A systematic review of approaches to assess fish health responses to anthropogenic threats in freshwater ecosystems

Anthropogenic threats such as water infrastructure, land-use changes, overexploitation of fishes and other biological resources, invasive species and climate change present formidable challenges to freshwater biodiversity. Historically, management of fish and fishery species has largely been based on studies of population- and community-level dynamics; however, the emerging field of conservation physiology promotes the assessment of individual fish health as a key management tool. Fish health is highly sensitive to environmental disturbances and is also a fundamental driver of fitness, with implications for population dynamics such as recruitment and resilience. However, the mechanistic links between particular anthropogenic disturbances and changes in fish health, or impact pathways, are diverse and complex. The diversity of ways in which fish health can be measured also presents a challenge for researchers deciding on methods to employ in studies seeking to understand the impact of these threats. In this review, we aim to provide an understanding of the pathway through which anthropogenic threats in freshwater ecosystems impact fish health and the ways in which fish health components impacted by anthropogenic threats can be assessed. We employ a quantitative systematic approach to a corpus of papers related to fish health in freshwater and utilize a framework that summarizes the impact pathway of anthropogenic threats through environmental alterations and impact mechanisms that cause a response in fish health. We found that land-use changes were the most prolific anthropogenic threat, with a range of different health metrics being suitable for assessing the impact of this threat. Almost all anthropogenic threats impacted fish health through two or more impact pathways. A robust understanding of the impact pathways of anthropogenic threats and the fish health metrics that are sensitive to these threats is crucial for fisheries managers seeking to undertake targeted management of freshwater ecosystems.

Validating Constructs of the Depression, Anxiety, and Stress Scale-21 and Exploring Health Indicators to Predict the Psychological Outcomes of Students Enrolled in the Pacific Islands Cohort of College Students

The Depression, Anxiety, and Stress Scale-21 (DASS-21) has been used in various countries to assess the mental states of individuals. The objectives of this study were to validate the DASS-21 for use in Guam, an island that endures a high burden of mental health challenges, such as suicide, and examine the predictive impact of selected health indicators on DASS-21 variables. Three years of data (2017-2019) were pooled from the Pacific Islands Cohort of College Students (PICCS) study conducted annually at the University of Guam. In total, 726 students were included in the secondary data analysis. MPlus statistical software was used to perform a confirmatory factor analysis (CFA) for the validation and structural equation modeling (SEM) for the predictive modeling. The results from the CFA suggested an acceptable model fit (RMSEA: 0.073, CFI: 0.901, TLI: 0.889, RMR: 0.044), while SEM suggested that sleep quality and physical activity were significant predictors of DASS-21 variables. Therefore, the DASS-21 is a valid instrument for measuring depression, anxiety, and stress among emerging adults in Guam.

Cannabis and Public Health: A Study Assessing Regular Cannabis Users Through Health Indicators

Background and Objective: An increasing number of countries are deciding to regulate the medicinal and/or recreational use of cannabis (Cannabis sativa L.). However, there is a lack of information on the impact of regular consumption of this substance on public health. In this study, for the first time, regular cannabis consumers in Spain were assessed using health indicators, comparing these data with the general population. Methods: Various items of the Enquesta de Salut de Catalunya (ESCA) and other items related to cannabis use were selected to build a survey and administer it to a representative sample of regular cannabis users in Catalonia. Results: Most of the indicators did not show any deterioration in the health of regular cannabis users compared with the general population. It was observed that users suffered from more sleep problems and about 40% of the sample would like to discontinue cannabis use, suggesting a dependence pattern. About 30% of the sample was able to discontinue the use of prescription medications because of cannabis. Social support and sleep problems, and not cannabis use, were predictors of depression and well-being scores. Conclusions: It seems that regular cannabis use, despite contributing to problems related to sleep quality or dependence, does not have a negative impact on public health in a manner detectable using health indicators.

Welfare Assessment on Different-Sized Dairy Goat Farms in the Northern Serbian Province of Vojvodina

This research aimed for the first time to identify the essential welfare problems on 46 goat dairy farms in Vojvodina,based on the goat AWIN welfare protocol. The study showed that space allowance per goat was 1.55, 1.86 and 2.50 m2/goat (large, medium, small-sized farms, respectively). Most farms possessed the soil floor and straw as a flooring material. The small and medium farms more allowed access to the outdoor area. Contrary, large-sized farms mostly kept goats in fully housed systems with reduced opportunities for the goats to express their natural behavior. Management procedures were significantly different (p < 0.05) between the investigated farms. Differences were mainly in bedding, feeding and culling strategies. Low productivity was the main cause of culling in all farm types. Small-sized farms carried out more often disbudding (42.9%) in comparison with medium (21.4%) and large-sized ones (14.3%). Group level observation showed that the main areas of concern were associated with hair coat condition and kneeling at the feeding rack (p < 0.05). Inadequate BCS, udder asymmetry and claw overgrowth were frequently recorded. The prevalence of thin and fat goats was highest in large-sized farms All farm size categories and management systems showed certain welfare weaknesses. Thus, the findings highlighted the need for higher implementation of animal welfare principles and improvement of management techniques to meet the welfare requirements of dairy goats.

Part 3: Effects of diet modification on selected health indicators

OBJECTIVES

The aim of the research was to check whether, and to what extent, dietary changes affect the selected indicators of health, including well-being.

METHODS

The study, lasting 3 years, included 52 chronically mentally ill people. Hand grip strength (HGS) measurements ‟before" and ‟after" feeding adjustments were performed using a SaehanTM pear dynamometer, blood pressure measurements were made using an Omron blood pressure monitor. Well-being was assessed using the UMACL Adjective Mood Scale. Based on the analysis of medical records, the study also included: the number of infections of the upper respiratory tract, the number of autoaggressive/aggressive behaviors and the frequency of stay of extremely offensive/agitated residents in the hospital.

RESULTS

The dietary changes were reflected in the increased value of the hand grip strength (especially in women), lowered or normalized blood pressure to normal or recommended values, lowered tension arousal, accompanied by an increase in energetic arousal and hedonic tone (translating into improved well-being and mood), and a decrease in the number of episodes of aggression/self-aggression and associated hospitalizations.

CONCLUSIONS

The dietary changes resulted in an improvement in the tested parameters as well as in reduction in the amount of food wasted by the residents. There was also a decrease in the number of catarrh of the upper respiratory tract, which reduced the overall number and quantity of prescribed drugs.

Impact of a PROgram of Cardiovascular nursE interventionS in a VALVular haEmodynamic Unit (PROCESS-VALVE) on Quality Indicators: A Quasi-Experimental Ambispective Study

Background

The percutaneous treatment of heart valve diseases carried out in the hemodynamic service is constantly growing. After analyzing the mortality, readmissions, success of the procedure, and complications, several studies support this type of percutaneous procedure. The increase in these procedures has required the creation of multidisciplinary teams and new diagnostic and care circuits, such as presurgical consultations and postsurgical follow-ups. Even so, there is little evidence regarding the effect of these consultations on quality indicators.

Purpose

The objective of this study is to evaluate the impact of a program of presurgical and postsurgical nurse interventions (PROCESS-VALVE) on quality indicators of the health of patients undergoing percutaneous valve procedures.

Patients and Methods

The influence of presurgical and postsurgical consultations on quality indicators will be evaluated through an ambispective quasi-experimental study. Patients will be recruited at a tertiary-level hospital in Barcelona, Spain. For the control group, data will be collected retrospectively from patients who underwent percutaneous valve procedures but did not receive pre- or postsurgical consultations. The intervention group comprises those patients agreeing to participate in the study and the hemodynamic nurse valve consultation program (PROCESS-VALVE). In addition, we will assess whether a face-to-face postsurgical consultation equally improves quality indicators compared to postsurgical telephone consultation; for this, a sub-study will be carried out comparing face-to-face or telephone postsurgical follow-up by means of a randomized controlled clinical trial with simple blinding in the intervention group.

Discussion

This study will generate scientific evidence regarding the impact on quality indicators of a nursing intervention via presurgical and postsurgical consultations. In addition, it will allow us to decide the most appropriate follow-up strategy for this type of patient.

Trial Registration

ClinicalTrials.gov NCT05179278, registration date 01/05/2022.

Key findings from NFHS-5 India report: Observing trends of health indicators between NFHS-4 and NFHS-5

The National Health Family Survey (NFHS) is one of the largest cross-sectional surveys in the world and plays a very important role in seeing the health sector's growth in India. Its comprehensiveness in data points serves as a baseline for policymakers to amend or continue the health policy at the national and state levels. It is also imperative to look up the survey's major findings and compare the same with the previous survey finding to obtain a trend (positive/negative) of the placed data indicators. In writing this information, we aim to provide a researched paper to undergraduates and postgraduates in medical education to identify the trends or gap pockets in NFHS-4 and NFHS-5. These findings might help them as an educational piece of work and further research evidence in their local community. Also, the present work is the compilation of demographic characteristics and major health indicators.

Digital health solution for monitoring and surveillance of Amyotrophic Lateral Sclerosis in Brazil

Amyotrophic Lateral Sclerosis (ALS) is a complex and rare neurodegenerative disease given its heterogeneity. Despite being known for many years, few countries have accurate information about the characteristics of people diagnosed with ALS, such as data regarding diagnosis and clinical features of the disease. In Brazil, the lack of information about ALS limits data for the research progress and public policy development that benefits people affected by this health condition. In this context, this article aims to show a digital health solution development and application for research, intervention, and strengthening of the response to ALS in the Brazilian Health System. The proposed solution is composed of two platforms: the Brazilian National ALS Registry, responsible for the data collection in a structured way from ALS patients all over Brazil; and the Brazilian National ALS Observatory, responsible for processing the data collected in the National Registry and for providing a monitoring room with indicators on people diagnosed with ALS in Brazil. The development of this solution was supported by the Brazilian Ministry of Health (MoH) and was carried out by a multidisciplinary team with expertise in ALS. This solution represents a tool with great potential for strengthening public policies and stands out for being the only public database on the disease, besides containing innovations that allow data collection by health professionals and/or patients. By using both platforms, it is believed that it will be possible to understand the demographic and epidemiological data of ALS in Brazil, since the data will be able to be analyzed by care teams and also by public health managers, both in the individual and collective monitoring of people living with ALS in Brazil.

The Impact of Continuity of Care on Health Indicators in Patients With Type 2 Diabetes Mellitus in Family Medicine Clinics in Riyadh

BACKGROUND

Diabetes Mellitus Type 2 (DM2) is highly prevalent in Saudi Arabia, with many experiencing complications due to the disease. Family medicine physicians are usually the primary care providers responsible for the medical management of type 2 diabetes mellitus patients. Microvascular and macrovascular complications can occur if type 2 diabetes mellitus is poorly managed. Effective management of health indicators in patients with DM2 relating to glycated hemoglobin (HbA1c), low density lipoprotein cholesterol, blood pressure, and tobacco use is an essential part of medical care to prevent complications. Due to the projected increase in the number of patients with DM2, there is huge concern surrounding the management of this chronic illness that requires review. This study aims to evaluate the impact of continuity of care on health indicators among family medicine patients diagnosed with diabetes mellitus type 2 and to analyze the effect of continuity of care regarding the completion of age-appropriate preventive health screenings.

METHODS

 This is a retrospective cohort study. Data collected from electronic medical records of patients 40-75 years of age that received care at the Family Medicine clinics that were diagnosed with type 2 diabetes mellitus with ≥4 clinic visits from January 1, 2017, to June 30, 2020, at King Faisal Specialist Hospital & Research Centre in Riyadh, Saudi Arabia. Data collected included demographic data, body mass index, smoking status, blood pressure, past medical history, preventive health screening completed, and laboratory results, including HbA1c and lipid profile. The continuity of care index and usual provider continuity score indices were calculated for the analysis to measure continuity of care.

RESULTS

 Three hundred and fifty-two patients were included in the study. Most of the patients were Saudi (74.15%), female (51.99%), and married (82.67%). In addition, 90.34% accounted for a high usual provider continuity of care score (UPCS), and 64.20% of the patients had a high continuity of care index (COCi). Younger age groups were significantly more prevalent in the high UPCS group (p=0.037). Additionally, patients of non-Saudi nationalities constituted a significantly larger proportion of the high UPCS group. Single patients showed high UPCS. Comorbidities were not different between the groups, except inflammatory joint disease, which was more common in the low COCi group. Preventative screening measures were also not different between the groups; however, the type of colon cancer screening differed, where patients with high COCi more frequently underwent colonoscopies (13.3% vs. 4.4%, p=0.015) instead of fecal occult blood tests.

CONCLUSION

 For the first time, we report the implications of the continuity of care for DM2 patients in Saudi Arabia and the Middle East. Continuity of care did not result in the improvement of health indicators or in the completion of preventive health screenings in diabetic patients. Further studies are needed in the region to confirm our findings and assess the association between continuity of care and patient health indicators impact.

Education, health indicators and fertility outcomes: a longitudinal analysis of couples in Britain

Previous studies have shown that highly educated women are more likely to realise their fertility aspirations, or experience a faster progression to a higher order birth, compared to lower educated women. This is often explained by improved economic or social resources among the higher educated. However, it is unclear whether educational differences in health behaviours may also contribute to these differential fertility outcomes. In this study, we use data from Waves 1-7 of the UK Longitudinal Household Study, combined with data from the Nurse Health Assessment from Wave 2 to estimate couples' likelihood of experiencing additional childbirth within six years. A discrete-time event history model is employed to analyse the transition to a higher order birth, while accounting for both partners' level of education as well as smoking patterns and body mass index. We find that couples in which the female partner is highly educated are more likely to experience childbirth within six years compared to others. In addition, female smoking is negatively associated with the likelihood of childbirth, while no significant effect has been found for male health factors. Female health indicators explain some of the variation in fertility outcomes for women with lower secondary education compared to degree-educated women. However, education remains a significant predictor of the transition to higher order births, also after accounting for male and female health indicators. It is therefore important to consider both socio-economic and health factors in order to understand variations in fertility outcomes.

Development and validation of a health and nutrition module for the project-level Women's Empowerment in Agriculture Index (pro-WEAI+HN)

Agricultural development projects increasingly aim to improve health and nutrition outcomes, often by engaging women. Although evidence shows such projects can improve women's and children's health and nutrition and empower women, little is known about their impacts on women's health- and nutrition-related agency and the extent to which impacts emerge through women's empowerment, largely due to a lack of instruments that measure the dimensions of women's agency that are directly relevant to health and nutrition outcomes. We developed an optional, complementary module for the project-level women's empowerment in agriculture index (pro-WEAI) to measure health- and nutrition-related agency (pro-WEAI + HN). Our method for developing related indicators used data collected from six agricultural development programmes implemented across Bangladesh, Burkina Faso and Mali (pooled sample = 12,114) and applied psychometric analysis (exploratory and confirmatory factor analysis) and the Alkire-Foster methodology. Results revealed seven indicators covering women's agency in the areas of her own health and diet; her health and diet during pregnancy; her child's diet; breastfeeding and weaning; purchasing food and health products; and acquiring food and health products. Multigroup confirmatory factor analysis revealed measurement invariance across contexts and samples. Tests of association (Cramer's V) and redundancy suggest that the pro-WEAI + HN indicators measured aspects of agency that are distinct from the core pro-WEAI. The uptake of these indicators in studies of nutrition-sensitive agricultural development projects may strengthen the evidence on how such programming can enhance women's empowerment to improve health and nutrition outcomes for themselves and their children.

Analysis and Forecast of Indicators Related to Medical Workers and Medical Technology in Selected Countries of Eastern Europe and Balkan

Health indicators measure certain health characteristics in a specific population or country and can help navigate the health systems. As the global population is rising, the demand for an increase in the number of health workers is simultaneously rising. The aim of this study was to compare and predict the indicators related to the number of medical workers and medical technologies in selected countries in Eastern Europe and Balkan in the studied period. The article analyzed the reported data of selected health indicators extracted from the European Health for All database. The indicators of interest were the number of physicians, pharmacists, general practitioners and dentists per 100,000 people. To observe the changes in these indicators through the available years, we used linear trends, regression analysis and forecasting to the year 2025. The regression analysis shows that the majority of the observed countries will experience an increase in the number of general practitioners, pharmacists, health workers/professionals and dentists, as well as in the number of computerized tomography scanners and the number of magnetic resonance units, predicted to occur by 2025. Following trends of medical indicators can help the government and health sector to focus and navigate the best investments for each country according to the level of their development.

Public health indicators for cerebral palsy: A European collaborative study of the Surveillance of Cerebral Palsy in Europe network

BACKGROUND

Public health indicators (PHIs) play an increasingly important role in health policy decision-making. Although cerebral palsy (CP) is the commonest physical disability in children, its impact at population level has not been systematically measured so far.

OBJECTIVES

We aimed to propose six PHIs for CP designed to annually document the extent of CP and effectiveness of perinatal organisation, the burden of this condition, access to health services and preventive health strategies in the post-neonatal period and to report on the latest updated estimations using population-based data routinely collected by European CP registries.

METHODS

The study included children with CP born between 2002 and 2011. Harmonised data (number of cases, functional profile, imaging) were extracted from the Surveillance of Cerebral Palsy in Europe (SCPE) database. Eligibility criteria for analyses were applied separately for each indicator by selecting registries, birth years and CP cases. Current estimates were based on the last 3 birth years, while trends were reported over a 10-year period. All analyses were descriptive. Sensitivity analyses were carried out to examine the stability of the results using various thresholds of percentages of missing values.

RESULTS

Analyses were performed on a total of 8621 children with CP from 12 to 17 SCPE registries. A decreasing prevalence of pre/perinatal CP overall, as well as in preterm and full-term-born children, was observed. The burden of the condition was strongly dependent on CP subtype and the presence of associated impairments. Access to brain imaging ranged from 80% to 100% depending on registries. The overall prevalence of post-neonatally acquired CP was approximately 0.8 per 10,000 live births over the study period.

CONCLUSIONS

Population-based CP registries can provide data that are relevant for generating key outcomes of interest at the population level, thus potentially contributing to improving public health policies for children with disabilities.

Assessment of Diabetes-Related Health Disparities among the Marshallese Living in the Republic of the Marshall Islands

There is a high prevalence of type 2 diabetes mellitus (T2DM) among the Marshallese in the Republic of the Marshall Islands (RMI). However, no prior literature has examined self-reported health indicators, self-management activities, barriers to care, diabetes knowledge, and family support for diabetes management. This study examined health indicators among participants with T2DM (n=41). Clinical measures included glycated hemoglobin (HbA1c) and fasting glucose level, blood pressure, pulse pressure, and cholesterol levels. Survey items included participants' self-reported health indicators, self-management activities, barriers to care, diabetes knowledge, and family support for diabetes management. Clinical health indicators demonstrate the poor health status of the participants, including uncontrolled fasting glucose levels and HbA1c levels (61.9% had an HbA1c ≥9.0%), high blood pressure, elevated pulse pressure (65.9% had pulse pressure >40 mmHg), and high total cholesterol. Participants report limited knowledge and participation in diabetes self-management behaviors, limited family support, and faced numerous barriers to medical care, medications, and supplies. This study provides insight into the T2DM disparities experienced by Marshallese in the RMI. This study is the first to document the self-reported health indicators, self-management activities, barriers to care, diabetes knowledge, and family support for diabetes management. The results highlight the need for T2DM management interventions and will be used to refine a culturally adapted intervention for delivery in the RMI.

Effect of short-term consumption of pork supplemented by organic selenium on selenium concentration, antioxidant status, and lipid parameters of consumers

The aim of the research was to evaluate the impact of consumption of pork enriched with selenium on selenium concentration, antioxidant status and lipid parameters of consumers. The research involved 59 probands in four experiments from the general population of Slovakia. The probands consumed 200 g of enriched meat with organic selenium from pork fed with selenized yeast three times a week during one month. Probands of exp.1 consumed freshly prepared lunch and probands of exp. 2-4 consumed sterilized meat. During the experiment, three blood collections were carried out. After short-term consumption of enriched pork with selenium, concentration of selenium in the blood serum of probands increased significantly in exp. 1 and 4 (P < 0.05). TAS increased significantly after 28 days in exp. 2, 3 and 4 (P < 0.05 and P < 0.001). The level of T-C and TG significantly decreased in exp. 2 and 4 (P < 0.05). HDL-C levels non-significantly increased (P > 0.05) in exp. 1, 3, and 4. The levels of LDL-C significantly decreased in exp. 2 (P < 0.05). These results demonstrated that pork appears to be a suitable component for increase the selenium intake of consumers.

The effect of synbiotics and probiotics on the growth performance, gastrointestinal function and health status of turkeys

The aim of this study was to evaluate the growth performance, gastrointestinal function and health status of turkeys fed diets supplemented with synbiotic preparations, as compared with commercial probiotic feed additives. The experiment lasted for 15 weeks. The research material comprised 600 female BIG 6 turkeys (6 treatments, 5 replicates, 20 birds per replicate). The turkeys from the control group (I) received a diet without additives. Groups II and III received a basal diet with the addition of probiotic BioPlus 2B or Cylactin at 0.4 g/kg diet, respectively. In groups IV, V and VI turkeys were fed diets with synbiotic preparations S1 (L. reuteri, L. plantarum, L. pentosus, S. cerevisiae + inulin), S2 (L. reuteri, L. plantarum, L. pentosus, S. cerevisiae, L. rhamnosus + inulin) and S3 (L. reuteri, L. plantarum, L. pentosus, S. cerevisiae, L. rhamnosus, L. paracasei + inulin) at 0.5 g/kg diet, respectively. The following parameters were monitored: growth performance, carcass quality, the chemical composition of meat, the structure (length, weight, villus height, crypt depth) and functional parameters (pH, viscosity) of selected segments of the gastrointestinal tract, and the health status of birds (lysozyme, gamma-globulins, ceruloplasmin and total protein). Dietary supplementation with probiotics and synbiotics contributed to an increase in the final body weights of turkeys, a decrease in the feed conversion ratio and an increase in values of the European Production Efficiency Factor (p ≤ 0.05). Synbiotics improved the immune status of birds by increasing serum gamma-globulin levels and decreasing ceruloplasmin activity at 8^th week of age (p ≤ 0.05). Synbiotics and probiotics also contributed to a decrease in crop and caecal pH (p ≤ 0.05). The analysed additives had no effect on carcass dressing percentage, carcass quality characteristics or the chemical composition of breast muscles. The tested synbiotics as well as commercial probiotics can be valuable feed additives, improving the growth performance and immune status of turkeys.

Health Monitoring of Aerospace Structures Utilizing Novel Health Indicators Extracted from Complex Strain and Acoustic Emission Data

The development of health indicators (HI) of diagnostic and prognostic potential from generally uninformative raw sensor data is both a challenge and an essential feature for data-driven diagnostics and prognostics of composite structures. In this study, new damage-sensitive features, developed from strains acquired with Fiber Bragg Grating (FBG) and acoustic emission (AE) data, were investigated for their suitability as HIs. Two original fatigue test campaigns (constant and variable amplitude) were conducted on single-stringer composite panels using appropriate sensors. After an initial damage introduction in the form of either impact damage or artificial disbond, the panels were subjected to constant and variable amplitude compression–compression fatigue tests. Strain sensing using FBGs and AE was employed to monitor the damage growth, which was further verified by phased array ultrasound. Several FBGs were incorporated in special SMARTapes^TM, which were bonded along the stiffener’s feet to measure the strain field, whereas the AE sensors were strategically placed on the panels’ skin to record the acoustic emission activity. HIs were developed from FBG and AE raw data with promising behaviors for health monitoring of composite structures during service. A correlation with actual damage was attempted by leveraging the measurements from a phased array camera at several time instances throughout the experiments. The developed HIs displayed highly monotonic behaviors while damage accumulated on the composite panel, with moderate prognosability.

Associations between meeting 24-hour movement guidelines and health in the early years: A systematic review and meta-analysis

This systematic review examined the compliance with the 24-h movement guidelines, and investigated its associations with health indicators for healthy children under 5 years of age. MEDLINE, PsycINFO, EMBASE, PubMed, Web of Science and SPORTDiscus were searched for peer-reviewed studies and the last search was conducted on 27 October 2020. The Newcastle-Ottawa Scales were used to assess the quality of included studies. Eighteen articles including 8,943 participants from 11 countries were included. On average around 13% of the children met all three guidelines. Meta-analyses of the associations between meeting all three guidelines and adiposity yielded no significant results (r = - 0.03; 95% CI = - 0.12, 0.06; I² = 51%; P = 0.48). Meeting more guidelines was associated with better psychosocial health (3/4 studies). Associations between meeting individual or combined guidelines and motor development yielded mixed results (2/2 studies), while no associations between meeting guidelines and cognitive development were observed (1 study). Compliance with all three guidelines was low. Further evidence is required to understand the associations between meeting the 24-h movement guidelines and health outcomes. Nevertheless, there was evidence of a dose-response relationship between meeting the guidelines and better psychosocial health in the early years.

Analysis of Latina/o Sociodemographic and Health Data Sets in the United States From 1960 to 2019: Findings Suggest Improvements to Future Data Collection Efforts

Introduction. Prior to 1980, U.S. national demographic and health data collection did not identify individuals of Hispanic/Latina/o heritage as a population group. Post-1990, robust immigration from Latin America (e.g., South America, Central America, Mexico) and subsequent growth in U.S. births, dynamically reconstructed the ethnoracial lines among Latinos from about 20 countries, increasing racial admixture and modifying patterns of health disparities. The increasing racial and class heterogeneity of U.S. Latina/os demands a critical analysis of sociodemographic factors associated with population health disparities. Purposes. To determine the state of available Latina/o population demographic and health data in the United States, assess demographic and health variables and trends from 1960 to the present, and identify current strengths, gaps, and areas of improvement. Method. Analysis of 101 existing data sets that included demographic, socioeconomic, and health characteristics of the U.S. Latina/o population, grouped by three, 20-year intervals: 1960-1979, 1980-1999, and 2000-2019. Results. Increased Latina/o immigration and U.S. births between 1960 and 2019 was associated with increases of Latino population samples in data collection. Findings indicate major gaps in the following four areas: children and youth younger than 18 years, gender and sexual identity, race and mixed-race measures, and immigration factors including nativity and generational status. Conclusions. The analysis of existing ethnoracial Latina/o population data collection efforts provides an opportunity for critical analysis of past trends, future directions in data collection efforts, and an equity lens to guide appropriate community health interventions and policies that will contribute to decreasing health disparities in Latina/o populations.

Evolution of the Dietary Patterns Across Nutrition Transition in the Sardinian Longevity Blue Zone and Association with Health Indicators in the Oldest Old

Health and longevity in humans are influenced by numerous factors, including lifestyle and nutrition. However, the direct relationship between lifetime eating habits and functional capacity of the elderly is poorly understood. This study investigated the dietary changes across nutrition transition (NT) in the early 1960s, in a population located in the Sardinia island known for its longevity, dubbed as "Longevity Blue Zone" (LBZ), as well as the relationship between the dietary patterns and a panel of health indicators. A total of 150 oldest-old participants (89 women and 61 men, age range 90-101 years) living in the LBZ were recruited. Participants were interviewed using validated questionnaires to assess the consumption frequency of common food items, as well as the correlation with self-rated health, comorbidity, affective and cognitive level, physical mobility, disability and anthropometric parameters. Differences between subgroups were evaluated using the Mann-Whitney U test for independent samples or the Wilcoxon signed-rank test for paired samples. Correlation analysis was performed by calculating the Spearman correlation coefficient, separately in males and females. Compared to the pre-NT epoch, the consumption of meat, olive oil and fresh fruit slightly increased, while the consumption of lard, legumes and vegetables decreased. A significant association was found between increased olive oil intake across NT and self-rated health (ρ = 0.519), mobility (ρ = 0.502), improved vision (ρ = -0.227) and hearing (ρ = -0.314); increased chicken meat intake and performance in activities of daily living (basic activities of daily living: ρ = 0.351; instrumental activities of daily living: ρ = 0.333). Instead, vegetable consumption showed low correlation with health indicators. A mild increase in meat intake, mostly pastured poultry, is associated with better physical performance in the Sardinian LBZ elders, suggesting that a supply of protein may have been crucial to maintaining adequate functional capacity.

Indices of Cardiovascular Health, Body Composition and Aerobic Endurance in Young Women; Differential Effects of Two Endurance-Based Training Modalities

Endurance training (ET) has multiple beneficial effects on cardiovascular health (CVH), but there is an evident lack of knowledge on differential effects of various types of ET on indices of CVH in women. The aim of this study was to analyse the effectiveness of two different types of ET on changes in indicators of CVH in apparently healthy adult women. The sample included 58 women (24 ± 3 years; height: 165 ± 6 cm, mass: 66.7 ± 7.2 kg, BMI: 24.3 ± 2.5 kg/m², at baseline) divided into one control non-exercising group (n = 19), and two exercising experimental groups (EE). The first EE participated in choreographed aerobic-endurance training (CAT; n = 19), while the second participated in treadmill-based endurance exercise (TEE; n = 20) during the experimental protocol (8 weeks, 24 training sessions). The testing included pre- and post-exercise protocols and measures of anthropometric/body composition indices, lipid panel, and endurance capacity. Two-way analysis of variance for repeated measurements with consecutive post hoc analysis was applied to the “group” and “measurement” variables. The main significant ANOVA effects found for measurement, and “Group x Measurement” interaction (p < 0.05) were found for all variables but body height. The EE induced positive changes in lipid panel variables, anthropometric/body-build status, and endurance capacity. However, TEE improved endurance capacity to a greater extent than CAT. The results suggest that that the optimal exercise intensity and self-chosen type of physical-activity may result in positive effects on indices of CVH, even in women of young age and good health status.

The health of Italians before and after the economic crisis of 2008

This article examines the relationship between the financial crisis of 2008 and the health of Italians using aggregate and individual health indicators in correlation with the socioeconomic changes which have occurred in the Italian population. First, the study contextualises the changes referring to some important health indicators (life expectancy, death and suicide rates). Then, the main hypothesis on the relation between worsened individual health conditions and socioeconomic deterioration is tested. For this purpose, individual data from 2005 to 2013 stemming from Health Condition and Use of Health Services surveys (Italian National Institute of Statistics) are analysed. The results show that the social categories most severely affected by the crisis, in both employment and economic terms, were basically the same as those that experienced a worsening of their physical and psychological health conditions. These categories of people have a low level of educational attainment, live in southern and insular regions and are most often men.

Automatic Assessment of Keel Bone Damage in Laying Hens at the Slaughter Line

Simple Summary

Keel bone damage (KBD) is very prevalent in commercial laying hen flocks with a wide range of affected hens/flock. It can cause pain, and affected hens have been found to be less mobile. The assessment of this animal welfare indicator provides important feedback for the farmer about flock health and consequently on the need for interventions. However, the assessment of keel bone damage is time-consuming, and prior training is needed in order to gain reliable results. Optical detection methods can be a means to automatedly score hens at the slaughter line with high sample sizes and in a standardized way. We developed and validated an automatic 3D camera-based detection system. While it generally underestimates the presence of KBD due to the purely visual assessment and technical constraints, it nevertheless shows good accuracy and high correlation of prevalences with those visually determined by a trained human assessor. Therefore, this system opens up opportunities to better monitor and combat a severe animal welfare problem in the long-term.

Abstract

Keel bone damage (KBD) can be found in all commercial laying hen flocks with a wide range of 23% to 69% of hens/flock found to be affected in this study. As KBD may be linked with chronic pain and a decrease in mobility, it is a serious welfare problem. An automatic assessment system at the slaughter line could support the detection of KBD and would have the advantage of being standardized and fast scoring including high sample sizes. A 2MP stereo camera combined with an IDS imaging color camera was used for the automatic assessment. A trained human assessor visually scored KBD in defeathered hens during the slaughter process and compared results with further human assessors and automatic recording. In a first step, an algorithm was developed on the basis of assessments of keel status of 2287 hens of different genetics with varying degrees of KBD. In two optimization steps, performance data were calculated, and flock prevalences were determined, which were compared between the assessor and the automatic system. The proposed technique finally reached a sensitivity of 0.95, specificity of 0.77, accuracy of 0.86 and precision of 0.81. In the last optimization step, the automatic system scored on average about 10.5% points lower KBD prevalences than the human assessor. However, a proposed change of scoring system (setting the limit for KBD at 0.5 cm deviation from the straight line) would lower this deviation. We conclude that the developed automatic scoring technique is a reliable and potentially valuable tool for the assessment of KBD.

Tobacco Use and Its Association with Mental Morbidity and Health Compromising Behaviours in Adolescents in Indonesia

Background:

Limited evidence has been established on associations between tobacco use and mental morbidity and health compromising behaviours. The study aimed to investigate the associations between tobacco use, mental problems, and health risk behaviour among adolescents attending school in Indonesia. Methods: Nationally representative data were studied from 11,124 adolescents that took part in the cross-sectional “Indonesia Global School-Based Student Health Survey (GSHS) in 2015”.

Results:

The prevalence of current tobacco use was 12.8%. In adjusted logistic regression analysis, compared to non-current or never tobacco users, current tobacco use was associated with eight of eight mental problem indicators (lonely, anxiety, no close friend, suicidal ideation, suicide plan, suicide attempt and current alcohol use), two of four dietary risk behaviours (soft drink and fast food consumption) and seven of ten other health risk behaviours (in a physical fight, bullied, injury, ever sex, school truancy, and two sub-optimal hand hygiene behaviours).

Conclusion:

Compared to nontobacco users, current tobacco users had significantly higher mental problem indicators and health risk behaviours. Multiple comorbidity with tobacco use should be targeted in interventions.

The Relationships between Screen Use and Health Indicators among Infants, Toddlers, and Preschoolers: A Meta-Analysis and Systematic Review

Evidence suggests that excessive screen time in early childhood is related to children's physical and mental health. This study aimed to review the relationships between screen media use and several health indicators in infants, toddlers, and preschoolers. A systematic search was conducted by two independent reviewers on PubMed, Web of Science, Embase, and Cochrane Library to identify the eligible studies, with an end date of 13 August 2019. Included studies (published in English) were peer-reviewed and met the determinate population (children aged 0-7 years with screen media exposure and related health outcomes). The AHRQ, NOS, and the Cochrane Handbook were used to evaluate the cross-sectional study, cohort study, and RCT, respectively. A meta-analysis and narrative syntheses were employed separately. Eighty studies (23 studies for meta-analysis) met the inclusion criteria for the systematic review. Strong evidence of the meta-analysis suggested that excessive screen time was associated with overweight/obesity and shorter sleep duration among toddlers and preschoolers. Excessive screen use was associated with various health indicators in physical, behavioral, and psychosocial aspects. Better-quality research on newer media devices, on various kinds of contents in young children, and on dose-response relationships between excessive screen use and health indicators are needed to update recommendations of screen use.

Dietary Sodium Intake and Health Indicators: A Systematic Review of Published Literature between January 2015 and December 2019

As the science surrounding population sodium reduction evolves, monitoring and evaluating new studies on intake and health can help increase our understanding of the associated benefits and risks. Here we describe a systematic review of recent studies on sodium intake and health, examine the risk of bias (ROB) of selected studies, and provide direction for future research. Seven online databases were searched monthly from January 2015 to December 2019. We selected human studies that met specified population, intervention, comparison, outcome, time, setting/study design (PICOTS) criteria and abstracted attributes related to the study population, design, intervention, exposure, and outcomes, and evaluated ROB for the subset of studies on sodium intake and cardiovascular disease risks or indicators. Of 41,601 abstracts reviewed, 231 studies were identified that met the PICOTS criteria and ROB was assessed for 54 studies. One hundred and fifty-seven (68%) studies were observational and 161 (70%) focused on the general population. Five types of sodium interventions and a variety of urinary and dietary measurement methods were used to establish and quantify sodium intake. Five observational studies used multiple 24-h urine collections to assess sodium intake. Evidence mainly focused on cardiovascular-related indicators (48%) but encompassed an assortment of outcomes. Studies varied in ROB domains and 87% of studies evaluated were missing information on ≥1 domains. Two or more studies on each of 12 outcomes (e.g., cognition) not previously included in systematic reviews and 9 new studies at low ROB suggest the need for ongoing or updated systematic reviews of evidence on sodium intake and health. Summarizing evidence from assessments on sodium and health outcomes was limited by the various methods used to measure sodium intake and outcomes, as well as lack of details related to study design and conduct. In line with research recommendations identified by the National Academies of Science, future research is needed to identify and standardize methods for measuring sodium intake.

Evolution of External Health Costs of Electricity Generation in the Baltic States

Implementation of strict policies for mitigating climate change has a direct impact on public health as far as the external health costs of electricity generation can be reduced, thanks to the reduction of emission of typical pollutants by switching to cleaner low carbon fuels and achieving energy efficiency improvements. Renewables have lower external health costs due to the lower life cycle emission of typical air pollutants linked to electricity generation, such as SO₂, NOx, particulate matter, NH₃, or NMVOC (Non-methane volatile organic compounds), which all appear to have serious negative effects on human health. Our case study performed in the Baltic States analyzed the dynamics of external health costs in parallel with the dynamics of the main health indicators in these countries: life expectancy at birth, mortality rates, healthy life years, self-perceived health, and illness indicators. We employed the data for external health costs retrieved from the CASES database, as well as the health statistics data compiled from the EUROSTAT database. The time range of the study was 2010–2018 due to the availability of consistent health indicators for the EU Member States. Our results show that the decrease of external health costs had a positive impact on the increase of the self-perceived good health and reduction of long-standing illness as well as the decrease of infant death rate. Our conclusions might be useful for other countries as well as for understanding the additional benefits of climate change mitigation policies and tracking their positive health impacts. The cooperation initiatives on clean energy and climate change mitigation between countries like One Belt One Road initiative by the Chinese government can also yield additional benefits linked to the public health improvements.

National Monitoring for Menstrual Health and Hygiene: Is the Type of Menstrual Material Used Indicative of Needs Across 10 Countries?

Surveys monitoring population health and sanitation are increasingly seeking to monitor menstrual health. In the absence of established indicators, these surveys have most often collected data on the type of menstrual material used. This study investigated whether such data provides a useful indication of women's menstrual material needs being met. Using data from 12 national or state representative surveys from the Performance Monitoring and Accountability 2020 program, we compared self-reported menstrual material use against respondents' reported menstrual material needs (including needing clean materials, money, or access to a vendor). The use of menstrual pads did not indicate that menstrual material needs were met for many respondents. Of those exclusively using pads, a pooled 26.4% (95% Confidence Interval 17.1-38.5) of respondents reported that they had unmet material needs. More disadvantaged groups were particularly misrepresented; of rural women exclusively using pads, a pooled 38.5% (95%CI 27.3-51.1) reported unmet material needs, compared to 17.1% (95%CI 12.4-23.0) of urban women. Similar disparities were observed for levels of education and wealth, with a pooled 45.9% (95%CI 29.2-63.6) of women in the lowest wealth quintile reporting unmet material needs. Findings suggest that caution is needed when using menstrual material use as an indicator for menstrual health.

Global Incidence and Mortality Patterns of Pedestrian Road Traffic Injuries by Sociodemographic Index, with Forecasting: Findings from the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study

(1) Background: Pedestrian injuries (PIs) represent a significant proportion of road traffic injuries. Our aim was to investigate the incidence and mortality of PIs in different age groups and sociodemographic index (SDI) categories between 1990 and 2017. (2) Method: Estimates of age-standardized incidence and mortality along with trends of PIs by SDI levels were obtained from the Global Burden of Disease from 1990 to 2017. We also forecasted the trends across all the SDI categories until 2040 using the Statistical Package for the Social Sciences (SPSS Statistics for Windows, version 23.0, Chicago, IL, USA) time series expert modeler. (3) Results: Globally, the incidence of PIs increased by 3.31% (−9.94 to 16.56) in 2017 compared to 1990. Men have higher incidence of PIs than women. Forecasted incidence was 132.02 (127.37 to 136.66) per 100,000 population in 2020, 101.52 (65.99 to 137.05) in 2030, and reduced further to 71.02 (10.62 to 152.65) by 2040. Globally across all SDI categories, there was a decreasing trend in mortality due to PIs with the global estimated percentage reduction of 37.12% (−45.19 to −29.04). (4) Conclusions: The results show that PIs are still a burden for all SDI categories despite some variation. Although incidence and mortality are expected to decrease globally, some SDI categories and specific vulnerable age groups may require particular attention. Further studies addressing incidence and mortality patterns in vulnerable SDI categories are needed.

Scoping review: Community-based programmes with people affected by leprosy

OBJECTIVE

To analyse community intervention programmes for people affected by leprosy in 'global priority countries'.

METHODS

Scoping review of articles in the databases PubMed, Scopus, SciELO, Lilacs and Web of Knowledge that made reference to community intervention programmes aimed at people affected by leprosy in global priority countries and which presented an evaluation of results. Analytical variables analysed were methodological characteristics of the study, type of intervention classified according to the Community-Based Rehabilitation Matrix, indicators and results of the evaluation, and the degree of participation of the community, which was graphically represented as a spidergram.

RESULTS

Thirty articles met the inclusion criteria. They were mostly related to the health component of the RBC matrix and aimed at the adult population. All evaluated the indicators used positively. The degree of participation generally ranged between mobilisation and collaboration.

CONCLUSION

Community intervention programmes for people affected by leprosy have a positive effect on health. There are attempts to include affected people and the community in implementing these programmes, but it is not possible to establish a direct relationship with effects of their participation on health due to the study designs used. Future research using more robust methods that include leprosy patients are necessary to evaluate the effectiveness of community participation.

Health Indicators of Lesbian, Gay, Bisexual, and Other Sexual Minority (LGB+) Youth Living in Rural Communities

OBJECTIVE

To investigate whether the intersectionality of being lesbian, gay, bisexual, and other sexual minority youth (LGB+) and living in a rural community may portend worse concurrent health indicators than identifying as heterosexual and/or living in a nonrural community.

STUDY DESIGN

Data were collected online between 2010 and 2011 from 5100 13- to-18-year-old youth across the US. Youth were randomly recruited from within the Harris Panel Online and through targeted outreach efforts to LGBT+ youth by a youth-focused nonprofit. The survey questionnaire was self-administered and included measures used in the present study and other measures related to the goal of the Teen Health and Technology study.

RESULTS

Living in a rural community was not associated with additional challenges beyond those posed by LGB+ status. Instead, most noted differences in indicators of psychosocial challenge were between LGB+ and heterosexual youth, regardless of rural vs nonrural community living status. For example, sexual minority youth, both male and female, were more likely to have used substances, have depressive symptomatology, have low self-esteem, and report being bullied in the past year compared with both rural and nonrural heterosexual youth.

CONCLUSIONS

Findings suggest that LGB+ youth living in rural areas are equally likely to face psychosocial challenges as LGB+ youth living in nonrural areas. Pediatricians and other healthcare providers who work with youth should be mindful of creating LGB+ inclusive environments that can promote self-disclosure by youth who may benefit from additional health services or clinical support for psychosocial challenges.

Production and use of estimates for monitoring progress in the health sector: the case of Bangladesh

Background: In order to support the progress towards the post-2015 development agenda for the health sector, the importance of high-quality and timely estimates has become evident both globally and at the country level.

Objective and Methods: Based on desk review, key informant interviews and expert panel discussions, the paper critically reviews health estimates from both the local (i.e. nationally generated information by the government and other agencies) and the global sources (which are mostly modeled or interpolated estimates developed by international organizations based on different sources of information), and assesses the country capacity and monitoring strategies to meet the increasing data demand in the coming years. Primarily, this paper provides a situation analysis of Bangladesh in terms of production and use of health estimates for monitoring progress towards the post-2015 development goals for the health sector.

Results: The analysis reveals that Bangladesh is data rich, particularly from household surveys and health facility assessments. Practices of data utilization also exist, with wide acceptability of survey results for informing policy, programme review and course corrections. Despite high data availability from multiple sources, the country capacity for providing regular updates of major global health estimates/indicators remains low. Major challenges also include limited human resources, capacity to generate quality data and multiplicity of data sources, where discrepancy and lack of linkages among different data sources (local sources and between local and global estimates) present emerging challenges for interpretation of the resulting estimates.

Conclusion: To fulfill the increased data requirement for the post-2015 era, Bangladesh needs to invest more in electronic data capture and routine health information systems. Streamlining of data sources, integration of parallel information systems into a common platform, and capacity building for data generation and analysis are recommended as priority actions for Bangladesh in the coming years. In addition to automation of routine health information systems, establishing an Indicator Reference Group for Bangladesh to analyze data; building country capacity in data quality assessment and triangulation; and feeding into global, inter-agency estimates for better reporting would address a number of mentioned challenges in the short- and long-run.

Measuring the Impact of Environment on the Health of Large Cities

The relative significance of indicators and determinants of health is important for local public health workers and planners. Of similar importance is a method for combining and evaluating such markers. We used a recently developed index, the Urban Health Index (UHI), to examine the impact of environmental variables on the overall health of cities. We used the UHI to rank 57 of the world’s largest cities (based on population size) in low- and middle-income countries. We examined nine variables in various combinations that were available from the Demographic and Health Surveys conducted in these countries. When arranged in ascending order, the distribution of UHIs follows the previously described pattern of gradual linear increase, with departures at each tail. The rank order of cities did not change materially with the omission of variables about women’s health knowledge or childhood vaccinations. Omission of environmental variables (a central water supply piped into homes, improved sanitation, and indoor solid fuel use) altered the rank order considerably. The data suggest that environmental indicators, measures of key household level risk to health, may play a vital role in the overall health of urban communities.

Block-wise comprehensive health index in Gadchiroli: A tribal district in Maharashtra

BACKGROUND

The National Health Mission expects bottom-up approach for preparing Project Implementation Plan and also expects special attention toward tribal areas. Some district-level health information is available from national health surveys, but subdistrict-level information is mostly not available. Gadchiroli is the farthest district from the state capital. There are 12 blocks in the district. It is a notified tribal district having 8.61%-81.50% tribal population in different blocks and block-wise urbanization varies from 0.00% to 37.10%.

OBJECTIVES

The objective was to assess community health status at block level in Gadchiroli district and then develop comprehensive health index for ranking the blocks.

METHODS

The author has used available secondary data sources including Census, Survey of Cause of Death scheme, health management information system, Directorate of Economics and Statistics, and Maharashtra Medical Council. Ten indicators were selected after discussion with public health specialists to evolve comprehensive health index. Blocks having best statistic in each indicator were given 100 marks and other blocks were given proportionate marks. Thus, the highest possible score for any block was 1000.

RESULTS

The range of block-wise score was from 424 to 781. The highest scoring block was Gadchiroli and was an outlier. The comprehensive score was having correlation with urbanization, r = 0.63 (95% confidence limits, 0.09-0.88). After principal component analysis, the extracted three components were responsible for most of the variations.

CONCLUSIONS

Reasonably reliable and valid block-wise data are available to carry out community health assessment and develop comprehensive health index. The index is useful for comparison among blocks.

What Physical Fitness Component Is Most Closely Associated With Adolescents' Blood Pressure?

This study aimed to determine which of four selected physical fitness variables, would be most associated with blood pressure changes (systolic and diastolic) in a large sample of adolescents. This was a descriptive and cross-sectional, epidemiological study of 1,117 adolescents aged 14-19 years from southern Brazil. Systolic and diastolic blood pressure were measured by a digital pressure device, and the selected physical fitness variables were body composition (body mass index), flexibility (sit-and-reach test), muscle strength/resistance (manual dynamometer), and aerobic fitness (Modified Canadian Aerobic Fitness Test). Simple and multiple linear regression analyses revealed that aerobic fitness and muscle strength/resistance best explained variations in systolic blood pressure for boys (17.3% and 7.4% of variance) and girls (7.4% of variance). Aerobic fitness, body composition, and muscle strength/resistance are all important indicators of blood pressure control, but aerobic fitness was a stronger predictor of systolic blood pressure in boys and of diastolic blood pressure in both sexes.

The WHO global reference list of 100 core health indicators: the example of Sierra Leone

The global reference list of 100 core health indicators is a standard set of indicators published by the World Health Organization in 2015. We reviewed core health indicators in the public domain and in-country for Sierra Leone, the African continent and globally. Review objectives included assessing available sources, accessibility and feasibility of obtaining data and informing efforts to monitor program progress. Our search strategy was guided by feasibility considerations targeting mainly national household surveys in Sierra Leone and topic-specific and health statistics reports published annually by WHO. We also included national, regional and worldwide health indicator estimates published with open access in the literature and compared them with cumulative annual indicators from the weekly national epidemiological bulletin distributed by the Sierra Leone Ministry of Health and Sanitation. We obtained 70 indicators for Sierra Leone from Internet sources and 2 (maternal mortality and malaria incidence) from the national bulletin. Of the 70 indicators, 14 (20%) were modified versions of WHO indicators and provided uncertainty intervals. Maternal mortality showed considerable differences between 2 international sources for 2015 and the most recent national bulletin. We were able to obtain the majority of core indicators for Sierra Leone. Some indicators were similar but not identical, uncertainty intervals were limited and estimates differed for the same year between sources. Current efforts to improve health and mortality surveillance in Sierra Leone will improve availability and quality of reporting in the future. A centralized core indicator reporting website should be considered.

Can the Apgar Score be Used for International Comparisons of Newborn Health?

BACKGROUND

The Apgar score has been shown to be predictive of neonatal mortality in clinical and population studies, but has not been used for international comparisons. We examined population-level distributions in Apgar scores and associations with neonatal mortality in Europe.

METHODS

Aggregate data on the 5 minute Apgar score for live births and neonatal mortality rates from countries participating in the Euro-Peristat project in 2004 and 2010 were analysed. Country level associations between the Apgar score and neonatal mortality were assessed using the Spearman rank correlation coefficient.

RESULTS

Twenty-three countries or regions provided data on Apgar at 5 minutes, covering 2 183 472 live births. Scores <7 ranged from 0.3% to 2.4% across countries in 2004 and 2010 and were correlated over time (ρ = 0.88, P < 0.01). There were large differences in healthy baby scores: scores of 10 ranged from 8.8% to 92.7% whereas scores of 9 or 10 ranged from 72.9% to 96.8%. Countries more likely to score 10 s, as opposed to 9 s, for healthy babies had lower proportions of Apgar <7 (ρ = -0.43, P = 0.04). Neonatal mortality rates were weakly correlated with Apgar score <7 (ρ = -0.06, P = 0.61), but differences over time in these two indicators were correlated (ρ =0.56, P = 0.02).

CONCLUSIONS

Large variations in the distribution of Apgar scores likely due to national scoring practices make the Apgar score an unsuitable indicator for benchmarking newborn health across countries. However, country-level trends over time in the Apgar score may reflect real changes and merit further investigation.

Health in a fragile state: a five-year review of mortality patterns and trends at Somalia's Banadir Hospital

Background

The recurrent civil conflict in Somalia has impeded progress toward improving health and health care, with lack of data and poor performance of health indicators. This study aimed at making inference about Banadir region by exploring morbidity and mortality trends at Banadir Hospital. This is one of the few functional hospitals during war.

Methods

A retrospective analysis was conducted with data collected at Banadir Hospital for the period of January 2008–December 2012. The data were aggregated from patient records and summarized on a morbidity and mortality surveillance form with respect to age groups and stratified by sex. The main outcome was the number of patients that died in the hospital. Chi-square tests were used to evaluate the association between sex and hospital mortality.

Results

Conditions of infectious origin were the major presentations at the hospital. The year 2011 recorded the highest number of cases of diarrhea and mortality due to diarrhea. The stillbirth rate declined during the study period from 272 to 48 stillbirths per 1,000 live births by 2012. The sum of total cases that were attended to at the hospital by the end of 2012 was four times the number at the baseline year of the study in 2008; however, the overall mortality rate among those admitted declined between 2008 and 2012.

Conclusion

There was reduction in patient mortality at the hospital over the study period. Data from Banadir Hospital are consistent with findings from Banadir region and could give credible public health reflections for the region given the lack of data on a population level.

Sustainable Development Goals for Monitoring Action to Improve Global Health

Women and children compose the largest segment of the more than 1 billion people worldwide who are unable to access needed health care services. To address this and other global health issues, the United Nations brought together world leaders to address growing health inequities, first by establishing the Millennium Development Goals in 2000 and more recently establishing Sustainable Development Goals, which are an intergovernmental set of 17 goals consisting of 169 targets with 304 indicators to measure compliance; they were designed to be applicable to all countries. Goal number 3, "Good Health and Well-Being: Ensure Heathy Lives and Promote Well-Being for All at All Ages," includes targets to improve the health of women and newborns.

Global Mortality Impact of the 1957-1959 Influenza Pandemic

BACKGROUND

Quantitative estimates of the global burden of the 1957 influenza pandemic are lacking. Here we fill this gap by modeling historical mortality statistics.

METHODS

We used annual rates of age- and cause-specific deaths to estimate pandemic-related mortality in excess of background levels in 39 countries in Europe, the Asia-Pacific region, and the Americas. We modeled the relationship between excess mortality and development indicators to extrapolate the global burden of the pandemic.

RESULTS

The pandemic-associated excess respiratory mortality rate was 1.9/10,000 population (95% confidence interval [CI], 1.2-2.6 cases/10,000 population) on average during 1957-1959. Excess mortality rates varied 70-fold across countries; Europe and Latin America experienced the lowest and highest rates, respectively. Excess mortality was delayed by 1-2 years in 18 countries (46%). Increases in the mortality rate relative to baseline were greatest in school-aged children and young adults, with no evidence that elderly population was spared from excess mortality. Development indicators were moderate predictors of excess mortality, explaining 35%-77% of the variance. Overall, we attribute 1.1 million excess deaths (95% CI, .7 million-1.5 million excess deaths) globally to the 1957-1959 pandemic.

CONCLUSIONS

The global mortality rate of the 1957-1959 influenza pandemic was moderate relative to that of the 1918 pandemic but was approximately 10-fold greater than that of the 2009 pandemic. The impact of the pandemic on mortality was delayed in several countries, pointing to a window of opportunity for vaccination in a future pandemic.

Can the health of a nation be correlated to its state of internal peace?

The Institute for Economics and Peace has ranked 162 territories within the United Nations according to how they score on a scale of 1.0 (most peaceful) to 5.0 (least peaceful) in a 'Global Peace Index' (GPI). The GPI 2015 values range from 1.148 (Iceland) to 3.645 (Syria). In this pilot study, we report significant correlations (Spearman rank coefficients) between each country's GPI and indicators of the health of its citizens (life expectancies, death rates and health expenditures): these significances are marginally enhanced when Sub-Saharan African countries are excluded. Our findings may indicate avenues for promoting a healthy global society, but more detailed and comprehensive analyses should be conducted in order for the factors behind the correlations to be identified and applied with more certainty.

Estimating family planning coverage from contraceptive prevalence using national household surveys

Background

Contraception is one of the most important health interventions currently available and yet, many women and couples still do not have reliable access to modern contraceptives. The best indicator for monitoring family planning is the proportion of women using contraception among those who need it. This indicator is frequently called demand for family planning satisfied and we argue that it should be called family planning coverage (FPC). This indicator is complex to calculate and requires a considerable number of questions to be included in a household survey.

Objectives

We propose a model that can predict FPC from a much simpler indicator – contraceptive use prevalence – for situations where it cannot be derived directly.

Design

Using 197 Multiple Indicator Cluster Surveys and Demographic and Health Surveys from 82 countries, we explored least-squares regression models that could be used to predict FPC. Non-linearity was expected in this situation and we used a fractional polynomial approach to find the best fitting model. We also explored the effect of calendar time and of wealth on the models explored.

Results

Given the high correlation between the variables involved in FPC, we managed to derive a relatively simple model that depends only on contraceptive use prevalence but explains 95% of the variability of the outcome, with high precision for the estimated regression line. We also show that the relationship between the two variables has not changed with time. A concordance analysis showed agreement between observed and fitted results within a range of ±9 percentage points.

Conclusions

We show that it is possible to obtain fairly good estimates of FPC using only contraceptive prevalence as a predictor, a strategy that is useful in situations where it is not possible to estimate FPC directly.

Korea Community Health Survey Data Profiles

In 2008, Korea Centers for Disease Control and Prevention initiated the first nationwide survey, Korea Community Health Survey (KCHS), to provide data that could be used to plan, implement, monitor, and evaluate community health promotion and disease prevention programs. This community-based cross-sectional survey has been conducted by 253 community health centers, 35 community universities, and 1500 interviewers. The KCHS standardized questionnaire was developed jointly by the Korea Centers for Disease Control and Prevention staff, a working group of health indicators standardization subcommittee, and 16 metropolitan cities and provinces with 253 regional sites. The questionnaire covers a variety of topics related to health behaviors and prevention, which is used to assess the prevalence of personal health practices and behaviors related to the leading causes of disease, including smoking, alcohol use, drinking and driving, high blood pressure control, physical activity, weight control, quality of life (European Quality of Life-5 Dimensions, European Quality of Life-Visual Analogue Scale, Korean Instrumental Activities of Daily Living ), medical service, accident, injury, etc. The KCHS was administered by trained interviewers, and the quality control of the KCHS was improved by the introduction of a computer-assisted personal interview in 2010. The KCHS data allow a direct comparison of the differences of health issues among provinces. Furthermore, the provinces can use these data for their own cost-effective health interventions to improve health promotion and disease prevention. For users and researchers throughout the world, microdata (in the form of SAS files) and analytic guidelines can be downloaded from the KCHS website (http://KCHS.cdc.go.kr/) in Korean.

Effectiveness of a multiple-strategy community intervention to reduce maternal and child health inequalities in Haryana, North India: a mixed-methods study protocol

BACKGROUND

A multiple-strategy community intervention, known as National Rural Health Mission (NRHM), launched in India to improve the availability of and access to better-quality healthcare, especially for rural, poor mothers and children. The final goal of the intervention is to reduce maternal and child health inequalities across geographical areas, socioeconomic status groups, and sex of the child. Extensive, in-depth research is necessary to assess the effectiveness of NRHM, on multiple outcome dimensions. This paper presents the design of a new study, able to overcome the shortcomings of previous research.

OBJECTIVE

To propose a comprehensive, methodologically sound protocol to assess the extent of implementation and the effectiveness of NRHM measures to improve maternal and child health outcomes and reduce maternal and child health inequalities.

DESIGN

A mixed-methods approach (quantitative and qualitative) is proposed for this study in Haryana, a state in North India. NRHM's health sector plans included health system strengthening, specific maternal and child healthcare strategies, and communitization. Mission documents and reports on progress, financial monitoring, and common and joint review will be reviewed in-depth to assess the extent of the implementation of plans. Data on maternal and child health indicators will be obtained from demographic health surveys held before, during, and after the implementation of the first phase of the NRHM (2005-2012) and compared over time. Differences in maternal and child health indicators will be used to measure maternal and child health inequalities; these will be compared pre- and post-NRHM. Focus group discussions (FGDs) with service providers and in-depth interviews with program managers, community representatives, and mothers will be conducted until data saturation is achieved, in two districts of Haryana. Using Nvivo software, an inductive qualitative content analysis will be performed to search for the broader themes across the interviews and FGDs. Ethical approval was obtained from the Ethics Committee of the Post Graduate Institute of Medical Education and Research.

[The evolution of national health and the development of the nursing practice in Taiwan]

Nursing is an applied science. While there is a wide range of nursing theories and nursing care models, resolving the health problems and meeting the health needs of clients is the common objective of all in the nursing profession. The nursing profession may be subdivided into hospital clinical nursing and community health nursing (CHN). CHN is further subdivided into public health nursing, school health nursing, and industrial health nursing. The past 60 years has been a period of significant growth and improvement in Taiwan that has enhanced the nation's socioeconomic condition, general living standards, and general public health. The nursing profession has seen profound progress as well, not only in terms of content but also in terms of nursing care models, which are increasingly framed around core public health needs and take into consideration different health perspectives. Nursing in Taiwan has gradually established its own professional function and autonomy.

Healthy Cities indicators--a suitable instrument to measure health?

The evidence-base for a health strategy should include information on the determinants of health and how they link together if it is to influence the health of the population. The WHO European Healthy Cities Network developed a set of 53 healthy city indicators (HCIs), to describe the health of its citizens and capture a range of local initiatives addressing the wider dimensions of health. This was the first systematic effort to collect and analyze a range of data from European cities. The analysis provided important insights into the interpretation, availability, and feasibility of collecting data, resulting in the development of a revised set of 32 indicators with improved definitions. An analysis of the revised indicators showed that this data was more complete and feasible to collect. It provided useful information to cities contributing to developing a description of health and thus helping to identify health problems. It also highlighted issues about the importance of collecting qualitative as well as quantitative data, the number of indicators and the appropriateness of using the indicators to compare different cities. HCIs facilitated the collection of routinely available health data in a systematic manner. The introduction of HCIs has encouraged cities to adopt a structured process of collecting information on the health of their citizens and build on this information by collecting appropriate local data for developing a city health profile to underpin a city health plan that would set out strategies and interventions to improve health and provide the evidence-base for health plans.

Comparison of regional differences in health indicators and standard mortality ratio for stroke in subjects in ehime prefecture

OBJECTIVE

The purpose of this study was to investigate regional differences in the standard mortality ratio (SMR) and risk factors (including dietary habits) for stroke across the three regions of Ehime Prefecture - Toyo (east), Chuyo (central), and Nanyo (south).

PARTICIPANTS AND METHODS

We obtained medical records derived from 956,979 medical examinations carried out at JA Ehime Kouseiren Medical Examination Centers between April 1994 and March 2006. We analyzed data from 132,090 subjects (Toyo - 47,654, Chuyo - 38,435, Nanyo - 46,001) who underwent their first medical examination during this period. To analyze differences between the three regions, we first calculated the SMR for stroke based on data from the Basic Residential Registers and Health Statistics Bureau. Secondly, we calculated significant differences in body mass index, systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose (Glu), and total cholesterol (T-CHO). Thirdly, we used the Chi-square test to calculate significant differences in the percentage of subjects who consumed the following foods on a daily basis: rice, bread, eggs, fish, meat, vegetables, dairy products, and fruit juice.

RESULTS

Despite the fact that regional differences in the SMR for stroke have been decreasing, in both men and women in Nanyo, the mean values for SBP and DBP were significantly higher and the mean value for T-CHO was significantly lower than in Toyo and Chuyo. In Nanyo, the percentage of subjects who consumed rice and fish (men and women), meat (men), and juice (women) on a daily basis was higher than in Toyo and Chuyo.

CONCLUSION

In Nanyo, higher SMR for stroke may be related to high SBP and DBP and low T-CHO. As background to these results, it is also thought that regional differences in dietary habits may have an influence.

Predictors of sexual behaviour among church-going youths in Nairobi, Kenya: a cross-denominational study

We surveyed church-going youths in Nairobi, Kenya, to investigate denominational differences in their sexual behaviour and to identify factors related to those differences. In comparison with youths attending mainline churches, the youths surveyed at Pentecostal/evangelical churches were less likely to have ever had sex. Furthermore, although male youths in the mainline churches were more likely than their female counterparts to have ever had sex, no such difference emerged between the male and female youths attending Pentecostal/evangelical churches. For youths from both types of churches, not only individual religious commitment (being 'born again') but also contextual religiosity (i.e. the extent of socialisation in their faith communities) explained the variations in their sexual behaviour and attitudes. Finally, the effect of denomination on one's intention to have sex in the next 12 months was mediated by the frequency of talk about spiritual issues with church confidants.

Cumulative risk assessment and environmental equity in air permitting: interpretation, methods, community participation and implementation of a unique statute

In 2008, the statute authorizing the Minnesota Pollution Control Agency (MPCA) to issue air permits was amended to include a unique requirement to analyze and consider “cumulative levels and effects of past and current environmental pollution from all sources on the environment and residents of the geographic area within which the facility’s emissions are likely to be deposited.” Data describing the Statute Area suggest it is challenged by environmental and socioeconomic concerns, i.e., concerns which are often described by the phrase ‘environmental equity’. With input from diverse stakeholders, the MPCA developed a methodology for implementing a cumulative levels and effects analysis when issuing air permits in the designated geographic area. A Process Document was created defining explicit steps a project proposer must complete in the analysis. An accompanying Reference Document compiles all available environmental health data relevant to the Statute Area that could be identified. The final cumulative levels and effects methodology is organized by health endpoint and identifies hazard, exposure and health indices that require further evaluation. The resulting assessment is summarized and presented to decision makers for consideration in the regulatory permitting process. We present a description of the methodology followed by a case study summary of the first air permit processed through the “cumulative levels and effects analysis”.

The impact of living arrangements and deinstitutionalisation in the health status of persons with intellectual disability in Europe

BACKGROUND

Despite progress in the process of deinstitutionalisation, very little is known about the health conditions of people with intellectual disability (PWID) who live in large institutions and PWID living in small residential services, family homes or independent living within the community. Furthermore, there are no international comparison studies at European level of the health status and health risk factors of PWID living in fully staffed residential services with formal support and care compared with those living in unstaffed family homes or independent houses with no formal support.

METHODS

A total of 1269 persons with ID and/or their proxy respondents were recruited and face-to-face interviewed in 14 EU countries with the P15, a multinational assessment battery for collecting data on health indicators relevant to PWID. Participants were grouped according to their living arrangements, availability of formal support and stage of deinstitutionalisation.

RESULTS

Obesity and sedentary lifestyle along with a number of illnesses such as epilepsy, mental disorders, allergies or constipation were highly prevalent among PWID. A significantly higher presence of myocardial infarctions, chronic bronchitis, osteoporosis and gastric or duodenal ulcers was found among participants in countries considered to be at the early stage of deinstitutionalisation. Regardless of deinstitutionalisation stage, important deficits in variables related to such medical health promotion measures as vaccinations, cancer screenings and medical checks were found in family homes and independent living arrangements. Age, number of people living in the same home or number of places in residential services, presence of affective symptoms and obesity require further attention as they seem to be related to an increase in the number of illnesses suffered by PWID.

DISCUSSION

Particular illnesses were found to be highly prevalent in PWID. There were important differences between different living arrangements depending on the level of formal support available and the stage of deinstitutionalisation. PWID are in need of tailored primary health programs that guarantee their access to quality health and health promotion and the preventative health actions of vaccination programs, systematic health checks, specific screenings and nutritional controls. Extensive national health surveys and epidemiological studies of PWID in the EC member states are urgently needed in order to reduce increased morbidity rates among this population.