City Public Health Research Articles

Bloodstream infections in hospitalized patients before and during the COVID-19 surge in a community hospital in the South Bronx

Bloodstream infections in hospitalized patients before and during the COVID-19 surge in a community hospital in the South Bronx

List of essential public healthcare functions as a basis for analysis and evaluation of the public health system in a city

Introduction. The World Health Assembly in resolution WHA69.1 defined the essential public health operations (EPHO) as the most cost-effective, comprehensive and sustainable ways of improving population health and reducing the burden of disease. In recent years Russia has been actively working to introduce a system for motivating people to lead healthy lifestyles into the medical prevention system. A special place is given to the regions. Moscow as an independent region of the Russian Federation has a great potential in this field. However, for the effectiveness of health system planning and public health promotion measures at the national, regional and municipal levels, more clarity is needed on the issue of EPHOs. Objectives. To study the main characteristics of EPHO list and results of its application in the countries of the world as a tool of public health system construction on the level of a city. Materials and methods. A content analysis of World Health Organization documents, scientific publications of foreign and domestic authors, country reports on the development of EPHOs lists and evaluation of POPs implementation was performed. Results. The list of EPHOs varies from country to country because of different national priorities, demographics, financial resources, etc. The European Region's list of ten EPHOs describes elements inside and outside the public health system. The list of EPHOs is used as a tool for analyzing public health systems or organizations at the national and local level. Discussion. More conceptual clarity is needed for public health systems planning and public health advocacy, as well as adaptation of the EPHO assessment tool to the context of Moscow. Conclusion. The structure of the EPHOs list included in the instrument of WHO Regional Office for Europe can reflect the public health landscape in Moscow and be used as a tool for investigation of public health systems or organizations at the city level and can contribute to the elaboration of the unified city public health policy and establishment of integrated public health services.

Bottom-Up Approach to Establish Coordination Mechanisms for Disaster Preparedness Among Largely Private Health-Care Providers in Central Tokyo

In Japan, despite its private-dominant and disjointed health-care system, national initiatives to coordinate various types of health-care facilities are lacking. Municipal governments manage this task with limited resources. This study describes a successful example of a bottom-up approach to create city-wide collaboration for disaster preparedness. In Minato City, located in central Tokyo, a group of physicians created a project involving a city-wide disaster medical care drill. The city Public Health Center, in charge of health-care systems including disaster medicine, helped the group to increase proponents of the project. The city-wide disaster drill started in November 2017; thereafter, the drills were held every year. Participation in drills by various health-care personnel helped establish a city-wide system for disaster medical care, coordination mechanisms among stakeholders, increased motivation among health-care personnel, and development of in-hospital systems. This approach is flexible and applicable to various forms of health-care systems in other areas.

Qualitative and Quantitative Study on Components of Future Time Perspective and Their Association with Persistent Treatment for Type 2 Diabetes.

IntroductionFuture time perspective (FTP) means the capacity to foresee, anticipate, and plan for future desired outcomes, and it contributes to persistent treatment for type 2 diabetes mellitus (T2DM). However, the components of FTP specific to T2DM patients have not been clarified. This study aimed to explore the components of FTP and to examine the associations between such components and persistent/impersistent diabetes treatment.MethodsIn this cross-sectional study, using qualitative and quantitative methods, 106 T2DM patients were enrolled by purposive sampling. The participants were interviewed in October and November 2018 by public health nurses in Koriyama City Public Health Center, Japan. In addition to the participants’ status of treatment engagement (persistent/impersistent), their responses regarding reasons for persistent/impersistent treatment were collected and then summarized into nine subthemes, which were then merged into two main themes according to the presence or absence of FTP with a sense of T2DM ownership for analysis.ResultsThe main theme, “presence of FTP with a sense of T2DM ownership,” included subthemes such as “securing social independence,” “planning on living a long and healthy life,” “prioritizing avoiding being a burden on family and friends,” “valuing improvement of diabetes,” “avoiding tragic results,” “optimistically viewing treatment as a form of self-development,” and “improving mental health,” whereas the main theme, “absence of FTP with a sense of T2DM ownership,” included “lack of consciousness of disease” and “living a dissipated life.” The association between the presence of FTP with a sense of T2DM ownership and persistent treatment for T2DM was found using Fisher’s exact test (p < 0.001).ConclusionHealth care professionals should support T2DM patients in having an FTP with a sense of T2DM ownership and purpose in life instead of treatment goals when such patients mention their dissipated life or lack of insight into the disease.

Expect postoperative care disruptions for orthopaedic trauma patients during the COVID-19 pandemic: a retrospective review of patient care trends

Background: With the global COVID-19 pandemic arriving in New York City (NYC) public health measures were instituted to prevent disease spread. Orthopaedic trauma continued despite the pandemic, and patients were left attempting to obtain postoperative care while the city’s focus shifted to the pandemic. The purpose of this study was to evaluate postoperative care of patients treated for orthopaedic trauma during the COVID-19 pandemic in NYC and identify areas for improvement in the event of an expected second wave. Methods: All patients who received operative care for orthopaedic trauma during the pandemic time period by two fellowship-trained orthopaedic traumatologists were identified, and their records were reviewed. Results: Forty-nine patients were included for analysis. Six patients (12%) tested positive for COVID-19. Six of 24 patients (25%) who were recommended to be discharged to inpatient rehabilitation refused. Of the 31 patients discharged home, nine patients (29%) refused in-home services. Thirteen of 31 patients (42%) reported a delay in receiving outpatient physical therapy, and five patients (16%) reported difficulty filling prescriptions. There were 1,814 scheduled visits in the orthopaedic trauma clinic from March to May 2019 with 1,126 attended visits (62%). During the pandemic there were 295 scheduled visits with 175 attended visits (59%, P=0.367). At the peak of the pandemic in April 2020 there were 58 scheduled visits with 27 attended visits (47%, P=0.017). Conclusions: Patients treated for orthopaedic trauma during the COVID-19 pandemic were at increased risk of improper discharge, delay in outpatient services, and absent follow-up, which may together pose an increased risk of adverse events. Level of Evidence: Level IV.

Strategies to Improve Nutrition Counseling Services for Diabetes Patients in Denpasar City Public Health Center

Strategies to Improve Nutrition Counseling Services for Diabetes Patients in Denpasar City Public Health Center

Trends of Emergency Calls During the Coronavirus Disease-19 Pandemic in Nur-Sultan

BACKGROUND: The new coronavirus infection (coronavirus disease [COVID]-19) has become a serious obstacle on the health-care systems in Kazakhstan, as well as throughout the world. Certainly, the extent of emergency medical services (EMSs) use at some stage within the COVID-19 pandemic has been increased. However, the impact on the use of EMS in Kazakhstan during the COVID-19 pandemic has not been studied. AIM: The aim of this study was to analyze the dynamics of changes in the number of emergency medical calls during the COVID-19 pandemic, depending on the time of year, day of the week, and the causes for the calls. METHODS: This study retrospectively evaluated the Nur-Sultan (capital of Kazakhstan) EMS data for the period after the pandemic was first seen in Kazakhstan. The necessary permissions for the study were obtained from the Nur-Sultan City Public Health Department. EMS data for the same time interval (February 1–May 1) in the past 3 years (2018, 2019, and 2020) were compared. The data were taken from the database of the automated control system “Komek 103,” which is used in the ambulance station since the end of 2019, and the automated dispatch information systems “ADIS” used by the ambulance station in Nur-Sultan. RESULTS: During the COVID-19 pandemic, EMS call rates had been maximum common on Mondays and Thursdays by 13, 75%. The evaluation suggests that the quantity of male sufferers extended by 14, 05% in the course of the pandemic length, as compared to the pre-pandemic length. The quantity of patients with inside the 65+ age group in the course of the pandemic length has extended by 31.5%. During the pandemic, the signs and symptoms of fever enlarged significantly by 83%. Moreover, suicides elevated by 61% during the pandemic period. During the COVID‐19 pandemic, using EMS particularly for time touchy illnesses, which include hypertension (−31%), surgical emergencies (acute abdomen) (−40%), cerebrovascular illnesses (−11%), and other heart illnesses (−29%) decreased. CONCLUSIONS: During the pandemic period, there was an increase in the calls from male patients, compared to the pre-pandemic period. Moreover, during the COVID-19 pandemic, EMS call rates had been increased on Mondays and Thursdays. We found an alteration with inside the sample of obtained calls. Furthermore, the quantity of patients with inside the 65+ age group in the course of the pandemic length has extended.

Outcomes of COVID-19 Admissions in the New York City Public Health System and Variations by Hospitals and Boroughs During the Initial Pandemic Response.

Introduction: In the initial pandemic regional differences may have existed in COVID-19 hospitalizations and patient outcomes in New York City. Whether these patterns were present in public hospitals is unknown. The aim of this brief study was to investigate COVID-19 hospitalizations and outcomes in the public health system during the initial pandemic response.Methods: A retrospective review was conducted on COVID-19 admissions in New York City public hospitals during the exponential phase of the pandemic. All data were collected from an integrated electronic medical records system (Epic Health Systems, Verona, WI). Overall, 5,422 patients with at least one admission each for COVID-19 were reviewed, with a study of demographic characteristics (including age, gender, race, BMI), pregnancy status, comorbidities, facility activity, and outcomes. Data related to hospitalization and mortality trends were also collected from City of New York website. These data often involved more than one facility and/or service line resulting in more location or treatment facility counts than patients due to utilization of services at more than one location and transfers between locations and facilities.Results: Higher mortality was associated with increasing age with the highest death rate (51.9%) noted in the age group >75 years (OR 7.88, 95%CI 6.32–10.08). Comorbidities with higher mortality included diabetes (OR 1.5, 95% CI 1.33–1.70), hypertension (OR 1.62, 95% CI 1.44–1.83), cardiovascular conditions (OR 1.66, 95% CI 1.47–1.87), COPD (OR 1.86, 95% CI 1.39–2.50). It was deduced that 20% of all New York City COVID-19 positive admissions were in public health system during this timeframe. A high proportion of admissions (21.26%) and deaths (19.93%) were at Elmhurst Hospital in Queens. Bellevue and Metropolitan Hospitals had the lowest number of deaths, both in borough of Manhattan. Mortality in public hospitals in Brooklyn was 29.9%, Queens 28.1%, Manhattan 20.4%.Conclusion: Significant variations existed in COVID-19 hospitalizations and outcomes in the public health system in New York City during the initial pandemic. Although outcomes are worse with older age and those with comorbidities, variations in hospitals and boroughs outside of Manhattan are targets to investigate and strategize efforts.

Initiating antiretroviral treatment for newly diagnosed HIV patients in sexual health clinics greatly improves timeliness of viral suppression.

The 'JumpstART' program in New York City (NYC) public Sexual Health Clinics (SHC) provides patients newly diagnosed with human immunodeficiency virus (HIV) with antiretroviral medication (ART) (1-month supply) on day of diagnosis and active linkage to HIV care (LTC). We examined viral suppression (VS) among patients who did and did not receive JumpstART services. Retrospective cohort. Among newly diagnosed SHC patients (23 November 2016-30 September 2018) who were matched to the NYC HIV surveillance registry to obtain HIV laboratory test results through 30 June 2019, we compared 230 JumpstART and 73 non-JumpstART patients regarding timely LTC (≤30 days), probability of VS (viral load < 200 copies/ml) by 3 months post-diagnosis, and time to and factors associated with achieving VS within the follow-up period. Of 303 patients, 76% (230/303) were JumpstART and the remaining were non-JumpstART patients; 36 (11%) had acute HIV infections. LTC ≤30 days was observed for 63% of JumpstART and 73% of non-JumpstART patients. By 3 months post-diagnosis, 83% of JumpstART versus 45% of non-JumpstART patients achieved VS (log-rank, P < .0001). Median times to VS among virally suppressed JumpstART and non-JumpstART patients were 31 (interquartile range [IQR]: 24-51) and 95 days (IQR: 52-153), respectively. For groups with and without timely LTC, JumpstART was associated with viral suppression within 3 months post-diagnosis, after adjusting for age and baseline viral load. Prompt ART initiation among SHC patients, some with acute HIV infections, resulted in markedly shortened intervals to VS. Immediate ART provision and active LTC can be key contributors to improved HIV treatment outcomes and the treatment-as-prevention paradigm, with potential for downstream, population-level benefit.

Fertility Deisire and Associated Factors Among People on Antiretroviral Treatment at a Public Health Facility in Hawassa City, Southern Ethiopia

Background: Fertility desire is the plan of people to have a child or more children in the face of being diagnosed with HIV and plan to a commitment to implement the desire.Increasing quality of life for patients leads to a desire for fertility in people living with HIV/AIDS and fertility desires were increased due to easy accessibility and availability of antiretroviral treatment drugs. Objectives: To assessed fertility desire and associated factors among people living on ante-retro viral treatment at Hawassa city southern Ethiopia, 2019. A study was conducted in Hawassa city public health facilities from May 09 –July 07/07/2019 Methods: An institutional-based cross-sectional study was conducted in Hawassa city public health facilities from May 09 – July 07/07/2019. Four hundred (400) study participants were selected using a simple random sampling technique. Data were collected by using interviewer-administered pre-tested structured questionnaires and chart review. The collected data were entered into EPI data version 3.1 software and then transported to SPSS version 20 for cleaning and data analysis.Bivariate and multivariate logistic regression was used to identify associated factors at p<0.05 was taken as a significant value with a 95% confidence level. Results:A total of 400 clients were included in the study giving a response rate of 97%. The overall fertility desire was 53.6% (95%CI: 48.7%, 58.2%). Age, sexual practice in the last six months, and discussed reproductive health with antiretroviral treatment providers were significantly associated with fertility desire.Younger age was positively associated with fertility desire, age group (18-29), [Adjust odds ratio =5.75 95%CI (2.85, 11.57)] , age group(30-39), [Adjust odds ratio= 4.71 95%CI:(2.55, 8.71)] Sexual practice in the last six months [Adjust odds ratio = 3.00 95%CI(1.46, 6.16)]and counseling reproductive health withantiretroviral treatment provider[Adjust odds ratio = 3.10 95%CI:(1.86,5.15)]. Conclusion: The prevalence of fertility desire in this study was higher than in previous studies while factors associated with fertility desire were age, sexual practice in the last six months, and discuss reproductive health with antiretroviral treatment providers. Keywords: Antiretroviral treatment, Fertility Desire, Hiv/Aids

Antenatal care service satisfaction and its associated factors among pregnant women in public health centres in Hawassa city, Southern Ethiopia

Background: Self-reported client satisfaction is vital in order to address service provider and facility-based factors that can be upgraded to maximise antenatal care (ANC) satisfaction and utilisation in service-providing institutions. Objective: This study aimed to assess ANC service satisfaction and associated factors among pregnant women attending Hawassa city public health centres (HC), Sidama regional state, Southern Ethiopia. Methods: This health facility–based cross-sectional study was conducted on 422 pregnant women from 14 March to 13 April 2017. Exit interview data were collected from pregnant women attending care service at five randomly selected public HC. Results: Overall, 79.2% were satisfied with the ANC service. As per specific components, 74.2% of respondents were satisfied with the information provided, and 74.2% were satisfied with the institution’s health care. Respondents who had received iron tablets were 3.2 times more likely to be satisfied than their counterparts (adjusted odds ratio (AOR)=3.2, 95% confidence interval (CI) 1.7–5.9). Pregnant women who were counselled on human immunodeficiency virus infection and its testing were 4.3 times more likely to be satisfied than those who had not received such counselling (AOR=4.3, 95% CI 2.2–8.4). Also, those women who waited ⩽30 minutes (AOR=2.6, 95% CI 1.2–5.5) and who received information on foetal movement (AOR=3.5, 95% CI 1.8–6.5) were significantly associated with ANC service satisfaction. Conclusion: More than 20% of pregnant women were not satisfied with ANC services. This reflects a need for attention in each aspect of health-care service provision in order to assure client satisfaction.

More Than Shelter: Housing for Urban Maternal and Infant Health.

Housing quality, stability, and affordability have a direct relationship to socioemotional and physical health. Both city planning and public health have long recognized the role of housing in health, but the complexity of this relationship in regard to infant and maternal health is less understood. Focusing on literature specifically relevant to U.S. metropolitan areas, I conduct a multidisciplinary literature review to understand the influence of housing factors and interventions that impact infant and maternal health. The paper seeks to achieve three primary goals. First, to identify the primary “pathways” by which housing influences infant and maternal health. Second, the review focuses on the role and influence of historical housing discrimination on maternal health outcomes. Third, the review identifies emergent practice-based housing interventions in planning and public health practice to support infant and maternal health. The literature suggests that the impact of housing on infant health is complex, multifaceted, and intergenerational. Historical housing discrimination also directly impacts contemporary infant and maternal health outcomes. Policy interventions to support infant health through housing are just emerging but demonstrate promising outcomes. Structural barriers to housing affordability in the United States will require new resources to foster greater collaboration between the housing and the health sectors.

Eat Well El Paso!: Lessons Learned From a Community-Level Restaurant Initiative to Increase Availability of Healthy Options While Celebrating Local Cuisine.

Restaurants have the potential to improve nutrition and positively shape social norms. We describe lessons learned and recommended strategies from Eat Well El Paso! (EWEP), a local restaurant initiative. Descriptive case study. EWEP partnered with local restaurants from 2012-2017 in El Paso, Texas, along the US/Mexico border. Our sampling frame included EWEP staff and managers/owners at participating restaurants, of which the majority participated (80% and 85%, respectively). EWEP was a local restaurant initiative led by the city public health department. EWEP contracted registered dietitians to assist locally-owned restaurants to increase availability of healthy menu options. Observation, key informant interviews, and document review assessed participation, barriers, and facilitators to restaurant participation and program sustainability. Thematic and descriptive analyses. 57% of restaurants completed the full on-boarding process, but long-term retention was low (24% of completers). Restaurant managers/owners perceived value in marketing, nutritional analysis, and menu design. Barriers included scheduling, complexity of restaurant culture, fear of food inspections, restaurant turnover, competing responsibilities, and lack of dedicated funding. Although local context and sample size may limit generalizability, lessons learned and recommended strategies are relevant and informative for communities working to increase restaurants' healthy menu options.

P0275 / #754: HIGH-FLOW NASAL CANNULA FOR INFANT ACUTE RESPIRATORY FAILURE OUTSIDE THE PEDIATRIC INTENSIVE CARE UNIT. DESCRIPTION OF A REGIONAL PROTOCOL IMPLEMENTATION.

Aims & Objectives: Each winter, infants with acute lower respiratory infections (ALRI) stress Buenos Aires city public health system resources. Since 2017, the Maternal-Child Health Department of the city progressively included high-flow nasal cannula (HFNC) therapy in ALRI treatment protocol in general wards from 6 hospitals (three in 2017, six in 2018-2019). Objective. To describe patient outcomes of this experience and explore potential factors related to treatment failure. Methods: Prospective, descriptive study with infants <18 months-old hospitalized for ALRI between June-September of 2017-2019. Only 2017 data has been published previously. All children unable to reach pre-specified low-flow therapeutic targets received HNFC therapy. Failure was defined as ICU admission. Variables are expressed as count (percentage) or median (interquartile range). Comparisons were made with Fisher’s exact test or Wilcoxon rank-sum test. Results: Along the three-year period 1710 patients were registered with 39.8%, 50.0% and 34.5% HFNC use rate. There were no significant baseline differences between patients when comparing hospitals, years and HFNC requirement. HFNC duration was: 94 hs (62-140), 94 hs (63-140) and 83 hs (51-131) for each year (p=0.078, for last comparison). Length of stay wasn’t different between years. HFNC failure was observed in 8.7%, 5.7% and 7.3%, respectively. Over pooled data, respiratory rate at first hour from HFNC initiation was higher in the failure group: 60/min (50-65) vs. 50/min (44-60), p=0.002. No complications were reported. Overall mortality was 0%.Conclusions: The implementation of protocol-driven HNFC therapy in general wards revealed as a safe tool. A lack of reduction in respiratory rate was associated with treatment failure.

The Influence of Average Temperature and Relative Humidity on New Cases of COVID-19: Time-Series Analysis.

BackgroundThe influence of meteorological factors on the transmission and spread of COVID-19 is of interest and has not been investigated.ObjectiveThis study aimed to investigate the associations between meteorological factors and the daily number of new cases of COVID-19 in 9 Asian cities.MethodsPearson correlation and generalized additive modeling (GAM) were performed to assess the relationships between daily new COVID-19 cases and meteorological factors (daily average temperature and relative humidity) with the most updated data currently available.ResultsThe Pearson correlation showed that daily new confirmed cases of COVID-19 were more correlated with the average temperature than with relative humidity. Daily new confirmed cases were negatively correlated with the average temperature in Beijing (r=–0.565, P<.001), Shanghai (r=–0.47, P<.001), and Guangzhou (r=–0.53, P<.001). In Japan, however, a positive correlation was observed (r=0.416, P<.001). In most of the cities (Shanghai, Guangzhou, Hong Kong, Seoul, Tokyo, and Kuala Lumpur), GAM analysis showed the number of daily new confirmed cases to be positively associated with both average temperature and relative humidity, especially using lagged 3D modeling where the positive influence of temperature on daily new confirmed cases was discerned in 5 cities (exceptions: Beijing, Wuhan, Korea, and Malaysia). Moreover, the sensitivity analysis showed, by incorporating the city grade and public health measures into the model, that higher temperatures can increase daily new case numbers (beta=0.073, Z=11.594, P<.001) in the lagged 3-day model.ConclusionsThe findings suggest that increased temperature yield increases in daily new cases of COVID-19. Hence, large-scale public health measures and expanded regional research are still required until a vaccine becomes widely available and herd immunity is established.

Factors associated with unemployment or job change due to the treatment of designated intractable diseases

Unemployment or job change due to treatment for a disease is affected by various factors such as disease type, degree of disability, and workplace patient support. This study aimed to clarify the factors affecting the unemployment/job-change rate among workers who had designated intractable diseases. A questionnaire survey was administered to 3,210 designated patients with intractable diseases who underwent applications for renewal of medical care subsidies at the Hirakata City Public Health Center during fiscal year 2019 (July-December). Of these patients, 539 workers aged 20-59 years who were employed as regular workers, temporary contract worker/dispatched workers, and part-time workers when they became designated intractable diseases were subjects of the analysis. Unemployment/job-change due to the treatment for a designated intractable disease was treated as an event occurrence, while the absence of unemployment/job-change due to disease at the time of the survey were considered censored cases. The Kaplan-Meier method was used to determine the trend of the unemployment/job-change rate associated with the duration of work. The Cox proportional hazard model was used to examine the relationship between unemployment/job-change and factors such as gender, age at onset, disease groups, activities of daily living, types of employment, experienced workplace supports (e.g., reduced working hours and hourly paid leave), and existence of insoluble medical difficulties at the workplace. The unemployment/job-change rate due to treatment for designated intractable disease was 19.4%. Significantly independent factors of unemployment/job-change were the following: 50s at onset (compared to those in their 30s, HR = 2.55, 95% CI (1.21-5.37)), requiring outing assistance (compared to going out alone, 2.31 (1.13-4.71)), being a temporary contract worker/dispatched worker (compared to a regular worker, 2.66 (1.20-5.89)), existence of insoluble medical difficulties at workplace (4.15 (2.43-7.09)). Experienced workplace support was not a significant factor in preventing unemployment/job-change. Age at onset, degree of disability, form of employment, and existence of insoluble medical difficulties at the workplace were significantly associated with unemployment/job change due to treatment for designated intractable diseases. The relationship between workplace patient supports and unemployment/job-change was not clear, but to reduce medical difficulties in the workplace, workplace supports must be expanded. Given that workplace support is not an obligatory effort for employers, it is necessary to establish a system where employers can easily promote workplace support.

Characteristics, comorbidities and survival analysis of young adults hospitalized with COVID-19 in New York City.

This study reviewed 395 young adults, 18–35 year-old, admitted for COVID-19 to one of the eleven hospitals in New York City public health system. Demographics, comorbidities, clinical course, outcomes and characteristics linked to hospitalization were analyzed including temporal survival analysis. Fifty-seven percent of patients had a least one major comorbidity. Mortality without comorbidity was in 3.8% patients. Further investigation of admission features and medical history was conducted. Comorbidities associated with mortality were diabetes (n = 54 deceased/73 diagnosed,74% tested POS;98.2% with diabetic history deceased; Wilcoxon p (Wp) = .044), hypertension (14/44,32% POS, 25.5%; Wp = 0.030), renal (6/16, 37.5% POS,11%; Wp = 0.000), and cardiac (6/21, 28.6% POS,11%; Wp = 0.015). Kaplan survival plots were statistically significant for these four indicators. Data suggested glucose >215 or hemoglobin A1c >9.5 for young adults on admission was associated with increased mortality. Clinically documented respiratory distress on admission was statistically significant outcome related to mortality (X2 = 236.6842, df = 1, p < .0001). Overall, 28.9% required supportive oxygen beyond nasal cannula. Nasal cannula oxygen alone was required for 71.1%, who all lived. Non-invasive ventilation was required for 7.8%, and invasive mechanical ventilation 21.0% (in which 7.3% lived, 13.7% died). Temporal survival analysis demonstrated statistically significant response for Time to Death <10 days (X2 = 18.508, df = 1, p = .000); risk lessened considerably for 21 day cut off (X2 = 3.464, df = 1, p = .063), followed by 31 or more days of hospitalization (X2 = 2.212, df = 1, p = .137).

Factors Affecting Nonmarital Pregnancy in Teenagers at Soe City Public Health Center Work Area, Soe City Sud-District, South Mid-East Regency

Teen pregnancy is an international phenomenon that has not been resolved until now. Free sex behavior is an effect of out of wedlock pregnancy. The purpose of this research is what factors that affect out of wedlock nonmarital pregnancy on the teenager in the working area of Soe city public health center, South Central Timor regency. This research used descriptive quantitative research design, factors that affect out of wedlock pregnancy on teenager as a variable and 127 total population and simple random sampling used as a technique with 55 respondents. This research was conducted on 29-11 June 2019, in the work area of Soe city public health center, South Central Timor Regency. Research instrument used a questionnaire and data analysis used distribution of frequency percentage. The results showed that, 32 respondent (59%) were lack of knowledge, 35 respondent (64%) were influencing promiscuity, 31 respondents (57%) were more permissive to peer group norms, 35 respondents (64%) were parenting support while 21 respondent (38%) were technology and social media affect. This indicated that the most influential factor out of wedlock nonmarital pregnancy on teenager were individual factor that the teenager were lack of knowledge about reproductive health and sexuality, behavior factor that the teenager influenced by promiscuity, and environmental factor that parenting issue.

Empirical research on smart city construction and public health under information and communications technology

Big data and the internet of things in smart cities play an increasingly important role in the health of urban residents. However, few studies have collected empirical evidence to determine whether the implementation of smart cities can have a positive impact on healthcare. Using three years of panel data from the CHARLS national baseline survey, we examined whether and how smart city construction affects the health status of residents. The results show that the construction of smart cities improves residents’ health status. This relationship is achieved by reducing the use of outpatient services and increasing the utilization of inpatient services. Furthermore, compared with urban residents, rural residents show more significant behavioural changes in their use of medical services under the influence of smart city construction.

The Effect of Early Childhood Sexual Abuse on Mental Health Among Postpartum Women Visiting Public Health Facilities in Bahir Dar City, Ethiopia: Multicenter Study.

BackgroundThere is a scarcity of evidence regarding the effects of early childhood sexual abuse on mental health among women in Sub-Saharan Africa. The purpose of this study was to assess the proportion of postpartum depression and associated factors among postnatal women in care in public health facilities of Bahir Dar city, northwest Ethiopia. This study also aimed at evaluating the effect of early childhood sexual abuse on postpartum depression.MethodsA multicenter cross-sectional study was conducted among 988 postpartum women in care at Bahir Dar city’s public health facilities. A two-stage sampling technique and interviewer administered structured questionnaire were utilized. Edinburgh Postnatal Depression Scale (EPDS) with a cutoff point of ≥ 12 was employed to report postpartum depression. Binary logistic regression model was fitted and the level of significance was reported based on AOR with 95% CI at p-value of < 0.05.ResultsThe prevalence of postpartum depression was 33.8% (95% CI: 31, 37) and 55.3% (95% CI: 46, 64) among all study participants and mothers having a history of childhood sexual abuse, respectively. Participants’ age of < 25 years (AOR = 3.1; 95% CI: 1.9, 5.3) and 25–34 years (AOR= 2.0; 95% CI: 1.3, 3.2), family size of >5 (AOR = 2.5; 95% CI: 1.1, 5.7), alcohol use (AOR = 2.2; 95% CI: 1.6, 2.9), history of childhood sexual abuse (AOR = 2.8; 95% CI: 1.9, 4.3), joblessness (AOR = 1.4; 95% CI: 1.1, 1.9) and growing up with biological mothers (AOR = 0.5; 95% CI: 0.4, 0.8) have stastical significant association with postpartum depression as compared to the respective reference group.ConclusionA significantly higher burden of postpartum depression was observed among mothers with a history of childhood sexual abuse. Thus, controlling childhood sexual abuse and other psychosocial determinants would improve maternal mental wellness.