Development Of Public Health Policies Research Articles

The impact of dietary fructose on gut permeability, microbiota, abdominal adiposity, insulin signaling and reproductive function

The excessive intake of fructose in the regular human diet could be related to global increases in metabolic disorders. Sugar-sweetened soft drinks, mostly consumed by children, adolescents, and young adults, are the main source of added fructose. Dietary high-fructose can increase intestinal permeability and circulatory endotoxin by changing the gut barrier function and microbial composition. Excess fructose transports to the liver and then triggers inflammation as well as de novo lipogenesis leading to hepatic steatosis. Fructose also induces fat deposition in adipose tissue by stimulating the expression of lipogenic genes, thus causing abdominal adiposity. Activation of the inflammatory pathway by fructose in target tissues is thought to contribute to the suppression of the insulin signaling pathway producing systemic insulin resistance. Moreover, there is some evidence that high intake of fructose negatively affects both male and female reproductive systems and may lead to infertility. This review addresses dietary high-fructose-induced deteriorations that are obvious, especially in gut permeability, microbiota, abdominal fat accumulation, insulin signaling, and reproductive function. The recognition of the detrimental effects of fructose and the development of relevant new public health policies are necessary in order to prevent diet-related metabolic disorders.

Prioritizing population oral health through public policy in Australia: the Victorian experience.

Dental caries, a non-communicable disease, is one of the most prevalent diseases globally and share common modifiable risk factors with obesity such as excess sugar intake. However, prioritization by governments to improve population oral health has been limited and is typically excluded from the discourse of public health policy development. Therefore, interventions that target dental caries can have other co-benefits including obesity prevention. In Victoria, Australia, local government authorities have a regulatory requirement to develop their Municipal Health and Wellbeing Plans. The aim of this paper is to identify whether prioritization for oral health by local government authorities in Victoria has changed through the subsequent renewal of the Victorian Public Health and Wellbeing Plans 2011-2015 and 2019-2023. Three desktop audits for all publicly available Municipal Health and Wellbeing Plans by local government authorities in Victoria were conducted between 2014 and 2022. Key terms related to oral health was searched within these policy documents and categorized into six indicators: (i) included oral health as a priority, (ii) linked healthy eating and oral health, (iii) supported the Achievement Program, (iv) included the Smiles 4 Miles program, (v) advocated for fluoridated drinking water, and (vi) included other strategies related to oral health. Overall, there was statistically significant reduction in five of the six indicators, with the exception for prioritization of other strategies related to oral health such as targeting excess sugar intake and smoking. A multi-sectoral approach, that includes oral health would be advantageous to address the growing burden of non-communicable diseases.

'An extra fight I didn't ask for': A qualitative survey exploring the impact of calories on menus for people with experience of eating disorders.

The UK government made it mandatory for large restaurants and cafes in England to display calorie labels on menus. Existing evidence identifies minimal potential for benefit, but significant potential for harm to those with eating disorders. To date, only one published study has directly explored the impact of this legislation on those with eating disorders. This study explores the impact of calorie labelling on menus on adults with experience of eating disorders in England. A qualitative online survey was designed and distributed, and 399 adults with current or past experience/s of eating disorders completed the survey. Reflexive thematic analysis was used, informed by a critical realist approach. Six themes were developed: (1) impacts on relationships, (2) exclusion and increased isolation, (3) restricted freedom, (4) dis/embodiment, (5) anger and frustration at the perpetuation of diet culture and (6) we are all responsible for ourselves. Most participants felt calorie labels on menus is detrimental to their eating disorder and/or recovery. People are navigating multiple opposing cultural narratives around health, bodies and eating disorder recovery that can put additional barriers in place to developing a relationship with food and body that they would like. Calorie labelling on menus is likely to adversely impact those with eating disorders. Menus with calories should be available separately but should not be the first or only one provided. People with experience of eating disorders should be directly involved in the development of public health legislation and policy that is likely to affect them.

Prevalence of primary and secondary subfertility and its associated factors in Regional Director of Health Services area in Colombo district Sri Lanka: A community-based cross-sectional study

Introduction: Subfertility is a major life issue that affects the quality of life. Most of them are residing in developing countries. The prevalence of subfertility is an essential element to identify the magnitude of the problem in each country.Objective: To assess the prevalence of primary and secondary subfertility and its associated factors in the Colombo district, Sri Lanka.Methodology: This cross-sectional study used a stratified cluster sampling method to recruit 3104 married women aged between 15-49 in 38 urban and rural clusters in the Colombo district, Sri Lanka. The study was conducted in 2018-19 and used a structured questionnaire based on the clinical definition of subfertility.Results: The point prevalence of primary subfertility was 6.08 (95% CI:5.3-7.0). A significantly high prevalence of primary subfertility was reported among female partners with tertiary education (aOR:2.80; 95% CI:1.08-7.39) compared to primary or no education and employed women (aOR:1.88; 95% CI:1.37-2.57) compared to unemployed women. The point prevalence of secondary subfertility was 8.40 (95% CI:7.4-9.4). A significantly high prevalence of secondary subfertility was reported among female partners with tertiary education (aOR:2.55; 95% CI:1.16-5.59) compared to primary or no education, unemployed women (aOR:1.65; 95% CI:1.25-2.19) compared to employed women and women of other ethnic groups (aOR:1.97; 95% CI:1.13-3.32) compared to Moor ethnic group.Conclusion: The prevalence of both primary and secondary subfertility was 14.5% (95% CI:13.3-15.7) among the married women aged between 15-49 years in the Colombo Regional Director of Health Services area. The development of effective and rational public health policies for the prevention of subfertility and increased availability of advance reproductive technology facilities should be considered.

P-384 Advanced paternal age: a mapping of the ethical issues

Abstract Study question What are the ethical issues raised by advanced paternal age? Summary answer Advanced paternal age is an ethically challenging phenomenon at the intersection of perinatal ethics, public health ethics, research ethics and policymaking. What is known already Although there is no clear indication on when begins advanced paternal age (APA), there is a tendency to consider 40 years old and over as a turning point in male reproduction. APA is now associated with several risks for male fertility, miscarriages, future child health and psychological development. Clinicians, scientists, social science researchers and ethicists have pointed several ethical issues raised by APA. For the moment, the scope of this discussion has not been fully assessed in a systematic way. Study design, size, duration To support a comprehensive evaluation of APA, we propose a mapping of the ethical issues of APA. Participants/materials, setting, methods First, we conducted a systematic literature review to identify ethical issues pointed by researchers and clinicians. Second, this first list of issues was discussed by a panel of experts (N = 23) through a web survey. The results from both data collections were triangulated by qualitative analysis into an integrated list of issues. Main results and the role of chance Six groups of issues emerged from data analysis. The first group relates to issues associated with the family project. In other words, how to balance the risks of APA with the benefits of the family project. The second group looks at the issues for healthcare professionals, i.e., how to support the family project while respecting the professional duty to protect their patients’ wellbeing. The third group refers to the gender justice issues and how APA generates inequities between gendered reproductive roles. The fourth group covers the public health dimension of APA and the justification to create intervention to respond to a collective and potentially intergenerational phenomenon. The fifth group is concerned about ways to develop sound and fair policies to respond to the challenges of APA. The sixth group encompasses research ethics issues on how to respectfully develop the field of research on APA. Limitations, reasons for caution APA is a burgeoning field of research, and it faces two principal limitations: (1) there is no clear understanding of the molecular mechanism of APA effect, and (2) data on the psychosocial dimension of APA is scarce. For these reasons, the ethical reflection is still speculative. Wider implications of the findings These findings offer a roadmap for future research on the ethics of APA. They provide a comprehensive understanding of issues that can be discussed during preconception counselling. At last, they suggest indications for the development of public health interventions or policies dedicated to address the most challenging aspects of APA. Trial registration number not applicable

Understanding parental knowledge, attitudes and self-efficacy in professional help-seeking for child anxiety

BackgroundChild anxiety disorders are highly prevalent yet undertreated. As parents are often ‘gatekeepers’ to children receiving treatment and support, this study aimed to investigate modifiable parental factors affecting professional help-seeking for their children from general practitioners (GPs), psychologists, and paediatricians. MethodsIn this study, 257 Australian parents of children aged 5–12 years with elevated anxiety symptoms completed a cross-sectional online survey. The survey assessed help-seeking from a GP, psychologist, and paediatrician (General Help Seeking Questionnaire), as well as anxiety knowledge (Anxiety Literacy Scale), help-seeking attitudes (Attitudes Toward Seeking Professional Psychological Help), personal stigma (Generalised Anxiety Stigma Scale) and self-efficacy (Self-Efficacy in Seeking Mental Health Care). Results66.9% of participants had sought help from a GP, 61.1% from a psychologist, and 33.9% from a paediatrician. Help-seeking from a GP or psychologist was associated with lower personal stigma (p = .02 and p = .03 respectively). Participants who sought help from a psychologist also had more positive attitudes toward seeking professional support (p = .01). Conversely, knowledge of anxiety disorders and self-efficacy were not associated with help-seeking from any source. LimitationsLimitations of the study include the representativeness of our sample (female gender, higher education level); unexplained variance potentially accounted for by other factors (e.g., structural barriers); lack of prior validation of measures in a parent sample. ConclusionsThis research will inform the development of public health policy and psychoeducation interventions for parents, to reduce personal stigma and increase positive attitudes towards professional help-seeking, in turn improving help-seeking for child anxiety.

Increasing Visibility of Sickle Cell Disease in Indiana: Establishing Baseline Prevalence Using Integrated Data From Multiple Sources.

The Indiana Sickle Cell Data Collection (IN-SCDC) program aims to provide timely, reliable, and locally relevant information on the sickle cell disease (SCD) population in Indiana to inform public health interventions, research, and policy development. We describe the development of the IN-SCDC program and report the prevalence and geographic distribution of people with SCD in Indiana using an integrated data collection approach. Using multiple integrated data sources and case definitions established by the Centers for Disease Control and Prevention, we classified cases of SCD in Indiana during 2015-2019. We calculated the prevalence and incidence of SCD and described characteristics of people with SCD. We identified 1695 people living with SCD in Indiana during the study period. The median age of people living with SCD was 21 years, and 1474 (87.0%) were Black or African American. Most (n = 1596, 91%) resided in metropolitan counties. The age-adjusted prevalence of SCD was 24.7 cases per 100 000 people. The prevalence of SCD among Black or African American people was 209.3 per 100 000 people. The incidence was 1 in 2608 live births overall and 1 in 446 live births among Black or African American people. Eighty-six deaths were confirmed in this population during 2015-2019. Our results establish a baseline for the IN-SCDC program. Baseline and future surveillance program efforts will help accurately inform standards of care for treatments, identify gaps in coverage and access to care, and provide guidance for legislators and community-based organizations.

Food Insecurity and Associated Factors among Households in Maputo City.

Food insecurity (FI) is a global concern and is one of the main causes of malnutrition in low- and middle-income countries. In Mozambique, the burden of FI and how various factors contribute to FI is not well known. This study aimed to investigate the prevalence of FI and its associated factors in southern Mozambique. Data from 1842 household heads in Maputo City were analyzed in a cross-sectional design. Food insecurity was measured using a modified version of the US Department of Agriculture Household Food Security scale, and its association with socio-demographic factors was assessed through multiple regressions. Altogether, 79% of the households were food insecure; of these, 16.6% had mild FI, 28.1% moderate and 34.4% severe FI. The study revealed that low-income households, those with less educated heads, and those engaged in informal work were significantly more prone to FI. Likewise, dietary diversity and the number of meals were also significant predictors of FI. These findings suggest the need for decent work and job creation, which calls for joint efforts from government, the private sector, and international institutions. Furthermore, these key drivers should be considered in the development of public health policies and programs designed to alleviate household FI and malnutrition in Mozambique.

The Changing Environment in Postgraduate Education in Orthopedic Surgery and Neurosurgery and Its Impact on Technology-Driven Targeted Interventional and Surgical Pain Management: Perspectives from Europe, Latin America, Asia, and The United States.

Personalized care models are dominating modern medicine. These models are rooted in teaching future physicians the skill set to keep up with innovation. In orthopedic surgery and neurosurgery, education is increasingly influenced by augmented reality, simulation, navigation, robotics, and in some cases, artificial intelligence. The postpandemic learning environment has also changed, emphasizing online learning and skill- and competency-based teaching models incorporating clinical and bench-top research. Attempts to improve work-life balance and minimize physician burnout have led to work-hour restrictions in postgraduate training programs. These restrictions have made it particularly challenging for orthopedic and neurosurgery residents to acquire the knowledge and skill set to meet the requirements for certification. The fast-paced flow of information and the rapid implementation of innovation require higher efficiencies in the modern postgraduate training environment. However, what is taught typically lags several years behind. Examples include minimally invasive tissue-sparing techniques through tubular small-bladed retractor systems, robotic and navigation, endoscopic, patient-specific implants made possible by advances in imaging technology and 3D printing, and regenerative strategies. Currently, the traditional roles of mentee and mentor are being redefined. The future orthopedic surgeons and neurosurgeons involved in personalized surgical pain management will need to be versed in several disciplines ranging from bioengineering, basic research, computer, social and health sciences, clinical study, trial design, public health policy development, and economic accountability. Solutions to the fast-paced innovation cycle in orthopedic surgery and neurosurgery include adaptive learning skills to seize opportunities for innovation with execution and implementation by facilitating translational research and clinical program development across traditional boundaries between clinical and nonclinical specialties. Preparing the future generation of surgeons to have the aptitude to keep up with the rapid technological advances is challenging for postgraduate residency programs and accreditation agencies. However, implementing clinical protocol change when the entrepreneur-investigator surgeon substantiates it with high-grade clinical evidence is at the heart of personalized surgical pain management.

Seroprevalence of SARS-CoV-2 and Vaccination Coverage among Residents of a Lower-Middle-Class Population in the Federal District, Brazil.

Estimating seroprevalence and vaccination coverage against COVID-19 is crucial to the development of well-targeted public health policies at the local level. Here, we estimated seroprevalence and vaccination coverage in a lower-middle-class population in Brazil. We conducted an observational, cross-sectional, population-based survey from 24 September to 19 December 2021. CMIA tests were used to detect anti-SARS-CoV-2 IgG against the N-protein. The overall seroprevalence was 24.15% (177/733), and vaccination coverage was 91.40% (670/733); 72.09% (483/670) were fully vaccinated. Among vaccinated participants, seroprevalence was 24.77% (95% CI 21.50-28.04; 166/670), with a prevalence ratio (PR) of 1.03 (95% CI 0.98-1.08; p-value 0.131). Among participants who received an mRNA vaccine with S-based epitope (485), seroprevalence was 16.29% (95% CI 13.04-19.85; 79/485). Among unvaccinated participants, seroprevalence was 17.46% (95% CI 10.04-28.62; 11/63). Finally, in spite of the political climate and other possible causes for vaccine hesitancy, the positive Brazilian culture towards vaccination might have curbed hesitancy.

Wellbeing, psychological distress and self-harm in late adolescence in the UK: the role of gender and personality traits

ABSTRACT Concerns about mental health difficulties and reduced wellbeing in adolescents are on the rise in public discourses and the media. This study utilised data from the Millennium Cohort Study (Waves 6 and 7) to examine 17- year- olds’ mental health and wellbeing in relation to gender and personality traits, and longitudinal differences in social and emotional difficulties and prosocial behaviour from mid to late adolescence. Across measures of mental health and wellbeing, the findings showed that adolescent girls fared much worse than boys, particularly in reporting psychological distress and self-harm. Longitudinal analyses showed that as young women moved from mid to late adolescence, they scored higher in psychological distress and social, emotional and behavioural difficulties. Also, compared to boys, girls rated themselves higher on neuroticism, a personality trait, which emerged as a strong predictor of psychological distress. The findings from this study have implications for young people’s mental health and wellbeing and gender inequality. Given the current policy concerns about young people’s mental health difficulties and self-harm, this study is hoped to contribute to an informed debate about wellbeing through gender and personality lenses while raising questions about current understandings of wellbeing and education and public health policy developments.

The Lived Experiences of Male Sex Workers: A Global Qualitative Meta-Synthesis

The sex industry literature predominantly focuses on the lived experiences of cisgender female sex workers, their customers, and work dynamics. Recently, there has been a shift in the discourse regarding sex work as the sex industry has been openly represented within art, fashion, and film. As such, there has been a growing number of qualitative studies dedicated to investigating cisgender men’s experiences of the sex industry. This article seeks to identify and synthesize these emergent findings to identify possible gaps in the literature, aid in defining new research opportunities, and guide public health policy development. Using qualitative meta-synthesis, 66 original studies were identified and analyzed. Nine meta-themes emerged. Findings demonstrated that male sex workers (MSWs) encounter many of the same experiences that have been previously documented by female sex workers, such as work-related discrimination and the influence of economics on their interest and involvement in the industry. However, MSWs also experience areas of privilege and discrimination unique to their lived experiences. This was particularly salient for men who sold sex in countries where sexual minorities are criminalized or decriminalized but not legalized. These findings highlight the need for responsive sex worker resources tailored to address the unique issues faced by MSWs.

COVID-19 mitigation behaviors among English-Speaking Hmong Americans

BackgroundCOVID-19 mitigation strategies such as masking, social distancing, avoiding group gatherings, and vaccination uptake are crucial interventions to preventing the spread of COVID-19. At present, COVID-19 data are aggregated and fail to identify subgroup variation in Asian American communities such as Hmong Americans. To understand the acceptance, adoption, and adherence to COVID-19 mitigation behaviors, an investigation of Hmong Americans’ contextual and personal characteristics was conducted.MethodsThis study aims to describe COVID-19 mitigation behaviors among Hmong Americans and the contextual and personal characteristics that influence these behaviors. A cross-sectional online survey was conducted from April 8 till June 1, 2021, with Hmong Americans aged 18 and over. Descriptive statistics were used to summarize the overall characteristics and COVID-19 related behaviors of Hmong Americans. Chi-square and Fisher’s Exact Test were computed to describe COVID-19 mitigation behaviors by gender and generational status (a marker of acculturation).ResultsThe sample included 507 participants who completed the survey. A majority of the Hmong American participants in our study reported masking (449/505, 88.9%), social distancing (270/496, 55.3%), avoiding group gatherings (345/505, 68.3%), avoiding public spaces (366/506, 72.3%), and obtaining the COVID-19 vaccination (350/506, 69.2%) to stay safe from COVID-19. Women were more likely to socially distance (P = .005), and avoid family (P = .005), and social gatherings (P = .009) compared to men. Social influence patterns related to mitigation behaviors varied by sex. Men were more likely compared to women to be influenced by Hmong community leaders to participate in family and group gatherings (P = .026), masking (P = .029), social distancing (P = .022), and vaccination uptake (P = .037), whereas healthcare providers and government officials were social influencers for social distancing and masking for women. Patterns of social distancing and group gatherings were also influenced by generational status.ConclusionContextual and personal characteristics influence COVID-19 mitigation behaviors among English speaking Hmong Americans. These findings have implications for identifying and implementing culturally appropriate health messages, future public health interventions, policy development, and ongoing research with this population.

Deliberative dialogue on euthanasia in girls, boys and adolescents. Prequel to the Cabildo Ciudadano (Citizen Council) carried out in Colombia.

To date, there is a lack of published information on the utilization of the Deliberative dialogue methodology and the right to a dignified death in minors under 18 years of age in Colombia and Latin America. To examine the issue of children and adolescents' entitlement to a dignified death, including the criteria for exclusion, and to formulate a comprehensive plan for pediatric palliative care. A public policy document will be created with the aim of supporting the implementation of Resolution 825/2018. Participatory Action Research utilizing a Deliberative dialogue methods that has been adapted based on feminist epistemological principles. The outcome of the exercise was the production of a document containing Public Policy recommendations regarding euthanasia in minors and its submission to the Ministry of Health and Social Protection of Colombia a few days prior to the release of the Resolution regulating the right to a dignified death for this population. Additionally, the conclusions of this event enabled the creation of a guide for the implementation of (Cabildos Ciudadanos) Citizen Council, in which girls, boys, and adolescents are included, trans-disciplinarity is encouraged, and feminist epistemological foundations are explored. The deliberative dialogue method may serve as a cost-efficient alternative to replace or complement participatory approaches utilized in the development of public health guidelines and policies.

Self-reported reasons for opioid and analgesic misuse among participants without cancer in the United States

ABSTRACT Background This study examined opioid and analgesic misuse, and associated reasons for misuse, among participants without cancer in the United States. Methods We extracted data from three distinct waves of the National Survey on Drug Use and Health (NSDUH, 2017–2019). Using weighted multivariable logistic regression models, we examined the associations between misuse and its reasons. Results Among individuals without cancer who misused pain relievers, the top three reasons for misuse were to relieve physical pain (62.6%), to get high (29.2%), or to relax (28.9%). For compound analgesics, the top three reasons for misuse were similar: relieving physical pain (67.9%), getting high (22.1%), and relaxation (25.6%). Compared to participants who misused opioids, respondents using compound analgesics and other pain relievers had lowers odds of using pain relievers for getting high (all p < .05). Conclusion Understanding the underlying reasons for opioid and analgesic misuse can inform development of public health policy and help in determining best practices for prescription and monitoring programs.

The Association between Physical Environment and Externalising Problems in Typically Developing and Neurodiverse Children and Young People: A Narrative Review.

The physical environment is of critical importance to child development. Understanding how exposure to physical environmental domains such as greenspace, urbanicity, air pollution or noise affects aggressive behaviours in typical and neurodiverse children is of particular importance given the significant long-term impact of those problems. In this narrative review, we investigated the evidence for domains of the physical environment that may ameliorate or contribute to the display of aggressive behaviours. We have considered a broad range of study designs that include typically developing and neurodiverse children and young people aged 0-18 years. We used the GRADE system to appraise the evidence. Searches were performed in eight databases in July 2020 and updated in June 2022. Additional articles were further identified by hand-searching reference lists of included papers. The protocol for the review was preregistered with PROSPERO. Results: We retrieved 7174 studies of which 67 are included in this review. The studies reported on green space, environmental noise and music, air pollution, meteorological effects, spatial density, urban or rural setting, and interior home elements (e.g., damp/sensory aspects/colour). They all used well validated parent and child reported measures of aggressive behaviour. Most of the studies were rated as having low or unclear risk of bias. As expected, noise, air pollution, urbanicity, spatial density, colour and humidity appeared to increase the display of aggressive behaviours. There was a dearth of studies on the role of the physical environment in neurodiverse children. The studies were heterogeneous and measured a range of aggressive behaviours from symptoms to full syndromes. Greenspace exposure was the most common domain studied but certainty of evidence for the association between environmental exposures and aggression problems in the child or young person was low across all domains. We found a large knowledge gap in the literature concerning neurodiverse children, which suggests that future studies should focus on these children, who are also more likely to experience adverse early life experiences including living in more deprived environments as well as being highly vulnerable to the onset of mental ill health. Such research should also aim to dis-aggregate the underlying aetiological mechanisms for environmental influences on aggression, the results of which may point to pathways for public health interventions and policy development to address inequities that can be relevant to ill health in neurodiverse young people.

Associations between residential environmental health and sleep quality: Potential mechanisms

BackgroundSleep quality is an important dimension of sleep health. There are few studies on the relationship between residential environment and sleep quality in China. We validated the connection between them and explored the moderating role of spatial-geographic characteristics and the role of emotional stress and somatic function as mediators. MethodsUsing survey data collected by the Chinese General Social Survey in 2021, 2717 respondents were included in the analysis. First, OLS regression was used for baseline analysis. Second, a generalized ordered logit model was used to analyze the more precise correlations between residential environmental health and sleep quality. Finally, the mediating role of emotional stress and somatic function was explored using the KHB method. ResultsIn the baseline analysis, both the positive correlations of residential natural environmental health and residential health resources on people's sleep quality were tested. Further analysis revealed that the correlation of natural environmental health was more about protecting people from poor sleep quality (having “good” and “very good” sleep quality). The residential health resources correlated with whether people reported very good sleep quality. Regional development disparities played a negative moderating role in the relationship between residential health resources and sleep quality. Also, the mediating role of emotional stress and somatic function were supported, and the mediating role of somatic function was higher in proportion. ConclusionSleep quality was positively correlated with residential environmental health; the economic development gap between regions played a moderating role; and the correlation was generated by people's emotional stress and somatic function. In the development of public health policy, it is necessary to actively address various environmental issues, provide convenient health facilities in living spaces, and bolster the policy inclinations of less developed areas.

Household Dietary Diversity among the Ethnic Minority Groups in the Mekong Delta: Evidence for the Development of Public Health and Nutrition Policy in Vietnam.

Poor household dietary diversity has been linked to malnutrition in individuals, households, and cumulatively in populations. High rates of malnutrition among Khmer ethnic children aged five years and younger have been reported in Tri Ton district, Vietnam. This paper aims to further investigate household dietary diversity and associated factors among Khmer ethnic minority populations in Vietnam. A cross sectional study was conducted from October 2018 to April 2019 in Tri Ton District, An Giang Province. By employing a multistage sampling technique, a total of 402 (99.8% response rate) participants were interviewed to measure household dietary diversity using a structured and validated questionnaire developed by FAO. Both bivariate and multivariate logistic regression analyses were carried out to identify factors associated with household dietary diversity. The results showed that the prevalence of low, medium and high dietary diversity scores were 21.4%, 70.4% and 8.2%, respectively. Male-headed households, literacy level, household income, exposure to mass media on nutrition and health information, and frequency of eating were positively associated with household dietary diversity (p &lt; 0.05). However, owning a vegetable and rice farm was not statistically related to households' dietary diversification. The paper concludes that the magnitude of household diversified dietary intakes was essentially low to medium in participants' households. These findings have provided evidence to inform the development of the National Nutrition Strategy-2021-2030 in Vietnam, to be revised in 2045. This national strategy proposes appropriate interventions, programs and policies to improve socioeconomic status in ethnic groups and in mountainous areas to enhance populations' health and well-being including controlling childhood malnutrition. In order to improve population health and wellbeing in Tri Ton District, further actions to address effective dietary practices including strengthening nutrition and health communication about the need to improve household dietary diversity to high levels are recommended.

Temperature-related mortality in China from specific injury

Injury poses heavy burden on public health, accounting for nearly 8% of all deaths globally, but little evidence on the role of climate change on injury exists. We collect data during 2013-2019 in six provinces of China to examine the effects of temperature on injury mortality, and to project future mortality burden attributable to temperature change driven by climate change based on the assumption of constant injury mortality and population scenario. The results show that a 0.50% (95% confident interval (CI): 0.13%–0.88%) increase of injury mortality risk for each 1 °C rise in daily temperature, with higher risk for intentional injury (1.13%, 0.55%–1.71%) than that for unintentional injury (0.40%, 0.04%–0.77%). Compared to the 2010s, total injury deaths attributable to temperature change in China would increase 156,586 (37,654–272,316) in the 2090 s under representative concentration pathways 8.5 scenario with the highest for transport injury (64,764, 8,517–115,743). Populations living in Western China, people aged 15–69 years, and male may suffer more injury mortality burden from increased temperature caused by climate change. Our findings may be informative for public health policy development to effectively adapt to climate change.

Desigualdades na cobertura vacinal infantil: potenciais lições do caso da Guiné-Bissau

Immunization is one of the main interventions responsible for the decline in under-5 mortality. This study aimed to assess full immunization coverage trends and related inequalities, according to wealth, area of residence, subnational regions, and maternal schooling level in Guinea-Bissau. Data from the 2006, 2014, and 2018 Guinea-Bissau Multiple Indicator Cluster Surveys (MICS) were analyzed. The slope index of inequality (SII) was estimated by logistic regression for wealth quintiles and maternal schooling level as a measure of absolute inequality. A linear regression model with variance-weighted least squares was used to estimate the annual change of immunization indicators at the national level and for the extremes of wealth, maternal schooling level, and urban-rural areas. Full immunization coverage increased by 1.8p.p./year (95%CI: 1.3; 2.3) over the studied period. Poorer children and children born to uneducated mothers were the most disadvantaged groups. Over the years, wealth inequality decreased and urban-rural inequalities were practically extinguished. In contrast, inequality of maternal schooling level remained unchanged, thus, the highest immunization coverage was among children born to the most educated women. This study shows persistent low immunization coverage and related inequalities in Guinea-Bissau, especially according to maternal schooling level. These findings reinforce the need to adopt equity as a main principle in the development of public health policies to appropriately reduce gaps in immunization and truly leave no one behind in Guinea-Bissau and beyond.