Basic Public Health Research Articles

Promoting equality in utilization of basic public health services in China: the role of the family doctor contract service

Background The Family Doctor Contract Service (FDCS) system is a service model for primary care reform launched in 2016 to offer families and individuals active and continuous health care by a team of family doctors within primary care institutions in China. Objectives This study aimed to estimate socioeconomic-related inequalities in the utilization of basic public health services, and to identify the contribution of FDCS to promoting equality. Methods Data for the study were collected from a 2023 cross-sectional household health survey in western China, involving 39,456 participants. The concentration index (C) was employed for analyzing the extent of socioeconomic-related inequalities in the utilization of basic public health services and the coarsened exact matching technique was employed for sensitivity analysis in order to reduce selection bias. Results Our results indicated pro-poor inequalities in the utilization of health records (C = −0.046), free health check-ups (C = −0.009), and follow-ups for hypertension (C = −0.051). Additionally, a more equitable distribution across the economic spectrum was observed within the FDCS group (people who voluntarily contracted for services) compared to the non-FDCS group. The FDCS demonstrated more favorable positive impacts among individuals with higher (quintiles 60–80%) and the highest (top 20%) socioeconomic status. The FDCS contributed 83.94%, 59.24%, and 36.92% to pro-poor inequalities in the utilization of three basic public health services. These contributions reflected the positive impact of the FDCS on utilization. Conclusions Government policy and service delivery models require a paradigm shift to promote a stronger primary healthcare approach to practice, as evidenced by the effectiveness of the FDCS in promoting equality.

Public Services in the Field of Basic Health for Mothers and Children in Talawaan District, North Minahasa Regency, North Sulawesi Province

Maternal mortality rate and infant mortality rate are an indication of the low level of population welfare. Likewise, the high disparity in socio-economic levels - rich and poor, between regions and between urban and rural areas. Therefore, health services for mothers and children are the main priority in health development. The government at all levels of government has established and implemented health programs for mothers and children. However, it has not provided a good impact on the aspect of basic public services. Health services for mothers and children through integrated service posts are more visible at the village level and require serious attention from the government because they are very far from health service centers such as regional hospitals. Therefore, this study was conducted to describe and explain basic public health services for mothers and children in Talawaan District, North Minahasa Regency. This study is considered important from the aspect of public health and related to strengthening social capital in the superior fields of social humanities, arts and culture as well as the development and strengthening of institutional systems, health policies, and community empowerment in the superior fields of health and medicine in the Sam Ratulangi University research strategy plan. Data were collected through interviews with the Head of the Health Service and Health Center, Posyandu officers and pregnant mothers and those with toddlers. Observations were made by looking directly at basic health services in Talawaan District. Secondary data were collected during health service activities and conducting electronic searches on Google Scholar and ResearchGate. The analysis was carried out based on the stages of reduction, interpretation, drawing conclusions and verification/triangulation. The research findings that public services in the field of basic health are accessible, acceptable, fair and safe for mothers and children but are not yet fully efficient and effective in their implementation. The concept found from this study is that the community needs basic health services for mothers and children that are easy to access and accept, fair to all levels of society and medically safe. While the principles of efficiency and effectiveness are more about the interests of the organization in the use of resources and achieving goals.

The joint effect of cumulative metabolic parameters on the risk of type 2 diabetes: a population-based cohort study

Background and aimsThis study aimed to examine the cumulative effects of body mass index (BMI), body roundness index (BRI), pulse pressure (PP), triglycerides (TG), high-density lipoprotein cholesterol (HDL) and fasting plasma glucose (FPG) on Type 2 diabetes (T2D) morbidity.MethodsA total of 78,456 participants aged older than 45 years were extracted from basic public health services in China. During the 2-year follow-up, 6,942 individuals had developed T2D. The binary logistic regression models and multinomial logistic regression models were conducted to investigate the effects of cumulative metabolic parameters on incident T2D, prediabetes regression and progression.ResultsWe found statistically deleterious impacts of exposure to high cumulative BMI, BRI, PP, TG and low cumulative HDL on T2D morbidity and prediabetes progression. Compared to the group with low cumulative of all five parameters, the adjusted ORs for new-onset T2D for participants presenting with 1–2, 3, and 4–5 elevated metabolic parameters were 1.41(1.31,1.52), 1.93(1.74,2.13) and 2.21(1.94,2.51), respectively. There was additive interaction between FPG level and cumulative metabolic parameters with T2D. Compared with participants with the lowest quartile of FPG and low cumulative of all 5 parameters, those with the highest quartile of FPG and high cumulative of 4–5 parameters had a 14.63 [95% CI (12.27, 17.42)] higher risk of incident T2D.ConclusionsParticipants with more numbers of high-cumulative metabolic parameters were associated with a higher risk of incident T2D and prediabetes progression. A high level of normal FPG could enhance these risks.

Waste management training intervention on knowledge and attitude of integrated health service cadres and housewives in West Kalimantan

Background: Healthy village is an innovative concept prioritizing health and well-being in community development, encompassing basic health services, sanitation, clean water, environmental cleanliness, public health, food safety, and community empowerment. Purpose: To analyze the impact of Waste management training provided to integrated health service cadres and housewives. Method: A quantitative quasi-experiment study, participants were selected using purposive sampling and the Slovin formula, resulting in 82 participants from Sungai Asam village. Univariate statistical analysis was conducted, including a paired t-test to assess changes within groups and an independent t-test for between-group comparisons. Results: Support for waste management was influenced by the knowledge and attitudes of both cadres and housewives. In the cadre group, knowledge increased from an average of 15.780 in the pre-test to 18.439. For the housewives group, knowledge rose from an average of 14.561 in the pre-test to 15.634. Attitudes in the cadre group improved from 50.122 in the pre-test to 62.609, while in the housewives group, attitudes increased from 42.170 to 47.365. Conclusion: Waste management training significantly enhanced knowledge and attitudes in both groups, with a more substantial improvement observed among cadres. The study effectively demonstrated the impact of Waste management training on fostering a healthier village environment.

Pelaksanaan Program "Cek Tensi dan Gula Darah Gratis" oleh KKN Kelompok 14 Universitas Abdurrab di Tembilahan

This activity aims to increase public health awareness through free blood pressure and blood sugar check services. The activity was carried out on Car Free Day (CFD) in Tembilahan, Jl. Swarna Bumi, by KKN Group 14 of Abdurrab University. The community who attended not only received health services, but also information about Abdurrab University through the distribution of brochures. The methods used were direct service and health education. The results showed high enthusiasm from the community with 100 participants checking their blood pressure and 80 participants checking their blood sugar. This program succeeded in increasing basic public health knowledge and improving the positive image of the university.

A competency model for basic public health professionals in public health emergencies.

To develop and validate a comprehensive competency model for basic public health professionals to enhance their response to public health emergencies. Staff working in basic public health institutions such as the Centre for Disease Control, community health services and township health centres were selected as the study population. Through an integrative literature review, structured questionnaire survey (n = 1310), exploratory factor analysis and confirmatory factor analysis, we developed and validated a competency model. Exploratory factor analysis was utilized to extract common factors, and confirmatory factor analysis was employed to establish the model and ensure its robustness. Identified competencies by exploratory factor analysis encompass professional and technical skills, medical professionalism, specialized medical knowledge, cognitive and managerial aptitude, public health service competence, emergency response proficiency and physical and mental quality. The model displayed high validity, with a Kaiser-Meyer-Olkin score of 0.933, the χ2 value of Bartlett's test of sphericity was 4169.238 at 889 degrees of freedom (df) (p < 0.001) and the cumulative contribution rate was 60.7%. The confirmatory analysis yielded a final model fit (χ2/df = 2.461) with satisfactory adjusted fit indicators. This validated competency model provides a robust framework for selecting, training and evaluating basic public health professionals, potentially enhancing overall emergency response capabilities.

Heterogeneity in public health service utilization and its relationship with social integration among older adult migrants in China: a latent class analysis.

The older adult migrant population in China is on the rise, which presents challenges for the national public health service system. However, the heterogeneity of public health service utilization and its relationship with social integration among the older adult migrant population remains unclear. This study aims to explore the heterogeneity the public health service utilization and how it relates to their social integration. A total of 6,178 older adult migrants from the China Migrants Dynamic Survey (CMDS) in 2017 were included in this study. Exploratory factor analysis was used to categorize social integration into four dimensions. Latent class analysis (LCA) was used to identify different sub-groups of public health service utilization. ANOVA and multivariate logistic regression were used to determine the characteristics of different sub-groups. Three potential classes of public health service utilization were identified: low utilization of basic public health services class (N = 3,264,52.756%), medium utilization of basic public health services class (N = 1,743,28.172%), and high utilization of basic public health services class (N = 1,180,19.072%). Gender, education, extent of mobility, and move alone or not, flow time were all predictors of the class of public health service utilization. There were significant differences in social integration across potential categories (p<0.0001). The utilization of public health services of the older adult migrants is affected by many aspects. Social integration deserves attention as a significant influencing factor in the utilization of public health services. The government should pay attention to the characteristics of the older adult migrants and formulate relevant policies in a targeted manner in order to improve the utilization of public health services of the older adult migrants.

The effect of basic public health service equalization on settlement intention of migrant workers in China: the mediating effect model based on subjective feelings

BackgroundDuring the 14th Five-Year Plan, China aims to transform rural migrants into urban citizens and ensure equal access to public services to enhance new urbanization. Understanding migrant workers' settlement intentions is crucial for their citizenship development. Based on the fundamental role of the right to life and health, equalization of basic public health services is essential. Therefore, understanding the potential impact of public health services equalization on the settlement intention of migrant workers is crucial in China’s new urbanization.MethodIn this study, we utilized data from the 2017 wave of China Migrants Dynamic Survey (CMDS) and employed the Propensity Score Matching method to investigate the impact of basic public health service equalization policy on the settlement intention of migrant workers. Additionally, we utilized the Mediation Effect Model to uncover the impact mechanism.ResultsOur findings indicate that basic public health service equalization policy has a significant positive effect on increasing the settlement intention of migrant workers, with an even greater effect observed among the low-income group, the cross-provincial subsample, and the new generation subsample. The results of the Mediation Effect Model suggest that Basic public health service equalization policy can bolster the subjective integration willingness and subjective identity of migrant workers, thereby enhancing their settlement intention.ConclusionBased on the results, we propose to strengthen the promotion of the basic public health service equalization policy and expand the coverage of health records to further increase the settlement intention of migrant workers.

Mediation Effect of Obesity on the Association of Socioeconomic Status with Blood Pressure in the Elderly Hypertensive Population.

Socioeconomic status (SES) plays a crucial role in blood pressure (BP) control. SES may influence BP control through obesity indices, such as body mass index (BMI) and waist circumference (WC). This study aimed to understand the relationships between SES and BP control in the elderly hypertensive population, and to determine whether BMI and WC mediate the relationship between SES and BP control. The study was conducted in Jia County, Henan Province, China, from 1 July to 31 August 2023. The 18,963 hypertensive people over 65 years old who were included in the National Basic Public Health Service Program were investigated. The study utilized questionnaire surveys to collect data on participants' demographic characteristics, disease history, lifestyle behaviors, antihypertensive medication, and measured height, weight, and blood pressure. SES was indexed by participants' self-reported educational level, family income, and occupation, and categorized into low, medium, and high groups by using latent category analysis (LCA). Logistic regression models were used to analyze the associations between SES and BP control. Obesity indicators, represented by BMI and WC, were included in mediation models to examine the indirect effects of BMI/WC on the association between SES and BP control. The mean age of 17,234 participants was 73.4 years and 9888 (57.4%) of the participants were female. The LCA results indicated the number of participants in low SES, middle SES, and high SES groups were 7760, 8347, and 1127, respectively. Compared with the low SES group, the odds ratios (ORs) and 95% confidence intervals (CIs) for the association of BP control with middle SES and high SES were 1.101 (1.031, 1.175), and 1.492 (1.312, 1.696). This association was similarly found in the subsequent subgroup analyses (p < 0.05). Compared with low SES, our findings further suggested that BMI (indirect effects: 95% CIs: -0.004--0.001; p < 0.001) and WC (indirect effects: 95% CIs: -0.003--0.001; p = 0.020) play a suppressing role in the association between high SES and BP control. Our study indicated that the elderly hypertensive population with high SES may have a better result for BP control. However, we found that BMI/WC plays a suppressing role in this association. This indicated that despite the better BP control observed in elderly hypertensive populations with high SES, BMI and WC might undermine this beneficial relationship. Therefore, implementing strategies for obesity prevention is an efficient way to maintain this beneficial association between high SES and BP control.

The status and challenges of primary health care in China

This article systematically reviews the development of primary healthcare (PHC) in China over the past 45 years, using data from the “China Health Statistics Yearbook” for 2010–2012, the "China Health and Family Planning Statistics Yearbook" for 2013–2017, and the "China Health Statistics Yearbook" for 2018–2022, along with 2023 World Bank data on infant mortality rate, maternal mortality rate, and average life expectancy for China and upper middle income countries. The development of PHC in China is divided into four stages, and the achievements included the gradual improvement of the PHC network, universal coverage of basic medical insurance, and the expansion of basic public health services in scope and funding. There has been a steady increase in family doctor contracting percentages and continuous improvement in the health status of women and children, ranking key health indicators of China among the top of upper-middle-income countries. Current challenges include imbalanced infrastructure development in PHC, a declining proportion of medical insurance funds, lack of vitality in operational mechanisms, and low salary levels and imperfect incentive system . This paper summarizes the international experience relevant to primary health care and proposes future development strategies in China.

Addressing healthy aging in China: Practices and prospects.

One important challenge for global development is aging. China is one of the world's countries with the highest elderly population and the most rapid aging; in 2022, the percentage of the population over 65 was 14.9%; by 2050, it is expected to rise to 26.1%. China's health security, elderly care, and healthcare services are facing serious challenges as a result of this aging trend. With 80% of provinces including medical and elderly care in national basic public health care programs, China has adopted a proactive national plan to combat population aging. Moreover, geriatric departments have been established at 69.3% of public general hospitals at secondary and higher tiers, 48% of provinces have devises preventive interventions for disability and dementia in the elderly, 48 percent of provinces are serving as test regions for medical care related to rehabilitation, and 49 cities are involved in long-term care insurance (LTCI) trials that encompass 170 million people. There are 4,259 medical and health care facilities that provide hospice care services, 152 hospice care pilot regions, and 87,000 pairs of contracts between medical and health care facilities and elderly care providers. These developments provide a strong basis, but there are still major obstacles to overcome. The Chinese Government is urged to adopt early preventive measures, offer more ongoing, practical, and cost-effective diagnostic and treatment services, allocate resources equitably, and use intelligent technologies to enhance elderly care. The ultimate goals are to lessen the financial burden, enhance the health of the elderly, and offer a vital global resource.

Impact of digital infrastructure construction on the migrants’ utilization of basic public health services in China

BackgroundGlobal digitalization significantly impacts public health by improving healthcare access for marginalized populations. In China, socioeconomic disparities and the Hukou system create significant barriers for the migrant population to access basic public health services (BPHS). This study aimed to assess how digital infrastructure construction (DIC) affects BPHS utilization among China’s migrant populations, filling a gap in the literature regarding the relationship between digital advancements and health service accessibility.MethodsThis research used micro-level data from the 2018 China Migrants Dynamic Survey and incorporated variables aligned with the Broadband China policy to employ a comprehensive empirical strategy. It included baseline regressions, robustness checks through propensity score matching and machine learning techniques, and heterogeneity analysis to explore the differential impacts of DIC based on gender, age, education level, and Hukou status.ResultsThe findings revealed that DIC significantly enhances the likelihood of migrants establishing health records and registering with family doctors, demonstrating quantifiable improvements in health service utilization. Heterogeneity analysis further indicated that the beneficial impacts of DIC were more pronounced among female migrants, those with higher education levels, younger populations, and urban Hukou holders.ConclusionsDIC plays a crucial role in bridging the accessibility gap to BPHS for migrant populations in China, contributing to narrowing health disparities and advancing social equity. These results emphasize the significance of digital infrastructure in public health strategies and offer valuable insights for policymakers, healthcare providers, and researchers. Future research should prioritize longitudinal studies on the sustained effects of DIC and tailor digital health initiatives to meet the unique needs of migrant populations, promoting inclusive health policy planning and implementation.

A calculation of capitation-based payment standardto chronic disease cases in primary care settings

BackgroundOutpatient medical care payment play a pivotal role in the reform of medical insurance payment methods. With ongoing reforms in China, a variety of payment strategies, including capitation and the ambulatory patient groups (APG) point method, are being progressively implemented. ObjectiveThis study aims to identify appropriate capitation calculation methods for chronic diseases in Beijing and to provide recommendations for implementing capitation payments reforms in the city. MethodsWe focused on four prevalent chronic diseases—hypertension, diabetes, coronary heart disease, and stroke—and analyzed basic medical data and public health funding in Beijing's districts C and H as case studies. This research was aimed at developing a capitation calculation method tailored to these locales, determining payment standards for major chronic diseases in primary care clinics, and thus supporting the advancement of capitation reform for outpatient chronic diseases. ResultsUsing medical insurance data and public health funding data from 2017 to 2019, a top-down allocation was employed to determine the capitation payment standards in district H: 4,693.11 Yuan for hypertension, 6,597.70 Yuan for diabetes, 5,644.46 Yuan for coronary heart disease, and 6,437.78 Yuan for stroke. A bottom-up costing approach was used in district C, resulting in payment standards of 4,884.18 Yuan for hypertension, 5,960.63 Yuan for diabetes, 3,733.93 Yuan for coronary heart disease, and 3,886.66 Yuan for stroke. ConclusionThe outpatient costs associated with different chronic disease populations vary considerably. In view of maintaining equity in medical insurance and the fairness of capitation fees, it is imperative to apply risk adjustments to the benchmark capitation fee. Personalized services should be tailored to the diverse types and severities of chronic diseases. It is also crucial to provide customized basic medical and public health services to various chronic disease patients as part of the capitation payment reform for outpatient services. Additionally, enhancing the capabilities of community health services in managing chronic diseases, improving contracting percentages, and establishing effective incentive and evaluation mechanisms for general practitioners are essential for equitable distribution of surplus from capitation payments.

Minnesota Public Health Corps: A New Model For Building The Governmental Public Health Workforce.

Governmental public health agencies in the US are understaffed, and ongoing shortages will have a detrimental effect on their ability to provide basic public health services and protections. Public Health AmeriCorps was established in 2022 to support efforts to create a stronger and more diverse public health workforce nationwide. The Minnesota Public Health Corps, one of the largest Public Health AmeriCorps models, is a capacity-building program that places AmeriCorps members directly into governmental public health settings across the state. We used data from the first year of the Minnesota Public Health Corps (2022-23) to describe the experiences of thirty-five sites participating in the program. We also examined preliminary findings about how it shaped AmeriCorps members' skills and prospects related to career development in public health. Corps members were younger and more diverse than the current public health workforce in Minnesota, and the majority said that they intended to pursue a public health career. Host sites reported improved capacity to deliver public health services and indicated that corps members helped them reach new populations. Our evaluation demonstrates that this statewide program may be a scalable model to address parts of the acute capacity gaps at public health agencies, as well as long-term efforts to revitalize the workforce.

Construction of a Predictive Model for Diabetes Mellitus Type 2 in Middle-Aged and Elderly Populations Based on the Medical Checkup Data of National Basic Public Health Service

To establish a universally applicable logistic risk prediction model for diabetes mellitus type 2 (T2DM) in the middle-aged and elderly populations based on the results of a Meta-analysis, and to validate and confirm the efficacy of the model using the follow-up data of medical check-ups of National Basic Public Health Service. Cohort studies evaluating T2DM risks were identified in Chinese and English databases. The logistic model utilized Meta-combined effect values such as the odds ratio (OR) to derive β, the partial regression coefficient, of the logistic model. The Meta-combined incidence rate of T2DM was used to obtain the parameter α of the logistic model. Validation of the predictive performance of the model was conducted with the follow-up data of medical checkups of National Basic Public Health Service. The follow-up data came from a community health center in Chengdu and were collected between 2017 and 2022 from 7602 individuals who did not have T2DM at their baseline medical checkups done at the community health center. This community health center was located in an urban-rural fringe area with a large population of middle-aged and elderly people. A total of 40 cohort studies were included and 10 items covered in the medical checkups of National Basic Public Health Service were identified in the Meta-analysis as statistically significant risk factors for T2DM, including age, central obesity, smoking, physical inactivity, impaired fasting glucose, a reduced level of high-density lipoprotein cholesterol (HDL-C), hypertension, body mass index (BMI), triglyceride glucose (TYG) index, and a family history of diabetes, with the OR values and 95% confidence interval (CI) being 1.04 (1.03, 1.05), 1.55 (1.29, 1.88), 1.36 (1.11, 1.66), 1.26 (1.07, 1.49), 3.93 (2.94, 5.24), 1.14 (1.06, 1.23), 1.47 (1.34, 1.61), 1.11 (1.05, 1.18), 2.15 (1.75, 2.62), and 1.66 (1.55, 1.78), respectively, and the combined β values being 0.039, 0.438, 0.307, 0.231, 1.369, 0.131, 0.385, 0.104, 0.765, and 0.507, respectively. A total of 37 studies reported the incidence rate, with the combined incidence being 0.08 (0.07, 0.09) and the parameter α being -2.442 for the logistic model. The logistic risk prediction model constructed based on Meta-analysis was externally validated with the data of 7602 individuals who had medical checkups and were followed up for at least once. External validation results showed that the predictive model had an area under curve (AUC) of 0.794 (0.771, 0.816), accuracy of 74.5%, sensitivity of 71.0%, and specificity of 74.7% in the 7602 individuals. The T2DM risk prediction model based on Meta-analysis has good predictive performance and can be used as a practical tool for T2DM risk prediction in middle-aged and elderly populations.

Effects of internal migrants' health on economic resilience in China's Yangtze River Delta urban agglomeration: moderating effects of basic public health services.

Internal migrants constitute a significant generality in the socioeconomic development of developing countries. With the frequent occurrence of major public health emergencies, obstacles to labor supply due to health issues among internal migrants not only affect their livelihood stability but also urban economic resilience. Moreover, the design of basic public health service systems tends to favor local residents over internal migrants, further exacerbating the health and employment risks of internal migrants. As a result, urban economic resilience faces significant challenges. The objective of this study was to deconstruct economic resilience into economic resistance and recovery abilities, investigate the net effect and its heterogeneity of internal migrants' health on economic resilience in China's Yangtze River Delta urban agglomeration (CYRD), and the mediating effect from labor participation rate and labor time supply, as well as the moderating effect of basic public health services. Based on the China Migrants Dynamic Survey data (CMDS), the study empirically estimated the effects of internal migrants' health on economic resilience in CYRD through microeconometric analysis methods, mediating and moderating effect model. Our findings indicate that internal migrants' health has a positive effect on economic resilience in CYRD. For each unit increase in migrants' health, it will drive up the average economic resistance ability by 0.0186 and the average recovery ability by 0.0039. Secondly, the net effects of migrants' health on economic resilience show significant structural differences, industry and city heterogeneity. The effect of migrants' health on economic resistance ability is significantly higher than that on economic recovery ability; The effect of migrants' health on economic resilience of the secondary industry is higher than that of the tertiary industry; The cities with high economic resistance and recovery abilities have more prominent positive effect from migrants' health. Thirdly, migrants' health not only has a direct effect on the economic resistance and recovery abilities, but also has a mediating effect on which through labor participation rate and labor time supply. Enhancing the accessibility and quality of basic public health services is beneficial for enhancing the positive effects of internal migrants' health on economic resilience.

Association of healthy lifestyle score with control of hypertension among treated and untreated hypertensive patients: a large cross-sectional study.

Hypertension stands as the leading single contributor to the worldwide burden of mortality and disability. Limited evidence exists regarding the association between the combined healthy lifestyle score (HLS) and hypertension control in both treated and untreated hypertensive individuals. Therefore, we aimed to investigate the association between HLS and hypertension control among adults with treated and untreated hypertension. This cross-sectional study, including 311,994 hypertension patients, was conducted in Guangzhou using data from the National Basic Public Health Services Projects in China. The HLS was defined based on five low-risk lifestyle factors: healthy dietary habits, active physical activity, normal body mass index, never smoking, and no alcohol consumption. Controlled blood pressure was defined as systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg. A multivariable logistic regression model was used to assess the association between HLS and hypertension control after adjusting for various confounders. The HLS demonstrated an inverse association with hypertension control among hypertensive patients. In comparison to the low HLS group (scored 0-2), the adjusted odds ratios (95% confidence intervals) for hypertension were 0.76 (0.74, 0.78), 0.59 (0.57, 0.60), and 0.48 (0.46, 0.49) for the HLS groups scoring 3, 4, and 5, respectively (Ptrend < 0.001). Notably, an interaction was observed between HLS and antihypertensive medication in relation to hypertension control (Pinteraction < 0.001). When comparing the highest HLS (scored 5) with the lowest HLS (scored 0-2), adjusted odds ratios (95% confidence intervals) were 0.50 (0.48, 0.52, Ptrend < 0.001) among individuals who self-reported using antihypertensive medication and 0.41 (0.38, 0.44, Ptrend < 0.001) among those not using such medication. Hypertensive patients adhering to a healthy lifestyle without medication exhibited better blood pressure management than those using medication while following a healthy lifestyle. HLS was associated with a reduced risk of uncontrolled blood pressure.

Disparities in awareness and utilisation of National Essential Public Health Services between the floating population and the registered residents: a cross-sectional study in China

ObjectiveThere are differences between the floating population and the registered population in the awareness and use of the National Essential Public Health Services (NEPHS) due to the influence of China’s...

History of development of undergraduate public health education in Bulgaria.

The study aims to present a historical review and analysis of the establishment and development of undergraduate public health (PH) education in Bulgaria from 1878 until 2019. А search and selection of historical documents was performed, including laws, rules, regulations, government plans, programmes, scientific publications from periodical medical press, journals, specialized monographs, and books. A retrospective analysis of the normative documents related to the organization of the sanitation and public health activities, and to the provision of professional undergraduate education of the public health workforce in Bulgaria has been carried out. The required competences and tasks of the specialists exercising public health control services were extracted. The development in the public health educational activities were followed in three consecutive periods: the newly independent state (1878-1944); the socialist state (1945-1990); the democratizing state (1990-2019). The development of organized PH activities began after the liberation of Bulgaria in 1878. The historical analysis reveals a direct link between the major socioeconomic changes in the country and the organization of PH undergraduate education which passed through dynamic transformations. The professional education in the sphere of PH started with the training of feldshers, followed by sanitary feldsher and sanitary health inspectors performed in secondary vocational medical schools during the socialist period, reaching the stage of undergraduate university PH education provided by medical colleges associated with universities in the third period. Despite the continuous development in the organization of undergraduate PH education in Bulgaria, its content is still not fully compatible with the basic European PH services and actions. There is a growing need for wider standardization and integration of undergraduate PH education in the EU so that the specialty can reach the status of a regulated health profession similar to medicine, nursing, and others.

Association of adiposity indicators with cardiometabolic multimorbidity risk in hypertensive patients: a large cross-sectional study.

Cardiometabolic multimorbidity (CMM) has emerged as a prominent public health concern. Hypertensive patients are prone to develop comorbidities. Moreover, the accumulation of visceral adipose tissue is the main cause for the development of cardiometabolic diseases. The cardiometabolic index (CMI), lipid accumulation product (LAP), visceral adiposity index (VAI), and Chinese visceral adiposity index (CVAI) not only assess adipose tissue mass but also reflect adipose tissue dysfunction. So far, no study has been reported to evaluate the association of CMI, LAP, VAI, and CVAI with CMM risk in hypertensive patients. Therefore, this study aimed to assess the association between these adiposity indicators and the risk of CMM among Chinese hypertensive patients. In this cross-sectional study, a total of 229,287 hypertensive patients aged 35 years and older were included from the National Basic Public Health Service Project. All participants underwent a face-to-face questionnaire survey, physical examination, and the collection of fasting venous blood samples. Multivariable logistic regression models were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Receiver operating characteristic curve was utilized to evaluate the identification ability for CMM. After adjusting for confounders, each 1-standard deviation increase in CMI, LAP, VAI, and CVAI was associated with a 14%, 8%, 12%, and 54% increased risk of CMM, respectively. When comparing the highest quartile of these indicators with the lowest quartile, individuals in the highest quartile of CMM, LAP, VAI, and CVAI had a 1.39-fold (95% CI 1.30, 1.48), 1.28-fold (95% CI 1.19, 1.37), 1.37-fold (95% CI 1.29, 1.46), and 2.56-fold (95% CI 2.34, 2.79) increased risk of CMM after adjusting for potential confounders. Notably, a nonlinear association was observed for CMI, LAP, and VAI with the risk of CMM (all P nonlinearity < 0.001). CVAI exhibited the highest area under the receiver operating characteristic curve (AUC) among all the included adiposity indices in this analysis. This study indicated the significant positive association of CMI, LAP, VAI, and CVAI with the risk of CMM in hypertensive patients. Among these indicators, CVAI demonstrated the most robust performance in predicting CMM risk and may serve as a valuable tool for identifying CMM risk in Chinese hypertensive patients.