Important Public Health Measure Research Articles

Spirituality, religiosity and the mental health consequences of social isolation during Covid-19 pandemic.

Background:Evidence shows that religiosity and spirituality (R/S) are highly used in critical moments of life and that these beliefs are associated with clinical outcomes. However, further studies are needed to assess these beliefs during the COVID-19 pandemic.Aims:To evaluate the use of R/S during the COVID-19 pandemic in Brazil and to investigate the association between R/S and the mental health consequences of social isolation.Methods:Cross-sectional study conducted in May 2020. Online surveys were carried out assessing sociodemographics, R/S measures, and social isolation characteristics and mental health consequences (hopefulness, fear, worrying and sadness). Adjusted regression models were used.Results:A total of 485 participants were included from all regions of Brazil. There was a high use of religious and spiritual beliefs during the pandemic and this use was associated with better mental health outcomes. Lower levels of worrying were associated with greater private religious activities (OR = 0.466, CI 95%: 0.307–0.706), religious attendance (OR = 0.587, CI 95%: 0.395–0.871), spiritual growth (OR = 0.667, CI 95%: 0.448–0.993) and with an increase in religious activities (OR = 0.660, CI 95%: 0.442–0.986); lower levels of fear were associated with greater private religious activities (OR = 0.632, CI 95%: 0.422–0.949) and spiritual growth (OR = 0.588, CI 95%: 0.392–0.882) and, lower levels of sadness (OR = 0.646, CI 95%: 0.418–0.997) were associated with spiritual growth. Finally, hope was associated with all R/S variables in different degrees (ranging from OR = 1.706 to 3.615).Conclusions:R/S seem to have an important role on the relief of suffering, having an influence on health outcomes and minimizing the consequences of social isolation. These results highlight the importance of public health measures that ensure the continuity of R/S activities during the pandemic and the training of healthcare professionals to address these issues.

19 Factors Associated with County-Level SARS-CoV-2 Testing Volume in Nine States

Rigorous SARS-CoV-2 testing is an important public health measure as it leads not only to early identification and prevention of transmission, but also to optimization of emergency care and resource allocation. Yet, the US has experienced a significant burden of illness, with reports suggesting a disproportionate amount falling on racial/ethnic minorities. Despite the public health importance, little is known about the discrepancies in the testing rate by region and race/ethnicity. In this context, we investigated the differences in and factors associated with per capita testing volumes.

Effects of in-hospital breast feeding on brain function development in preterm infants in China: study protocol for a prospective longitudinal cohort study

IntroductionDue to immature brain development, preterm infants are more likely to develop neurological developmental defects compared with full-term infants. Most preterm infants without neurodevelopmental damage can eventually reach the same...

Changes in Self-Reported Physical Activity Predict Health-Related Quality of Life Among South African Schoolchildren: Findings From the DASH Intervention Trial.

Introduction: Regular physical activity is associated with multiple health benefits for children. Evidence from cross-sectional studies suggests that physical activity is positively associated with health-related quality of life (HRQoL). The promotion of physical activity, and hence HRQoL, through a school-based intervention is therefore an important endeavor, particularly in disadvantaged areas of low- and middle-income countries, including South Africa.Methods: We designed a multicomponent physical activity intervention that was implemented over a 20-week period in 2015 in eight disadvantaged primary schools of Port Elizabeth, South Africa. Overall, 758 children aged 8–13 years participated. HRQoL was measured with the 27-item KIDSCREEN questionnaire. Self-reported physical activity was assessed with a single item of the Health-Behavior of School-Aged Children test, and cardiorespiratory fitness with the 20-m shuttle run test. Post-intervention scores were predicted with mixed linear regression models, taking into consideration the clustered nature of the data.Results: Higher baseline levels as well as increasing levels of self-reported physical activity predicted all dimensions of children's HRQoL. Baseline levels and increases in cardiorespiratory fitness predicted children's self-perceived physical well-being (one of the HRQoL subscales). Participation in the multicomponent physical activity intervention did not affect children's HRQoL.Conclusion: Higher and increasing self-reported physical activity predict all assessed HRQoL dimensions, which underlines that the promotion of regular physical activity among children living in disadvantaged settings is an important public health measure. Policy makers should encourage schools to create physical activity friendly environments, while schools should implement regular physical education as proposed by the school curriculum.

Diabetes mellitus and associated factors, determined by glycated hemoglobin

Abstract Objective To analyze the prevalence of diabetes mellitus (DM) according to different diagnostic criteria, in the Brazilian adult population, according to laboratory results from the Brazilian National Health Survey. Methods Analysis of laboratory data from the National Health Survey, collected between 2014 and 2015. The prevalence of diabetes was calculated according to different diagnostic criteria. The prevalence of diabetes was calculated according to the criterion of glycosylated hemoglobin ≥ 6.5% or using medication, using Poisson regression and calculating crude and adjusted PR and 95%CI. Results The prevalence of diabetes according to different criteria varies from 6.6 to 9.4%. Intermediate or pre-diabetes hyperglycemia ranged from 6.8 to 16.9%. Considering laboratory criteria or medication use, the prevalence of DM was 8.4 (95%CI 7.65-9.11). The adjusted PR for gender, age, educational level and region was lower for males (PR 0.75; 95%CI 0.63 - 0.89), increased with age: 30 to 34 years (PR 2.32; 95% CI 1.33 - 4.07), 40 to 59 years PR 8.1; 95%CI 4.86 - 13.46), 60 years old or older (PR 12.6; 95%CI 7.1 - 21.0), and higher educational levels was protective (PR 0.8; 95%CI 0.6 - 0.9). Therewas a higher PR in the Central West Region (PR 1.3; 95%CI 1.04 - 1.7), in overweight people (PR 1.8; 95%CI 1.4 - 2.1), and in obese people (PR 3.3; 95%CI 2.6 - 4.1). Conclusions The prevalence of diabetes was higher in females, people over 30 years of age, in populations with low educational levels, and people who were overweight and obese. The study advances in determining the diabetes situation in the country through laboratory criteria. These data demonstrate the importance of controlling hyperglycemia in order to avoid the vascular and systemic effects of DM. Key messages This is the first study to analyze the prevalence of DM using laboratory data from a representative sample of the Brazilian population. The study pointed to a strong association between overweight and obesity and diabetes, showing the importance of public health measures to encourage healthy eating and physical activity.

High SARS-CoV-2 seroprevalence in health care workers but relatively low numbers of deaths in urban Malawi

Background: In low-income countries, like Malawi, important public health measures including social distancing or a lockdown have been challenging to implement owing to socioeconomic constraints, leading to predictions that the COVID-19 pandemic would progress rapidly. However, due to limited capacity to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, there are no reliable estimates of the true burden of infection and death. We, therefore, conducted a SARS-CoV-2 serosurvey amongst health care workers (HCWs) in Blantyre city to estimate the cumulative incidence of SARS-CoV-2 infection in urban Malawi. Methods: We recruited 500 otherwise asymptomatic HCWs from Blantyre City (Malawi) from 22nd May 2020 to 19th June 2020 and serum samples were collected from all participants. A commercial ELISA was used to measure SARS-CoV-2 IgG antibodies in serum. Results: A total of 84 participants tested positive for SARS-CoV-2 antibodies. The HCWs with positive SARS-CoV-2 antibody results came from different parts of the city. The adjusted seroprevalence of SARS-CoV-2 antibodies was 12.3% [CI 8.2 - 16.5]. Using age-stratified infection fatality estimates reported from elsewhere, we found that at the observed adjusted seroprevalence, the number of predicted deaths was eight times the number of reported deaths. Conclusions: The high seroprevalence of SARS-CoV-2 antibodies among HCWs and the discrepancy in the predicted versus reported deaths suggests that there was early exposure but slow progression of COVID-19 epidemic in urban Malawi. This highlights the urgent need for development of locally parameterised mathematical models to more accurately predict the trajectory of the epidemic in sub-Saharan Africa for better evidence-based policy decisions and public health response planning.

Characterization of patients with chronic hepatitis C attended at a hepatology clinic of a community hospital in North Brooklyn in New York City

Background: Screening for chronic hepatitis C (C-HCV) is an important public health measure to prevent its complications. Thus, the aim of this study was to characterize the population of patients with C-HCV attended at a hepatology clinic in North Brooklyn in New York City. Methods: Relevant clinical data were collected retrospectively by chart review of patients with C-HCV, at least 18 years old, attended between 2005 and 2019, period chosen because of feasibility. Results: 258 patients were identified of whom 156(60%) were men, with a mean age of 59.3years (yrs) (29-87), 46(18%) being up to 50, and 172 (67%) in the baby boomer category. Risk factors were intravenous drug use (IDU) in 87(34%), blood transfusions in 29 (11%), tattoos in sixteen (6%), twelve (5%) multifactorial, and unknown in 98 (38%) patients. The majority had an abnormal serum liver profile. The most common genotype was 1a. 205 (79%) were treatment naïve (TN) and 51(20%) experienced (TE). Of the TE, 38(75%) had been treated with interferon/ribavirin, and the rest with direct acting agents (DAA). All patients treated de novo received DAAs approved in or after 2014. Sustained virological response (SVR), i.e. cure, and was documented in 176 patients (71%) at weeks 12 or 24 post-treatment. Lack of adherence to follow up was an important barrier to cure. Conclusions: Treatment of C-HCV was effective in the diverse community of North Central Brooklyn, however, programs to improve adherence to treatment are necessary. Additionally, the expansion of screening for C-HCV beyond baby boomers is paramount in its eradication.

Changing trend in mortality rate of multiple myeloma after introduction of novel agents: A population-based study.

Previously, the main treatment for multiple myeloma (MM) was cytotoxic chemotherapies, including autologous stem-cell transplantation (ASCT), but survival benefit in the elderly was limited. More recently, clinical trials and practical experience with novel agents with superior efficacy have shown improved survival, including in the elderly. However, this improvement cannot be simply interpreted as a decline in mortality rate that is an important public health measure of progress against cancer. Here, we assessed the trends in mortality rates of MM in parallel with incidence rates in Japan and the U.S. We used national mortality data and population-based cancer registry data in both countries from 1995 to 2015, during which 74 972 patients in Japan and 229 290 patients in the U.S. died of MM. Trends in mortality and incidence rates were characterized using joinpoint regression analysis. Despite upward trends in incidence, mortality rates showed a significant decrement after 2005 in Japan, with an annual percent change [APC (95% confidence interval)] of -2.5% (-2.9% to -2.1%), and after 2002 in the U.S., with an APC of -2.0% (-2.6% to -1.5%). In both countries, the change in mortality trend coincided with the introduction of the novel agents. Moreover, improvements in mortality were particularly large in patients aged 70 to 79 years, who cannot receive ASCT. Our results indicate that the benefits of novel agents for MM are appreciable at the population level and may encourage further development of novel agents for malignancies that can be widely applied to the patients.

Consideration on improving public health emergency management ability of current medical health system

COVID-19 is a Public Health Emergency of International Concern (PHEIC). Direct economic loss is expected to be much more than that of SARS outbreak in 2003. The risk factors of COVID-19 epidemic at the early stage included the misjudgment of the epidemic, delay in reporting this emerging infectious disease, nosocomial infection-caused transmission of the virus into local communities, and weak public health interventions. The infection rate (or the incidence) reflects the prophylactic effect in population. Case fatality reflects the therapeutic effect of clinical intervention. There were sufficient medical resources at the national top levels accumulated in Wuhan. Furthermore, medical professionals and sufficient medical supplies from other provinces have been assigned to join in the fighting against the epidemic in Wuhan. However, the case fatality in Wuhan has been kept the highest in China, indicating that clinical treatment for this virus-caused emerging infectious disease, whose pathogenesis remains to be elucidated, with limited effect in controlling this epidemic. The unusual, extremely costly public health interventions including the temporarily city quarantine and transportation ban issued by the central government are crucial in controlling this epidemic. The control of epidemic indicates the importance of public health measures but also reflected its insufficient capacity in China. Recently, profit-seeking mechanism run in Chinese health service system disorganized the balance of clinical service and public health service patterns in China, promoting the vicious circle of "attaching importance to clinical treatment and despising disease prophylaxis" , damaging the infrastructure of public health capacity, thus contributing to the formation of the inevitability in various fortuities of public health emergency. To strength the capacity of our medical service system to respond to public health emergency efficiently, two key issues should be considered. First, public health service, which should be fixed as the health section of the governments' public services by the law, must be greatly improved to meet the increasing health needs of the publics. Second, the vicious circle of profit-seeking-caused "attaching importance to clinical treatment and despising disease prophylaxis" should be immediately broken to optimize the national health service system in China by increasing the investment in public health service.

Better preventing and mitigating the effects of Covid-19.

Currently, there are no proven medical treatments against SARS-CoV-2, the virus responsible for Covid-19. In addition to the all important public health measures needed to prevent the spread of this disease, a number of strategies related to our exposome are recommended herein, to better prevent and mitigate the effects of a SARS-CoV-2 infection through enhancement of our immune system and reduction of inflammation.

COVID‐19 and implications for eating disorders

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Effects of low-level fluoride exposure on glucose homeostasis in female NOD mice

Water fluoridation is an important public health measure for the control of dental caries. Recent animal studies have shown that low doses of fluoride (F) in the drinking water, similar to those found in public water supplies, increase insulin sensitivity and reduce blood glucose. In the present study we evaluated the effects of low-level F exposure through the drinking water on glucose homeostasis in female NOD mice. Seventy-two 6-week mice were randomly divided into 2 groups according to the concentration of F in the drinking water (0-control, or 10 mg/L) they received for 14 weeks. After the experimental period the blood was collected for analyses of plasma F, glucose and insulin. Liver and gastrocnemius muscle were collected for proteomic analysis. Plasma F concentrations were significantly higher in the F-treated than in the control group. Despite treatment with fluoridated water reduced plasma levels glucose by 20% compared to control, no significant differences were found between the groups for plasma glucose and insulin. In the muscle, treatment with fluoridated water increased the expression of proteins related to muscle contraction, while in the liver, there was an increase in expression of antioxidant proteins and in proteins related to carboxylic acid metabolic process. Remarkably, phosphoenolpyruvate carboxykinase (PEPCK) was found exclusively in the liver of control mice. The reduction in PEPCK, a positive regulator of gluconeogenesis, thus increasing glucose uptake, might be a probable mechanism to explain the anti-diabetic effects of low doses of F, which should be evaluated in further studies.

Perception and practice of handwashing among public secondary school students in Somolu Local Government Area, Lagos, Nigeria - A cross-sectional study

Background: Hand hygiene is a simple and effective means of preventing the spread of communicable diseases, and the promotion of hand hygiene is an important public health measure. This study assessed knowledge, attitude, and practice of and barriers to handwashing among secondary school students in Somolu Local Government Area (LGA), Lagos, Nigeria. Methods: The study was a descriptive cross-sectional, conducted in selected secondary schools in Somolu LGA, Lagos State. Multistage sampling method was employed to select 420 respondents from the selected public secondary schools. Self-administered and pretested questionnaires were used to collect data. Analysis was done using IBM SPSS version 22. Descriptive and bivariate analyses were conducted with level of significance (P) at ≤0.05. Results: The mean ± standard deviation age of the respondents was 14.09 ± 2.06 years. Less than two-third (64.0%) of the respondents had good knowledge, almost all (99.5%) had positive attitude, while about 71% had good practice of handwashing. Forgetfulness (49.8%) and laziness (33.8%) were the major reasons for not practicing handwashing at home as opposed to unavailability of soap (50%) and lack of nearby water supply (46.2%) in schools. A statistically significant association was found between class of respondents, parent's level of education, and handwashing practices (P < 0.05). Conclusion: Although majority of the respondents had positive attitude toward handwashing, knowledge and practice of handwashing, which is a key to infection control, was not at par with their attitudes. We recommend targeted health education sessions on handwashing and provision of handwashing facilities in secondary schools.

69 Falls: A Manifestation of Frailty and Sarcopenia

Abstract Falls is one of the major adverse outcomes of frailty and sarcopenia, and may be considered a downstram consequence of these emerging geriatric syndromes. Frailty consists of both physical and cognitive components, which lead to increased falls risk. Community screening for frailty and sarcopenia may be included as an important public health measure, to be followed by more detailed falls risk assessment requiring various measurements. At the same time falls prevention or rehabilitation programs need to take into account the presence of frailty and/or sarcopenia and their appropriate management, to achieve optimal results.

An observational study to assess the knowledge and attitude of medical students regarding hand washing

Background: Hand hygiene is a milestone in the field of infectious disease control. Promotion of improved hand hygiene has been recognized as an important public health measure. Therefore hand washing is being promoted in various ways. This study has been conducted to assess the level of knowledge and attitude regarding hand hygiene practices amongst the medical students to identify areas of gaps in their knowledge, attitude and practices.Methods: This is a cross sectional study conducted among medical undergraduates of a private medical college in western Utter Pradesh. A pre tested questionnaire with multiple choice questions was used for collection of data.Results: A total of 246 MBBS students participated in the study out of which 50.4 % students were male and rest were female. 78.5% participants were belonging to the age group 19-21 years. Students have good knowledge of hand washing irrespective of their educational front.Conclusions: The results of our study are fairly good still a proper training program is required to generate awareness among the community. Maintenance of hand hygiene should be a part of our education system at primary level.

Estimating the Malaria Attributable Fever Fraction Accounting for Parasites Being Killed by Fever and Measurement Error

ABSTRACTMalaria is a major health problem in many tropical regions. Fever is a characteristic symptom of malaria. The fraction of fevers that are attributable to malaria, the malaria attributable fever fraction (MAFF), is an important public health measure in that the MAFF can be used to calculate the number of fevers that would be avoided if malaria was eliminated. Despite such causal interpretation, the MAFF has not been considered in the framework of causal inference. We define the MAFF using the potential outcome framework, and define causal assumptions that current estimation methods rely on. Furthermore, we demonstrate that one of the assumptions—that the parasite density is correctly measured—generally does not hold because (i) fever kills some parasites and (ii) parasite density is measured with error. In the presence of these problems, we reveal that current MAFF estimators can be significantly biased. To develop a consistent estimator, we propose a novel maximum likelihood estimation method based on exponential family g-modeling. Under the assumption that the measurement error mechanism and the magnitude of the fever killing effect are known, we show that our proposed method provides approximately unbiased estimates of the MAFF in simulation studies. A sensitivity analysis is developed to assess the impact of different magnitudes of fever killing and different measurement error mechanisms. Finally, we apply our proposed method to estimate the MAFF in Kilombero, Tanzania. Supplementary materials for this article are available online.

Early childhood caries and oral health care of Hong Kong preschool children.

Surveys have shown that the prevalence of early childhood caries (ECC) among 5-year-old children decreased from 63% in 1993 to 55% in 2017. Caries experience was unevenly distributed; 81% of the caries lesions were found in 26% of the children. Risk factors, including oral hygiene practice behaviors, sugar consumption, parental oral health-related knowledge, and sociodemographic backgrounds, were significantly related to ECC. Oral health promotion aimed at managing the burden of ECC has been implemented. Water fluoridation was launched in 1961, and the fluoride concentration has been adjusted to 0.5 ppm since 1988. It is considered an important dental public health measure in Hong Kong. The Department of Health set up the Oral Health Education Unit in 1989 to deliver oral health education to further improve the oral health of preschool children. Other nongovernmental organizations also launched short-term oral health promotion programs for preschool children. However, no significant change in the prevalence of ECC has been observed in the recent two decades. There is a necessity to revisit dental public health policies and develop effective evidence-based strategies to encourage changes in oral health-related behaviors to forestall the impending epidemic of ECC in Hong Kong.

A case report of atlanto-axial instability in a Down Syndrome patient.

Down Syndrome (DS)-also referred to as Trisomy 21-is associated with multiple deformities affecting various systems of the body. Joint laxity resulting in unstable atlanto-occipital and atlanto-axial joints-with an increased susceptibility to fatal cord injuries-is a recognized phenomenon in patients with DS. We report on a 30-year-old man with DS from Tanzania with no previous neck complaints, who presented with a 5-week progressive history of paraparesis that evolved into a quadriparesis. During his initial presentation, the patient reported that 5 months ago he had been involved in a headlock during a playground encounter. Primary prevention of the traumatic spinal cord injuries is an important public health measure and a heightened emphasis should be placed to prevent such injuries in high risk populations-including DS patients.

Early childhood caries, salivary and microbiological aspects among 3- to 4-year-old children in Cali, Colombia.

To investigate the presence of early childhood caries (ECC) in relation to plaque index, colony-forming units of Streptococcus mutans (S. mutans) and Lactobacillus spp., pH and salivary buffer capacity in day-care pre-schooler's aged 3-4years old in Cali, Colombia, 2016. Caries prevalence was determined in 124 children using the International Caries Detection and Assessment System and plaque index. In addition, a non-stimulated saliva sample was obtained to determine its pH, and buffer capacity. 55.65% of the children had ECC. The mean decayed-missing-filled teeth index was 2.94 ± 4.26. The absence or presence of ECC, compared to the median plaque index showed statistically significant differences (p < 0.05). There was not an association between ECC and S. mutans, Lactobacillus spp. colonies, pH and buffer capacity of saliva. This study reported association between ECC and the increasing amount of bacterial plaque. Other important biological risk factors were not associated with ECC. Regular tooth cleaning can be the most important public health measure to control ECC in day-care children.

Hand hygiene practices among school children of a periurban area Firozabad district

Background: Hand hygiene is a milestone of infectious disease control, and promotion of improved hand hygiene has been recognized as an important public health measure. The present study was undertaken to assess the hand hygiene practices among the school students of a peri urban area in district Firozabad.Methods: This six months cross sectional study was carried out among the students of an Intermediate college situated in a peri urban area of Firozabad district, U. P. All the students who were present in the respective classes (Vth–VIIth standard) were surveyed. A structured, self-administered pretested questionnaire was used to collect detailed information about the subjects‟ self-reported hand washing practices. Data entry and statistical analysis were performed using the Microsoft Excel and SPSS windows version 14.0 software.Results: Out of total 76 students, 97.4% practiced hand washing after defecation with Soap and water, while 63.2% did hand washing after cleaning with soap and water and 31.6% washed hands before eating food with Soap and water. A higher proportion of males showed proper hand hygiene practices than females. Proper Hand hygiene practices increased with the increase in education.Conclusions: Teaching the correct hand hygiene practice at an early age with help students to be healthy in later life. Thus primordial prevention is the key to reduce infection in school children.