Excellent Health Research Articles

Physical Activity and Body Mass Index (BMI) as Predictors of Health-related Quality of Life in Montana Adults

Background: Health-related quality of life (HRQOL) is an important concept related to how health status affects a person’s life. Engaging in physical activity (PA) and maintaining healthy body weight are each linked to favorable HRQOL. However, the extent to which PA and body weight independently influence HRQOL is less known. The aim of this research was to examine how meeting PA guidelines and body mass index (BMI) affect a measure of HRQOL in adults. Methods: The Montana Behavioral Risk Factor Surveillance System (BRFSS, 2019) was used for this study. Three different PA guideline variables were used and included a two-level aerobic PA (APA) (met APA or did not meet APA) measure, a two-level muscle strengthening activity (MSA) (met MSA or did not meet MSA) measure, and a two-level PA guidelines (APA/MSA) (met both APA and MSA or did not meet both) measure. BMI was calculated from self-reported height and weight (kg/m2). HRQOL was assessed from a question asking participants to rate their general health with the following response options: “excellent”, “very good”, “good”, “fair” or “poor”. Multinomial logistic regression was used to examine the independent effects of PA and BMI on each HRQOL rating (relative to excellent) while controlling for sociodemographic variables. Results: Differences in HRQOL prevalence was seen within all sociodemographic variables except sex. Additionally, BMI was significantly (p Mean = 30.30, SE = 0.32) compared to those reporting excellent, very good or good health (Mean = 27.28, SE = 0.09), with a similar trend seen across all sociodemographic groups. The fully adjusted regression model including APA/MSA showed decreased odds of very good (OR = 0.75, 95% CI: 0.60 – 0.92), good (OR = 0.61, 95% CI: 0.49 – 0.78), fair (OR = 0.56, 95% CI: 0.40 – 0.78), and poor health (OR = 0.44, 95% CI: 0.28 – 0.69) (relative to excellent health) for adults meeting both APA and MSA. In the same model, increased odds was seen for very good (OR = 1.08, 95% CI: 1.06 – 1.10), good (OR = 1.15, 95% CI: 1.13 – 1.18), fair (OR = 1.19, 95% CI: 1.16 – 1.23), and poor health (OR = 1.16, 95% CI: 1.12 – 1.21) (relative to excellent health) for each 1-unit increase in BMI (1.00 kg/m2). Similar findings were seen in the separate APA model but not the MSA model. Conclusion: This study found that meeting PA guidelines and BMI were both independently related to HRQOL in adults. However, meeting MSA showed lower effects and inconsistent effects on HRQOL. Health promotion specialists concerned with improving HRQOL should promote both APA and MSA guidelines along with healthy body weight behavior. Physical activity programming should consider APA a priority over MSA for improving HRQOL in Montana adults.

Feasibility of implementing formal long-distance mentorship for public health physicians: a case study of Association of Public Health Physicians of Nigeria

BackgroundConflicting schedules and geographic access limit prospects for mutually beneficial relationships between experts and early career professionals. A formal long-distance mentorship program could address these barriers and potentially bridge the gap of traditional face-to-face mentorship. This study was done to determine the feasibility of implementing a formal long-distance mentorship program amongst public health physicians of Nigeria.MethodA mixed-method study comprising of in-depth interviews and surveys was used to collect information from members of the Association of Public Health Physicians in Nigeria. A total of 134 survey participants were recruited consecutively during an annual scientific meeting of the association. In-depth interviewees were purposively selected to ensure diversity in expertise, experience, and social stratifiers such as age. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were analyzed using thematic content analysis.ResultsPublic health physicians of Nigeria are willing to participate in a formal Long-Distance Mentorship Program, and four elements of feasibility were highlighted as necessary for implementing the program. Namely i) capacity to coordinate LDMP, ii) technical expertise and individual competence to provide mentorship, iii) financial capacity to implement and sustain LDMP, and iv) demand for mentorship by mentees. There is a consensus that the organizational structure of the National Postgraduate Medical College of Nigeria and West African College of Physicians provide an enabling environment to initiate a LDMP for public health physicians of Nigeria. The vast human resources with various expertise and the annual National conferences can be leveraged upon to champion and administer the program. However, there is a need for an administrative structure and technical expertise to enable proper coordination. More so, the need for demand creation and the financial requirement was considered gaps that need to be filled to be able to ensure feasibility. Bivariate analysis showed a significant relationship between the dependent variable (preferred role- mentor/mentee) and independent variables (age, year of graduation, and the number of years of practice), while the binary logistic regression model showed that physicians are more likely to participate as mentors with each unit increase in the number of years of practice. This further buttressed the need to commence the mentoring process as soon as trainees gain entrance into the program, as mentorship does not just prepare them for excellent public health practice, but also builds their capacity to mentor the younger and upcoming public health physicians.ConclusionThere are enabling structures to incorporate a formal long-distance mentorship program for public health physicians in Nigeria, and physicians are willing to participate in such a program. However, the feasibility of establishing a successful and sustainable program will require robust coordination, technical expertise, demand creation, and financial commitment at both institutional and college levels.

Counter-hegemonic Computing: Toward Computer Science Education for Value Generation and Emancipation

Students’ lives, both in and out of school, are full of different forms of value. Wealthy students enjoy value in the form of financial capital; their fit to hegemonic social practices; excellent health care and so on. Low-income students, especially those from African American, Native American, and Latinx communities, often lack access to those resources. But there are other forms of value that low-income students do possess. Most examples of what we will call Counter-Hegemonic Practice (CHP) in the African American community involve some mixture of Indigenous African heritage, contemporary innovation in the Black community, and other influences. Moving between these value forms and the computing classroom is a non-trivial task, especially if we are to avoid merely using the appearance of culture to attract students. Our objective in this paper is to provide a framework for deeper investigations into the computational potentials for CHP; its potential as a link between education and community development; and a more dignified role for its utilization in the CS classroom. We report on a series of collaborative engagements with CHP, largely focused on African American communities.

A Comparative Study of Health and Well-being Among Cisgender and Binary and Nonbinary Transgender Adolescents in Spain.

Purpose: The aim of this study was to describe the well-being and mental health of Spanish adolescents by gender identity using a nationally representative sample. Methods: The sample comprised 1212 15-18-year-old adolescents who participated in the 2018 Spanish edition of the international Health Behaviour in School-aged Children study. Of the total sample, 90 were identified as binary transgender adolescents, 213 as nonbinary transgender adolescents, and 909 as cisgender adolescents (selected through a matching process from an original sample of 17,375 cisgender adolescents). Comparisons of frequencies and means (chi-square, t-test, and analysis of variance) were used to analyze self-reported health, life satisfaction, health-related quality of life (HRQOL), psychosomatic complaints, and sense of coherence (SOC). Results: Nonbinary transgender adolescents reported the lowest levels of perceived excellent health (p < 0.001), the highest frequency of psychological complaints (p < 0.001) and physical complaints (p < 0.05), and a lower SOC (p < 0.05) compared with both cisgender and binary transgender adolescents. Likewise, nonbinary transgender adolescents reported lower levels of life satisfaction (p < 0.001) and HRQOL (p < 0.001) than cisgender adolescents. Conclusions: The differences found between binary and nonbinary transgender youth highlight the diversity within the transgender community. Both research and intervention programs should consider the unique experiences within the transgender community to adapt sensitively to their needs.

Patterns of Healthcare Expenditures among Older United States Adults with Pain and Different Perceived Health Status.

The objective of this study was to assess the pattern of healthcare expenditures among United States (U.S.) adults aged ≥50 years with pain and annual total positive healthcare expenditures with different levels of perceived health. The study used the 2018 Medical Expenditure Panel Survey data. Unadjusted and adjusted linear regression models were used to compare logarithmically transformed total healthcare expenditures between those with excellent, very good, good, and fair/poor health. The a priori alpha value was 0.05. The study included 5123 U.S. adults aged ≥50 with self-reported pain (excellent = 8.9%, very good = 28.3%, good = 36.2%, fair/poor = 26.6%). In adjusted analyses, compared to fair/poor health, those with excellent health had the greatest adjusted reduction in expenditures (55% lower), followed by very good health (36.5% lower) and good health (24.9% lower). In conclusion, total positive healthcare expenditures were comparatively lower among those with better perceived health status for older (≥50 years) U.S. adults with pain that interfered with normal work in the past four weeks.

Edukasi dan Simulasi Bekerja Sehat Selamat pada Pekerja Industri Batu Bata di Korong Tanjung Pisang Nagari Sintuk Kabupaten Padang Pariaman

In order to achieve success and high work productivity, informal sector businesses, which are growing fast in society, need excellent occupational health support. However, the number of workers in Indonesia is directly proportional to the number of work accidents, which is still high. Based on Social Security Administering Agency (BPJS) data in 2018, work accident cases were 123,000, an increase of 20% compared to 2017. Brick production business is one of the informal industries that found in various regions, including in Korong Tanjung Pisang Nagari Sintuk, Padang Pariaman Regency, West Sumatra. Worker activities risk accidents such as being crushed, falling, burns, and occupational diseases such as respiratory infections, low back pain, dermatitis, nail damage, and work fatigue. The activity method was door-to-door hazard communication on the first day and safe and healthy work education with simulations on the second day. The activity resulted in increased participants' knowledge about workplace hazards and risks and healthy and safe working methods. It was indicated by the increasing number of workers who know healthy and safe working. The pre-test result was that five workers had high knowledge, three had moderate knowledge, and 17 had insufficient knowledge. However, in the post-test result, 18 workers had high knowledge, three had moderate knowledge, and four had low knowledge. In conclusion, this activity is beneficial, providing a solution for a better way of working.

Patient and health system determinants of experiences of care at primary health care clinics in eThekwini, KwaZulu-Natal, 2018.

BackgroundRespect for persons includes three sub-elements: dignity, autonomy and confidentiality, whilst client orientation has four sub-elements: prompt attention, quality of basic amenities, access to social support for hospitalised individuals and choice of health providers.AimThis study sought to determine patient and health system determinants of experiences of care.SettingStudy was conducted at primary health care clinics in eThekwini, KwaZula-Natal.MethodsA self-administered questionnaire was used to collect data from 384 patients who received ambulatory care at six primary health care facilities (three community healthcare centres and three clinics) between June 2018 and November 2018.ResultsThree hundred and sixty nine respondents were included in the study. Eighty one percent (299) of the respondents were female, 67.2% (248) were single and 89.7% (331) were black Africans. Fifty (13.6%) respondents reported their health status to be poor, whilst 47 (12.5%) reported excellent health, with the majority (72.0%) reporting ‘good’ or ‘fair’ health. The patients’ experience score for the study population was 89.0% (IQR 81% – 98%). Patients who attended clinics had a 6.53 (p < 0.001) times increased odds of reporting good patients’ experience score compared with patients who attended community healthcare centres. Although ideal clinic status had a positive association with patients’ experience score (odds ration [OR]: 1.75; p > 0.05) this was not significant.ConclusionPatients attending clinics had a better experience compared with community health centres. Ideal clinic status showed a positive but not statistical significant association with good patient experiences. This may suggest that factors other than structural improvements play an important role in patients’ experience.

Trends in Health Information Technology Use Among the US Population With and Without Cardiovascular Risk Factors, 2012-2018: Evidence From the National Health Interview Survey.

BackgroundThe COVID-19 pandemic has required clinicians to pivot to offering services via telehealth; however, it is unclear which patients (users of care) are equipped to use digital health. This is especially pertinent for adults managing chronic diseases, such as obesity, hypertension, and diabetes, which require regular follow-up, medication management, and self-monitoring.ObjectiveThe aim of this study is to measure the trends and assess factors affecting health information technology (HIT) use among members of the US population with and without cardiovascular risk factors.MethodsWe used serial cross-sectional data from the National Health Interview Survey for the years 2012-2018 to assess trends in HIT use among adults, stratified by age and cardiovascular risk factor status. We developed multivariate logistic regression models adjusted for age, sex, race, insurance status, marital status, geographic region, and perceived health status to assess the likelihood of HIT use among patients with and without cardiovascular disease risk factors.ResultsA total of 14,304 (44.6%) and 14,644 (58.7%) participants reported using HIT in 2012 and 2018, respectively. When comparing the rates of HIT use for the years 2012 and 2018, among participants without cardiovascular risk factors, the HIT use proportion increased from 51.1% to 65.8%; among those with one risk factor, it increased from 43.9% to 59%; and among those with more than one risk factor, it increased from 41.3% to 54.7%. Increasing trends in HIT use were highest among adults aged >65 years (annual percentage change [APC] 8.3%), who had more than one cardiovascular risk factor (APC 5%) and among those who did not graduate from high school (APC 8.8%). Likelihood of HIT use was significantly higher in individuals who were younger, female, and non-Hispanic White; had higher education and income; were married; and reported very good or excellent health status. In 2018, college graduates were 7.18 (95% CI 5.86-8.79), 6.25 (95% CI 5.02-7.78), or 7.80 (95% CI 5.87-10.36) times more likely to use HIT compared to adults without high school education among people with multiple cardiovascular risk factors, one cardiovascular risk factor, or no cardiovascular risk factors, respectively.ConclusionsOver 2012-2018, HIT use increased nationally, with greater use noted among younger and higher educated US adults. Targeted strategies are needed to engage wider age, racial, education, and socioeconomic groups by lowering barriers to HIT access and use.

Nutritional supplements in modern sports: basic principles of application

One of the most important factors for a good result affect in sports are: lack of stress (emotional and nervous overstrain), rest, healthy sleep. The main condition is excellent food. The article considers the positive impact of the use of sports supplements to improve performance in sports and in general for the excellent well-being of the athlete. The aim of the work is to prove the use of nutritional supplements in the training of athletes, especially weightlifters, is quite effective and necessary for high athletic performance. Nutrition plays a huge role in achieving maximum results in fitness, bodybuilding and sports in general. When creating a training strategy, the basis of the nutrition program should be the use of certain types of products. Nutritional supplements, as it follows from this term, are only a supplement, a kind of support for proper nutrition and intensive training (especially with weights). Nutritional supplements are not a panacea, they can in no way replace proper nutrition and proper training. Nutritional supplements are substances that are a building material, protect and increase the function of cells in the body, and do not have a negative impact on human health.&#x0D; Maintaining excellent health is achieved through the use of sports supplements because the need for these drugs in athletes is very high. Athletes due to heavy physical activity spend a lot of energy, nutrients such as vitamins, minerals, amino acids. We see prospects for further research in a detailed consideration of the main components of sports supplements.

Comparison of EuroQol-5D-3L and Short Form-6D Utility Scores in Family Caregivers of Colorectal Cancer Patients: A Cross-Sectional Survey in China.

Objective: To compare the EuroQol-5D-3L (EQ-5D-3L) and the Short Form-6D (SF-6D) utility scores in family caregivers (FCs) of colorectal cancer (CRC) patients.Method: This study was performed on FCs of CRC patients from three primary cancer centers in the capital city of the Heilongjiang province. The participants (FCs) who were enrolled, filled the EQ-5D-3L, along with the SF-6D questionnaire. Two tools were compared for their distribution, discriminant validity, agreement, and convergent validity along with known-groups validity.Result: Two hundred ninety-two FCs of CRC patients were enrolled. The score distribution of the SF-6D along with the EQ-5D-3L were not normal. A ceiling impact was seen in 31.8% of the FCs for EQ-5D-3L; however, none for the SF-6D. Good associations (Spearman’s rho = 0.622, p < 0.01) and intraclass correlation coefficient (ICC 0.637 and average ICC 0.778) between the two scores were observed. The EQ-5D-3L yielded higher utility scores in contrast with the SF-6D in the better health subclass. The SF-6D distinguished better between excellent and good health statuses, with better effect size and relative efficiency statistics. Both tools showed good known-groups validity.Conclusion: The utility scores of SF-6D were remarkably lower relative to that of the EQ-5D-3L, but the difference may be clinically insignificant. However, the SF-6D may be superior because of the lack of ceiling impact. SF-6D exhibited a better convergent validity along with discrimination validity of excellent health condition and improved known-groups validity efficiency.

Well-Being of Ambulatory Adults With Cerebral Palsy: Education, Employment, and Physical Function of a Cohort Who Received Specialized Pediatric Care.

Introduction: The transition from pediatric health care and school systems presents enormous challenges for young adults with cerebral palsy (CP). The lack of strong societal support during this seminal life event is well-documented and leads many adults with CP to struggle with independence, higher education, and employment. Despite the relatively high prevalence of CP, information about the experiences and function of adults with CP in our society continues to be limited. The purpose of this project was to describe well-being by assessing education, employment, physical function, walking activity, and utilization of health care in an ambulatory adult cohort with CP who received specialized pediatric care at our center.Method: In this Institutional Review Board-approved prospective study, we invited former patients from our tertiary care pediatric CP center to complete a set of patient-reported outcomes including (1) the Patient-Reported Outcomes Measurement Information System domains of physical function and pain interference, (2) the Satisfaction with Life Scale, and a project-specific demographic questionnaire about education, employment, income, independence, pain, and health care utilization. Participants also wore a pedometer for 8 days to monitor community walking activity. Chi-squared pairwise or t-tests were used as appropriate to compare survey responses and walking activity data between three groups: participants who self-reported, those who reported by proxy, and published normative data from age-matched typically developing adult (TDA) samples.Results: One hundred twenty-six adults with CP consented to participate; 85 self-reported [age 29.7 ± 4.3 years; Gross Motor Function Classification System: I (28%), II (47%), and III, (25%)] and 41 reported by proxy [age 29.7 ± 4.1 years; Gross Motor Function Classification System: I (10%), II (68%), and III (22%)]. For the group who self-reported, high school graduation rate (99%) was similar to TDA (92%; p = 0.0173) but bachelor's degree achievement rate (55%) was higher than TDA (37%; p < 0.001). Despite more advanced education, the unemployment rate in this group was higher than national levels at 33% and was associated with high utilization of Social Security Disability Insurance (33%). Within the self-reporting group, 13% required a caregiver. For the group who reported by proxy, educational levels (73% high school graduates, 0 bachelor's degree) were lower than the general population (p < 0.001) and unemployment was higher than the national level, at 64%. Unemployment in this group was associated with high utilization of Social Security Disability Insurance (85%). Within the proxy-reporting group, 71% required a caregiver. The full cohort demonstrated lower levels of physical function according to the Patient-Reported Outcomes Measurement Information System and less community walking activity compared with TDA references (p < 0.001). This cohort of adults with CP reported significantly higher frequency of chronic pain (48 vs. 12% for TDA; p < 0.001), but less pain interference with daily activities than TDA based on Patient-Reported Outcomes Measurement Information System results (p < 0.001). This cohort reported good to excellent overall health (93%) and high utilization of primary care (98%), but limited utilization of specialty care, specifically orthopedic care (21%) and physical therapy (15%).Discussion: This cohort of adults with CP had similar levels of education as the general population, but had relatively high rates of unemployment, caretaker need, and Social Security Disability Insurance utilization. Although chronic pain was frequent, the impact of pain on work and independent living did not exceed reports from a typically developing reference. Better targeted societal resources for adults with physical disabilities are urgently needed to allow equitable access to employment, promote opportunities for independence, and enable full participation in community life.

The Analysis of Effectiveness of Elastic Training (Resistant) Bands Application to Develop Explosive Strength

ned: 1) the smallest increase in the standing long jump was observed in the group in which there were trainings with elastic training bands – 4,3 cm; in the group where isometric exercises were used, the increase in standing long jump was 10,9 cm; in the group in which students trained with weights, the increase in the standing long jump was 14 cm; 2) the increase of the leg press index at an angle of 45° in the group that used elastic training bands as a means of weighting was the lowest, i.e. 14 kg; in the group performing isometric exercises it was the highest – 19,5 kg; in the group that used weights – 18 kg.&#x0D; Purpose: to research the effectiveness of elastic training bands (resistance bands) application to develope explosive strength in a comparative aspect.&#x0D; Material and methods: theoretical material for the article has been taken from the research of Ukrainian and foreign scholars and experts. The basis for the study was a research laboratory of functional diagnostics and physical rehabilitation. The study involved 60 18-19-year-old students (40 girls and 20 boys), young people with excellent, very good or good health status. The main methods used for the experiment and the article were comparison, questionnaires, final tests, statistical analysis (parametric and nonparametric analysis, systematization, creation of varieties (arrays), determination of Student’s t-test and Pearson’s χ2 test).&#x0D; Results: the questionnaire of students on the expected effectiveness of various ways of explosive strength training revealed that the lowest result was expected from isometric exercises (5%), the average one was found out from the use of weights (61,67%), and the highest result was shown from the application of elastic training (resistant) bands (65%). According to the results of the experiment the following data has been obtained: 1) the smallest increase in the standing long jump was observed in the group in which there were trainings with elastic training bands – 4,3 cm; in the group where isometric exercises were applied, the increase in standing long jump was 10,9 cm; in the group in which students trained with weights, the gain in the standing long jump was 14 cm; 2) the increase of the leg press index at an angle of 45° in the group that used elastic training bands as a means of weighting was the lowest, i.e. 14 kg; in the group performing isometric exercises it turned out to be the highest – 19,5 kg; in the group that used weights – 18 kg.&#x0D; Conclusion: our experiment involved comparing the impact on the explosive strength development of different means of weighting: elastic training bands, isometric exercises and weighting objects. Despite the expectations of the respondents it was demonstrated that the application of the elastic training bands does not have a significant advantage over other means of weighting. The resistance bands application show lower results compared to the training with the isometric weighting and weighting of objects. The application of exercises in the isometric mode of weighting showed a significant gain in explosive strength, although the expected results were not met. The application of objects’ weighting showed the expected high results. Therefore, the prediction of the high efficiency of elastic training bands as a means of weighting turned out to be spurious

Examining perceived effects of same-sex marriage legalization among sexual minority women: Identifying demographic differences and factors related to alcohol use disorder, depression, and self-perceived health.

Reductions in structural stigma, such as gaining access to legalized same-sex marriage, is associated with positive psychological and physical health outcomes among sexual minorities. However, these positive outcomes may be less robust among sexual minority women (SMW). This study examined how perceptions of the impact of legalized same-sex marriage among SMW may 1) differ by demographic characteristics and 2) predict alcohol use disorder, depression, and self-perceived health. A diverse sample of SMW (N=446) completed an online survey in 2020 assessing the perceived impact of legalized same-sex marriage across six social-ecological domains: 1) personal impact, 2) stigma-related concerns, 3) couple impact, 4) family support, 5) work/school impact, and 6) local social climate towards LGBTQ people. Perceived impact across multiple domains differed by relationship status and sexual identity (e.g., lesbian compared to bisexual identity); only family support differed by race/ethnicity. Stigma-related concerns (e.g., experiencing or witnessing hostility or discrimination because of sexual identity, despite legalized same-sex marriage) were associated with greater odds of depression and lower odds of reporting excellent, very good, or good health. Odds of depression were lower among participants who reported higher personal impact, a greater number of family members supportive of same-sex marriage, and a more positive local social climate. Family support also predicted self-perceived health. However, participants who perceived increased support in work/school contexts after legalized same-sex marriage had higher odds of alcohol use disorder. Overall, findings underscore the importance of policy in improving health outcomes through reducing stigma-related concerns and improving social acceptance.

Mediated Relationships between Supplemental Nutrition Assistance Program Benefits, Food Hardships, Health Status, and Emergency Department Use Among Low‐Income Children with and without Special Health Care Needs

Research ObjectiveThe Supplemental Nutrition Assistance Program (SNAP) has been found to reduce food hardships, which are associated with poor health and health care outcomes among children. Evidence that SNAP improves adult health and healthcare outcomes is growing, but studies including children have been limited. The need to assess these potential relationships among children with special health care needs (SHCN) is particularly pronounced, given their heightened social and health care complexity. We therefore aimed to (i) examine relationships between SNAP, food hardships, health status, and health care use among children, and (ii) examine whether SHCN status modified any of these relationships.Study DesignTo estimate the relationship between SNAP and food hardships, we followed prior studies in using a bivariate probit model with state‐level SNAP administrative policies as instruments (to account for disproportionate self‐selection into SNAP among households with high food hardships). We estimated this model within a structural equation modeling framework to simultaneously estimate downstream associations with health status and health care use. Household food insufficiency (FI) and excellent health status (versus very good, good, fair, or poor; a robust dichotomization among children) were modeled as mediators of the relationship between any SNAP receipt and any emergency department (ED) use over the prior year. We interacted SHCN status with SNAP to assess modification, and we adjusted for sociodemographic and environmental variables (e.g., exposure to smoking). Associations were estimated as the combination of direct and indirect effects. Predicted probabilities were calculated for interpretability.Population StudiedUsing pooled 2016, 2017, and 2018 National Survey of Children's Health data (nationally representative), we examined 17,791 children in households with income below 150% of the federal poverty level (a cutoff used in prior studies), 4710 of whom had SHCN based on a validated instrument.Principal FindingsSNAP was associated with: decreased FI likelihood, increased excellent health status likelihood, and decreased ED use likelihood; SHCN status was associated with an increase in the magnitude of each of these relationships. All associations had p‐values ≤0.001. See table: FI Excellent Health Status ED Use Total No SHCN SHCN Total No SHCN SHCN Total No SHCN SHCN No SNAP 65% 63% 73% 46% 54% 22% 35% 29% 53% SNAP 32% 31% 35% 66% 74% 45% 21% 16% 33% Δ −33 −32 −37 +20 +20 +22 −14 −13 −19 ΔΔ −5 +3 −7 Δ: difference in percentage points (pp), SNAP vs. no SNAP ΔΔ: difference‐in‐difference in pp; (SNAP vs. no SNAP if SHCN) vs. (SNAP vs. no SNAP if no SHCN) ConclusionsSNAP was associated with significant beneficial effects regarding a child's likelihood of experiencing FI, excellent health status, and ED use, with even more beneficial effects found for children with SHCN.Implications for Policy or PracticeThough an incomplete solution, SNAP may improve child health and healthcare outcomes, particularly for children with elevated vulnerabilities. Greater investments in food hardship relief by healthcare systems (e.g., SNAP enrollment assistance, food Rx programs) and policymakers (e.g., increased SNAP benefits, reduced enrollment barriers) may pay substantial dividends in improved outcomes for these populations and the health systems providing them care.Primary Funding SourceNational Institutes of Health.

How genomic selection has increased rates of genetic gain and inbreeding in the Australian national herd, genomic information nucleus, and bulls

Genomic selection has been commonly used for selection for over a decade. In this time, the rate of genetic gain has more than doubled in some countries, while inbreeding per year has also increased. Inbreeding can result in a loss of genetic diversity, decreased long-term response to selection, reduced animal performance and ultimately, decreased farm profitability. We quantified and compared changes in genetic gain and diversity resulting from genomic selection in Australian Holstein and Jersey cattle populations. To increase the accuracy of genomic selection, Australia has had a female genomic reference population since 2013, specifically designed to be representative of commercial populations and thus including both Holstein and Jersey cows. Herds that kept excellent health and fertility data were invited to join this population and most their animals were genotyped. In both breeds, the rate of genetic gain and inbreeding was greatest in bulls, and then the female genomic reference population, and finally the wider national herd. When comparing pre- and postgenomic selection, the rates of genetic gain for the national economic index has increased by ~160% in Holstein females and ~100% in Jersey females. This has been accompanied by doubling of the rates of inbreeding in female populations, and the rate of inbreeding has increased several fold in Holstein bulls since the widespread use of genomic selection. Where cow genotype data were available to perform a more accurate genomic analysis, greater rates of pedigree and genomic inbreeding were observed, indicating actual inbreeding levels could be underestimated in the national population due to gaps in pedigrees. Based on current rates of genetic gain, the female reference population is progressing ahead of the national herd and could be used to infer and track the future inbreeding and genetic trends of the national herds.

Prevalence and Factors Associated Depression or Depressive Symptoms in Patients with HIV/AIDS

HIV/AIDS is still a serious public health problem across the world. WHO reported that there were 37.7 million HIV positive patient in 2020. Patient HIV/AIDS are more prone to developing mental illnesses, including depression. Depression is more common in HIV-positive (HIV+) people than in HIV-negative (HIV-). The factor associated with depression in HIV/AIDS patients include age, gender, stigma, discrimination, social support, living alone, marital, educational, employment status, socioeconomic, the use of ART, CD4 count, and disease course. The high prevalence of depression and depressive symptom in HIV/AIDS patient emphasize the significance of delivering excellent mental health treatment, as well as the importance of long-term support and routine depression management.

The Relationship Between the Health Literacy Level of Pregnant Women and COVID-19 Knowledge, Attitudes and Behaviors

Objective: This study was conducted to determine pregnant women's health literacy level and evaluate the relationship between the determined health literacy levels with COVID 19 knowledge, attitudes, and behaviors. Materials and Methods: This descriptive and cross-sectional study was conducted on 381 pregnant women between September 2020 and February 2021. The questionnaire, 25 questions about socio-demographic characteristics and knowledge, attitudes and behaviors with COVID 19, and “Turkey Health Literacy Scale-32 (THLS-32)” consisting of 32 questions was applied by face-to-face interview technique. Results: The average age of participants is 28.70 ± 5.45, and 58.8% of them have an education level above high school. It is the first pregnancy of 27.0% of participants. The average week of gestation is 22.45 ± 9.94. Of the participants, 23.9% have inadequate, 19.7% limited, 28.3% adequate and 28.1% have excellent general health literacy. The average general health literacy average is 33.28 ± 12.63. Health literacy level is high in participants with education level, employment, number of pregnancies and lower pregnancy (p <0.05). Adequate health literacy level is higher in participants who say fever, respiratory distress, and cough are the symptoms of COVID-19 (p <0.05). Adequate health literacy (disease prevention and health promotion) level is higher in participants who avoid close contacts such as handshaking or hugging (p <0.05). Conclusion: More than half of pregnant women is adequate health literacy levels. Adequate health literacy is high in compliance COVID-19 rules. Improving health literacy can provide benefits in solving both COVID-19 disease and other health problems.

A Hospital's Legal Responsibility For Patient Rights During The Covid-19 Pandemic - A Review From The Health Sector's Law Regulations

The hospital's legal responsibility to fulfill the patient's rights cannot be separated from the hospital's obligations to the patient, according to the law. This is governed by the Health Law, the Hospital Law, and the Law on Medical Practice. Various statutory provisions were also applied during the Covid-19 pandemic, which was declared a public health emergency, including the Infectious Disease Outbreak Law, the Health Quarantine Law, Presidential Decree No. 11 of 2020 concerning the Determination of the Corona Virus Disease 2019 (Covid-19) Public Health Emergency, and Permenkes No. 4 of 2018 concerning Hospital Obligations and Patience. In practice, the growing number of Covid-19 cases in Indonesia has resulted in hospitals being unable to accommodate patients in need of treatment, particularly those with severe and critical conditions who require intensive care units. With bed occupancy rates (BOR) exceeding 85 percent in almost all hospitals, the community must understand that hospitals must prioritize care for patients with moderate, severe, or life-threatening conditions. In any case, the Covid-19 pandemic had an effect on the quality of hospital care provided to patients. The study used normative juridical research methods and empirical evidence to examine hospitals' legal responsibility for upholding patient rights during the Covid-19 pandemic. The study's findings indicate that, despite limitations in providing excellent health care to patients, hospitals must uphold patient rights to safety and security during hospitalization. As a result, it is necessary to establish a legal framework that protects the rights of health care workers and hospitals providing services to patients during this pandemic, particularly the protection of work standards, occupational health and safety standards, and labor social security standards. In terms of facilities and infrastructure, the government must assist by increasing the number of emergency hospitals to accommodate the anticipated increase in Covid-19 patients.

The Effects of Antenatal Depression and Women's Perception of Having Poor Health on Maternal Health Service Utilization in Northern Ghana.

To examine the effects of antenatal depression and women's perceived health during the antenatal period on maternal health service utilization in rural northern Ghana; including how the effect of antenatal depression on service use might be modified by women's perceived health. Probable antenatal depression was assessed using the Patient Health Questionnaire (PHQ-9). Linear regression was used for the outcome of number of antenatal care (ANC) visits, and logistic regression was used for the outcomes of facility delivery, postnatal care (PNC) within 7 days and completion of continuum of care. Continuum of care was defined as having had four or more ANC visits, delivered at a health facility and had PNC visit within 7 days. Antenatal depression had very small or no association with maternal health service utilization. Women with self-perceived fair or poor health were significantly less likely to use PNC within 7 days and less likely to complete the continuum of care. As for effect modification, we found that for women with probable moderate or severe antenatal depression (a score of 10 or greater), those with perceived fair or poor health used fewer ANC visits and were less likely to use PNC within 7 days than those with perceived excellent, very good or good health. Women experiencing moderate or severe antenatal depression and/or who self-perceive as having poor health should be identified and targeted for additional support to access and utilize maternal health services.

Research Progress of Seaweed Fermentation with Lactic Acid Bacteria

Edible seaweed is one of the most important marine food stuffs. Many nutrient elements such as proteins, carbohydrates, vitamins, minerals, and bioactive substances such as polysaccharides, phenols, etc. have been found in the tissue of seaweed. More and more researchers have revealed that seaweed is fermentable to lactic acid bacteria (LAB) due to its nutritional facts. It has been shown that LAB fermentation can improve the quality or safety of seaweed products, and promote the release or production of some bioactive compounds. Thus, seaweed fermentation by using LAB can provide a wide array of fermented seaweed-based foods with excellent health benefits. In this paper, according to the relevant research reports of seaweed fermentation by lactic acid bacteria at home and abroad in recent years, the types of fermentation by lactic acid bacteria, the feasibility of seaweed fermentation by lactic acid bacteria and the main types of lactic acid bacteria, as well as the effect and role of lactic acid bacteria in seaweed fermentation are described, and the development and application status of seaweed fermentation by lactic acid bacteria in food industry is summarized. Finally, the future trends and prospects in this research field are analyzed to provide a certain reference for the further development of more healthy LAB fermented seaweed foods.