous use and experimental/recreational use. Regular gambling was not associated with healthcare renunciation, but disordered gambling was.

CONCLUSION

This study showed that addictive behaviors, including substance use and gambling, were part of the burden of vulnerability of people who forgo care. Therefore, drug use and gambling patterns should be a focus in the development of policies to reduce health inequalities, not only for heavy and chronic drug users.

Primary headache disorders in the adult general population of Pakistan - a cross sectional nationwide prevalence survey

Background

The large geographical gaps in our knowledge of the prevalence and burden of headache disorders include almost all of Eastern Mediterranean Region (EMR). We report a nationwide population-based study in Pakistan, an EMR country with the sixth largest population in the world, conducted as a project within the Global Campaign against Headache.

Methods

We surveyed six locations from the four provinces of Pakistan: Punjab, Sindh, Khyber Pakhtunkhwa and Baluchistan. We randomly selected and visited rural and urban households in each. One adult member (18–65 years) of each household, also randomly selected, was interviewed by a trained non-medical interviewer from the same location using a previously-validated structured questionnaire translated into Urdu, the national language. We estimated 1-year prevalences of the headache disorders of public-health importance and examined their associations with demographic variables using multivariate analysis.

Results

There were 4223 participants (mean age 34.4 ± 11.0 years; male 1957 [46.3%], female 2266 [53.7%]; urban 1443 [34.2%], rural 2780 [65.8%]). Participation proportion was 89.5%. Headache in the previous year was reported by 3233 (76.6% [95% CI: 75.3–77.8%]). The age- and gender-adjusted 1-year prevalence of migraine was 22.5% [21.2–23.8%] (male 18.0% [16.8–19.2%], female 26.9% [25.6–28.2%]), of tension-type headache (TTH) 44.6% [43.1–46.1%] (male 51.2% [49.7–52.7%], female 37.9% [36.4–39.4%]), of probable medication-overuse headache 0.7% [0.5–1.0%] (male 0.7% [0.5–1.0%], female 0.8% [0.5–1.1%]) and of other headache on ≥15 days/month 7.4% [6.6–8.2%] (male 4.4% [3.8–5.0%], female 10.4% [9.5–11.3%]). Migraine was more prevalent in females by a factor of 3:2 although this association barely survived (P = 0.039) after correcting for other factors. TTH was more prevalent in males by about 4:3 (P = 0.026). All headache and migraine were age-related, peaking in the age group 40–49 years; TTH peaked a decade earlier. Higher education (P = 0.004) and income (P = 0.001) were negatively associated with prevalence of migraine.

Conclusion

With three quarters of its population affected, headache disorders must be on the public-health agenda of Pakistan. Worldwide, these disorders are the third leading cause of disability; information from specific enquiry into the burden attributable to headache disorders in this country is needed to inform health policy and priority-setting, and will be reported soon.

Serum levels of brominated flame retardants (BFRs: PBDE, HBCD) and influence of dietary factors in a population-based study on Swedish adults

The aim of this study was to investigate associations between serum concentrations of brominated flame retardants and personal characteristics, including diet, in adults participating in a population-based study in Sweden 2010-11. Moreover, observed concentrations were used in a health risk assessment, using published health-based reference values. Serum samples of 170 adult individuals of both sexes were analyzed for 10 PBDE congeners and HBCD by GC-MS. When including concentrations between LOD and LOQ, highest median serum concentration was observed for BDE-153 (1.2 ng/g serum lipid), followed by BDE-209 (0.95 ng/g lipid), BDE-47 (0.49 ng/g lipid) and BDE-100 (0.21 ng/g lipid). Median concentration of HBCD was 0.10 ng/g lipid. A few markedly elevated concentrations of BDE-209, HBCD (77-78 ng/g lipid) and BDE-47 (44 ng/g lipid) were observed. The only statistical significant findings were higher BDE-153 concentrations in men than in women, and positive associations between serum BDE-153 concentrations and consumption of fish (total), beef, mutton and poultry. PBDE concentrations were in accordance with concentrations reported in other European countries but generally lower than those found in North America. Median PBDE serum concentrations observed in adults from Sweden suggest sufficient health protection, when compared with published health-based reference values, although some outliers with high serum concentrations had lower safety margins.

Prevalence, correlates, comorbidity and severity of generalized anxiety disorder in Singapore

Despite its pervasiveness and associated impairment, generalized anxiety disorder (GAD) remains a poorly recognized disorder. Furthermore, given that GAD has been relatively understudied in Asia, the current study examined the prevalence, correlates and co-morbid conditions of this disorder in a multi-ethnic population of Singapore. Data was utilized from the Singapore Mental Health Study (SMHS), a cross-sectional epidemiological survey conducted among the adult population (n=6616) aged 18 years and above. The Composite International Diagnostic Interview version 3.0 (CIDI v3.0) was used to assess co-morbidity as well as the life-time and 12-month prevalence of disorders. Functional impairment and treatment-seeking behavior were also assessed. The life-time (0.9%) and 12-month (0.4%) prevalence estimates in the current study were found to be lower than those reported in Western populations but comparable to the prevalence estimates found in Asian countries. The relatively lower prevalence rate of GAD in this study suggests the possible role of culture in reporting and manifestation of anxiety symptomatology. The failure of a substantial proportion of individuals to seek treatment despite self-reported impairment was also identified as an area of concern.

Familial occurrence of headache disorders: A population-based study in mainland China

BACKGROUND

Headache disorders are highly prevalent worldwide, and familial occurrence and heredity are contributory factors attracting the interest of epidemiological researchers. Our purpose, in a large sample drawn nationwide from the Chinese general population, was to evaluate the frequency of similar headache in first-degree relatives (FDRs) of those with different headache types.

METHODS

This was a questionnaire-based nationwide cross-sectional door-to-door survey using cluster random-sampling, selecting one adult (18-65 years) per household. Headache was diagnosed by ICHD-II criteria. Participants with headache were asked whether or not any FDRs had similar headache to their own. Chi-squared test and multivariate logistic regression analysis were used to assess the strength and significance of associations.

RESULTS

Of 5041 survey participants (participation rate 94.1%), 1060 (21.0%) were diagnosed with headache (migraine 469 [9.3%], tension-type headache [TTH] 543 [10.8%], headache on ≥15 days/month 48 [0.95%]). From these, 31 were excluded because of missing data about FDRs, leaving 1029 for analysis (male 350 [mean age: 46.7±11.4years]; female 679 [mean age 46.3±11.2years]). Similar headache in one or more FDRs was reported by 22.2% (95% CI: 19.6-24.7%) overall, by 25.1% (21.1-29.1%) of those with migraine, by 19.1% (15.7-22.4%) with TTH and by 29.2% (16.3-42.0%) with headache on ≥15 days/month. The differences was significant between migraine and TTH (OR=1.4, p=0.023), but were not significant between headache on ≥15 days/month and TTH (OR=1.7, p=0.093), migraine and headache on ≥15 days/month (OR=1.2,p=0.534). In multivariate analysis: for migraine versus TTH,AOR=1.2 (p=0.015); for headache on ≥15 days/month versus TTH, AOR 2.3 (p=0.018).

CONCLUSION

Headache was highly prevalent in China and common among FDRs of those with any type of headache (headache on ≥15 days/month>migraine>TTH). Against the background of the general-population prevalence of each disorder, familial occurrence was a very highly influential factor in headache on ≥15 days/month. There are important implications in this for public health and education.

The economic impact of early retirement attributed to rheumatic diseases: results from a nationwide population-based epidemiologic study

OBJECTIVES

To measure early retirement due to self-reported rheumatic diseases (RDs) and to estimate the respective indirect costs and years of working life lost (YWLL).

METHODS

We used individual level data from the national, cross-sectional, population-based EpiReumaPt study (September 2011-December 2013) where 10,661 inhabitants were randomly surveyed in order to capture and characterize all cases of RD within a representative sample of the Portuguese population. In this analysis, we used all participants aged between 50 and 64 years, near the official retirement age. A national database was used to calculate productivity values by gender, age and region, using the human capital approach. YWLL were estimated as the difference between each participant's current age and the respective retirement age, while the potential years of working life lost (PYWLL) were given by the difference between official and actual retirement ages. We also calculated the percentage of time in inactivity (inactivity ratio = YWLL/Active age-range [15-64 years old]).

RESULTS

29.9% of the Portuguese population with ages between 50 and 64 years were retired with 13.1% self-reporting retirement due to RD. The estimated annual indirect cost following premature retirement attributed to RD was €910 million (€555 per capita; €1625 per self-reported RD patient and €13,592 per early retiree due to RD). Females contributed with 84% for these costs (€766 million; €882 per capita vs €187 from males). We observed a total number of 389,939 accumulated YWLL (228 per 1000 inhabitants) and 684,960 PYWLL (401 per 1000 inhabitants). The mean YWLL and PYWLL inactivity ratios were 12% and 21%, respectively. RD patients with higher values of disability have the highest risk of early retirement.

CONCLUSIONS

Early retirement attributed to self-reported RD amounts to approximately 0.5% of the national gross domestic product (GDP) in 2013, due to large YWLL. Both the public health concern and the economic impact highlight the need to prioritize investments in health and social protection policies targeting patients with rheumatic conditions.

The association between social capital and loneliness in different age groups: a population-based study in Western Finland

Background

Previous studies of loneliness have largely focused on establishing risk factors in specific age groups such as in later life or in young people. Researchers have paid less attention to the link between social capital and loneliness across different age groups. The aim of this study was to examine the association between social capital and experienced loneliness in different age groups in a Finnish setting.

Methods

The data originates from a population-based cross-sectional survey conducted among 4618 people aged 15–80 in Western Finland in 2011. The response rate was 46.2 %. The association between social capital, measured by frequency of social contacts, participation in organisational activities, trust and sense of belonging to the neighbourhood and loneliness was tested by logistic regression analyses stratified by four age groups.

Results

Frequent loneliness (defined as experienced often or sometimes) was higher among younger people (39.5 %) compared to older people (27.3 %). Low levels of trust were linked to loneliness in all four age groups. The association between other aspects of social capital and loneliness varied across age groups.

Conclusions

Frequent loneliness is common among the general adult population and could be seen as a public health issue. Our findings imply that low social capital, especially in terms of low trust, may be a risk factor for loneliness. However, further research is needed to assess the influence of poor health and reverse causality as explanations for the findings.

Prevalence of preventable household risk factors for childhood burn injury in semi-urban Ghana: A population-based survey

OBJECTIVE

Childhood burns are a leading cause of injury in low- and middle-income countries; most of which are preventable. We aimed to describe the prevalence of household risk factors for childhood burn injury (CBI) in semi-urban Ghana to inform prevention strategies for this growing population.

METHODS

We conducted a population-based survey of 200 households in a semi-urban community in Ghana. Households were randomly selected from a list of 6520 households with children aged <18 years. Caregivers were interviewed about CBI within the past 6 months and potentially modifiable household risk factors.

RESULTS

Of 6520 households, 3856 used charcoal for cooking (59%) and 3267 cooked indoors (50%). In 4544 households (70%), the stove/cooking surface was within reach of children under-five (i.e., <1m). Higher household wealth quintiles (OR 0.95; 95%CI 0.61-1.49) and increasing age (OR 0.82; 95%CI 0.68-0.99) were associated with lower odds of CBI. Living in uncompleted accommodation (OR 11.29; 95%CI 1.48-86.18 vs rented room) and cooking outside the house (OR 1.13; 95%CI 0.60-2.14 vs cooking indoors) were also predictive of CBI.

CONCLUSIONS

This study identified a high prevalence of CBI risk factors in semi-urban households that may benefit from targeted community-based prevention initiatives.

Elevated blood pressure and headache disorders in China--associations, under-treatment and implications for public health

Background

Both hypertension (HTN) and headache disorders are highly prevalent worldwide. Our purpose, in a nationwide study of the Chinese general population, was to evaluate any association between primary headache disorders and elevated blood pressure (eBP). We could not collect data on antihypertensive therapy, but took the view that, whatever such therapy might be taken, eBP was a sign that it was failing to meet treatment needs. Therefore, as a secondary purpose, important from the public-health perspective, we would present the prevalence of eBP (treated or not) as indicative of unmet health-care need in China.

Methods

This was a questionnaire-based nationwide cross-sectional door-to-door survey using cluster random-sampling, selecting one adult (18–65 years) per household. Headache was diagnosed by ICHD-II criteria and eBP as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Chi-squared test and multivariate logistic regression analysis were used to assess the strength and significance of associations. We set significance at P ≤ 0.05.

Results

Of 5,041 survey participants (participation rate 94.1 %), 154 were excluded because of missing BP data, leaving 4,987 for analysis [mean age: 43.6 ± 12.8 years; male 2,532 (mean age: 43.4 ± 12.9 years); female 2,455 (mean age 43.9 ± 12.8 years)]. There were 466 participants with migraine, 535 with tension type headache (TTH) and 48 with all causes of headache on ≥15 days/month. The prevalence of eBP was 22.1 % (males 22.9 %, females 21.3 %). No associations of eBP with any of the headache disorders survived multivariate adjusted analysis. The demographic and anthropometric variables most strongly associated with eBP were higher age (AOR 3.7) and being overweight (AOR 2.4), seen in both genders. Less strong were male gender, lower educational level and urban habitation.

Conclusions

We found no clear-cut associations between eBP and any headache disorder. The associations with demographic and anthropometric variables may have acted as confounders in past reports to the contrary. We did find an alarmingly high prevalence of eBP, recognizing that this signals substantial under-treatment in China of a serious condition, and therefore a major public-health concern.

Slow decline of hepatitis B burden in general population: Results from a population-based survey and longitudinal follow-up study in Taiwan

BACKGROUND & AIMS

Hepatitis B virus (HBV) infection poses a global public health threat. HBV vaccination has proven highly effective in preventing the infection; however, its long-term impact on the general population has not been addressed. We conducted analysis to determine the total and changing burden of chronic HBV infection and evaluate the serological status between vaccinated and unvaccinated in Taiwan.

METHODS

Participants in "The Taiwanese Survey on Prevalence of Hyperglycemia, Hyperlipidemia and Hypertension" in 2002 (n=6602), and 4088 with follow-up survey in 2007 were included. HBsAg (including titers), anti-HBs, anti-HBc, HBeAg, anti-HBe, HBV genotypes and viral loads were assayed. Prevalence and evolving patterns of these seromarkers was compared between vaccinated and unvaccinated cohorts and predictors of persistent HBsAg positivity and negativity were examined.

RESULTS

The overall prevalence of chronic HBV infection was 13·7% (95% CI, 12.9% to 14.5%) and about two thirds had past exposure (anti-HBc: 68·46%) in 2002. The vaccinated cohort tended to have lower prevalence of HBsAg and anti-HBc, and a higher proportion of anti-HBs and HBeAg positivity, genotype C and high viral load. The majority (85·42%) were consistently HBsAg negative while 12·65% were consistently positive, and 8·98% achieved seroclearance in a five-year period. In the vaccinated cohort, no subjects had acquired new exposure and became HBsAg positive, and only one (0.54%) cleared HBsAg, demonstrating the durability of vaccination through teenage and young adulthood.

CONCLUSIONS

This comprehensive, population-representative-survey shows that 20 years after universal vaccination, the backlog still composed a substantial burden of chronic HBV infections in Taiwan.

Ocular Trauma in a Rural Population of North China: The Handan Eye Study

OBJECTIVE

To determine the prevalence of ocular trauma and the proportion of blindness and visual impairment due to trauma in a rural population in northern China.

METHODS

The Handan Eye Study is a population-based cross-sectional study that surveyed 6830 Chinese people aged 30+ years from 13 randomly selected villages in Yongnian County, city of Handan, Hebei Province, in July, 2006. All participants underwent a standardized interview and extensive examinations. A structured questionnaire was used to collect information on ocular trauma.

RESULTS

Of the 5837 participants who filled out the questionnaire, 124 subjects [2.1%; 95% confidence interval (CI), 1.8%-2.5%] reported a history of ocular trauma in either eye, including 19 (0.3%) persons reporting trauma in both eyes. Men were more likely to have an eye injury than women [odds ratio (OR), 3.3; 2.2-4.9]. In multiple logistic regression models, ocular trauma was significantly more frequent among normotensive participants when compared with hypertensive participants (hypertensive vs. normotensive: OR, 0.6; 0.4-0.9) and among participants who had a history of falls (OR, 2.4; 1.2-4.8). The proportion of unilateral visual impairment and unilateral blindness due to trauma were 10.5% (13 subjects) and 21.0% (26 subjects), respectively.

CONCLUSION

Our study reports the prevalence of severe ocular trauma among adults in rural China, revealing a high proportion of blindness and visual impairment due to trauma. These findings suggest the need for educational strategies to increase eye health awareness in this rural population with focus on providing at least appropriate first aid care to reduce blindness due to trauma.

Subthreshold and threshold DSM-IV generalized anxiety disorder in Singapore: Results from a nationally representative sample

Previous nationally representative studies have reported prevalence of DSM-IV generalized anxiety disorder (GAD). However, subthreshold and threshold GAD expressions remain poorly understood. The current study examined the prevalence, correlates and co-morbidity of a broader diagnosis of GAD in Singapore. The Singapore Mental Health Study (SMHS) was an epidemiological survey conducted in the population (N=6616) aged 18 years and older. The Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was used to establish mental disorder diagnoses. The lifetime prevalence for subthreshold GAD (2.1%) and threshold GAD (1.5%) in the current sample was found to be lower than in Western populations. Younger age group, Indian ethnicity, previously married, chronic physical conditions, and being unemployed were associated with higher odds of having more severe expression of generalized anxiety. The relatively lower prevalence rate of subthreshold GAD expression suggests possible cultural interferences in the reporting and manifestation of anxiety symptomatology. Despite the low prevalence, significant impacts on functioning and comorbidity among subthreshold generalized anxiety cases indicate the importance of early treatment to ensure a better prognosis.