Long-standing Health Problems Research Articles

Fourteen-year trends in overweight, general obesity, and abdominal obesity in Amazonian indigenous peoples.

Available data show that the epidemiological profile of most indigenous Brazilian populations is characterized by the coexistence of long-standing health problems (high prevalence of infectious and parasitic diseases, malnutrition, and deficiency diseases, such as anemia in children and women of reproductive age), associated with new health problems, especially those related to obesity (hypertension, type 2 diabetes mellitus and dyslipidemia). Based on this scenario, this study analyzed the nutritional profile of the adult population of seven indigenous peoples from the Brazilian Amazon in the years 2007 and 2021. A total of 598 adults individuals were analyzed in 2007 (319 women and 279 men) and 924 in 2021 (483 women and 441 men), from seven indigenous peoples located in the state of Pará, who were assisted during health actions carried out in 2007 and in 2021. Body mass index classification used the World Health Organization criteria for adults: low weight, < 18.5kg/m2; normal weight, ≥ 18.5 and < 25kg/m2); overweight, ≥ 25 and < 30kg/m2, and obesity, ≥ 30kg/m2. A waist circumference (WC) < 90cm in men and < 80cm in women was considered normal. The data revealed heterogeneous anthropometric profiles, with a low prevalence of nutritional changes in the Araweté, Arara and Parakanã peoples, and high proportions of excess weight and abdominal obesity in the Kararaô, Xikrin do Bacajá, Asurini do Xingu and Gavião peoples, similar to or even higher than the national averages. Different stages of nutritional transition were identified in the indigenous peoples analyzed, despite apparently having been subjected to the same environmental pressures that shaped their nutritional profile in recent decades, which may indicate different genetic susceptibilities to nutritional changes. The evidence shown in this study strongly suggests the need to investigate in greater depth the genetic and environmental factors associated with the nutritional profile of Brazilian indigenous peoples, with assessment of diet, physical activity and sociodemographic and socioeconomic variables that enable the development of appropriate prevention and monitoring measures.

Advancing a Comprehensive Multilevel Approach to Sexual Violence Prevention Using Existing Efficacious Programs.

Sexual violence (SV) is a serious and long-standing public health problem on college campuses. At institutions of higher education, campus administrators, activists, and practitioners have worked for decades to address campus SV. Despite federally mandated campus SV prevention programming, rates of campus SV remain unchanged. The purpose of this commentary is to outline a strategy for enhancing campus SV prevention efforts using a comprehensive multilevel approach utilizing existing efficacious programs. The following three strategies for implementing optimal campus SV prevention are proposed, which include (a) the need to prioritize efficacy, (b) targeting multiple levels of the social ecology, and (c) leveraging the benefits of in-person programming and technology-driven prevention. A call to action is included for both institutions of higher education administrators and practitioners to implement and invest in comprehensive multilevel interventions using existing, efficacious SV programs, ideally combining a technology-based program with an in-person component. Furthermore, a coordinated effort between prevention and response is needed to achieve successful prevention of campus SV and revictimization, including a connection with the community for postassault interventions. Thus, implementing multilevel interventions on college campuses using existing evidence-based programs in combination with a coordinated community response of postassault interventions can bring the campus community together and is optimal to moving the needle on rates of campus SV.

Chronicity and COVID-19: Kinship, Illness and the State in Pakistan

Based on a year-long study involving interviews and surveys among low-income households in Karachi and Lahore, this article describes how participants articulated their experience of the pandemic through ideas of ‘chronicity’ which consisted of poor material conditions, longstanding health problems, and the risks of COVID-19 infections. I consider the bundling of the three elements in relation to the Pakistani state’s imposition of social distancing regulations through its security infrastructure which resulted in reinscribing social differences based on class and religion. Through ethnographic research, I consider how the centrifugal forces at play in the cities at large were negotiated in kinship as members came together during times of illness and emergencies, and conversely, when care to intimate kin was neglected as social distancing practices were taken up selectively in a way that overlapped with deep seated hostilities within families, resulting in further impacting the health of the vulnerable in the absence of adequate health services.

Alcohol and khat dual use among male adults in Ethiopia: A multilevel multinomial analysis.

Substance use has been a long-standing global public health problem with detrimental physical, psychological, social, and economic consequences at individual and societal levels. Large-scale and gender-specific studies on the dual use of alcohol and khat are limited. This study aimed to estimate the prevalence of dual alcohol and khat use and identify associated factors among male adults in Ethiopia. The present study used data from the 2016 Ethiopian Demographic and Health Survey (EDHS). Prior to data analysis, the data were weighted to ensure a representative sample and obtain a reliable estimate. Multilevel multinomial logistic regression was used to identify the factors associated with alcohol and khat use. Adjusted Odds Ratios (AOR) with 95% confidence interval and P value ≤ 0.05 in the multivariable model were used to identify significant factors associated with alcohol and khat use. This study included 12,688 participants, of which (80.29%) were from rural areas. The mean age of participants was 30.92 years old. The prevalence of neither Alcohol nor Khat users were (33.2%); 95% Confidence Interval (CI) (32.4-34.1) only Khat users (22.0%); 95% CI (21.2-22.7), only Alcohol users (35.6%); 95% CI (34.7-36.4), and dual Alcohol and Khat users were (9.0%); 95% CI (8.5-9.5). At the individual level: being in the age group of 15-29 years and 30-49years increases the odds of Khat chewing by AOR (95%CI) 2.27 (1.75, 2.89) and 1.55 (1.16, 2.07) times, respectively. At the community level: males from Amhara 3.49(1.91, 6.42), and Tigray 2.7(1.49, 5.05) regions were more likely to drink alcohol. The high prevalence of dual alcohol and khat use implies for greater access to evidence-based treatment. Multiple factors are associated with alcohol and khat use at individual and community levels. All male adults would benefit from targeted preventive strategies.

Association of gender-related factors and household food security in southwest Oromia, Ethiopia: evidence from a cross-sectional study

BackgroundFood insecurity is a major concern across Ethiopia and a long-standing public health problem. Vulnerability to food insecurity varies by several individual and household factors; however, understanding the role of gender-related factors can serve as additional input for designing policy and interventions. A cross-sectional survey was conducted in the Yayu Coffee Forest Biosphere Reserve in southwest Oromia, Ethiopia as part of a baseline assessment for the My Forest, My Livelihood, My Family program. A total of 1.113 households were selected from six woredas (districts) using a two-stage sampling procedure. The outcome variable was measured using the Household Food Insecurity Access Scale, version 3. The association between gender-related factors and household food security was assessed by fitting a logistic regression.ResultsThe prevalence of food insecurity was 62.4%, with 28.1% of households assessed as severely food insecure. Households with both the wife and husband making decisions about major purchases were associated with an increased odds of household food security (adjusted odds ratio [AOR] 1.44, confidence interval [CI] 1.06, 1.96). The odds increased when the woman alone made these decisions (AOR 2.15, CI 1.20, 3.85). Women’s formal education was also associated with increased odds of household food security.ConclusionsThis study adds evidence that policy and programmatic interventions that improve the agency of women to participate in asset ownership and household economic decision making, expand female literacy and education, and diversify income sources to include off-farm wage employment in the Yayu Coffee Forest Biosphere Reserve are important steps for improving household food security.

The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence.

Although national guidelines explicitly state that personality disorder can be diagnosed and treated in young people aged 12 to 18 years (adolescents), most clinicians remain hesitant. This creates a gap between science and practice, which we argue is largely motivated by moral reasons and, therefore, is best challenged by ethical arguments. We provide seven arguments in support of the notion that it is ethically right to diagnose and treat personality disorder when it occurs in adolescents. Central to these arguments is the scientific evidence that features of personality disorder are among the best predictors of a complex cluster of psychopathology leading to impairments in many areas of current and future mental, social and vocational functioning. We argue that intervention during adolescence and young adulthood is not only humane, but also critical for efforts to avert the longstanding psychosocial and health problems that seem refractory to treatment in adults with personality disorder. Moreover, we argue that regular services are often inadequately equipped to meet the needs of young people with personality disorder and that the common 'stepped-care' approach should be replaced by a 'staged-care' approach. Finally, we argue that early detection and intervention might have anti-stigmatizing effects, similar to other areas of healthcare in which stigmatizing labels have changed meaning when the conditions to which they refer have become more amenable to treatment.

Prevalence of diarrheal disease and associated factors among under-five children in flood-prone settlements of Northwest Ethiopia: A cross-sectional community-based study.

Diarrheal illnesses are a long-standing public health problem in developing countries due to numerous sanitation issues and a lack of safe drinking water. Floods exacerbate public health issues by spreading water-borne infectious diseases such as diarrhea through the destruction of sanitation facilities and contamination of drinking water. There has been a shortage of studies regarding the magnitude of diarrheal disease in flood-prone areas. Therefore, this research aimed to evaluate the prevalence of diarrheal disease and its predictors among under-five children living in flood-prone localities in the south Gondar zone of Northwest Ethiopia. A community-based cross-sectional research was carried out in flood-prone villages of the Fogera and Libokemkem districts from March 17 to March 30, 2021. Purposive and systematic sampling techniques were used to select six kebeles and 717 study units, respectively. Structured and pretested questionnaires were used to collect the data. A multivariable analysis was performed to determine the predictors of diarrheal disease, with P-value <0.05 used as the cut-off point to declare the association. The prevalence of a diarrheal disease among under-five children was 29.0%. The regular cleaning of the compound [AOR: 2.13; 95% CI (1.25, 3.62)], source of drinking water [AOR: 2.36; 95% CI: (1.26, 4.41)], animal access to water storage site [AOR: 3.04; 95% CI: (1.76, 5.24)], vector around food storage sites [AOR: 9.13; 95% CI: (4.06, 20.52)], use of leftover food [AOR: 4.31; 95% CI: (2.64, 7.04)], and fecal contamination of water [AOR: 12.56; 95% CI: (6.83, 23.20)] remained to have a significant association with diarrheal diseases. The present study found that the prevalence of the diarrheal disease among under-five children was high. Routine compound cleaning, the source of drinking water, animal access to a water storage site, vectors near food storage sites, consumption of leftover food, and fecal contamination of water were significant predictors of diarrheal disease. Therefore, it is advised to provide improved water sources, encourage routine cleaning of the living area, and offer health education about water, hygiene, and sanitation.

Nutritional Status of Pre-School Children Attending Anganwadi Centres in Chittoor, Andhra Pradesh, India

Context/Background: Malnutrition among children is a long-standing public health problem in India. Objective: To assess the nutritional status of pre-school children and to identify the socio-demographic determinants of malnutrition. Methodology: In this community-based cross-sectional study, 194 under-five children were recruited from rural and urban areas of Chittoor district, Andhra Pradesh. Anthropometric measurements including weight, and mid upper arm circumference were measured and age standardized weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) were calculated. The proportion of under nutrition (WAZ &lt;-2 standard deviation (SD)), stunting (HAZ &lt;-2SD), and wasting (WHZ &lt;-2SD) were calculated along with the determinants. Results: The mean age of the participants was 40.5 months (SD- 9.1 months), 101 (52.1%) were from rural areas, and 96 (495%) female. The median z-scores for WAZ, HAZ, and WHZ were -1.22, -0.98, and -0.78respectively. The HAZ values were significantly low in- urban children (-0.81; 95% CI: -0.4, -1.21), among the non-Hindu children (-0.92; 95% CI: -0.35, -1.5). The overall prevalence of underweight, stunting, and wasting were- 13.4% (95% CI: 8.5%, 18.3%), 23.7% (95% CI: 17.6%, 29.8%), and 19.6% (95% CI: 11.9%, 25.3%) respectively. There were a total 16 (8.3%, 95% CI: 5.6%, 11.0%) severely malnourished children. Urban residence (OR 6.75; 95% CI: 3.03 – 15.04) was a strong predictor of stunting. Conclusion: Malnutrition remains to be a public health problem in this area. Strengthening of existing program implementation coupled with evidence generation on malnutrition can be the key strategies in combating malnutrition.

Healthcare use among people with diabetes mellitus in Europe: a population-based cross-sectional study

ObjectiveThis study aimed to determine the association of health determinants, lifestyle and socioeconomic variables on healthcare use in people with diabetes in Europe.DesignA cross-sectional study was conducted using data from...

Normative data and socio-demographic determinants of the Dermatology Life Quality Index in a large online sample of the Hungarian population

Background Population norms are available for several generic health-related quality of life questionnaires, but rarely for disease- or specialty-specific questionnaires. Objectives The aim of our study was to calculate population norms for the Dermatology Life Quality Index (DLQI) score. Methods We conducted an online self-completed questionnaire survey on a large sample of the general Hungarian adult population. Respondents’ socio-demographic characteristics and dermatology-related quality of life aspects were recorded. Results A total of 2,001 participants completed the questionnaire, with the average age of 48.2 (SD = 16.6) years, half of the respondents in our sample (n = 981) reported long-standing health problems. The average DLQI score was 1.9 (SD = 4.0) with women having a higher average (2.0, SD = 3.9) than men (1.8, SD = 4.0; p=<0.001). The DLQI score differed among age-groups with younger people having relatively higher DLQI averages. When the multivariate linear regression model was applied, it showed that young age, lower income and unemployment status were associated with higher DLQI scores, while controlling for the existence of skin disease (p<0.05). Conclusions This study esthablished DLQI population norms among the general population, which may provide a reference point in health-policy and financing decision-making.

The incidence, prevalence, and contributing factors of overweight and obesity among adolescent population of India: A scoping review protocol.

IntroductionOverweight and obesity among the adolescent population are emerging as worldwide epidemics. Its increasing occurrence in India is highly concerning. Amidst the burden of malnutrition, where undernutrition is a long-standing health problem, the rising concerns around childhood overweight/obesity has several repercussions for this population. The aim of this scoping review is to map the evidence of the prevalence and contributing factors of overweight and obesity among adolescents (10 to 19 years) in the Indian population.MethodsThe study will be conducted according to the Arksey and O’Malley scoping review framework and the Joanna Briggs institute Reviewers’ manual. The Population, Concept and Context strategy (PCC) will ensure the review questions, eligibility criteria, and search strategy. The Systematic Review and Meta-analysis: Extension for Scoping Review (PRISMA-ScR) will be used for the findings of the study of Scoping Review. The Mixed Methods Appraisal Tool (MMAT), Version- 2018 will be used to assess the methodological quality of all relevant studies. Literature search will be done using electronic databases: PubMed, Google Scholar, SCOPUS, EMBASE, and Cochrane library by specific keywords such as “prevalence”; “overweight”; “obesity”; “obese”; “malnutrition”; “BMI”; “adolescent”; “teenager”; and “youth” etc. Additional studies will be considered using cross-references.

Construction and validation of a morbidity index based on the International Classification of Primary Care

Objectives In epidemiological studies it is often necessary to describe morbidity. The aim of the present study is to construct and validate a morbidity index based on the International Classification of Primary Care (ICPC-2). Design and Setting This is a cohort study based on linked data from national registries. An ICPC morbidity index was constructed based on a list of longstanding health problems in earlier published Scottish data from general practice and adapted to diagnostic ICPC-2 codes recorded in Norwegian general practice 2015 − 2017. Subjects The index was constructed among Norwegian born people only (N = 4 509 382) and validated in a different population, foreign-born people living in Norway (N = 959 496). Main outcome measures Predictive ability for death in 2018 in these populations was compared with the Charlson index. Multiple logistic regression was used to identify morbidities with the highest odds ratios (OR) for death and predictive ability for different combinations of morbidities was estimated by the area under receiver operating characteristic curves (AUC). Results An index based on 18 morbidities was found to be optimal, predicting mortality with an AUC of 0.78, slightly better than the Charlson index (AUC 0.77). External validation in a foreign-born population yielded an AUC of 0.76 for the ICPC morbidity index and 0.77 for the Charlson index. Conclusions The ICPC morbidity index performs equal to the Charlson index and can be recommended for use in data materials collected in primary health care. Key points This is the first morbidity index based on the International Classification of Primary Care, 2nd edition (ICPC-2) It predicted mortality equal to the Charlson index and validated acceptably in a different population The ICPC morbidity index can be used as an adjustment variable in epidemiological research in primary care databases

Misleading News Coverage of Research Findings Poses a Risk to Youth Mental Health and Safety

Misleading News Coverage of Research Findings Poses a Risk to Youth Mental Health and Safety

Regulatory mechanism of HIF-1α and its role in liver diseases: a narrative review.

ObjectiveTo summarize the structure, regulatory mechanism, and target genes of hypoxia-inducible factor-1 alpha (HIF-1α) and to comprehensively expound its role in various chronic liver diseases, thus providing a new perspective on the treatment of various liver diseases.BackgroundLiver disease, especially chronic liver disease, is a long-standing public health problem; the mortality rate due to end-stage cirrhosis and liver cancer is high worldwide and continues to grow. Moreover, there is a lack of effective targeted therapy for most liver diseases, such as fatty liver, alcoholic liver disease (ALD), and advanced liver cancer, for which drug treatment approaches are extremely limited. As the liver is a highly aerobic organ, an insufficient oxygen supply can induce a series of diseases, and HIF proteins play an important role in these processes.MethodsLiterature on HIF-1α and its effects on various liver diseases were extensively searched, and the feasibility and challenges of targeting HIF-1α to treat various chronic liver diseases were analyzed.ConclusionsHIF-1α is widely involved in the occurrence, development, and prognosis of ALD, nonalcoholic fatty liver disease (NAFLD), acetaminophen (APAP)-induced liver injury (AILI), viral hepatitis, hepatocellular carcinoma (HCC), and other liver diseases. HIF-1α participates in complex signaling pathways, and its expression is regulated in many liver diseases. These results suggest the feasibility and clinical significance of targeting HIF-1α to treat liver diseases.

“What it really takes” – A qualitative study of how professionals coproduce healthcare service with immigrant patients

BackgroundThe concept of coproduction shows great promise for meaningful partnerships between patients and health professionals. This is particularly relevant for immigrant patients who are less inclined to take an active role in consultations. The present study described health professionals’ practices and experiences of coproducing healthcare service with immigrant and refugee patients in clinical encounters. MethodsWe conducted a three-phase qualitative study with immigrant and refugee patients and health professionals at an interdisciplinary outpatient clinic for immigrants and refugees with complex long-standing health problems at a Danish university hospital. First, we conducted 25 observations of consultations between seven professionals (three doctors, three nurses, one social worker) and 24 patients with varied backgrounds and health problems. Findings were discussed in a focus group and individual interviews with the migrant clinic's staff. Finally, the themes were discussed with co-researchers and revised in a member check with experienced clinicians. Data were analyzed through meaning condensation, supported by the NVivo software. ResultsWe identified four themes characterizing the work of health professionals in creating coproduced healthcare service: a team effort of sense-making, disentangling the chaos first, when everything fails - listen to the patient, and continuity - becoming part of the patient's story. ConclusionInterdisciplinary work fostering values of doing what makes sense to form a positive partnership with the patient allows health professionals to act autonomously, flexibly, and creatively. Using communication tools designed around patient needs, create optimal conditions for coproduction as health professionals empathically validate and integrate patient experiences. Professionals need advanced listening and relational skills and tolerance of ambiguity and insecurity. Relational continuity facilitates long-term coproduction but also bears risks of emotional dependency.

FACTORS THAT AFFECTING SLEEP QUALITY IN ADOLESCENTS AT TEGAL CITY

Adolescent sleep problems should be considered as a longstanding health problem in society. One group that is at high risk of experiencing sleep disorders is adolescents. This is because in adolescents there are changes in sleep patterns including insufficient sleep duration, delayed sleep time, and differences in sleep patterns on weekdays and weekends, so the quality of adolescent sleep tends to decrease. The results of sleep deprivation can, among other things, affect the physical, mental, emotional and social development of adolescents, including brain maturity and decision-making skills. The problem of sleep disorders in adolescents is difficult to enforce, this is because sleep disorders are often not conveyed by adolescents. The purpose of this study was to identify the prevalence of sleep problems and the factors that influence the quality of adolescents (18-21 years) in Tegal City. This study used a cross-sectional descriptive analytic method with 217 respondents as the sample of the study from Tegal Nursing D3 students. Collecting data through google form and using the Indonesian version of the Pittsburgh Sleep Quality Index (PSQI) questionnaire, the Mornignness-Eveningness Questionnaire (MEQ). The results showed that there was a relationship between sleep quality and chronotype type (p value: 0.00 a = 0.000). Recommendations for adolescents need education about disturbances in adolescent sleep quality

Children: paying the price of Bolsonaro’s social policy reform in Brazil

The impact of social inequality on children has enormous implications for young people throughout their life journey by negatively impacting their health, well-being and life chances. Following the democratisation of Brazil, significant change resulted in improvements to the social welfare and health care systems, which had begun to address long-standing social and health problems. This article critically explores the implications of current retrograde right-wing populist political government policies for Brazilian children within the context of efforts to reduce income inequality and improve the life chances of children. While recognising the enormous challenges of poverty, racial discrimination, precarity and socio-economic conditions, social work has recognised that the enactment of the profession requires political engagement and action against all inequality in professional practice. The implications of retrogressive policy are explored, and the authors call upon the profession globally to recognise these structural socio-economic challenges and question whether social work can afford not to be engaged in seeking change.

Physical Activity Behaviour in 50- to 74-Year-Olds: Differences between Employed and Retired Individuals

(1) Objectives: The study aimed to examine data from Malta’s Health Interview Survey (HIS) to assess differences between persons in employment and those retired, across different time periods. (2) Methods: A repeat cross-sectional design was adopted. Data that were collected over a period of 12 years included three cross-sectional HIS waves (2002, 2008 and 2014). Data were analysed cross-sectionally and longitudinally using multilevel analysis. (3) Results: In total, 4690 participants between the ages of 50 and 74 years provided data on physical activity (PA). A statistical difference was found between those employed and retired, with the latter undertaking less PA MET min per week in 2002 and 2008. There was no difference in 2014. When adjusting for covariates, people in employment carried out less PA MET min per week (OR-0.16–−0.02) compared to retired individuals. Using multilevel modelling, this study shows that individual factors such BMI and long-standing illness are predictors of PA behaviour as opposed to time trends. (4) Conclusion: Retirement can increase PA measured in MET minutes per week. Individual factors such as BMI, long-standing health problems and self-rated health could be causing the higher levels seen in the employed population during the studied period.

Current Status and Future Perspective of Artificial Intelligence in the Management of Peptic Ulcer Bleeding: A Review of Recent Literature.

With the decreasing incidence of peptic ulcer bleeding (PUB) over the past two decades, the clinician experience of managing patients with PUB has also declined, especially for young endoscopists. A patient with PUB management requires collaborative care involving the emergency department, gastroenterologist, radiologist, and surgeon, from initial assessment to hospital discharge. The application of artificial intelligence (AI) methods has remarkably improved people’s lives. In particular, AI systems have shown great potential in many areas of gastroenterology to increase human performance. Colonoscopy polyp detection or diagnosis by an AI system was recently introduced for commercial use to improve endoscopist performance. Although PUB is a longstanding health problem, these newly introduced AI technologies may soon impact endoscopists’ clinical practice by improving the quality of care for these patients. To update the current status of AI application in PUB, we reviewed recent relevant literature and provided future perspectives that are required to integrate such AI tools into real-world practice.

Quality-of-Life Determinants in People with Diabetes Mellitus in Europe.

This study aims to analyze self-perceived health and lifestyles in the European Union Member States Iceland, Norway, and the United Kingdom, examining associations with diabetes prevalence; and to identify the demographic, economic and health variables associated with diabetes in this population. We performed a cross-sectional study of 312,172 people aged 15 years and over (150,656 men and 161,516 women), using data collected from the European Health Interview Survey (EHIS). The EHIS includes questions on the health status and health determinants of the adult population, as well as health care use and accessibility. To estimate the magnitudes of the associations with diabetes prevalence, we fitted multivariate logistic models. The EHIS data revealed a prevalence of diabetes in Europe of 6.5% (n = 17,029). Diabetes was associated with being physically inactive (OR 1.14; 95% CI 1.02–1.28), obese (OR 2.75; 95% CI 2.60–2.90), male (OR 1.46; 95% CI 1.40–1.53) and 65–74 years old (OR 3.47; 95% CI 3.09–3.89); and having long-standing health problems (OR 7.39; 95% CI, 6.85–7.97). These results were consistent in the bivariate and multivariate analyses, with an area under the receiver operating characteristic curve of 0.87 (95% CI 0.87–0.88). In a large European health survey, diabetes was clearly associated with a poorer perceived quality of life, physical inactivity, obesity, and other comorbidities, as well as non-modifiable factors such as older age and male sex.