National Public Health Service Research Articles

Heterogeneity in public health service utilization and its relationship with social integration among older adult migrants in China: a latent class analysis.

The older adult migrant population in China is on the rise, which presents challenges for the national public health service system. However, the heterogeneity of public health service utilization and its relationship with social integration among the older adult migrant population remains unclear. This study aims to explore the heterogeneity the public health service utilization and how it relates to their social integration. A total of 6,178 older adult migrants from the China Migrants Dynamic Survey (CMDS) in 2017 were included in this study. Exploratory factor analysis was used to categorize social integration into four dimensions. Latent class analysis (LCA) was used to identify different sub-groups of public health service utilization. ANOVA and multivariate logistic regression were used to determine the characteristics of different sub-groups. Three potential classes of public health service utilization were identified: low utilization of basic public health services class (N = 3,264,52.756%), medium utilization of basic public health services class (N = 1,743,28.172%), and high utilization of basic public health services class (N = 1,180,19.072%). Gender, education, extent of mobility, and move alone or not, flow time were all predictors of the class of public health service utilization. There were significant differences in social integration across potential categories (p<0.0001). The utilization of public health services of the older adult migrants is affected by many aspects. Social integration deserves attention as a significant influencing factor in the utilization of public health services. The government should pay attention to the characteristics of the older adult migrants and formulate relevant policies in a targeted manner in order to improve the utilization of public health services of the older adult migrants.

Associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with type 2 diabetes under the national essential public health services program

BackgroundThe rising prevalence of Type 2 diabetes (T2D) in China poses a critical health challenge, necessitating effective management strategies. The National Essential Public Health Services Program (NEPHSP), initiated in 2009, focuses on equitable access to health services, including T2D management. This study investigates the associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with T2D under NEPHSP, particularly examining the mediating role of self-care behaviors.MethodsConducted from April to November 2020 in Huai’an City, Jiangsu Province, this study involved 1,577 T2D patients enrolled in NEPHSP. We assessed perceived care quality using the Patient Assessment of Chronic Illness Care (PACIC) scale and developed a comprehensive self-care behavior score, covering nine essential health practices. Glycemic control was evaluated using HbA1c levels. Linear regression models were used to explore these associations, adjusting for demographic and clinical factors, while causal mediation analyses examined the role of intermediate variables.ResultsHigher PACIC scores significantly correlated with improved self-care behaviors (β = 0.294, 95% CI: 0.233 to 0.354) and were negatively associated with HbA1c levels (β=-0.109, 95% CI: -0.192 to -0.026). The self-care behavior score inversely related to HbA1c levels (β=-0.197, 95% CI: -0.263 to -0.132). Notably, self-care behaviors mediated 50.41% (P < 0.05) of the effect of perceived care quality on HbA1c levels.ConclusionsThis study demonstrates a substantial association between perceived care quality and better glycemic control in Chinese adults with T2D under NEPHSP, with self-care behaviors playing a crucial mediating role. These findings suggest that patient-centered care and comprehensive self-care practices are essential for effective T2D management within NEPHSP.

The Collaboration of Private Hospitals with the Public Health Service: The Case of La Rioja, Spain (1986-2019).

In Spain, the public National Health Service provides care to Spaniards and other residents and is tailored for a decentralized state of autonomies. Each Autonomous Community has legislative capacity in its organization and management. We study the case of the collaboration between private hospitals and the public health service in La Rioja, an Autonomous Community of Spain located in the North of the Iberian Peninsula, due to the importance that this relationship has in health systems, in general. We applied the case study method as a methodological tool in a long-term local study. The interpretation was carried out within a national context, which allows us to understand its meaning and the historical keys to hospital development in this region. Primary sources have been reviewed (mainly reports, catalogs, and censuses of hospitals from the Ministry of Health and the Government of La Rioja) and other secondary sources, located in archives, libraries, Institute of Rioja Studies, and Department of Health. The hospital system in La Rioja was characterized by a predominance of public beds compared with private ones, although there has been a growing trend in the number of private beds from 2013 onwards due to the incorporation of health and social care convalescent hospitals (two). La Rioja has been promoting public-private collaboration (seen as a strategic alliance) and focusing on agreements in the socio-health space, particularly using the management service agreement and the concession of work formulas. The development of the public health service in La Rioja, from 1986 to 2019, has been determined by a progressive lower dependence on specialized hospitals from other health services of neighboring Autonomous Communities and by a mixed public-private hospital system.

Patterns of healthcare use among children with immigrant and non-immigrant backgrounds in 2019 and 2020: evidence from the CRIAS cohort study in the metropolitan area of Lisbon, Portugal

BackgroundInternational migrant families may face various barriers in the access and use of health services. Evidence on immigrant children’s health care or prevention facilities’ utilisation patterns is scarce in Portugal. Therefore, the objectives of this study were to compare health services use between immigrant and non-immigrant children in the Metropolitan Area of Lisbon in 2019–2020 with the aim of informing public policies towards equitable access to, and use of health services.MethodsThe CRIAS (Health Trajectories of Immigrant Children) prospective cohort study enrolled 420 children (51.6% immigrant) born in 2015 and attending primary health care (PHC) services in 2019. We compared primary health care facilities and hospital paediatric emergency department (ED) utilisation patterns in the public National Health Service, together with reported private practitioners use, between immigrant and non-immigrant children in 2019 and 2020. The Pearson chi-squared test, Fisher-Freeman-Halton Exact test, two-proportion z-test and Mann‒Whitney U test were used to examine the differences between the two groups.ResultsIn 2019, no significant differences in PHC consultations attendance between the two groups were observed. However, first-generation immigrant children (children residing in Portugal born in a non-European Union country) accessed fewer routine health assessments compared to non-immigrant children (63.4% vs. 79.2%). When children were acutely ill, 136 parents, of whom 55.9% were parents of non-immigrant children, reported not attending PHC as the first point of contact. Among those, nearly four times more non-immigrant children sought healthcare in the private sector than immigrant children (p < 0.001). Throughout 2019, immigrant children used ED more often than non-immigrant children (53.5% vs. 40.4%, p = 0.010), as their parents reported difficulties in accessing PHC. In 2020, during the COVID-19 pandemic, fewer immigrant children accessed PHC compared to non-immigrant children (70% vs. 80%, p = 0.018). Both non-immigrant and immigrant children reduced ED use by 2.5 times, with a higher decrease among immigrant children (46% vs. 34%). In both 2019 and 2020, over 80% of immigrant and non-immigrant children used ED for conditions classified as having low clinical priority.ConclusionBeyond identifying health care use inequalities between immigrant and non-immigrant children, the study points to urgent needs for public policy and economic investments to strengthen PHC for all children rather than for some.

Difficulties of Families With Multiples Recognized by Regional Parenting Support Hubs: A National Public Health Service Study in Japan

In comparison to a singleton birth, pregnancy, delivery, and child rearing in families with multiples is more complicated and is associated with more difficulties. This study sheds light on how parenting support hubs all over Japan recognize the difficulties of families with multiples, and how they support them. A questionnaire was distributed to regional parenting support hubs in Japan. The questionnaire coverage included rural to urban areas in all parts of Japan. The questionnaire was presented and answered using Google Forms, a website, a fax, or an e-mail attachment ( n = 522). A factor analysis and t-tests were used to analyze the data. Regional parenting support hubs recognized that families with multiples have more difficulties and needs that require support than those with singletons, during both pregnancy and child rearing. However, they did not recognize any marked economic difficulties, which has been demonstrated to be an issue that affects families with multiples. Most regional parenting support hubs did not provide helpful support regarding speaking to parents of multiples, holding social events, or cooperating with other support groups, or rearing support hubs. When the helpful support measures that are recognized by parenting support hubs during the pregnancy/delivery period and the child-rearing period for families with multiple children are in comparison, such parenting support hubs recognized that families with multiples require more support during the pregnancy/delivery period. Parenting support hubs required information on the difficulties in supporting families with multiples and also required guidance on how such support should be provided. Parenting support hubs that cooperated with other hubs gave more support than those that did not. To link the recognition of the difficulties and needs of families with multiples to concrete measures, sufficient information on what is needed and how to support families with multiples should be provided. When presenting information on child rearing support for families with multiples, the importance of support during the child-rearing period should receive more attention. We found that cooperation is an important factor for enhancing parenting support.

Role of Portuguese community pharmacy and pharmacists in self-care

Portugal recognizes the importance of self-care in its policies and has been actively engaging in health literacy and citizen empowerment. The current National Health Plan for the period 2021–2030 clearly mentions the need to “take greater advantage of the network of community pharmacies throughout the national territory, in favour of the health of the community, from the protection and promotion of health, through health literacy, to the prevention and early detection of disease, and the aggravation of chronic disease, among others”. There is recognition of the role of pharmacists and community pharmacies. However, more needs to be done to promote intersectoral collaboration, particularly as community pharmacies are private entities but can nonetheless support the public national health service. Community pharmacies assisted many individuals during the pandemic to test suspect cases free of charge. The fight to end AIDS and viral hepatitis is another example where community pharmacies promote self-testing and ensure efficient screening and referral to diagnosis and treatment. Portugal has already moved to reimburse community pharmacies for services with some of them in areas of self-care including COVID-19 testing. Nevertheless, future challenges include making community pharmacies sustainable. Taking into account that community pharmacies are private entities that can supplement the public health service just as any other provider, it is essential to review payment models, referral mechanisms and access and integration of information from other partners in primary and secondary care.

Examining COVID-19 testing and vaccination behaviors by heritage and linguistic preferences among Hispanic, Latino, or Spanish RADx-UP participants

The Hispanic, Latino, or Spanish (hereafter, “Hispanic”) populations in the U.S. bear a disproportionate burden of COVID-19-related outcomes, including disease incidence and mortality. Developing culturally appropriate national public health services for Hispanic persons remains a challenge. This study examined the association of heritage and language preference with COVID-19 testing (tested vs. not tested) and vaccination (vaccinated vs. not vaccinated) outcomes among Hispanic participants from 18 Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) projects (n = 3308; mean age = 44.1 years [SD = 14.9], 60% women; 83% spoke other than English at home). Generalized estimating equation models adjusted for age, gender, education level, income, insurance coverage, geographic region, comorbidities, and prior infection. Relative to Mexican heritage, individuals identifying as Puerto Rican or Dominican were more likely to test for COVID-19, and South American heritage was associated with higher testing and vaccination rates. Speaking Spanish or another language at home was associated with increased testing compared with speaking English at home for individuals who preferred not to report their heritage, and increased vaccination for those with Mexican, Cuban, or Central American heritage. This study highlights heterogeneity in testing and vaccination behaviors among Hispanic populations based on heritage and language preference, underscoring the diversity within the U.S. Hispanic community. In contrast to other studies on linguistic acculturation and health care utilization, our study found that a language other than English spoken at home was associated with greater vaccine uptake. That is, enculturation – the retention of Spanish language and presumably of Hispanic cultural norms – was linked with being vaccinated.

Corruption and political interventions in public health authorities–Hellenic Republic Region of Attica: Conceptual analysis study

The national public health services and the organizations carried out over the practice of policy interventions and changes in the functioning of government, public policy, and public health sector administration. This conceptual study analyses the public health services and anti-corruption management organizations have direct links with political intervention. They have a negative impact on society and partially effective responses, also in times of pandemic, with affected epidemiological factors in the protection of public health. Leadership in the services plays a key role in ensuring smooth functioning and transparency, and the influence on them of the government and administrative machinery in Greece by the government.&lt;br /&gt; A phenomenon and practice, where the laws are completely renewed every time the government changes with the introduction of a specific policy. It is necessary that the structure and functioning of the state, public officials, and personnel be outlined in the context of the implementation of minimizing corruption. The primary purpose for integrity, a particular problem with the appointments of supervisors in these departments by direct assignment to the posts of directors, without considering the relevant legislation and without merit-based procedures and review by the special service councils that appoint directors based on criteria and legislation governing the evaluation of employees. Digital health services and e-government is also determining factor with a positive impact, universally, also and in times of pandemics will give benefits in relation to the anti-corruption actions. In this study give necessary methodology, systematic literature reviews and principles to anti-corruption.

Influência do consumo de álcool e tabaco em desfechos maternos e perinatais de puérperas atendidas no Sistema Único de Saúde

Abstract Objectives: to evaluate the association between alcohol and tobacco consumption during pregnancy with maternal and child health conditions. Methods: cross-sectional study with a probabilistic sample of pregnant women living in Santa Catarina who conducted prenatal care and childbirth in the public national health service in 2019. A face-to-face survey questionnaire was applied to 3,580 pregnant women including maternal health issues during pregnancy and perinatal health of the newborn. Crude logistic regression analyzes were performed and adjusted for socio-demographic and maternal health conditions. Results: the prevalence of alcohol and tobacco consumption during pregnancy was 7.2% and 9.3%, respectively. Alcohol consumption during pregnancy increased the chance of maternal anemia by 45% (CI95%=1.09-1.91), increased the chance of gestational diabetes by 73% (CI95%=1.14-2.63) and reduced the chance of hypertension (OR=0.59; CI95%=0.37-0.94). Tobacco consumption doubled the chance of low birth weight (OR=2.16; CI95%=1.33-3.51). Conclusion: the consumption of alcoholic beverages during pregnancy increased the chance of maternal health complications, such as anemia and gestational diabetes, while tobacco increased the chance of low birth weight.

Study of the Regulatory Mechanism of miR-26a-5p in Allergic Asthma.

Allergic asthma is a growing burden on national public health services due to its high prevalence. The aim of this experiment was to investigate whether miR-26a-5p affects cellular fibrosis and thus airway remodeling in asthmatic mice through the regulation of target genes. Screening for differentially expressed miRNAs in asthma model mice was carried out by constructing a mouse model of allergic asthma. qRT-PCR was performed to determine candidate miRNAs in each group of bronchial tissues. Western blot detection of the expression levels of predicted candidate target genes in each group of bronchial tissues was conducted. A dual luciferase assay was performed to validate the binding of miR-26a-5p to target genes. Fibronectin, a marker of cellular fibrosis, was detected via flow cytometry. CCK8 and BrdU staining were used to detect the proliferation ability of each group of cells. miR-26a-5p is able to target and bind to ABL2 3'-UTR, MMP16 3'-UTR and PDE7A 3'-UTR sequences. After interference with miR-26a-5p, improved bronchial histopathology and reduced peribronchial collagen deposition were found. Compared with the model group, interference with miR-26a-5p reduced lung fibrosis, decreased fibroblasts and increased apoptosis in mouse bronchial tissues; overexpression of miR-26a-5p decreased apoptosis in mouse bronchial tissues. Compared with the model group, the serum levels of IL-4, IL-5, IL-13 and I IFN-γ were decreased in the miR-26a-5p inhibitor group and increased in the miR-26a-5p mimic group. The immunohistochemical results showed that the expression of ABL2, MMP16 and PDE7A was significantly reduced after intervention with miR-26a-5p. Compared with the model group, the apoptosis rate of cells in the miR-26a-5p inhibitor group of the allergic asthma model was upregulated, the levels of IL-4, IL-5, IL-13, IFN-γ and ROS were decreased, the expression of the miRNA and proteins of ABL2, MMP16 and PDE7A was decreased, the expression of LC3A and P62 was significantly increased and the expression of LC3B, Beclin1, Atg5 and fibrosis markers collagen I and α-SMA was decreased. miR-26a-5p affects cellular fibrosis and thus airway remodeling in asthmatic mice by regulating target genes.

Factors associated with the uptake of national essential public health service package for hypertension and type-2 diabetes management in China's primary health care system: a mixed-methods study

China launched the primary health care (PHC) system oriented National Essential Public Health Service Package (NEPHSP) in 2009, to combat health challenges including the increasing burden from hypertension and type-2 diabetes (T2DM). In this study, the PHC system was assessed to understand factors influencing the uptake of the NEPHSP for hypertension and T2DM management. A mixed-methods study was conducted in seven counties/districts from five provinces across the mainland of China. Data included a PHC facility level survey and interviews with policy makers, health administrators, PHC providers, and individuals with hypertension and/or T2DM. The facility survey used the World Health Organisation (WHO) service availability and readiness assessment questionnaire. Interviews were thematically analysed using the WHO health systems building blocks. A total of 518 facility surveys were collected with over 90% in rural settings (n=474). Forty-eight in-depth individual interviews and 19 focus-group discussions were conducted across all sites. Triangulating the quantitative and qualitative data found that China's continuous political commitment to strengthening the PHC system led to improvements in workforce and infrastructure. Despite this, many barriers were identified, including insufficient and under-qualified PHC personnel, remaining gaps in medicines and equipment, fragmented health information systems, residents' low trust and utilization of PHC, challenges in coordinated and continuous care, and lack of cross-sectorial collaborations. The study findings provided recommendation for future PHC system strengthening, including improving the quality of NEPHSP delivery, facilitating resource-sharing across health facilities, establishing integrated care systems, and exploring mechanisms for better cross-sectorial engagement in health governance. The study is supported by National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Disease funding (APP1169757).

Gauging Public Health Literacy needs through Google Trends: the COVID-19 vaccination example

Abstract Background The rollout of the COVID-19 vaccination program in Portugal was one of the most successful in the world. However, there was still a challenge for Public Health services to determine the health literacy needs of the population in the context of a new vaccine and the uncertainty of the pandemic. The goal of this study was to evaluate the usefulness of Google Trends data to gauge the health literacy needs of the general population during the pandemic. Methods A Google Trends search was performed for Portugal including 5 topics related to health literacy needs of the population (“vaccination”, “scheduling”, “isolation”, “booster dose” and “vaccination certificate” ) between the 28th of december 2019 and the 10th of march 2022. The variation shows the relative popularity of each term referring to the total number of Google searches during that period in a normalized scale of 0-100. The variation was compared to the number of doses administered daily in Portugal and key moments of the vaccination campaign as defined by the Directorate-General for Health in Portugal. Results The terms “vaccination” and “isolation” had a steady rise in popularity from December 2019 to January 2021. The term “vaccination” was the most popular search term with peak popularity in July 2021 and a downward trend followed by an ascent to a lower peak in popularity in January 2022. The terms “scheduling” and “vaccination certificate” both followed a similar pattern, though at lower popularity levels. The term “isolation” was low on popularity since February 2021, with a significant rise and peak in January 2022. This variation relates to key dates during the Portuguese vaccination campaign. Conclusions Google Trends data seems to correlate with key events during the Portuguese COVID-19 vaccination campaign. That data might be incorporated in the planning framework of health literacy activities for national and local Public Health services. Key messages • Google Trends might be an important source of information for public health teams. • There is a need for further research into how Google Trends data can be incorporated with other sources of information to inform health literacy activities.

Awareness, Utilization and Health Outcomes of National Essential Public Health Service Among Migrants in China.

BackgroundThe national essential public health service (NEPHS) has been in operation for more than a decade. Numerous studies examined the utilization of NEPHS by migrants and the factors that influence it, but few examined the effect of NEPHS awareness and utilization on the health of inhabitants, particularly migrants. The purpose of this study is to ascertain the level of awareness and utilization of NEPHS, as well as to examine their health-improving effects on migrants.MethodsBased on the data from the 2017 China Migrants Dynamic Survey, linear probability model, ordered logit model and the propensity score matching methods were employed to investigate impact of awareness and utilization of NEPHS on the health among Chinese migrants. Mediating effect model were used to identify the mechanism of the impact of NEPHS on health.ResultsThe findings indicated that migrants' awareness and utilization of NEPHS are still insufficient. After adjusting for other factors, the study discovered that increased awareness and use of NEPHS had a beneficial influence on migrants' self-rated health. Further heterogeneity analysis revealed significant disparities in the health consequences of NEPHS awareness and utilization across subgroups. The effect of increased awareness and usage of NEPHS on health is stronger for middle-aged and elderly people, women, and low-educated migrants with urban household registration. The estimated results of the mediating effect model supported the mechanism that increased NEPHS awareness among the floating population could encourage its utilization and further improve the floating population's health.ConclusionsGiven that migrants' NEPHS utilization is still low and that NEPHS utilization has a positive effect on health, some targeted strategies, such as a variety of new media communication methods, health education related to occupational disease and tuberculosis prevention, and targeted NEPHS projects for specific groups, such as men, young and middle-aged groups, those with a high level of education, and rural migrants, should be conducted to improve the health of migrants.

Online information about mammography screening in Italy from 2014 to 2021

BackgroundMany studies have reported that the information women receive about the risk-to-benefit ratio of breast cancer screening is still scarce and biased toward benefit. In a study we conducted in 2014, we analysed online documents about breast cancer screening that were addressed to the general female public. In the present study, we used the same methodology to verify if the information provided to women was improved.MethodsWe evaluated documents addressed to the general female public and posted on the Internet by the Italian national and regional public health services. False-positive and false-negative screening results, biopsy-proven false-positive results, interval cancer, overdiagnosis, radiation exposure, and decrease in risk of mortality were analysed. In addition, quantitative data were searched.ResultsIn 2021, the most frequently reported information was reduction in breast cancer mortality (58.2%). The most frequently reported risk was a false-positive mammogram (42.5%). Similar frequency rates were reported for interval cancer, false-negative result, and radiation exposure (35.8%, 31.3%, and 28.3%, respectively). Overdiagnosis and biopsy-proven false-positive result were the less reported risks (20.1% and 10.4%). Thirteen documents provided quantitative data about reduction of mortality risk (16.7%), and only 19 provided quantitative data about risks or harms (8.4%). Almost all organisations sent letters of invitation to women (92.5%) and provided screening free of charge (92.5%). The most recommended was biennial screening for women aged between 50 and 69 years (48.5%). Compared with the information in 2014, that in 2021 showed some improvements. The most marked improvements were in the numbers of reports on overdiagnosis, which increased from 8.0 to 20.1%, and biopsy-proven false-positive result, which increased from 1.4 to 10.4%. Regarding the benefits of breast cancer screening, reduced mortality risk became increasingly reported from 2014 (34.5%) to 2021 (58.2%). Conversely, quantitative data remained scarce in 2021.ConclusionsModerate improvements in information were observed from 2014 to 2021. However, the information on breast cancer screening in documents intended for women published on Italian websites remain scarce.

Moderating effects of regional disparities on the relationship between individual determinants and public health service utilization among internal migrants: evidence from the China migrant dynamic survey in 2017

BackgroundRegional disparities and individual determinants have a significant impact on the accessibility of national essential public health services (NEPHS) for internal migrants (IMs) Nevertheless, few studies have explored the interaction between these two factors.MethodA cross-sectional sample of 102,632 IMs from the 2017 China Migrant Dynamic Survey was selected. The 28 provinces were divided into high-income provinces (HIPs) and low and middle-income provinces (LMIPs) according to their per capita disposable income (PCDI). Logistic regression was conducted using sex, residence duration, education, community type, migration range, social participation and relative personal income as independent variables, NEPHS awareness and health records registration (HRR) as dependent variables, and regional economic development level (REDL) as a moderating variable.ResultsThe rate of NEPHS awareness and HRR in HIPs (60.7, 30.6%) were lower (x2 = 42.486, p < 0.001; x2 = 25.573, p < 0.001) than those in LMIPs (62.9, 32.2%). After controlling for other variables, NEPHS awareness (OR = 1.379, p < 0.001) and HRR (OR = 1.661, p < 0.001) of IMs in HIPs were higher. Sub-group proportion of education Ms. in HIPs were higher. Sub-group = 1.379, p < 0.001) and HRR dependent mong internal migrants:, 61.0, 42.2%) were higher than those in LMIPs (60.4, 19.7, 35.8, 25.5%). Among urban communities, intra-provincial migration, social participation, education > 9 years, and middle-income, the protective effect of the first three factors on NEPHS awareness was greater in HIPs (OR = 1.386, p < 0.001; OR = 1.383, p < 0.001; OR = 2.008, p < 0.001) than in LMIPs (OR = 1.053, p < 0.001; OR = 1.109, p < 0.001; OR = 1.861, p < 0.001), while the effect of all five factors on HRR was greater in HIPs (OR = 1.440, p < 0.001; OR = 1.380, p < 0.001; OR = 1.895, p < 0.001; OR = 1.148, p < 0.001; OR = 1.146, p < 0.001) than in LMIPs (OR = 1.045, p < 0.05; OR = 1.169, p < 0.001; OR = 1.677, p < 0.001; OR = 1.027, p > 0.05; OR = 1.028, p > 0.05).ConclusionsREDL directly affected the NEPHS utilization of IMs, and the negative effects of vulnerable characteristics on the NEPHS utilization of IMs were amplified in HIPs. The government is urged to regard IMs with vulnerable characteristics in HIPs as the key population in future NEPHS equalization and take targeted measures to stimulate their enthusiasm to participate in NEPHS.

Epidemiology of dermatologic disease in Palau: a cross-sectional study in the national public and community health service.

Dermatologic disease is a neglected public health challenge that disproportionately affects resource-poor settings. Globally, dermatologic disease contributes the fourth highest burden of nonfatal disability with the most acute impact in the Oceanic region, including the Republic of Palau. Efforts to address the dermatologic health inequality are hindered without the necessary epidemiologic evidence to guide health policy in the resource-poor setting of Palau. We conducted a 4-year cross-sectional study of all Dermatology Service patients in the Belau National Hospital and outreach community health centers from 2015 to 2018. No other specialized dermatology service was available. Skin disease was classified by both diagnosis and Global Burden of Disease criteria and analyzed by age, gender, region, and surrounding Oceanic nations. The study enrolled 494 patients comprising 179 males and 315 females between 2015 and 2018. The most prevalent diseases were eczema (48.8%), superficial fungal infection (24.5%), and pruritus (22.7%). The neglected tropical disease of scabies was detected in four patients. Males were significantly more likely to present with cellulitis, keratinocyte carcinoma, stasis dermatitis, wounds, marine-related dermatitis, viral skin disease, tinea faciei, verruca, and xerosis and females with melasma and hyperpigmentation. This study presents the first primary epidemiologic data describing the prevalence of dermatologic disease in the Palauan adult population. The significant burden of disease in Palau compared with other Oceanic nations validates ongoing dermatology services and informs public health implications for resource allocation and disease management to achieve health equality in the resource-poor nation.

Mental health distress during the COVID-19 pandemic in Nigeria: Need for psychological intervention.

BackgroundThe world began to realise the impact of the coronavirus disease 2019 (COVID-19) in January 2020, and since then the number of people infected has exceeded 1 million globally. In less than 1 month following the first reported case in Nigeria, over 180 people had tested positive to the disease. Studies have shown that such rapidly spreading infectious diseases have the potential to create widespread fear, apprehension, panic and anxiety amongst the general public.AimThis study aimed at evaluating the impact of information dissemination and public mental healthcare needs during the COVID-19 pandemic in Nigeria. It also hopes to determine if there is an unmet need for telepsychiatry in Nigeria.SettingCommunity-based study covering the North, South and West of Nigeria.MethodsThis was a descriptive cross-sectional study using an on-line survey form via the snowballing sampling method.ResultsSocial media was identified as the main source of information concerning COVID-19, and half of the respondents opined that information dissemination was inadequate. Psychological distress was present in 90.5% of the participants and 61.8% admitted that this distress was worsened by fake news and myths concerning COVID-19. However, 53.8% of the participants were willing to access mental healthcare services, with telepsychiatry being the preferred choice.ConclusionThere is a need to implement a national public mental health service during this emergency. Telepsychiatry has numerous advantages in this context and maybe an opportunity to roll out a novel means of delivering mental healthcare.

The Factors Correlated With the Blood Pressure Control Among the Elderly Hypertension in Hangzhou

Abstract Background To evaluate the effectiveness of community health management of elderly hypertension, and to describe the status and related risk factors of blood pressure control. Methods This was a cross-sectional study. Hypertensive patients aged 60 years and above who took part in community health management in Hangzhou were selected. Data on lifestyle, obesity, blood lipids, fasting plasma glucose, and blood pressure were collected. Systolic blood pressure ≥140 and/or diastolic blood pressure ≥90 mm Hg were used to calculate the blood pressure control rate. Results There were 209,768 subjects with mean age (70.7 ± 7.1) years in the present study. The mean value of systolic and diastolic blood pressures was (141.4 ± 16.9) and (80.2 ± 10.0) mm Hg, respectively. The blood pressure control rate was 48.39%. The rate of the subjects with unhealthy lifestyles, obesity (or central obesity), dyslipidemia, and abnormal fasting plasma glucose was 86.27%, 38.20%, 58.16%, and 14.72%, respectively. The unhealthy lifestyle, obesity, abnormal fasting plasma glucose, and dyslipidemia, affected blood pressure control rate, with an odds ratio (95% confidence interval) of 1.18 (1.15–1.21), 1.23 (1.21–1.25), 1.44 (1.40–1.48), and 1.10 (1.09–1.11), respectively. When 4 risk factors were combined, odds ratio (95% confidence interval) was 1.96 (95% confidence interval 1.83–2.09) for poor blood pressure control. Overall, the percentage of isolated systolic hypertension was 34.87% and increased with age. Conclusions The blood pressure control rate of the elderly hypertension patients in the community health management by national essential public health service was 48.39%. Obesity, unhealthy lifestyle, abnormal fasting blood glucose, and dyslipidemia are risk factors of poor blood pressure control and have cumulative effects.

Disability stories: personal perspectives of people with disabilities on navigating the U.S. health system

Americans with disabilities and chronic illness or injury tend to be in poorer health, use more health services, and pay more for healthcare than those without disabilities. Consequently, their lives can be profoundly affected by federal and state health policies. The concerns of this population do not figure prominently in national health policy discourse and related public health and health services research efforts. This study sought to give voice to the lived experiences of people with disabilities as they navigate a fragmented U.S. healthcare system. We interviewed 30 adults who self-identified as having a disability and spoke or otherwise communicated in the English language. Directed content analysis was used to examine words and phrases in professionally transcribed documents by experienced qualitative researchers. We report and discuss four themes from the perspective of the participant, presented in thematic statements, related to vocation, finances, stressors, and advocacy. Points of Interest It is critical to include people with disabilities and chronic illness or injury in national conversations about health policy because their lives can be greatly affected by it. The current definition of disability and models to explain thinking about disability are widely contested and debated by people with disabilities. Americans with disabilities desire to have a fulfilling work life, but find it hard to maintain full time regular employment due to a lack of insurance. American people with disabilities live with constant financial pressure and may not enjoy the retirement that others imagine for themselves. Navigating various insurance programs results in a great deal of stress for Americans with disabilities.

The critical role of Digital Health in Public Health

Digitalization in itself is not simply a means to an end but involves an operational change in workflows that is on the critical-path to the digital transformation of public health. The COVID-19 pandemic has been a unique opportunity to put a shining light on all the different technologies that were available and also consider a large number of new and innovative technologies that were developed in a breath-taking place over a period of one year. These different initiatives also brought relevant advances in public health needs such as epidemiological surveillance, rapid case identification, interruption of community transmission and communication with different audiences. Moreover, social media channels, blogs and websites confirmed to be a fertile ground to find data for research, but also to spread misinformation - and public health professionals should be ready to counter that threat effectively. This presentation aims to provide a comprehensive background on digital tools and strategies that can be used in national and local public health services and how stakeholder alignment across different sectors could propel forward the implementation of digital solutions.