Representative Population Sample Research Articles

Which factors drive the choice of the French-speaking Quebec population towards a COVID-19 vaccination programme: A discrete-choice experiment.

The aims of this study were to elicit preferences about the coronavirus disease 2019 (COVID-19) vaccine campaign in the general French-speaking adult Quebec population and to highlight the characteristics of the vaccine campaign that were of major importance. A discrete-choice experiment (DCE) was conducted between April and June 2021, in Quebec, Canada. A quota sampling method by age, gender and educational level was used to achieve a representative sample of the French-speaking adult population. The choice-based exercise was described by seven attributes within a vaccine campaign scenario. A mixed logit (MXL) model and a latent class logit (LCL) model were used to derive utility values. Age, gender, educational level, income and fear of COVID-19 were included as independent variables in the LCL. A total of 1883 respondents were included for analysis, yielding 22,586 choices. From these choices, 3425 (15.16%) were refusals. In addition, 1159 (61.55%) individuals always accepted any of the vaccination campaigns, while 92 individuals (4.89%) always refused vaccine alternatives. According to the MXL, relative weight importance of attributes was effectiveness (32.50%), risk of side effects (24.76%), level of scientific evidence (22.51%), number of shots (15.73%), priority population (3.60%), type of vaccine (0.61%), and vaccination location (0.28%). Four classes were derived from the LCL model and attributes were more or less important according to them. Class 1 (19.8%) was more concerned about the effectiveness (27.99%), safety (24.22%) and the number of shots (21.82%), class 2 (55.3%) wanted a highly effective vaccine (40.16%) and class 3 (17.6%) gave high value to the scientific evidence (42.00%). Class 4 preferences (7.4%) were more balanced, with each attribute having a relative weight ranging from 1.84% (type of vaccine) to 21.32% (risk of side effects). Membership posterior probabilities to latent classes were found to be predicted by individual factors such as gender, annual income or fear of COVID-19. Vaccination acceptance relies on multiple factors. This study allowed assessment of vaccination-specific issues through a choice-based exercise and description of factors influencing this choice by segmenting the sample and drawing profiles of individuals. Moreover, besides effectiveness and safety, a major point of this study was to show the importance given by the general population to the level of scientific evidence surrounding vaccines. A small group of citizens was involved in the conception, design and interpretation of data. Participants of the DCE were all from the general population.

Frailty predicts all-cause and cause-specific mortality among older adults in Austria: 8-year mortality follow-up of the Austrian Health Interview Survey (ATHIS 2014)

BackgroundThe frailty index (FI) is an established predictor of all-cause mortality among older adults, but less is known with regard to cause-specific mortality, and whether the predictive power of the FI varies between men and women and by socio-economic position.MethodsWe assessed all-cause and cause-specific mortality during 8 years of follow-up (median = 7 years) among the population-representative sample of older adults (65 + , n = 2,561) from the European Health Interview Survey in Austria (ATHIS 2014). A FI at baseline was constructed from 41 health deficits. Official cause of death information from Statistics Austria was linked with the survey data by the Austrian Micro Data Center (AMDC). Next to all-cause mortality, we differentiated between mortality from cardiovascular diseases (CVD), cancer, and other causes. Cox proportional hazard models adjusted for socio-demographic variables and causes of death as competing risks were used to assess mortality prediction.ResultsAmong the participants, 43.5% were robust (FI < 0.10), 37.7% pre-frail (FI = 0.10–0.21), and 18.7% were frail (FI > 0.21). 405 (15.8%) participants died during follow-up. Among the deceased, 148 (36.5%) died from CVD, 127 (31.4%) died from cancer, and 130 (32.1%) died from other causes of death. The FI predicted all-cause (hazard ratio, HR = 1.33 per 0.1 FI and HR = 2.4 for frail compared to robust older adults) and cause-specific mortality risk (HRCVD = 1.25/2.46, HRcancer = 1.19/1.47, HRother = 1.49/3.59). Area under the curve (AUC) values were acceptable for CVD mortality (0.78) and other causes of death (0.74), and poor for cancer mortality (0.64).ConclusionsThe FI predicts all-cause and cause-specific mortality (CVD, other causes) well, which points to its relevance as a potential screening tool for risk stratification among community-dwelling older adults.

COVID-19 infection associated with poorer mental health in a representative population sample

ObjectiveThere is limited evidence of the direct effects of COVID-19 infection on mental health, and whether these are influenced by vaccination or physical health symptoms. We aimed to investigate the relationships of COVID-19 infection, current symptom presentation, and vaccination status with mental health symptoms in adults. Study design and settingA cross-sectional sample of the Australian adult population that was representative by age, gender, and location was recruited through market research panels (N = 1407, 51.3% female, mean age 47.9 years). Hierarchical regression analyses were used to examine the associations of COVID-19 infection history and current COVID-19 symptoms with symptoms of depression (Patient Health Questionnaire-9), generalized anxiety (Generalized Anxiety Disorder-7) and social anxiety (Mini-Social Phobia Inventory). ResultsCOVID-19 infection was associated with significantly higher depression and anxiety symptoms, but only in those who were not fully vaccinated. Current experience of COVID-related symptoms was associated with significantly higher depression and anxiety symptoms, and attenuated the direct effect of infection on mental health outcomes to non-significance. ConclusionCOVID-19 infection may be associated with increased mental health symptoms. However, the effects of infection on mental health were primarily evident in those who were not fully vaccinated and were explained by greater physical health problems associated with COVID-19 infection. The findings reinforce the efficacy of vaccination for reducing physical and mental health symptoms following infection.

Multidimensional characteristics of musculoskeletal pain and risk of hip fractures among elderly adults: the first longitudinal evidence from CHARLS.

Hip fractures are a major public health concern among middle-aged and older adults. It is important to understand the associated risk factors to inform health policies and develop better prevention strategies. Musculoskeletal pain is a possible implicating factor, being associated with physical inactivity and risk of falls. However, the association between musculoskeletal pain and hip fractures has not been clearly investigated. A nationally representative sample of the Chinese population was obtained from the China Health and Retirement Longitudinal Study (CHARLS). The study collected patient information on their demographic characteristics, socioeconomic status, other health-related behavior, and history of musculoskeletal pain and hip fractures. Univariate and multivariate analyses were conducted to investigate the factors influencing the risk of hip fracture, including factors related to the individual and to musculoskeletal pain. P for trend test was performed to assess the trend of each continuous variable. The robustness and bias were assessed using the bootstrap method. Restricted cubic spline regression was utilized to identify linear or non-linear relationships. Among the 18,813 respondents, a total of 215 individuals reported that they have experienced a hip fracture. An increased risk of hip fracture was associated with the presence of waist pain and leg pain (P < 0.05), as well as with an increased number of musculoskeletal pain sites (P < 0.05). For individuals aged 65 and above, a significant association was found between age and the risk of hip fracture (P < 0.05). Furthermore, respondents with lower education level had a higher risk of hip fracture compared to those with higher education levels (P < 0.05). In the Chinese population, the risk of hip fracture was found to be associated with both the location and extent of musculoskeletal pain, as well as with other factors such as age and demographic characteristics. The findings of this study may be useful for informing policy development and treatment strategies, and provide evidence for comparison with data from other demographic populations.

Chrono Dentistry and the association between shift work and oral health in a representative sample population: An Internet survey

Background: Most physiological processes in mammals display circadian rhythms that are driven by the endogenous circadian clock. Disruptions of the circadian clock have been associated with nearly every major human disease. With that as the central idea, this study attempted to see the variations in the form and function of the oral cavity with respect to the circadian cycle by comparing the oral health problems of daytime-only workers with those who worked night shifts. Aims: To study the relationship between the circadian clock and oral diseases by comparing the oral health problems and lifestyle of daytime-only and night shift workers. Methods and Material: A pre-validated questionnaire containing 12 close-ended questions was circulated among 40 night and 40 day shift workers. Appropriate statistical analysis was carried out. Results: Increased incidence of extractions and decay was found in night shift workers. Of all, 65% of the day shift workers had lost a few of their teeth to decay and extractions while the same was found in 70% of the night shift workers. Pain in teeth was also found to be prevalent in night shift workers with 80% of the participants claiming that they experienced pain in their teeth while 60% of the day shift workers experienced such pain. 90% of the participants claimed to be non-smokers in the day shift work. In the night shift, 52.5% of participants were current smokers. Smoking was prevalent among night shift workers. Conclusions: The results of this study show a clear relationship between night shift work and oral health problems. Hence, stronger measures to provide oral health maintenance support for night shift workers are needed.

Design of a multiple criteria decision analysis framework for prioritizing high-impact health technologies in a regional health service.

This study aims to develop a framework for establishing priorities in the regional health service of Murcia, Spain, to facilitate the creation of a comprehensive multiple criteria decision analysis (MCDA) framework. This framework will aid in decision-making processes related to the assessment, reimbursement, and utilization of high-impact health technologies. Based on the results of a review of existing frameworks for MCDA of health technologies, a set of criteria was proposed to be used in the context of evaluating high-impact health technologies. Key stakeholders within regional healthcare services, including clinical leaders and management personnel, participated in a focus group (n=11) to discuss the proposed criteria and select the final fifteen. To elicit the weights of the criteria, two surveys were administered, one to a small sample of healthcare professionals (n=35) and another to a larger representative sample of the general population (n=494). The responses obtained from health professionals in the weighting procedure exhibited greater consistency compared to those provided by the general public. The criteria more highly weighted were "Need for intervention" and "Intervention outcomes." The weights finally assigned to each item in the multicriteria framework were derived as the equal-weighted sum of the mean weights from the two samples. A multi-attribute function capable of generating a composite measure (multicriteria) to assess the value of high-impact health interventions has been developed. Furthermore, it is recommended to pilot this procedure in a specific decision context to evaluate the efficacy, feasibility, usefulness, and reliability of the proposed tool.

Prevalence of hemorrhoids and associated risk factors among adult patients: a cross-sectional study in Saudi Arabia

Objective: This study aimed to determine the prevalence of hemorrhoidal illness in a representative sample of the general population from various regions of Saudi Arabia and analyze the features of patients with hemorrhoidal disease and how they were treated. Methods: A cross-sectional study was conducted among the adult population in the western region of Saudi Arabia that included all adult men and women who agreed to participate. A pretested questionnaire was used to collect data. Result: The study enrolled 380 participants, most of whom were females (61.6%), whereas males counted for 38.4%. Most common type was external hemorrhoids (59.8%). Sedentary lifestyle was the leading risk factor (19.14%), followed by dehydration (14.49%). Conclusion: The prevalence of hemorrhoids was approximately 40% among participants, more commonly affecting women (more than 50%), with sedentary life as the most common risk factor and anal pain at the top of the associated symptoms list. It was suggested to run campaigns to educate people that it is a common disease and explain the different types and risk factors associated with hemorrhoids.

Association between plant-based diet quality and chronic kidney disease in Australian adults.

To examine associations between three different plant-based diet quality indices, chronic kidney disease (CKD) prevalence and related risk factors in a nationally representative sample of the Australian population. Cross-sectional analysis. Three plant-based diet scores were calculated using data from two 24-h recalls: an overall plant-based diet index (PDI), a healthy PDI (hPDI) and an unhealthy PDI (uPDI). Consumption of plant and animal ingredients from 'core' and 'discretionary' products was also differentiated. Associations between the three PDI scores and CKD prevalence, BMI, waist circumference (WC), blood pressure (BP) measures, blood cholesterol, apo B, fasting TAG, blood glucose levels (BGL) and HbA1c were examined. Australian Health Survey 2011-2013. n 2060 adults aged ≥ 18 years (males: n 928; females: n 1132). A higher uPDI score was associated with a 3·7 % higher odds of moderate-severe CKD (OR: 1·037 (1·0057-1·0697); P = 0·021)). A higher uPDI score was also associated with increased TAG (P = 0·032) and BGL (P < 0·001), but lower total- and LDL-cholesterol (P = 0·035 and P = 0·009, respectively). In contrast, a higher overall PDI score was inversely associated with WC (P < 0·001) and systolic BP (P = 0·044), while higher scores for both the overall PDI and hPDI were inversely associated with BMI (P < 0·001 and P = 0·019, respectively). A higher uPDI score reflecting greater intakes of refined grains, salty plant-based foods and added sugars were associated with increased CKD prevalence, TAG and BGL. In the Australian population, attention to diet quality remains paramount, even in those with higher intakes of plant foods and who wish to reduce the risk of CKD.

The Association between Urinary Sodium-Potassium Ratio, Kidney Function, and Blood Pressure in a Cohort from the General Population

Introduction: Subclinical kidney dysfunction may contribute to salt-sensitive hypertension. We assessed the association between the urinary sodium-potassium ratio (Na/K ratio) and blood pressure (BP) in a general population cohort without diabetes, chronic kidney disease, cardiovascular disease, or treated hypertension. We investigated whether any such association was mediated by the kidney function markers measured glomerular filtration rate (mGFR), urinary albumin-creatinine ratio (ACR), and urinary epidermal growth factor-creatinine ratio (EGF-Cr). Methods: The Tromsø Study is a population-based study of inhabitants of the municipality of Tromsø, Northern Norway. Participants aged 50–62 years, without diabetes, chronic kidney disease, or cardiovascular disease, were invited to the substudy Renal Iohexol Clearance Survey in Tromsø 6 (RENIS-T6; 2007–09). For the present study, we excluded participants reporting the use of 1 or more antihypertensive agents, leaving 1,311 RENIS-T6 participants for a cross-sectional analysis. We measured office BP, 24-h ambulatory blood pressure (ABP), and mGFR using iohexol clearance. Na/K ratio, ACR, and EGF-Cr were measured in morning urine samples. Results: Urinary Na/K ratio was significantly associated with systolic office BP and ABP independently of cardiovascular risk factors and kidney function markers. A one-standard deviation unit increase in the Na/K ratio was associated with increased systolic ABP by 1.0 (0.3–1.6) mm Hg. Urinary Na/K ratio showed a stronger association with office BP than ABP. EGF-Cr, ACR, and mGFR did not mediate the relationship between urinary Na/K ratio and systolic BP. Conclusions: In a representative sample of the middle-aged North-European population without diabetes, chronic kidney disease, cardiovascular disease, or treated hypertension, there was a consistent association between urinary Na/K ratio and BP. The association with BP was not mediated through kidney function measures, suggesting a relationship between a diet with high sodium and low potassium and higher BP regardless of kidney function.

Who are the users of Danish alternative media? A survey study on the prevalence of alternative news use in Denmark and profiles of the users

Abstract Nordic countries have experienced an upsurge of partisan alternative media positioning themselves as correctives of the mainstream, but only little is known about how many and who uses them. Building on original survey data from a representative sample of the adult Danish population (n = 2,455), this article presents the first study of the use of left-wing and right-wing alternative media in Denmark. Findings show that users are generally more likely to be older, male, and live in disadvantaged parts of the country, but that alternative media appeal across all levels of education and urban–rural divides. Results also show positive associations with use of national dailies and high political interest. Furthermore, use of alternative media is associated with taking ideological positions further to the left or right. Yet, the findings do not indicate that users generally take extreme positions. This study thus adds considerable nuance to the picture of alternative news users and also finds that alternative media with different degrees of alternativeness attract similar users.

Measuring Subjective Inequality: Development and Validation of the Perceived Economic Inequality Scale (PEIS).

The main goal of the present research is to develop and validate the Perceived Economic Inequality Scale (PEIS), an instrument measuring individuals' perceptions of economic inequality at the national level. The study was conducted on a representative sample of the Italian population (N = 1,446, 51% women). The factorial structure of the scale was assessed through cross-validated exploratory-confirmatory factor analyses. To inspect the PEIS psychometric properties, item and correlation analyses were performed. The results showed that the PEIS is a valid and reliable unidimensional measure of perceived economic inequality at the national level. Further support of the PEIS construct validity was provided by the correlation of the scale score with the perceived wage gap and ideological beliefs like the economic system justification, social dominance orientation, meritocratic beliefs, and participants' political orientation. Crucially, multigroup confirmatory factor analysis supported configural, metric, and scalar invariances of the scale across socio-demographic groups. The PEIS allows researchers to assess the subjective component of economic inequality by also serving as a useful tool for unpacking the psychological correlates of perceived inequality.

Smoking and consumption of ultra-processed foods - a combination of risky choices: A cross-sectional study using Vigitel 2018 data.

Smoking and unhealthy diet are important risk factors for cardiovascular and metabolic diseases, contributing to public health crises. To evaluate the consumption of natural/minimally processed and ultra-processed foods by Brazilian adults (18-59 years old) according to smoking status. Cross-sectional study of a representative population sample from 26 state capitals and the Federal District (Brazil-2018). Data were obtained from Vigitel-Surveillance System for Risk and Protection Factors for Chronic Diseases by Telephone Survey. Participants were categorized as smokers, ex-smokers, and never smokers. Multinomial logistic regression was used for analyses. Of the 30,800 adults evaluated, 9.4% (95%CI: 8.7-10.2) were smokers and 16.5% (95%CI: 15.8-17.3) were ex-smokers. Smokers were less likely to consume fruit and natural juice, and more likely to consume soda or artificial juice (≥ 5 days/week) than ex-smokers and never smokers. Regarding the daily frequency of consumption, smokers were observed to be less likely to eat fruit more than 1 time/day and more likely to drink ≥ 3 cups/cans of soda/day. Compared to never smokers, smokers had a 42% higher chance of consuming ≥ 3 glasses of natural juice/day. On the day before the interview, fruit, milk, tubers, squash, and okra consumption were lower among smokers than non-smokers. Smokers were more likely to report consuming soft drinks, fruit juice, sauces, ready-made dishes, margarine, and sausages. Smokers had lower fruit consumption, and higher consumption of natural juices and ultra-processed foods. We highlight the need for strategies that encourage healthy eating and smoking cessation.

The role of norm dynamics for climate relevant behavior: A 2019–2021 panel study of red meat consumption

More sustainable consumption is urgently called for but emerging very slowly at best. This paper contributes to the empirical foundation for understanding the role of norms in shaping, reinforcing, and changing consumption patterns. Drawing on institutional and social psychological theories and research, we investigate the development in normative influences on red meat consumption – a climate relevant behavior – over time. We apply cross lagged SEM analyses utilizing survey data from a representative sample of the Norwegian population the years 2019, 2020, and 2021. Red meat consumption is strongly supported by social norms in Norway but seems to be challenged by the societal attention to its negative climate impacts. Such attention may lead people to internalize norms for a climate-friendly diet and thus reduce their red-meat consumption. We find, however, that the influence of pro-climate mitigation norms on red meat consumption is weak and was further weakened in the 2020–21 period, during the Covid19 pandemic. An important question is whether and how policy measures can nurture pro-climate mitigation norms to reach a social “tipping point” regarding meat consumption. Implications for future research on norm dynamics are discussed.

Vegetarian diets: prevalence in the Russian population, regional accents and associations with cardiovascular risk factors. Results of the ESSE-RF, ESSE-RF2 and ESSE-RF3 epidemiological studies

At the present time, there is a growing trend of vegetarian diets, even in countries with a traditional Nordic diet.Aim. To study the prevalence and characteristics of vegetarian diets in the Russian population at the present stage.Material and methods. The analysis included data from representative samples of the adult population 25-74 years old, examined within three sections of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study in 20132014, 2017 and 2020-2022. A total of 57351 participants (24862 men and 32489 women) were analyzed. Nutrition assessment was carried out using the frequency method. Restrictive diets include semi-vegetarian, vegetarian and vegan diets. Data are presented as frequencies and odds ratios (OR) with 95% confidence intervals (CI).Results. The prevalence of restrictive diets in the Russian population according to three sections of the ESSE-RF study was 3,1%. There is an increase in the prevalence of these diets from 2,7% in 2013, to 3,6% in 2017 and 3,3% in 2020-2022. Men are less likely than women to exclude red meat from their diet (OR 0,55 [0,49-0,61], p&lt;0,05), as are married individuals (0,58 [0,52-0,64], p&lt;0,05). Persons with higher education more often follow a semi-vegetarian diet (OR 1,15 [1,04-1,27], p&lt;0,05). With age, the refusal to consume red meat in the population increases (p&lt;0,001). A semi-vegetarian diet is associated with a lower likelihood of general (OR 0,84 [0,71-0,99], p=0,037) and abdominal obesity (0,78 [0,52-0,64], p&lt;0,001), hypertriglyceridemia (0,82 [0,73-0,92], p=0,001) and hyperglycemia (0,81 [0,67-0,97], p=0,021). The probability of hypertension is lower among people who limit the consumption of animal products (semi-vegetarians (OR 0,85 [0,76-0,95], p=0,004) and vegetarians (0,62 [0,42-0,92], p=0,018), as well as hypercholesterolemia: in semi-vegetarians (0,90 [0,81-0,99], p=0,041), in vegetarians (0,68 [0,47-0,97], p=0,035) and in vegans (0,37 [0,15-0,91], p=0,030).Conclusion. In the Russian population, individuals following vegetarian diets (3,1% of the population) have a healthier profile of nutritional risk factors.

Health protective behaviours during the COVID-19 pandemic: Risk adaptation or habituation?

Many epidemiological works show that human behaviours play a fundamental role in the spread of infectious diseases. However, we still do not know much about how people modify their Health Protective Behaviours (HPB), such as hygiene or social distancing measures, over time in response to the health threat during an epidemic. In this study, we examined the role of the epidemiological context in engagement in HPB through two possible mechanisms highlighted by research into decision-making under risk: risk adaptation and risk habituation. These two different mechanisms were assumed to explain to a large extent the temporal variations in the public's responsiveness to the health threat during the COVID-19 pandemic. To test them, we used self-reported data collected through a series of 25 cross-sectional surveys conducted in France among representative samples of the adult population, from March 2020 to September 2021 (N = 50,019). Interestingly, we found that both mechanisms accounted relatively well for the temporal variation in the adoption of social distancing during the pandemic, which is remarkable given their different assumptions about the underlying social cognitive processes involved in response to a health threat. These results suggest that strengthening the incentives to encourage people to maintain health protective behaviours and to counter risk habituation effects is crucial to disease control and prevention over time.

Cross-sectional association between severe periodontitis and diabetes mellitus: A nation-wide cohort study.

To evaluate the cross-sectional association between severe periodontitis and diabetes mellitus (DM), in a representative sample of Spanish population. The di@bet.es epidemiological study is a population-based cohort study aimed to determine the prevalence and incidence of DM in the adult population of Spain. The at-risk sample at the final examination (2016-2017) included 1751 subjects who completed an oral health questionnaire. This questionnaire, together with demographic and risk factors, had been previously validated to build an algorithm to predict severe periodontitis in the Spanish population. Logistic regression models were used to evaluate the association between severe periodontitis and DM with adjustment for confounding factors. In total, 144 subjects developed DM, which yielded 8.2% cumulative incidence. Severe periodontitis was detected in 59.0%, 54.7% or 68.8% of the subjects depending on three different selected criteria at the 2016-2017 exam. All criteria used to define severe periodontitis were associated with DM in unadjusted analysis, but the magnitude of the association decreased after adjusting for significant confounders. The criteria '≥50% of teeth with clinical attachment loss ≥5 mm' presented an odds ratio of 4.9 (95% confidence interval: 2.2-10.7; p ≤ .001) for DM. Severe periodontitis is associated with DM in the Spanish population.

THE MINI-MENTAL STATE EXAMINATION IN A CHINESE POPULATION: RELIABILITY, VALIDITY, AND MEASUREMENT INVARIANCE

Abstract The Mini-Mental State Examination (MMSE) is a widely used screening tool for cognitive impairment and dementia in many cultures and regions. However, the properties of the MMSE in the Chinese context have not been evaluated with large population-representative samples. It is also unclear whether item properties of the MMSE differ across age and education subgroups. We study the psychometric properties of the MMSE using data from 8974 respondents aged 60 years or older in the 2018 Chinese Health and Retirement Longitudinal Study (CHARLS). Using item response theory (IRT) for the ordinal data, we confirm a three-dimensional factor structure for the MMSE in CHARLS in accordance with the underlying theoretical framework and establish acceptable model-data fit (SRMSR = 0.036). Total scores and subscale scores of the MMSE correlated positively with each other and correlated negatively with ADL (r = -0.19), IADL (-0.30), and CESD scores (-0.25). The reliability of the total MMSE scores was estimated at 0.78, indicating moderate measurement precision in the study population. Multiple group IRT analysis found that item characteristics and item functioning of 5 items differed by age group and 14 items differed by educational level. This analysis provided evidence on violations to measurement invariance of MMSE items, pointing to a need to account for item-level differences in measurement properties primarily with respect to education level when using the MMSE in CHARLS and, more generally, in Chinese populations. In addition, revised cognitive measures are advised to be used in CHARLS to improve the precision of measurement.

Latent class analyses of multimorbidity and all-cause mortality: A prospective study in Chilean adults.

Multimorbidity patterns can lead to differential risks for all-cause mortality. Within the Chilean context, research on morbidity and mortality predominantly emphasizes individual diseases or combinations thereof, rather than specific disease clusters. This study aimed to identify multimorbidity patterns, along with their associations with mortality, within a representative sample of the Chilean population. 3,701 participants aged ≥18 from the Chilean National Health Survey 2009-2010 were included in this prospective study. Multimorbidity patterns were identified from 16 chronic conditions and then classified using latent class analyses. All-cause mortality data were extracted from the Chilean Civil Registry. The association of classes with all-cause mortality was carried out using Cox proportional regression models, adjusting by sociodemographic and lifestyle variables. Three classes were identified: a) Class 1, the healthiest (72.1%); b) Class 2, the depression/cardiovascular disease/cancer class (17.5%); and c) Class 3, hypertension/chronic kidney disease class (10.4%). Classes 2 and 3 showed higher mortality risk than the healthiest class. After adjusting, Class 2 showed 45% higher mortality risk, and Class 3 98% higher mortality risk, compared with the healthiest class. Hypertension appeared to be a critical underlying factor of all-cause morbidity. Particular combinations of chronic diseases have a higher excess risk of mortality than others.

Optimization of Inhalation Technique Knowledge in the Pharmacies of Matosinhos Municipality, Portugal: An Intervention Project.

The therapeutic approach to the most common respiratory diseases, asthma and chronic obstructive pulmonary disease (COPD), involves the use of inhalation devices. Its use is essential, but incorrect use is frequent, and learning and reviewing the technique is necessary for the adequate management of these diseases. This study aims to increase the knowledge of health professionals from pharmacies in the municipality of Matosinhos, Portugal, about the correct inhalation technique. The project developed from May 2022 to June 2023 was based on a training session for pharmacy professionals that took place after professionals completed a questionnaire and after evaluating each participant's inhalation technique by the authorsusing a checklist. Both were reapplied three months after the first evaluation. Fifteen pharmacies in Matosinhos, Portugal, were invited, of which eight agreed to participate, with a total of 16 health professionals (30.8% of professionals in these pharmacies). We found that professionals questioned and taught users more times about the inhalation technique and that a greater number of professionals considered they knew how to correctly perform the inhalation technique in the second assessment. It was also possible to verify statistically significant differences (p<0.001) between the mean of correct steps in the inhalation technique between the first and second assessments. There was also an improvement in the qualitative analysis of errors in the inhalation technique. In the first assessment, the inhalation devices with the lowest percentage of correct steps were Forspiro® and Respimat®. In the second evaluation, the Diskus® and Ellipta® devices obtained 100% correct steps, with the K-haler® being the device with the lowest percentage. This study confirms the effectiveness of continuous training for health professionals and the importance of multidisciplinary cooperation in teaching inhalation techniques. Other studies are needed to complement these results, particularly with representative samples of the general population, or assessing the impact of this intervention in patients with respiratory diseases.

General and math vocabulary contributions to early numeracy skills in a large population-representative sample

There are well-documented associations between numeracy development in preschool age children and general and math vocabulary, literacy, and executive functions. However, the studies have largely included small samples of children with parents with either predominantly low or higher socioeconomic background (SES); further, few studies have included measures of all these domains in the same analyses. In this current study, we examined how general vocabulary, math vocabulary, rhyme detection and three measures of executive functions are associated with numeracy development in a population representative sample of 2,931 Danish children 3–5 years (51% male, 89% white). Multi-level regressions controlling for child age and, sex, and in some analyses also parental education and income confirmed that general vocabulary (β = 0.16), math language (β = 0.17), rhyme detection (β = 0.14), attention shifting (β = 0.09), inhibitory control (β = 0.05), and working memory (β = 0.09) each are associated with numeracy after controlling for covariates when estimated in the same model. Analyses of extreme performance (low-high) suggests a much closer and symmetrical connection between math language and numeracy compared to that between general vocabulary and numeracy. Interestingly, family SES is weakly but significantly related to all measures, most strongly for the vocabulary measures, but does not influence the pattern of results from regression analyses. In conclusion, both general vocabulary and mathematics-specific vocabulary contribute substantially to early numeracy skills. Rhyme detection and executive functions are also associated with numeracy skills, but with a lower magnitude.