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    Association of multimorbidity of non-communicable diseases with mortality: a 10-year prospective study of 0.5 million Chinese adults

    Zou, S.Wang, Z.Bhura, M.Tang, K....
    9页
    查看更多>>摘要：Objectives: Non-communicable diseases (NCDs) account for seven out of 10 deaths worldwide, whereas the pattern of multimorbidity of NCDs and its long-term impact on all-cause mortality remains largely unknown, especially among the Chinese population. This study aimed to investigate the associations between the number and patterns of multimorbidity with long-term risks of mortality and to estimate the influence of age on the relationship between multimorbidity and mortality. Study design: This was a prospective population-based cohort study. Methods: Data were obtained from the China Kadoorie Biobank study, which enrolled adults aged 30-79 years from 10 regions of China. The outcome was all-cause mortality, which was measured at a 10-year follow-up (9.93 +/- 1.82 years). A principal component analysis (PCA) was used to identify patterns of individuals with multimorbidity based on 16 self-reported or baseline-detected chronic conditions. Cox proportional hazards models were used to examine the associations of both the number and patterns of multimorbidity of NCDs with all-cause mortality. Stratified analyses were carried out to explore whether the associations of multimorbidity with all-cause mortality were modified by age, number, and the patterns of multimorbidity. Results: We included 512,712 individuals in our analysis, of which 176,619 (34.5%) had only one long-term condition (LTC), and 81,360 (15.9%) had multimorbidity. The crude mortality rate was highest in those aged between 70 and 79 years who also had >4 LTCs (44.38 per 1000 person-years). In participants with at least four LTCs at baseline, fully adjusted HRs were 4.58 (95% CI 2.65-7.93) for people belongs to 1960s-1970s, compared to 2.73 (95% CI 2.50-2.97) for 1920s-1930s. Six multimorbidity patterns were identified, including cardiometabolic syndrome, respiratory diseases, digestive/renal/urologic diseases, articular/rheumatic diseases, and neuropsychiatric diseases. For the multimorbidity patterns of car-diometabolic syndrome, fully adjusted HRs for all-cause mortality were 1.60 (95% CI 1.55-1.65) in par-ticipants with one LTC and 8.19 (95% CI 6.45-10.40) in those with four LTCs compared with the reference group (no LTCs). Conclusions: The observed higher risk of mortality in younger people with multimorbidity, as middle aged (30-49 years), calls for advocating primary prevention in the younger population and secondary prevention for the elderly to strengthen early detection and timely treatment. Health systems need to shift from single-disease models to more effective multimorbidity management. (c) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Gambling and online trading: emerging risks of real-time stock and cryptocurrency trading platforms

    Oksanen, A.Mantere, E.Vuorinen, ISavolainen, I...
    7页
    查看更多>>摘要：Objectives: Online platforms enable real-time trading activities that are similar to those of gambling. This study aimed to investigate the associations of traditional investing, real-time stock trading, and cryp-tocurrency trading with excessive behavior and mental health problems. Study design: This was a cross-sectional population-based survey. Methods: The participants were Finnish people aged 18-75 years (N 1/4 1530, 50.33% male). Survey asked about monthly regular investing, real-time stock-trading platform use, and cryptocurrency trading. The study had measures for excessive behavior: gambling (Problem Gambling Severity Index), gaming (Internet Gaming Disorder Test), internet use (Compulsive Internet Use Scale), and alcohol use (Alcohol Use Disorders Identification Test). Psychological distress (Mental Health Inventory), perceived stress (Perceived Stress Scale), COVID-19 anxiety, and perceived loneliness were also measured. Background factors included sociodemographic variables, instant loan taking, and involvement in social media identity bubbles (Identity Bubble Reinforcement Scale). Multivariate analyses were conducted with regression analysis. Results: Within the sample, 22.29% were categorized into monthly regular investors only, 3.01% were investors using real-time stock-trading platforms, and 3.59% were cryptomarket traders. Real-time stock-trading platform use and cryptocurrency trading were associated with younger age and male gender. Cryptomarket traders were more likely to have an immigrant background and have taken instant loans. Both real-time stock-trading platform use and cryptomarket trading were associated with higher excessive behavior. Cryptomarket traders especially reported higher excessive gambling, gaming, and internet use than others. Cryptomarket traders reported also higher psychological distress, perceived stress, and loneliness. Conclusions: Regular investing is not a risk factor for excessive behavior. However, rapid online trading platforms and applications were significantly more commonly used by participants reporting excessive behavior and mental health problems. The strong association between cryptomarket trading and excessive behavior in particular underlines the need to acknowledge the potential risks related to real -time trading platforms. (C) 2022 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health.
      原文链接:
    • NSTL
    • Elsevier

    Secondhand smoke exposure is associated with abnormal P-wave axis

    Skipina, T. M.Patel, N.Upadhya, B.Soliman, E. Z....
    4页
    查看更多>>摘要：Objectives: Secondhand smoke exposure (SHSE) is associated with increased risk of cerebrovascular accident (CVA). Abnormal P-wave axis (aPWA) is a marker for atriopathy that is also associated with CVA risk. We hypothesized that SHSE is associated with aPWA. Methods: This analysis included 5986 non-smokers (age 61.7 +/- 13.8 years, 45.8% men, 77.4% Whites) from the Third National Health and Nutrition Examination Survey. SHSE was defined as serum cotinine >= 1 ng/ml aPWA was defined as any P-wave axis outside of 0-75 degrees. Multivariable logistic regression was used to examine the association between SHSE and aPWA, overall and among subgroups stratified by demographics and comorbidities. Results: About 18.5% (n = 1109) of the participants had SHSE. aPWA was more prevalent among those with SHSE than those without (23.9% versus 19.8%, respectively, P-value = 0.003). In a model adjusted for sociodemographic and potential confounders, presence (versus absence) of SHSE was associated with increased odds of aPWA (odds ratio [95% confidence interval]: 1.28 [1.09, 1.50]; P-value = 0.003). This association was stronger among Whites vs non-Whites (interaction P-value = 0.04) and non-obese versus obese (interaction P-value = 0.04). Higher levels of serum cotinine were associated with increased odds of aPWA. Compared with serum cotinine level <1 ng/ml, serum cotinine >= 3 ng/ml and >6 ng/ml were associated with 35% (P value = 0.002) and 38% (P-value = 0.002) increased odds of aPWA, respectively. Conclusions: SHSE is associated with abnormal atrial conduction, measured as aPWA, with possible effect modification by ethnicity and obesity. These findings underscore the harmful effects of SHSE on cardiovascular health which merits a personalized risk assessment when counseling patients on SHSE. (C) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Reasons for participation and non-participation in colorectal cancer screening

    Berg-Beckhoff, GabrieleLeppin, AnjaNielsen, Jesper Bo
    7页
    查看更多>>摘要：Objectives: The aim of the present analysis is to identify the reasons for accepting or rejecting the invitation to be screened by the Faecal Immunochemical Test as part of the free Danish screening programme for colorectal cancer (CRC). Study design: A cross-sectional representative survey of 15,072 Danish citizens aged 50-80 years was collected in 2019 via a Web-based questionnaire administered by Statistics Denmark. Among the net sample of 6807 respondents (45%), 177 were excluded because of current treatment for colorectal disease. Methods: To determine the reasons for accepting or refusing the invitation to be screened for CRC, a latent class analysis was conducted, which allowed participants to provide several reasons for acceptance or rejection of screening. Results: The most important reason for participating in CRC screening was the active public programme. A further reason for participation was the perceived risk for CRC, mainly in combination with the public programme. The reasons for participation did not differ between individuals who had participated and those who intended to participate when offered. Among participants who declined screening, the most frequent reasons were that they forgot to participate or that they were concerned about the unpleasant test procedure. Among individuals who intended to decline screening, a perceived low risk for CRC was the most frequently cited reason. Conclusions: Recommendation from a general practitioner (GP) was not given as a frequent reason for CRC screening participation which is discussed as a challenge to participation rates in population based screening program The main reasons reported for non-participation in CRC screening (i.e. forgot to participate or the unpleasant test procedure) might be addressed by a stronger endorsement from GPs. (c) 2022 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
      原文链接:
    • NSTL
    • Elsevier

    Influence of microstructure and physical characteristics in the performance of non-professional masks sold in Sao Paulo

    de Lima, Lucas NascimentoReis, Daniel CostaSakano, Victor KenitiFranco, Marco Aurelio...
    9页
    查看更多>>摘要：Objectives: This study evaluates the performance of eight non-professional face masks sold in Sao Paulo, Brazil, to prevent aerial transmission of the SARS-CoV-2. Study design: This was a case report with comparative testing. Methods: The masks manufactured with different materials and designs were quantified according to their performance to prevent COVID-19 using two indicators: filtration efficiency (FE) and differential pressure. The fabric grammage and microscopy of the layers were analyzed to understand their influence on the performance indicators. Results: The results show no correlation between grammage in the FE and increasing grammage can compromise breathability indicator. Masks manufactured with cotton widely commercialized during the pandemic have non-uniformized results in FE indicators. Conclusions: There was no evidence between grammage and the number of layers in the FE indicator. The results pointed out that the layer's composition and the microstructure are the best way to evaluate the performance of non-professional masks used to prevent the aerial transmission of the SARS-CoV-2. (C) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Accountable care organization reform: past challenges and future opportunities for public health

    Baker, N.Singer, P. M.
    3页
    查看更多>>摘要：Objectives: This study aimed to analyze the regulatory landscape that governs accountable care organizations (ACOs) in the United States and the effects on organizational participation. Study design: This was a descriptive study of existing and prior regulations that govern ACOs in the United States. In addition, we analyze data on ACO participation over time. Methods: We used content analysis methods to the regulatory framework governing ACOs. Authors read and analyzed all regulations since 2012. Results: ACO participation has been undermined by a shifting regulatory landscape. Under the Trump administration, ACOs have had to take on additional risk earlier and that has contributed to the lowest number of participating organizations in the program's history. Conclusions: The Biden administration has the opportunity to remake regulations governing ACO development and support. (c) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Urban-rural disparities in old-age mortality vary systematically with age: evidence from Germany and England & Wales

    Ebeling, M.Rau, R.Sander, N.Kibele, E....
    8页
    查看更多>>摘要：Objectives: Population aging -which tends to be more pronounced in rural than in urban areas -poses important challenges for facilitating equal opportunities for aging well and 'aging in place.' Unmet health care needs among the older rural population may result in poorer health and higher mortality, but the scientific evidence of a systematic rural mortality disadvantage at older ages is scarce. We argue that systematic urban-rural mortality differences by age may be found if the confounding effect of life expectancy is considered. Study design: Nationwide population-based study. Methods: We draw on age-and sex-specific data for the population aged 60 thorn years in NUTS-3 regions in Germany (2016-2018) and LAU-1 regions in England & Wales (2017-2019). To account for the confounding effect of life expectancy, we compare age-specific mortality only across urban and rural regions with similar life expectancy levels. We quantify statistical uncertainty with bootstrapping. Results: The results show a remarkable shift from higher mortality in urban regions to higher mortality in rural regions with increasing age, when controlling for the confounding effect of life expectancy. That is, the urban mortality disadvantage is strongest for the population aged 60-79 years, whereas the pattern shifts toward a rural mortality disadvantage for the population aged 80 years and older. This pattern is present at all levels of life expectancy, for both sexes and in both countries. Conclusion: The shift from urban to rural excess mortality over age suggests that regions may vary in their capability to respond to arising health issues across older ages. This systematic mortality disadvantage is of high public health relevance and should be considered in designing policies to reduce regional mortality disparities. (c) 2022 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
      原文链接:
    • NSTL
    • Elsevier

    Utilization of health services and associated factors among fee waiver beneficiaries in Dawunt district, North Wollo zone, Ethiopia

    Jemal, J.Hagos, T.Fentie, MelkituZenebe, Getachew Assefa...
    6页
    查看更多>>摘要：Objective: This study aimed to assess the utilization of health services and associated factors among fee waiver beneficiaries in Dawunt district, Ethiopia, in 2020. Study design: A community-based cross-sectional study was used. Methods: Using an interviewer-administered questionnaire, data were collected from 550 randomly selected households. EpiData version 4.6 was used to enter data, and SPSS version 23 was used to analyze it. Multivariable logistic regression analysis was applied to identify the associated factors with health service utilization. Results: The overall health service utilization among fee waiver beneficiaries was 60.98% (95% confidence interval [CI]: 56.4-64.4%). Being an urban resident (adjusted odds ratio [AOR]: 3.2, 95% CI: 1.41-7.28), family size (AOR: 3.17, 95% CI: 1.49-6.75), perceived health status (AOR: 6.26, 95% CI: 3.76-10.41), travel time (AOR: 2.75, 95% CI: 1.25-6.06), perceived distance (AOR: 13.69, 95% CI: 5.22-35.91), and perceived medium (AOR: 3.07, 95% CI: 1.71-5.52) and cheap (AOR: 3.02, 95%CI: 1.43-6.36) transport costs were significantly associated with utilization of health services. Conclusions: This study revealed that the level of health service utilization among beneficiaries in the Dawunt district was 60.98%. Residence, family size, perceived health status, travel time to the nearest Health Facility (HF), perceived distance, and travel cost to reach the HFs were significantly associated with Health Services Utilization (HSU). Therefore, improving physical accessibility of health services and availability of necessary health services at an affordable cost will possibly result in better utilization of healthcare services. (c) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    'I don't want my son to be part of a giant experiment': public attitudes towards COVID-19 vaccines in children

    Williams, S. N.
    6页
    查看更多>>摘要：Objectives: This qualitative study explored public attitudes to COVID-19 vaccines in children, including reasons for support or opposition to them. Study design: This was a qualitative study using online focus groups and interviews. Methods: Group and individual online interviews were conducted with a diverse sample of 24 adults in the United Kingdom to explore their views on the issue of COVID-19 vaccination in children. Data were analysed using a framework approach. Results: COVID-19 vaccination in children was framed as a complex problem (a 'minefield'). Six themes emerged to explain participants views: (1) uncertainty over whether children can catch, transmit or be severely harmed by COVID-19; (2) lower risk tolerance for unknown longer term effects of the vaccine in children; (3) association of the vaccine programme with government's handling of the pandemic; (4) local social norms as a driver of hesitancy; (5) vaccinating children as a way to protect vulnerable adults; and (6) children's vaccination as parental choice. Conclusions: COVID-19 vaccination in children is perceived by members of the public as a complex issue, and many are torn or hesitant about the idea. Public health communications will need to combat this hesitancy if vaccine uptake for children is to be pursued as a public health policy. (c) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Hearing loss, depression, and medical service utilization among older adults: evidence from China

    Guan, LidingLiu, QingChen, DeshanChen, Chen...
    8页
    查看更多>>摘要：Objectives: To acquire a better understanding of the mechanisms underlying the association between hearing loss and medical service utilization, this study examined the relationship between hearing loss, depression, and medical service utilization. Study design: Using the methods of probability proportional to size, a survey conducted in 28 provinces, 150 countries/districts, 450 villages/urban communities, 11,628 households, and 19,816 individuals of China in 2018. Methods: The data for this article were derived from the 2018 China Health and Retirement Longitudinal Study, which enrolled 14,455 people aged 50-80 years. Hearing loss was determined using self-reported hearing status. Self-reported outpatient visits in the last month and hospitalization within the last year were used to determine medical service utilization. Depression was obtained from the CES-D-10 scale. Logistic regression and stepwise regression methods were used. Results: Older adults with hearing loss problems used significantly more outpatient care services (odds ratio [OR] = 1.292, 95% confidence interval [CI] 1.152, 1.449; P < 0.001) and inpatient care services (OR = 1.238, 95% CI 1.021, 1.501; P < 0.05) than those without hearing loss problems. Following that, individuals with hearing loss problems were more likely to experience depressive symptoms (OR = 1.467, 95% CI 1.345, 1.599; P < 0.001) than those without. Moreover, respondents with depressive symptoms used outpatient care services at a significantly higher rate (OR = 1.292, 95% CI 1.152, 1.449; P < 0.001) and inpatient care service at a significantly higher rate (OR = 1.238, 95% CI 1.021, 1.501; P < 0.05) compared with those without depressive symptom. Conclusion: This article discovered that depression acted as a mediation variable in the relationship between hearing loss and medical service utilization. This research provided possible interventions for reducing the burden of the healthcare system and society that older adults with hearing loss imposed. (c) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier