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Anderer S. More Than Half of US Rural Hospitals No Longer Offer Birthing Services-Here's Why. JAMA 2024; 331:815-817. [PMID: 38381424 DOI: 10.1001/jama.2024.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
This Medical News article discusses a new report on labor and delivery department closures in the rural US as well as potential financial and workforce solutions.
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Ye W, Thangavel G, Pillarisetti A, Steenland K, Peel JL, Balakrishnan K, Jabbarzadeh S, Checkley W, Clasen T. Association between personal exposure to household air pollution and gestational blood pressure among women using solid cooking fuels in rural Tamil Nadu, India. Environ Res 2022; 208:112756. [PMID: 35065931 PMCID: PMC8935388 DOI: 10.1016/j.envres.2022.112756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/06/2022] [Accepted: 01/15/2022] [Indexed: 05/22/2023]
Abstract
BACKGROUND The Household Air Pollution Intervention Network (HAPIN) trial is an ongoing multi-center randomized controlled trial assessing the impact of a liquified petroleum gas (LPG) cookstove and fuel intervention on health. Given the potential impacts of household air pollution (HAP) exposure from burning solid fuels on cardiovascular health during pregnancy, we sought to determine whether baseline exposures to particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), black carbon (BC) and carbon monoxide (CO) were associated with blood pressure among 799 pregnant women in Tamil Nadu, India, one of the HAPIN trial centers. METHODS Multivariable linear regression models were used to examine the association between 24-h personal exposure to PM2.5/BC/CO and systolic and diastolic blood pressure, controlling for maternal age, body mass index (BMI), mother's education, household wealth, gestational age, and season. At the time of measurement, women were between 9- and 20-weeks of gestation. RESULTS We found that systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in pregnant women exposed to higher levels of HAP, though only the result for CO and DBP reached conventional statistical significance (p < 0.05). We observed a positive association between CO and DBP among the entire study cohort: a 1-log μg/m3 increase in CO exposure was associated with 0.36 mmHg higher DBP (95% confidence interval [CI]: 0.02 to 0.70). The effect was stronger in pregnant women with higher CO exposures (in the 3rd [≥ 0.9 and < 2.1 ppm] and 4th quartiles [≥ 2.1 and ≤ 46.9 ppm]). We also found that pregnant women with PM2.5 exposures in the highest quartile (≥ 129.9 and ≤ 2100 μg/m3) had a borderline significant association (p = 0.054) with DBP compared to those who had PM2.5 exposures in the lowest quartile (≥ 9.4 and < 47.7 μg/m3). No evidence of association was observed for BC exposure and blood pressure. CONCLUSION This study contributes to limited evidence regarding the relationship between HAP exposure and blood pressure among women during pregnancy, a critical window for both mother and child's life-course health. Results from this cross-sectional study suggest that exposures to PM2.5 and CO from solid fuel use are associated with higher blood pressure in pregnant women during their first or second trimester.
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Affiliation(s)
- Wenlu Ye
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L Peel
- Dept of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Shirin Jabbarzadeh
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Chen H, Liao Y, Zhou W, Dong L, Wang W, Wang X. The change of myopic prevalence in children and adolescents before and after COVID-19 pandemic in Suqian, China. PLoS One 2022; 17:e0262166. [PMID: 35312694 PMCID: PMC8937315 DOI: 10.1371/journal.pone.0262166] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/19/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose The aim of this study was to investigate the change of myopic prevalence in students with different demographic characteristics before and after the COVID-19 pandemic in Suqian, China. Methods A retrospective, cross-sectional study was conducted. Student data from 52 schools in 2019 and 2020 were collected from the electronic medical records database through cluster sampling. Ophthalmic examinations were conducted on students from September to December in 2019 and 2020. Measurements of uncorrected visual acuity (UCVA) and noncycloplegic autorefraction were included to obtain the spherical equivalent refraction (SER) and prevalence of myopia. The difference in the rate of myopia and SER of students ages 6 to 18 with various demographic characteristics was compared between the two years. Results Records from 118,479 students in 2019 and the 121,881 students in 2020 were obtained. In 2019 and 2020, the prevalence of overall myopia increased from 43.1% to 48.9% (5.8 percentage point), and a substantial shift in myopic rate occurred in grades 4 to 6 (6.9 percentage point). The change in the prevalence of myopia in girls (5.9 percentage point) was approximately equal to that in boys (5.8 percentage point) and it was more common in rural students (5.9 percentage point) than in urban students (5.1 percentage point). The prevalence of low myopia increased more in children, and the prevalence of moderate myopia increased more in adolescents. The mean spherical equivalent refraction (SER) (-1.34±2.03 D) was lower in 2020 than in 2019 (-1.16±1.92 D), while SER decreased mainly at ages 7 to 15. The SER presented myopic status at the age of 9 (-0.55±1.26 D in 2019, -0.71±1.42 D in 2020), and attained moderate myopia at the age of 15 (-3.06±2.41 D in 2019, -3.22±2.40 D in 2020). Conclusions After the COVID-19 pandemic, myopia increased in this population with variable rates of increase in different demographic groups. The change of myopia in children was comparatively greater than that in adolescents. Therefore, we should take measures to prevent and control the development of myopia after the COVID-19 pandemic, especially for younger students.
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Affiliation(s)
- Hongyan Chen
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical university, Xuzhou, Jiangsu Province, China
- Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Ya Liao
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical university, Xuzhou, Jiangsu Province, China
- Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Wen Zhou
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical university, Xuzhou, Jiangsu Province, China
- Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Lei Dong
- The Primary and Middle School Health Care Center in Suqian, Suqian, Jiangsu Province, China
| | - Wei Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Xiaojuan Wang
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical university, Xuzhou, Jiangsu Province, China
- Xuzhou Medical University, Xuzhou, Jiangsu Province, China
- * E-mail:
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Hedstrom A, Mubiri P, Nyonyintono J, Nakakande J, Magnusson B, Vaughan M, Waiswa P, Batra M. Impact of the early COVID-19 pandemic on outcomes in a rural Ugandan neonatal unit: A retrospective cohort study. PLoS One 2021; 16:e0260006. [PMID: 34914748 PMCID: PMC8675646 DOI: 10.1371/journal.pone.0260006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/30/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND During the early COVID-19 pandemic travel in Uganda was tightly restricted which affected demand for and access to care for pregnant women and small and sick newborns. In this study we describe changes to neonatal outcomes in one rural central Ugandan newborn unit before and during the early phase of the COVID-19 pandemic. METHODS We report outcomes from admissions captured in an electronic dataset of a well-established newborn unit before (September 2019 to March 2020) and during the early COVID-19 period (April-September 2020) as well as two seasonally matched periods one year prior. We report excess mortality as the percent change in mortality over what was expected based on seasonal trends. FINDINGS The study included 2,494 patients, 567 of whom were admitted during the early COVID-19 period. During the pandemic admissions decreased by 14%. Patients born outside the facility were older on admission than previously (median 1 day of age vs. admission on the day of birth). There was an increase in admissions with birth asphyxia (22% vs. 15% of patients). Mortality was higher during COVID-19 than previously [16% vs. 11%, p = 0.017]. Patients born outside the facility had a relative increase of 55% above seasonal expected mortality (21% vs. 14%, p = 0.028). During this period patients had decreased antenatal care, restricted transport and difficulty with expenses and support. The hospital had difficulty with maternity staffing and supplies. There was significant community and staff fear of COVID-19. INTERPRETATION Increased newborn mortality during the early COVID-19 pandemic at this facility was likely attributed to disruptions affecting maternal and newborn demand for, access to and quality of perinatal healthcare. Lockdown conditions and restrictions to public transit were significant barriers to maternal and newborn wellbeing, and require further focus by national and regional health officials.
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Affiliation(s)
- Anna Hedstrom
- Departments of Pediatrics and Global Health, Neonatology, Seattle Children’s Hospital, University of Washington, Seattle, WA, United States of America
| | - Paul Mubiri
- Makerere University School of Public Health, Mulago, Kampala, Uganda
| | | | | | | | | | - Peter Waiswa
- Makerere University School of Public Health, Mulago, Kampala, Uganda
| | - Maneesh Batra
- Departments of Pediatrics and Global Health, Neonatology, Seattle Children’s Hospital, University of Washington, Seattle, WA, United States of America
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Osazuwa-Peters N, Barnes JM, Okafor SI, Taylor DB, Hussaini AS, Adjei Boakye E, Simpson MC, Graboyes EM, Lee WT. Incidence and Risk of Suicide Among Patients With Head and Neck Cancer in Rural, Urban, and Metropolitan Areas. JAMA Otolaryngol Head Neck Surg 2021; 147:1045-1052. [PMID: 34297790 PMCID: PMC8304170 DOI: 10.1001/jamaoto.2021.1728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 01/13/2023]
Abstract
Importance Patients with head and neck cancer (HNC) are known to be at increased risk of suicide compared with the general population, but there has been insufficient research on whether this risk differs based on patients' rural, urban, or metropolitan residence status. Objective To evaluate whether the risk of suicide among patients with HNC differs by rural vs urban or metropolitan residence status. Design, Setting, and Participants This cross-sectional study uses data from the Surveillance, Epidemiology, and End Results database on patients aged 18 to 74 years who received a diagnosis of HNC from January 1, 2000, to December 31, 2016. Statistical analysis was conducted from November 27, 2020, to June 3, 2021. Exposures Residence status, assessed using 2013 Rural Urban Continuum Codes. Main Outcomes and Measures Death due to suicide was assessed by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes (U03, X60-X84, and Y87.0) and the cause of death recode (50220). Standardized mortality ratios (SMRs) of suicide, assessing the suicide risk among patients with HNC compared with the general population, were calculated. Suicide risk by residence status was compared using Fine-Gray proportional hazards regression models. Results Data from 134 510 patients with HNC (101 142 men [75.2%]; mean [SE] age, 57.7 [10.3] years) were analyzed, and 405 suicides were identified. Metropolitan residents composed 86.6% of the sample, urban residents composed 11.7%, and rural residents composed 1.7%. The mortality rate of suicide was 59.2 per 100 000 person-years in metropolitan counties, 64.0 per 100 000 person-years in urban counties, and 126.7 per 100 000 person-years in rural counties. Compared with the general population, the risk of suicide was markedly higher among patients with HNC in metropolitan (SMR, 2.78; 95% CI, 2.49-3.09), urban (SMR, 2.84; 95% CI, 2.13-3.71), and rural (SMR, 5.47; 95% CI, 3.06-9.02) areas. In Fine-Gray competing-risk analyses that adjusted for other covariates, there was no meaningful difference in suicide risk among urban vs metropolitan residents. However, compared with rural residents, residents of urban (subdistribution hazard ratio, 0.52; 95% CI, 0.29-0.94) and metropolitan counties (subdistribution hazard ratio, 0.55; 95% CI, 0.32-0.94) had greatly lower risk of suicide. Conclusions and Relevance The findings of this cross-sectional study suggest that suicide risk is elevated in general among patients with HNC but is significantly higher for patients residing in rural areas. Effective suicide prevention strategies in the population of patients with HNC need to account for rural health owing to the high risk of suicide among residents with HNC in rural areas.
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Affiliation(s)
- Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Editorial Board Member, JAMA Otolaryngology–Head & Neck Surgery
| | - Justin M. Barnes
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Somtochi I. Okafor
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Adnan S. Hussaini
- Department of Otolaryngology–Head and Neck Surgery, Georgetown University Medical Center, Washington, DC
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield
- Simmons Cancer Institute, Springfield, Illinois
| | - Matthew C. Simpson
- Department of Otolaryngology–Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
- Advanced Health Data Research Institute, St Louis University, St Louis, Missouri
| | - Evan M. Graboyes
- Editorial Board Member, JAMA Otolaryngology–Head & Neck Surgery
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Walter T. Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
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Liu P, Liu X, Wei D, Nie L, Fan K, Zhang L, Wang L, Liu X, Hou J, Yu S, Li L, Wang C, Huo W, Mao Z. Associations of serum androgens with coronary heart disease and interaction with age: The Henan Rural Cohort Study. Nutr Metab Cardiovasc Dis 2021; 31:3352-3358. [PMID: 34625359 DOI: 10.1016/j.numecd.2021.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 07/18/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS We aimed to investigate the associations of testosterone and androstenedione with coronary heart disease, and the interaction effect of testosterone or androstenedione and age on coronary heart disease. METHODS AND RESULTS A total of 6178 participants were included in this study. Serum testosterone and androstenedione were detected by liquid chromatography-tandem mass spectrometry. Logistic regression and restricted cubic splines were used to assess the independent effects of testosterone and androstenedione on coronary heart disease. Interactive plots were employed to examine the interaction effects of testosterone or androstenedione with age on coronary heart disease. After adjusting for multiple variables, serum testosterone and androstenedione levels were negatively associated with coronary heart disease in males (tertile 3 vs tertile 1, odd ratio (OR) = 0.56, 95% confidence interval (CI) (0.33, 0.96), and OR = 0.40, 95% CI (0.22, 0.74)). Per 1 unit increase in ln-testosterone and ln-androstenedione was associated with a 24% (OR = 0.76, 95% CI (0.63, 0.91)) and 30% (OR = 0.69, 95% CI (0.55, 0.86)) lower risk of coronary heart disease, respectively. Additionally, the positive association of age with coronary heart disease was attenuated by increasing concentrations of ln-testosterone and ln-androstenedione concentration in males. CONCLUSIONS The results indicated that serum testosterone and androstenedione were negatively associated with coronary heart disease risk in Chinese rural males. To some extent, this study supports the application of hormone therapy in males with coronary heart disease, which can contribute to reducing the burden of coronary heart disease and related cardiovascular disease.
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Affiliation(s)
- Pengling Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xue Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Dandan Wei
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Luting Nie
- Department of Occupational and Environmental Health Sciences, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Keliang Fan
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Li Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Lulu Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Songcheng Yu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Linlin Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wenqian Huo
- Department of Occupational and Environmental Health Sciences, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
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Brooks WA, Zaman K, Goswami D, Prosperi C, Endtz HP, Hossain L, Rahman M, Ahmed D, Rahman MZ, Banu S, Shikder AU, Jahan Y, Nahar K, Chisti MJ, Yunus M, Khan MA, Matin FB, Mazumder R, Shahriar Bin Elahi M, Saifullah M, Alam M, Bin Shahid ASMS, Haque F, Sultana S, Higdon MM, Haddix M, Feikin DR, Murdoch DR, Hammitt LL, O’Brien KL, Deloria Knoll M. The Etiology of Childhood Pneumonia in Bangladesh: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S79-S90. [PMID: 34448747 PMCID: PMC8448409 DOI: 10.1097/inf.0000000000002648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pneumonia remains the leading infectious cause of death among children <5 years, but its cause in most children is unknown. We estimated etiology for each child in 2 Bangladesh sites that represent rural and urban South Asian settings with moderate child mortality. METHODS As part of the Pneumonia Etiology Research for Child Health study, we enrolled children 1-59 months of age with World Health Organization-defined severe and very severe pneumonia, plus age-frequency-matched controls, in Matlab and Dhaka, Bangladesh. We applied microbiologic methods to nasopharyngeal/oropharyngeal swabs, blood, induced sputum, gastric and lung aspirates. Etiology was estimated using Bayesian methods that integrated case and control data and accounted for imperfect sensitivity and specificity of the measurements. RESULTS We enrolled 525 cases and 772 controls over 24 months. Of the cases, 9.1% had very severe pneumonia and 42.0% (N = 219) had infiltrates on chest radiograph. Three cases (1.5%) had positive blood cultures (2 Salmonella typhi, 1 Escherichia coli and Klebsiella pneumoniae). All 4 lung aspirates were negative. The etiology among chest radiograph-positive cases was predominantly viral [77.7%, 95% credible interval (CrI): 65.3-88.6], primarily respiratory syncytial virus (31.2%, 95% CrI: 24.7-39.3). Influenza virus had very low estimated etiology (0.6%, 95% CrI: 0.0-2.3). Mycobacterium tuberculosis (3.6%, 95% CrI: 0.5-11.0), Enterobacteriaceae (3.0%, 95% CrI: 0.5-10.0) and Streptococcus pneumoniae (1.8%, 95% CrI: 0.0-5.9) were the only nonviral pathogens in the top 10 etiologies. CONCLUSIONS Childhood severe and very severe pneumonia in young children in Bangladesh is predominantly viral, notably respiratory syncytial virus.
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Affiliation(s)
- W. Abdullah Brooks
- From the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Doli Goswami
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hubert P. Endtz
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
- Department of Clinical Microbiology & Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
- Fondation Mérieux, Lyon, France
| | - Lokman Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Mustafizur Rahman
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dilruba Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Mohammed Ziaur Rahman
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Arif Uddin Shikder
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Yasmin Jahan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kamrun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | | | - Mohammed Yunus
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | | | | | - Razib Mazumder
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | | | - Muhammad Saifullah
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Muntasir Alam
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Fahim Haque
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sabiha Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Meredith Haddix
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Norwood DA, Dominguez LB, Paredes AA, Montalvan EE, Rodriguez Murillo A, Dougherty MK, Palsson OS, Dominguez RL, Morgan DR. Prevalence and Associated Dietary Factors of Rome IV Functional Gastrointestinal Disorders in Rural Western Honduras. Dig Dis Sci 2021; 66:3086-3095. [PMID: 33089482 DOI: 10.1007/s10620-020-06639-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The literature is limited regarding the prevalence of functional gastrointestinal disorders (FGIDs) in Central America, and the role of dietary factors. METHODS The Rome IV diagnostic questionnaire and National Cancer Institute Diet History questionnaire were administered in one-on-one interviews to a distributed cross section of the general adult population of Western Honduras. Our aim was to estimate prevalence of common FGIDs and symptoms and their relationships to dietary habits. RESULTS In total, 815 subjects were interviewed, of whom 151 fulfilled criteria for an FGID (18.5%). Gastroduodenal FGIDs were noted in 9.4%, with epigastric pain syndrome (EPS) more common than postprandial distress syndrome, 8.5% versus 1.6%. Among bowel disorders, functional abdominal bloating (FAB) was most prevalent (6.3%), followed by irritable bowel syndrome (3.6%), functional diarrhea (FDr; 3.4%), and functional constipation (1.1%). A significant inverse association was noted between regular bean intake and any FGID (OR 0.41, 95% CI 0.27-0.63), driven by IBS and FDr. Vegetable consumption was associated with lower prevalence of functional diarrhea (OR 0.12; 95% CI 0.04-0.35) and any diarrheal disorder (OR 0.11; 95% CI 0.04-0.31). Subjects with a median daily intake of ≥ 4 corn tortillas had 1.75 (95% CI 1.22-2.50) times the odds of having any FGID. CONCLUSIONS FGIDs were common in this rural low-resource setting in Central America, with an intriguing distribution of specific FGIDs. EPS and FAB were common, but IBS was not. Local dietary factors were associated with specific FGIDs, suggesting that diet may play a role in global variations of FGIDs.
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Affiliation(s)
- Dalton A Norwood
- Western Honduras Gastric Cancer Prevention Initiative, Western Regional Hospital, Hospital de Occidente, Avenida Solidaridad, 41101, Santa Rosa de Copan, Honduras
| | - Lucia B Dominguez
- Western Honduras Gastric Cancer Prevention Initiative, Western Regional Hospital, Hospital de Occidente, Avenida Solidaridad, 41101, Santa Rosa de Copan, Honduras
| | - Andrea A Paredes
- Western Honduras Gastric Cancer Prevention Initiative, Western Regional Hospital, Hospital de Occidente, Avenida Solidaridad, 41101, Santa Rosa de Copan, Honduras
| | - Eleazar E Montalvan
- Western Honduras Gastric Cancer Prevention Initiative, Western Regional Hospital, Hospital de Occidente, Avenida Solidaridad, 41101, Santa Rosa de Copan, Honduras
| | - Aida Rodriguez Murillo
- Western Honduras Gastric Cancer Prevention Initiative, Western Regional Hospital, Hospital de Occidente, Avenida Solidaridad, 41101, Santa Rosa de Copan, Honduras
| | - Michael K Dougherty
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, 4182, Bioinformatics, 130 Mason Farm RD, Chapel Hill, NC, 27599-6134, USA
| | - Olafur S Palsson
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, 4182, Bioinformatics, 130 Mason Farm RD, Chapel Hill, NC, 27599-6134, USA
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina School of Medicine, 130 Mason Farm Road, CB# 7080, Chapel Hill, NC, 27599, USA
| | - Ricardo L Dominguez
- Western Honduras Gastric Cancer Prevention Initiative, Western Regional Hospital, Hospital de Occidente, Avenida Solidaridad, 41101, Santa Rosa de Copan, Honduras
| | - Douglas R Morgan
- Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham (UAB), 373 Boshell Building, 1720 2nd Avenue South, Birmingham, AL, 35294-0012, USA.
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9
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Cohen C, Kleynhans J, Moyes J, McMorrow ML, Treurnicht FK, Hellferscee O, Mathunjwa A, von Gottberg A, Wolter N, Martinson NA, Kahn K, Lebina L, Mothlaoleng K, Wafawanaka F, Gómez-Olivé FX, Mkhencele T, Mathee A, Piketh S, Language B, Tempia S. Asymptomatic transmission and high community burden of seasonal influenza in an urban and a rural community in South Africa, 2017-18 (PHIRST): a population cohort study. Lancet Glob Health 2021; 9:e863-e874. [PMID: 34019838 PMCID: PMC8262603 DOI: 10.1016/s2214-109x(21)00141-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022]
Abstract
Background Data on influenza community burden and transmission are important to plan interventions especially in resource-limited settings. However, data are limited, particularly from low-income and middle-income countries. We aimed to evaluate the community burden and transmission of influenza in a rural and an urban setting in South Africa. Methods In this prospective cohort study approximately 50 households were selected sequentially from both a rural setting (Agincourt, Mpumalanga Province, South Africa; with a health and sociodemographic surveillance system) and an urban setting (Klerksdorp, Northwest Province, South Africa; using global positioning system data), enrolled, and followed up for 10 months in 2017 and 2018. Different households were enrolled in each year. Households of more than two individuals in which 80% or more of the occupants agreed to participate were included in the study. Nasopharyngeal swabs were collected twice per week from participating household members irrespective of symptoms and tested for influenza using real-time RT-PCR. The primary outcome was the incidence of influenza infection, defined as the number of real-time RT-PCR-positive episodes divided by the person-time under observation. Household cumulative infection risk (HCIR) was defined as the number of subsequent infections within a household following influenza introduction. Findings 81 430 nasopharyngeal samples were collected from 1116 participants in 225 households (follow-up rate 88%). 917 (1%) tested positive for influenza; 178 (79%) of 225 households had one or more influenza-positive individual. The incidence of influenza infection was 43·6 (95% CI 39·8–47·7) per 100 person-seasons. 69 (17%) of 408 individuals who had one influenza infection had a repeat influenza infection during the same season. The incidence (67·4 per 100 person-seasons) and proportion with repeat infections (22 [23%] of 97 children) were highest in children younger than 5 years and decreased with increasing age (p<0·0001). Overall, 268 (56%) of 478 infections were symptomatic and 66 (14%) of 478 infections were medically attended. The overall HCIR was 10% (109 of 1088 exposed household members infected [95% CI 9–13%). Transmission (HCIR) from index cases was highest in participants aged 1–4 years (16%; 40 of 252 exposed household members) and individuals with two or more symptoms (17%; 68 of 396 exposed household members). Individuals with asymptomatic influenza transmitted infection to 29 (6%) of 509 household contacts. HIV infection, affecting 167 (16%) of 1075 individuals, was not associated with increased incidence or HCIR. Interpretation Approximately half of influenza infections were symptomatic, with asymptomatic individuals transmitting influenza to 6% of household contacts. This suggests that strategies, such as quarantine and isolation, might be ineffective to control influenza. Vaccination of children, with the aim of reducing influenza transmission might be effective in African settings given the young population and high influenza burden.
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Affiliation(s)
- Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith L McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Azwifarwi Mathunjwa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil A Martinson
- Perinatal HIV Research Unit, South African Medical Research Council, Soweto Matlosana Collaborating Centre for HIV/AIDS and Tuberculosis, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology, National Research Foundations, Centre of Excellence for Biomedical Tuberculosis Research, University of the Witwatersrand, Johannesburg, South Africa; Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - Kathleen Kahn
- South African Medical Research Council Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit, South African Medical Research Council, Soweto Matlosana Collaborating Centre for HIV/AIDS and Tuberculosis, University of the Witwatersrand, Johannesburg, South Africa
| | - Katlego Mothlaoleng
- Perinatal HIV Research Unit, South African Medical Research Council, Soweto Matlosana Collaborating Centre for HIV/AIDS and Tuberculosis, University of the Witwatersrand, Johannesburg, South Africa
| | - Floidy Wafawanaka
- South African Medical Research Council Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gómez-Olivé
- South African Medical Research Council Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Thulisa Mkhencele
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Angela Mathee
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg, South Africa
| | - Stuart Piketh
- Unit for Environmental Science and Management, Climatology Research Group, North-West University, Potchefstroom, South Africa
| | - Brigitte Language
- Unit for Environmental Science and Management, Climatology Research Group, North-West University, Potchefstroom, South Africa
| | - Stefano Tempia
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; MassGenics, Duluth, GA, USA
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10
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Wong EB, Olivier S, Gunda R, Koole O, Surujdeen A, Gareta D, Munatsi D, Modise TH, Dreyer J, Nxumalo S, Smit TK, Ording-Jespersen G, Mpofana IB, Khan K, Sikhosana ZEL, Moodley S, Shen YJ, Khoza T, Mhlongo N, Bucibo S, Nyamande K, Baisley KJ, Cuadros D, Tanser F, Grant AD, Herbst K, Seeley J, Hanekom WA, Ndung'u T, Siedner MJ, Pillay D. Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study. Lancet Glob Health 2021; 9:e967-e976. [PMID: 34143995 PMCID: PMC8220132 DOI: 10.1016/s2214-109x(21)00176-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND There has been remarkable progress in the treatment of HIV throughout sub-Saharan Africa, but there are few data on the prevalence and overlap of other significant causes of disease in HIV endemic populations. Our aim was to identify the prevalence and overlap of infectious and non-communicable diseases in such a population in rural South Africa. METHODS We did a cross-sectional study of eligible adolescents and adults from the Africa Health Research Institute demographic surveillance area in the uMkhanyakude district of KwaZulu-Natal, South Africa. The participants, who were 15 years or older, were invited to participate at a mobile health camp. Medical history for HIV, tuberculosis, hypertension, and diabetes was established through a questionnaire. Blood pressure measurements, chest x-rays, and tests of blood and sputum were taken to estimate the population prevalence and geospatial distribution of HIV, active and lifetime tuberculosis, elevated blood glucose, elevated blood pressure, and combinations of these. FINDINGS 17 118 adolescents and adults were recruited from May 25, 2018, to Nov 28, 2019, and assessed. Overall, 52·1% (95% CI 51·3-52·9) had at least one active disease. 34·2% (33·5-34·9) had HIV, 1·4% (1·2-1·6) had active tuberculosis, 21·8% (21·2-22·4) had lifetime tuberculosis, 8·5% (8·1-8·9) had elevated blood glucose, and 23·0% (22·4-23·6) had elevated blood pressure. Appropriate treatment and optimal disease control was highest for HIV (78·1%), and lower for elevated blood pressure (42·5%), active tuberculosis (29·6%), and elevated blood glucose (7·1%). Disease prevalence differed notably by sex, across age groups, and geospatially: men had a higher prevalence of active and lifetime tuberculosis, whereas women had a substantially high prevalence of HIV at 30-49 years and an increasing prevalence of multiple and poorly controlled non-communicable diseases when older than 50 years. INTERPRETATION We found a convergence of infectious and non-communicable disease epidemics in a rural South African population, with HIV well treated relative to all other diseases, but tuberculosis, elevated blood glucose, and elevated blood pressure poorly diagnosed and treated. A public health response that expands the successes of the HIV testing and treatment programme to provide multidisease care targeted to specific populations is required to optimise health in such settings in sub-Saharan Africa. FUNDING Wellcome Trust, Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, South African Medical Research Council, and South African Population Research Infrastructure Network. TRANSLATION For the isiZulu translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Emily B Wong
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, AL, USA; Division of Infection and Immunity, University College London, London, UK.
| | - Stephen Olivier
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Resign Gunda
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Olivier Koole
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK
| | - Ashmika Surujdeen
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Day Munatsi
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | | | - Jaco Dreyer
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Siyabonga Nxumalo
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Theresa K Smit
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | | | | | - Khadija Khan
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | | | - Sashen Moodley
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Yen-Ju Shen
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Thandeka Khoza
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Ngcebo Mhlongo
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Sanah Bucibo
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Kennedy Nyamande
- Department of Pulmonology and Critical Care, Inkosi Albert Luthuli Hospital, Durban, South Africa; Department of Respiratory Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Kathy J Baisley
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK
| | - Diego Cuadros
- Department of Geography, University of Cincinnati, USA
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Lincoln International Institute for Rural Health, University of Lincoln, UK; Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Alison D Grant
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Department of Science and Innovation, Medical Research Council, South African Population Research Infrastructure, Durban, South Africa
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; London School of Hygiene & Tropical Medicine, London, UK
| | - Willem A Hanekom
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infection and Immunity, University College London, London, UK
| | - Thumbi Ndung'u
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infection and Immunity, University College London, London, UK; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; The Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard Medical School, Cambridge, MA, USA; Max Planck Institute for Infection Biology, Berlin, Germany
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Deenan Pillay
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Division of Infection and Immunity, University College London, London, UK
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11
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Suzuki A, Matsui M, Tung R, Iwamoto A. "Why did our baby die soon after birth?"-Lessons on neonatal death in rural Cambodia from the perspective of caregivers. PLoS One 2021; 16:e0252663. [PMID: 34097710 PMCID: PMC8183999 DOI: 10.1371/journal.pone.0252663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/19/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Neonatal deaths represent around half the deaths of children less than five-years old in Cambodia. The process from live birth to neonatal death has not been well described. This study aimed to identify problems in health care service which hamper the reduction of preventable neonatal deaths in rural Cambodia. METHODS This study adopted a method of qualitative case study design using narrative data from the verbal autopsy standard. Eighty and forty villages were randomly selected from Kampong Cham and Svay Rieng provinces, respectively. All households in the target villages were visited between January and February 2017. Family caregivers were asked to describe their experiences on births and neonatal deaths between 2015 and 2016. Information on the process from birth to death was extracted with open coding, categorized, and summarized into several groups which represent potential problems in health services. RESULTS Among a total of 4,142 children born in 2015 and 2016, 35 neonatal deaths were identified. Of these deaths, 74% occurred within one week of birth, and 57% were due to low-birth weight. Narrative data showed that three factors should be improved, 1) the unavailability of a health-care professional, 2) barriers in the referral system, and 3) lack of knowledge and skill to manage major causes of neonatal deaths. CONCLUSION The current health system has limitations to achieve further reduction of neonatal deaths in rural Cambodia. The mere deployment of midwives at fixed service points such as health centers could not solve the problems occurring in rural communities. Community engagement revisiting the principle of primary health care, as well as health system transformation, is the key to the solution and potential breakthrough for the future.
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Affiliation(s)
- Ayako Suzuki
- Project for Improving Continuum of Care with focus on Intrapartum and Neonatal Care in Cambodia, Japan International Cooperation Agency, Phnom Penh, Cambodia
| | - Mitsuaki Matsui
- Project for Improving Continuum of Care with focus on Intrapartum and Neonatal Care in Cambodia, Japan International Cooperation Agency, Phnom Penh, Cambodia
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Rathavy Tung
- Project for Improving Continuum of Care with focus on Intrapartum and Neonatal Care in Cambodia, Japan International Cooperation Agency, Phnom Penh, Cambodia
- National Maternal and Child Health Center, Phnom Penh, Cambodia
| | - Azusa Iwamoto
- Project for Improving Continuum of Care with focus on Intrapartum and Neonatal Care in Cambodia, Japan International Cooperation Agency, Phnom Penh, Cambodia
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
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12
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Asrie F, Bazezew A, Motbaynor A, Zeleke B, Dessie K, Bimrew S, Yalew A. Magnitude of Anemia and Associated Factors Among Human Immunodeficiency Virus Infected Children on Highly Active Antiretroviral Therapy at University of Gondar Comprehensive and Specialized Referral Hospital Northwest Ethiopia. Clin Lab 2021; 66. [PMID: 32538059 DOI: 10.7754/clin.lab.2019.190835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anemia is one of the most common hematological problems in HIV infected patients in the world. The main aim of this study was to determine the magnitude of anemia and associated factors among HIV infected children on highly active antiretroviral therapy attending University of Gondar Comprehensive and Specialized Referral Hospital. METHODS A retrospective study was conducted from 2013 to 2018 by reviewing medical records at University of Gondar Comprehensive and Specialized Referral Hospital ART clinic. Records of 238 HIV infected children on HAART were selected using a convenient sampling technique. Socio-demographic characteristics, clinical information, and hematological and immunological profiles of the study participants were collected from the patients record books. WHO cutoff value of hemoglobin was taken and adjusted to define anemia in higher altitude. Data was analyzed by using the SPSS version 20 statistical software, and odds ratios with 95% confidence intervals were used to quantify the strength of association between anemia and its potential predictors. RESULTS The overall prevalence of anemia among HIV infected children in this study was 38.7%. Of anemic children, 48.9% had mild, 39.1% moderate, and 11.9% severe anemia. This study showed that HIV infected children on Highly Active Antiretroviral Therapy who live in rural residence had a two-fold risk of being anemia than urban dwellers (AOR = 2.151, 95% CI, 1.123 - 4.122). There was no significant association with gender, WHO clinical stage, opportunistic infections, cotrimoxazole treatment, and CD4 count percentage. CONCLUSIONS Anemia is a common problem among the children taking highly active antiretroviral therapy. Therefore, health care workers need to routinely investigate and treat anemia, especially in rural dwellers. Furthermore, large scale and longitudinal studies are recommended to strengthen and explore the problem in depth.
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13
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Peña-Galo E, Turón-Alcaine JM, Gracia-Carrasco E, Alcedo-González J. [Evaluation of social distancing measures on the transmissibility of COVID-19 in rural areas. Retrospective logitudinal study of posible cases]. Semergen 2021; 47:181-188. [PMID: 33812795 PMCID: PMC7938792 DOI: 10.1016/j.semerg.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/04/2022]
Abstract
AIM To evaluate the social distance effect on the daily frequency of possible SARS-CoV-2 cases in Primary Care, in relation to the predictive model Kermack-McKendrick. METHODS Longitudinal retrospective study in 2 rural populations of Aragon (13,579h). A time series evaluation with a t-Student analysis was carry on, during the first 70 days of the pandemic. A simple Kermack-McKendrick predictive model was compared with the possible COVID-19 cases. Complementary ANOVA analysis to assess the before-after number of daily cases, follow-up days and days from symptoms onset to first contact with Primary Health Care. RESULTS Three hundred and fifty-nine cases were detected (53.4% women; 70.7% under 60). Primary Care followed 95.3% of cases. The number of cases during the first social distancing strategies was higher in comparison with the model (P=.004, P=.006 and P=.004) with a media of decreases of 6.7 possible cases by series. In relation to the lockdown period the model and cases are close (P=.608 and P=.093), with an average decrease of 1.8 cases per series. During post-containment, the number of cases per day (P<.001) and days of follow-up (P<.001) increased. CONCLUSIONS Social distancing and containment measures were effective in reducing the number of possible COVID-19 cases in rural areas. Primary Care followed most of the cases.
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Affiliation(s)
- E Peña-Galo
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, España; Equipo de Atención Primaria, Servicio Aragonés de la Salud, Calanda, Teruel, España.
| | - J M Turón-Alcaine
- Equipo de Atención Primaria, Servicio Aragonés de la Salud, Andorra, Teruel, España; Equipo de dirección, Sector Sanitario de Alcañiz, Alcañiz, Teruel, España
| | - E Gracia-Carrasco
- Equipo de Atención Primaria, Servicio Aragonés de la Salud, Andorra, Teruel, España
| | - J Alcedo-González
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, España; Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
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14
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Simkin J, Smith L, van Niekerk D, Caird H, Dearden T, van der Hoek K, Caron NR, Woods RR, Peacock S, Ogilvie G. Sociodemographic characteristics of women with invasive cervical cancer in British Columbia, 2004-2013: a descriptive study. CMAJ Open 2021; 9:E424-E432. [PMID: 33888548 PMCID: PMC8101640 DOI: 10.9778/cmajo.20200139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Although cancer screening has led to reductions in the incidence of invasive cervical cancer (ICC) across Canada, benefits of prevention efforts are not equitably distributed. This study investigated the sociodemographic characteristics of women with ICC in British Columbia compared with the general female population in the province. METHODS In this descriptive study, data of individuals 18 years and older diagnosed with ICC between 2004 and 2013 were obtained from the BC Cancer Registry. Self-reported sociodemographic characteristics were derived from standardized health assessment forms (HAFs) completed upon admission in the BC Cancer Registry. Standardized ratios (SRs) were derived by dividing observed and age-adjusted expected counts by ethnicity or race, language, and marital, smoking and urban-rural status. Differences between observed and expected counts were tested using χ2 goodness-of-fit tests. General population data were derived from the 2006 Census, 2011 National Household Survey and 2011/12 Canadian Community Health Survey. RESULTS Of 1705 total cases of ICC, 1315 were referred to BC Cancer (77.1%). Of those who were referred, 1215 (92.4%) completed HAFs. Among Indigenous women, more cases were observed (n = 85) than expected (n = 39; SR 2.16, 95% confidence interval [CI] 2.15-2.18). Among visible minorities, observed cases (n = 320) were higher than expected (n = 253; 95% CI 1.26-1.26). Elevated SRs were observed among women who self-identified as Korean (SR 1.78, 95% CI 1.76-1.80), Japanese (SR 1.77, 95% CI 1.74-1.79) and Filipino (SR 1.60, 95% CI 1.58-1.62); lower SRs were observed among South Asian women (SR 0.63, 95% CI 0.62-0.63). Elevated SRs were observed among current smokers (SR 1.34, 95% CI 1.33-1.34) and women living in rural-hub (SR 1.29, 95% CI 1.28-1.31) and rural or remote (SR 2.62, 95% CI 2.61-2.64) areas; the SR was lower among married women (SR 0.90, 95% CI 0.90-0.90). INTERPRETATION Women who self-identified as visible minorities, Indigenous, current smokers, nonmarried and from rural areas were overrepresented among women with ICC. Efforts are needed to address inequities to ensure all women benefit from cervical cancer prevention.
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Affiliation(s)
- Jonathan Simkin
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Laurie Smith
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Dirk van Niekerk
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Hannah Caird
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Tania Dearden
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Kimberly van der Hoek
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Nadine R Caron
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Ryan R Woods
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Stuart Peacock
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Gina Ogilvie
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
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15
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Abstract
This position statement provides researchers, practitioners, and policymakers an overview of pre-existing and COVID-related rural health inequities in the United States (U.S.) and how they have been exacerbated by the COVID-19 pandemic. "Health deserts," defined as "large areas with inadequate or nonexistent medical and trauma facilities," are common in rural regions of the U.S. While telehealth could address some of these health-related inequities, significant gaps in broadband Internet availability are also common in these more remote areas. The Society of Behavioral Medicine urges Congress to authorize increased funding to rural healthcare facilities and staffing, along with the development of enhanced broadband Internet infrastructure. In addition, incentivizing rural healthcare systems to deliver value-based care could enhance their capacity to implement population health and behavioral health strategies. To stem the spread of COVID-19 in higher-risk rural-based industries (e.g., food processing plants), SBM urges Congress to require the Occupational Safety and Health Administration (OSHA) to routinely inspect for and enforce COVID-19 mitigation procedures, such as provision of effective Personal Protective Equipment (PPE) to all front-line workers and consistent implementation of standardized testing and social distancing advisories. The context of rural communities underscores the importance of tailored approaches to mitigate rural health inequities and promote the well-being of rural residents.
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Affiliation(s)
- Pamela Behrman
- Department of Psychology, College of Mt. St. Vincent, Bronx, NY
| | - Marian L Fitzgibbon
- Institute for Health Research and Policy, University of Illinois, Chicago, IL
| | - Akilah Dulin
- Center for Health Promotion and Health Equity, Brown University, Providence, RI
| | - Monica L Wang
- Boston University School of Public Health, Boston, MA
| | - Monica Baskin
- School of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
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16
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Singh LH, Chandra AK, Yumnam SD, Sarkar D, Manglem RK, Dhabali T, Mookerjee S, Ray I. Thiocyanate in excess develops goiter followed by auto immune thyroid diseases even after effective salt iodization in a rural community of north east India. Ecotoxicol Environ Saf 2021; 208:111711. [PMID: 33396042 DOI: 10.1016/j.ecoenv.2020.111711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE Salt iodization in Manipur of north-east India failed to prevent endemic goiter, therefore an in depth study carried out to evaluate thyroid functions of goitrous subjects in a randomly selected region. METHODS Goiter survey conducted in children and women of reproductive ages by palpation followed by measurement of urinary iodine, thiocyanate and house-hold salt iodine to evaluate iodine nutritional status and consumption pattern of bamboo-shoots (BS). In all grade-2 goitrous subjects, free thyroxine, triiodothyronine, TSH, TPO and Tg antibodies, thyroid volume and echogenecity by ultrasonography and cytomorphology of thyroid by FNAC studied. RESULTS Study population was 2486 children and 1506 women, goiter prevalence was 12.59% and 16.27% respectively; median urinary iodine and mean thiocyanate were 166 µg/l and 0.729 ± 0.408 mg/dl while salt iodine was ≥30 ppm. Serum thyroid hormones and TSH profiles of all grade-2 goitrous subjects showed 16.21% were subclinically hypothyroid, 2.16% overt hypothyroid, 4.86% subclinically hyperthyroid and 6.48% overt hyperthyroid, serum TPO- and Tg-antibodies found positive in 41.62%. Ultrasonographic results showed 24% had enlarged thyroid and 86.4% hypoechoic. Cytomorphological studies showed prevalence of colloid goiter (41.08%), lymphocytic thyroiditis (37.83%), Hashimoto's thyroiditis (8.10%), autoimmune thyroiditis (4.32%), sub-acute thyroiditis (2.16%) and 1.62% each papillary, medullary carcinoma, simple diffused hyperplasia and adenomoid nodular goiter. CONCLUSIONS Grade-2 goitrous individuals in this mild goiter endemic region were affected by hypo- and hyperthyroidism with hypoechoic thyroid and thyroiditis. Thiocyanate that originates from BS even in presence of adequate iodine developed goiter and led goitrous population towards such diseases.
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Affiliation(s)
| | - Amar K Chandra
- Department of Physiology, University of Calcutta, 92, APC Road Kolkata, 700 009 Kolkata, West Bengal, India.
| | | | - Deotima Sarkar
- Department of Physiology, University of Calcutta, 92, APC Road Kolkata, 700 009 Kolkata, West Bengal, India
| | | | - Th Dhabali
- Babina Diagnostics, Imphal, Manipur, India
| | | | - Indrajit Ray
- Department of Human Physiology, Ramkrishna Mahavidyalaya (Govt. of Tripura), Tripura, India
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17
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Abstract
The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs)1-4. Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19)5-8. Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children.
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18
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Nguemeni Tiako MJ, Culhane J, South E, Srinivas SK, Meisel ZF. Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine. JAMA Netw Open 2020; 3:e2029043. [PMID: 33306115 PMCID: PMC7733157 DOI: 10.1001/jamanetworkopen.2020.29043] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE The incidence of opioid use during pregnancy is increasing, and drug overdoses are a leading cause of postpartum mortality. Most women who are pregnant do not receive medications for treatment of opioid use disorder, despite the mortality benefit that these agents confer. Furthermore, buprenorphine is associated with milder symptoms of neonatal abstinence syndrome (NAS) compared with methadone. OBJECTIVE To describe the prevalence and geographic distribution across the US of obstetrician-gynecologists who can prescribe buprenorphine (henceforth described as X-waivered) in 2019. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional, nationwide study linking physician-specific data to county- and state-level data was conducted from September 1, 2019, to March 31, 2020. Data were obtained on 31 211 obstetrician-gynecologists who accept Medicaid insurance through the Centers for Medicare & Medicaid Services Physician Compare data set and linked to the Drug Addiction Treatment Act buprenorphine-waived clinician list. EXPOSURES State-level NAS incidence and county-level uninsured rates and rurality. MAIN OUTCOMES AND MEASURES Prevalence and geographic distribution of obstetrician-gynecologists who are trained to prescribe buprenorphine. RESULTS Among the 31 211 identified obstetrician-gynecologists, 18 710 (59.9%) were women. Most had hospital privileges (23 236 [74.4%]) and worked in metropolitan counties (28 613 [91.7%]). Only 560 of the identified obstetrician-gynecologists (1.8%) were X-waivered. Obstetrician-gynecologists in counties with fewer than 5% uninsured residents had nearly twice the odds of being X-waivered (adjusted odds ratio [aOR], 1.59; 95% CI, 1.04-2.44; P = .04) compared with those in counties with greater than 15% uninsured residents. Compared with those located in metropolitan counties, obstetrician-gynecologists in suburban counties (eg, urban population of ≥20 000 and adjacent to a metropolitan area) were more likely to be X-waivered (aOR, 1.85; 95% CI, 1.26-2.71; P = .002). Compared with states with an NAS rate of 5 per 1000 births or less, obstetrician-gynecologists in states with an NAS rate of 15 per 1000 births or greater had nearly 5 times the odds of being X-waivered (aOR, 4.94; 95% CI, 3.60-6.77; P < .001). Obstetrician-gynecologists without hospital privileges were more likely to be X-waivered (aOR, 1.32; 95% CI, 1.08-1.61; P = .007). CONCLUSIONS AND RELEVANCE Fewer than 2% of obstetrician-gynecologists who accept Medicaid are able to prescribe buprenorphine, and their geographic distribution appears to be skewed in favor of suburban counties. This finding suggests that there is an opportunity for health systems and professional societies to incentivize X-waiver trainings among obstetrician-gynecologists to increase patients' access to buprenorphine, especially during pregnancy.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Medical student, Yale School of Medicine, New Haven, Connecticut
- Center for Emergency Care and Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Urban Health Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jennifer Culhane
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Eugenia South
- Center for Emergency Care and Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Urban Health Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Sindhu K. Srinivas
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Zachary F. Meisel
- Center for Emergency Care and Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV, University of Pennsylvania, Philadelphia
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19
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Cameron NA, Molsberry R, Pierce JB, Perak AM, Grobman WA, Allen NB, Greenland P, Lloyd-Jones DM, Khan SS. Pre-Pregnancy Hypertension Among Women in Rural and Urban Areas of the United States. J Am Coll Cardiol 2020; 76:2611-2619. [PMID: 33183896 PMCID: PMC7704760 DOI: 10.1016/j.jacc.2020.09.601] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Rates of maternal mortality are increasing in the United States with significant rural-urban disparities. Pre-pregnancy hypertension is a well-established risk factor for adverse maternal and offspring outcomes. OBJECTIVES The purpose of this study was to describe trends in maternal pre-pregnancy hypertension among women in rural and urban areas in 2007 to 2018 in order to inform community-engaged prevention and policy strategies. METHODS We performed a nationwide, serial cross-sectional study using maternal data from all live births in women age 15 to 44 years between 2007 and 2018 (CDC Natality Database). Rates of pre-pregnancy hypertension were calculated per 1,000 live births overall and by urbanization status. Subgroup analysis in standard 5-year age categories was performed. We quantified average annual percentage change using Joinpoint Regression and rate ratios (95% confidence intervals [CIs]) to compare yearly rates between rural and urban areas. RESULTS Among 47,949,381 live births to women between 2007 and 2018, rates of pre-pregnancy hypertension per 1,000 live births increased among both rural (13.7 to 23.7) and urban women (10.5 to 20.0). Two significant inflection points were identified in 2010 and 2016, with highest annual percentage changes between 2016 and 2018 in rural and urban areas. Although absolute rates were lower in younger compared with older women in both rural and urban areas, all age groups experienced similar increases. The rate ratios of pre-pregnancy hypertension in rural compared with urban women ranged from 1.18 (95% CI: 1.04 to 1.35) for ages 15 to 19 years to 1.51 (95% CI: 1.39 to 1.64) for ages 40 to 44 years in 2018. CONCLUSIONS Maternal burden of pre-pregnancy hypertension has nearly doubled in the past decade and the rural-urban gap has persisted.
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Affiliation(s)
- Natalie A Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rebecca Molsberry
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Dallas, Texas
| | - Jacob B Pierce
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amanda M Perak
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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20
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Mohan V, Anjana RM, Unnikrishnan R, Venkatesan U, Uma Sankari G, Rahulashankiruthiyayan T, Samhita SK, Subramanian Shanthi Rani C. Incidence of hypertension among Asian Indians: 10 year follow up of the Chennai Urban Rural Epidemiology Study (CURES-153). J Diabetes Complications 2020; 34:107652. [PMID: 32595016 DOI: 10.1016/j.jdiacomp.2020.107652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/01/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
Abstract
AIMS There are very few studies on incidence of hypertension from developing countries. We report on the incidence of hypertension and its risk factors in Chennai city in southern India. METHODS Participants were 1691 individuals from the Chennai Urban Rural Epidemiology Study (CURES) cohorts who did not have hypertension (normotensive n = 878, prehypertension n = 813) at baseline and who were followed for a median of 9.0 years. During the follow-up, 41 with missing blood pressure values were excluded, leaving 1650 individuals for the present analysis. Incidence rates of hypertension and predictors of progression to prehypertension and/or hypertension were estimated using Cox proportional hazards model. RESULTS During the follow-up period, 426 out of 1650 individuals developed hypertension, giving an overall incidence of hypertension of 28.7(95%CI 26.1-31.5) per 1000 person-years. Individuals with dysglycemia at baseline had higher incident rates of hypertension. Collectively, four modifiable risk factors [pre-hypertension, dysglycemia, central obesity and physical inactivity] accounted for 87.2% of the population attributable risk of incident hypertension. CONCLUSIONS Higher body weight, BMI, age and dysglycemia were associated with an increased risk of incident hypertension. Prehypertension, dysglycemia, central obesity and physical inactivity accounted for 87% of incident hypertension.
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Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control & ICMR Center for Advanced Research on Diabetes, Chennai, India.
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control & ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control & ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Ulagamathesan Venkatesan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control & ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Ganesan Uma Sankari
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control & ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Thangarajan Rahulashankiruthiyayan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control & ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Sharat Kumar Samhita
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control & ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Coimbatore Subramanian Shanthi Rani
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control & ICMR Center for Advanced Research on Diabetes, Chennai, India
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21
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Stansert Katzen L, Tomlinson M, Christodoulou J, Laurenzi C, le Roux I, Baker V, Mbewu N, le Roux KW, Rotheram Borus MJ. Home visits by community health workers in rural South Africa have a limited, but important impact on maternal and child health in the first two years of life. BMC Health Serv Res 2020; 20:594. [PMID: 32600455 PMCID: PMC7325027 DOI: 10.1186/s12913-020-05436-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 06/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More than 50% of Africa's population lives in rural areas, which have few professional health workers. South Africa has adopted task shifting health care to Community Health Workers (CHWs) to achieve the Sustainable Development Goals, but little is known about CHWs' efficacy in rural areas. METHODS In this longitudinal prospective cohort study, almost all mothers giving birth (N = 470) in the Zithulele Hospital catchment area of the OR Tambo District were recruited and repeatedly assessed for 2 years after birth with 84.7-96% follow-up rates. During the cohort assessment we found that some mothers had received standard antenatal and HIV care (SC) (n = 313 mothers), while others had received SC, supplemented with home-visiting by CHWs before and after birth (HV) (n = 157 mothers, 37 CHWs). These visits were unrelated to the cohort study. Multiple linear and logistic regressions evaluated maternal comorbidities, maternal caretaking, and child development outcomes over time. RESULTS Compared to mothers receiving SC, mothers who also received home visits by CHWs were more likely to attend the recommended four antenatal care visits, to exclusively breastfeed at 3 months, and were less likely to consult traditional healers at 3 months. Mothers in both groups were equally likely to secure the child grant, and infant growth and achievement of developmental milestones were similar over the first 2 years of life. CONCLUSION CHW home visits resulted in better maternal caretaking, but did not have direct benefits for infants in the domains assessed. The South African Government is planning broad implementation of CHW programmes, and this study examines a comprehensive, home-visiting model in a rural region.
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Affiliation(s)
- Linnea Stansert Katzen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Office 4009, 4th Floor, Education Building, Francie van Zijl Drive, Tygerberg, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Office 4009, 4th Floor, Education Building, Francie van Zijl Drive, Tygerberg, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Joan Christodoulou
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, 10920 Wilshire Blvd., Suite 350, Los Angeles, California 90024 USA
| | - Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Office 4009, 4th Floor, Education Building, Francie van Zijl Drive, Tygerberg, South Africa
| | - Ingrid le Roux
- Philani Maternal, Child Health and Nutrition Trust, Phaphani Street, Site C, Khayelitsha, Cape Town, South Africa
| | - Venetia Baker
- Philani Maternal, Child Health and Nutrition Trust, Phaphani Street, Site C, Khayelitsha, Cape Town, South Africa
| | - Nokwanele Mbewu
- Philani Maternal, Child Health and Nutrition Trust, Phaphani Street, Site C, Khayelitsha, Cape Town, South Africa
| | - Karl W. le Roux
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Office 4009, 4th Floor, Education Building, Francie van Zijl Drive, Tygerberg, South Africa
- Department of Family Medicine, Walter Sisulu University, Nelson Mandela Drive, Mthatha, 5117 South Africa
- Primary Health Care Directorate, Old Main Building, Groote Schuur Hospital, E47-25, Observatory 7925, Cape Town, South Africa
- Zithulele Training and Research Centre, Zithulele Hospital, Mqanduli District, Eastern Cape, South Africa
| | - Mary Jane Rotheram Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, 10920 Wilshire Blvd., Suite 350, Los Angeles, California 90024 USA
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22
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Quinn K, Eldridge Houser JL, Kapp JM. Missouri Rapid Rural Population Health Response to the COVID-19 Pandemic. Mo Med 2020; 117:177-179. [PMID: 32636540 PMCID: PMC7302036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Kathleen Quinn
- Associate Dean for Rural Health in the School of Medicine and with University Extension University of Missouri - Columbia, Columbia, Missouri
| | - Jennifer L Eldridge Houser
- County Engagement Specialist in Nutrition and Health Education in University Extension University of Missouri - Columbia, Columbia, Missouri
| | - Julie M Kapp
- School of Medicine and Population Health Sciences, Precision Health Initiative, University of Missouri - Columbia, Columbia, Missouri
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23
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Baliatsas C, Dückers M, Smit LA, Heederik D, Yzermans J. Morbidity Rates in an Area with High Livestock Density: A Registry-Based Study Including Different Groups of Patients with Respiratory Health Problems. Int J Environ Res Public Health 2020; 17:E1591. [PMID: 32121551 PMCID: PMC7084699 DOI: 10.3390/ijerph17051591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/17/2020] [Accepted: 02/24/2020] [Indexed: 01/12/2023]
Abstract
There is continuing debate and public health concern regarding the previously confirmed association between high livestock density and human health. The primary aim of the current study is to assess the prevalence of respiratory and other health problems in a livestock dense area in the Netherlands, based on recent longitudinal health data and a large sample. Analyses are expanded with the investigation of different subgroups of patients with respiratory health problems and the inclusion of various chronic and acute health outcomes, as well as prescribed medication. Prevalence of health symptoms and chronic conditions was assessed for the period 2014-2016, based on electronic health records registered in 26 general practices located in areas with intensive livestock farming in the Netherlands ("livestock dense area", n = 117,459 unique residents in total). These were compared with corresponding health data from general practices (n = 22) in different rural regions with a low density of livestock farms or other major environmental exposures ("control area", n = 85,796 unique residents in total). Multilevel regression models showed a significantly higher prevalence of pneumonia in the total sample in the livestock dense area, which was also observed among susceptible subgroups of children, the elderly, and patients with chronic obstructive pulmonary disease (COPD). Lower respiratory tract infections, respiratory symptoms, vertigo, and depression were also more common in the livestock dense area compared to the control area. In general, there were no significant differences in chronic conditions such as asthma, COPD, or lung cancer. Prescription rates for broad-spectrum antibiotics were more common among patients with pneumonia in the livestock dense area. Acute respiratory infections and symptoms, but not chronic conditions, were considerably more common in areas with a high livestock density. Identification of causal pathogens on the basis of serological analyses could further elucidate the underlying mechanisms behind the observed health effects.
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Affiliation(s)
- Christos Baliatsas
- Department of Disasters and Environmental Hazards, Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands; (M.D.)
| | - Michel Dückers
- Department of Disasters and Environmental Hazards, Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands; (M.D.)
| | - Lidwien A.M. Smit
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584 CM Utrecht, The Netherlands; (L.A.M.S.)
| | - Dick Heederik
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584 CM Utrecht, The Netherlands; (L.A.M.S.)
| | - Joris Yzermans
- Department of Disasters and Environmental Hazards, Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands; (M.D.)
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Odwee A, Kasozi KI, Acup CA, Kyamanywa P, Ssebuufu R, Obura R, Agaba JB, Makeri D, Kirimuhuzya C, Sasirabo O, Bamaiyi PH. Malnutrition amongst HIV adult patients in selected hospitals of Bushenyi district in southwestern Uganda. Afr Health Sci 2020; 20:122-131. [PMID: 33402900 PMCID: PMC7750061 DOI: 10.4314/ahs.v20i1.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Malnutrition is an important clinical outcome amongst HIV patients in developing countries and in Uganda, there is scarcity of information on its prevalence and risk factors amongst HIV adult patients. METHODS A cross-sectional study amongst 253 HIV patients in Bushenyi district assessed their nutritional status using the body mass index (BMI) and mid-upper arm circumference (MUAC), and a questionnaire was used to identify major risk factors. RESULTS The mean age of the study participants was 38.74 ± 0.80 yrs, while females and males were 52.2% and 47.8% respectively. Prevalence of malnutrition was 10.28% (95% CI: 6.82 - 14.69) in the study. Major socio-economic factors associated with malnutrition were being female, unemployed, dependent and with many family members. Patients with opportunistic infections, low adherence to HAART, and stage of HIV/AIDS had a higher risk of malnutrition. DISCUSSION In rural communities, a majority of malnourished patients are elderly and these were identified as priority groups for HIV outreach campaigns. The current policy of prioritizing children and women is outdated due to changing disease dynamics, thus showing a need to revise extension service provision in rural communities. CONCLUSIONS Malnutrition is a threat in HIV adult patients in rural communities of Uganda.
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Affiliation(s)
- Ambrose Odwee
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Keneth Iceland Kasozi
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University Western Campus, Box 71, Bushenyi, Uganda
| | - Christine Amongi Acup
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Patrick Kyamanywa
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Robinson Ssebuufu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Richard Obura
- School of Business and Management, Mountains of the Moon University, Box 837, Fort Portal, Uganda
| | - Jude B Agaba
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Danladi Makeri
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Claude Kirimuhuzya
- Department of Pharmacology, School of Pharmacy, Kampala International University Western Campus, Box 71 Bushenyi, Uganda
- Department of Pharmacology, School of Medicine, Kabale University, Kabale, Uganda
| | - Olivia Sasirabo
- School of Business and Management, Mountains of the Moon University, Box 837, Fort Portal, Uganda
| | - Pwaveno H Bamaiyi
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
- Postgraduate School and Research Directorate, Kampala International University Western Campus, Box 71, Bushenyi, Uganda
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Jos, Plateau State, Nigeria
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Wang M, Wu T, Yu C, Gao W, Lv J, Wu Y, Qin X, Tang X, Gao P, Zhan S, Cao W, Zhao Q, Huang S, Yang D, Li L, Hu Y. Association between blood pressure levels and cardiovascular deaths: a 20-year follow-up study in rural China. BMJ Open 2020; 10:e035190. [PMID: 32102826 PMCID: PMC7045167 DOI: 10.1136/bmjopen-2019-035190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline recommended 130/80 mm Hg as blood pressure (BP) target goals. However, the generalisability of this recommendation to populations at large with hypertension remains controversial. We assessed the association between BP and cardiovascular diseases (CVDs) mortality using a 20-year follow-up study among Chinese populations. DESIGN Prospective cohort study. PARTICIPANTS 7314 participants were followed up for a median of 20 years in Fangshan District, Beijing, China. METHODS The primary outcome variable was death from cardiovascular causes. The adjusted HR for CVDs mortality associated with baseline BP was calculated using Cox regression analysis. RESULTS We identified 350 deaths from CVDs (148 stroke, 113 coronary heart disease and 89 other CVDs) during follow-up. Hypertension (defined by systolic BP (SBP)/diastolic BP (DBP) ≥140/90 mm Hg) was significantly associated with mortality due to CVDs (HR=2.49, 95% CI=1.77 to 3.50) among people aged 35-59 years rather than people aged ≥60 years. In addition, there was no significant association between stage 1 hypertension defined by the 2017 ACC/AHA (SBP/DBP of 130-139/80-89 mm Hg) and CVDs mortality when compared with SBP/DBP of <120/80 in neither the participants aged <60 years (HR=0.90, 95% CI=0.54 to 1.50) nor participants aged ≥60 years (HR=1.47, 95% CI=0.94 to 2.29). CONCLUSION The study revealed hypertension of SBP/DBP≥140/90 mm Hg was an important risk factor of CVDs mortality, especially among people aged 35-59 years. However, stage 1 hypertension under the definition of 2017 ACC/AHA was not associated with an increased risk of CVDs mortality. This study indicated that whether adopting the new hypertension definition needs further consideration in rural Chinese populations.
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Affiliation(s)
- Mengying Wang
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Tao Wu
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Canqing Yu
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Wenjing Gao
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Jun Lv
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Yiqun Wu
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Xueying Qin
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Xun Tang
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Pei Gao
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Siyan Zhan
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Weihua Cao
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Qingshui Zhao
- General Office, Fangshan District Health Commission, Beijing, China
| | - Shaoping Huang
- General Office, Fangshan District Health Commission, Beijing, China
| | - Dongli Yang
- General Office, Fangshan District Health Commission, Beijing, China
| | - Liming Li
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Yonghua Hu
- Epidemiology and Biostatistics, Peking University, Beijing, China
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Yang T. Association between perceived environmental pollution and health among urban and rural residents-a Chinese national study. BMC Public Health 2020; 20:194. [PMID: 32028903 PMCID: PMC7006119 DOI: 10.1186/s12889-020-8204-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/13/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND China's economic boom has led to severe environmental pollution, which has created significant health risks for residents. Although current studies have found urban residents can sense the harmful effects of environmental pollution in China, few studies have talked about their rural counterparts' attitudes towards the health impacts of environmental pollution. Similarly, little research has talked about the inequality of environmental awareness between urban and rural residents. METHODS Descriptive and analytical statistics were used for the data analyses based on a national survey, namely, The 3rd Survey on the Status of Chinese Women in 2010, which was jointly conducted by the All China Women's Federation and the China Statistical Bureau in 2010. A total of 24741observations were selected. RESULTS Among urban residents, 67.21% reported that their total health was good, which was 1.35% lower than the reported rate of their rural counterparts; 25.88% of urban residents reported that their total health was general, which was nearly 3% higher than the reported rate of their rural counterparts; 6.91% of urban residents reported that their total health was poor, which was 1.63% lower than the reported rate of their rural counterparts. The study also found that the rates of urban residents who perceived air pollution (35.67%), water pollution (17.96%), garbage pollution (25.05%), and noise pollution (32.05%) were higher than those of their rural counterparts. Perceived air pollution, and perceived noise pollution both had a negative effect on urban residents' good health (B = - 0.14, p < 0.05; B = -0.23, p < 0.001). Perceived garbage pollution had a positive effect on urban residents' poor health (B = 0.33, p < 0.01). Perceived water pollution had no significant effect on urban residents' health. The four types of perceived environmental pollution all had insignificant effects on rural residents' health. CONCLUSIONS Rural residents lack awareness of the impacts of environmental pollution on health, which may create risks and vulnerability within the rural environment and the livelihood of these residents. Great attention should be paid to the impacts of environmental pollution on the health of not only urban residents but also rural residents, which will highly improve the support of green development among the public in China.
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Affiliation(s)
- Ting Yang
- School of Sociology, Huazhong University of Science & Technology, 1037 Luoyu Road, Wuchang, Wuhan, 430074, China.
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Essuon AD, Zhao H, Wang G, Collins N, Karch D, Rao S. HIV Testing Outcomes Among Blacks or African Americans - 50 Local U.S. Jurisdictions Accounting for the Majority of New HIV Diagnoses and Seven States with Disproportionate Occurrences of HIV in Rural Areas, 2017. MMWR Morb Mortal Wkly Rep 2020; 69:97-102. [PMID: 31999684 PMCID: PMC7004407 DOI: 10.15585/mmwr.mm6904a2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sansone G, Fong GT, Yan M, Meng G, Craig L, Xu SS, Quah ACK, Wu C, Feng G, Jiang Y. Secondhand smoke exposure and support for smoke-free policies in cities and rural areas of China from 2009 to 2015: a population-based cohort study (the ITC China Survey). BMJ Open 2019; 9:e031891. [PMID: 31831539 PMCID: PMC6924814 DOI: 10.1136/bmjopen-2019-031891] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To examine trends in smoking prevalence in key venues (workplaces, restaurants, bars) and in public support for comprehensive smoke-free laws, with comparisons between cities and rural areas in China. DESIGN Data are from Waves 3-5 (2009-2015) of the International Tobacco Control (ITC) China Survey, a cohort survey of smokers and non-smokers. Logistic regression analyses employing generalised estimating equations assessed changes in smoking prevalence and support for smoke-free laws over time; specific tests assessed whether partial smoking bans implemented in three cities between Waves 3 and 4 had greater impact. SETTING Face-to-face surveys were conducted in seven cities (Beijing, Changsha, Guangzhou, Kunming, Shanghai, Shenyang and Yinchuan) and five rural areas (Changzhi, Huzhou, Tongren, Yichun and Xining). PARTICIPANTS In each survey location at each wave, a representative sample of approximately 800 smokers and 200 non-smokers (aged 18+) were selected using a multistage cluster sampling design. MAIN OUTCOME MEASURES Prevalence of smoking (whether respondents noticed smoking inside restaurants, bars and workplaces); smoking rules inside these venues; and support for complete smoking bans in these venues. RESULTS Although smoking prevalence decreased and support increased over time, neither trend was greater in cities that implemented partial smoke-free laws. Smoking was higher in rural than urban workplaces (62% vs 44%, p<0.01), but was equally high in all restaurants and bars. There were generally no differences in secondhand smoke (SHS) exposure between smokers and non-smokers except in rural workplaces (74% vs 58%, p<0.05). Support for comprehensive bans was equally high across locations. CONCLUSIONS Partial laws have had no effect on reducing SHS in China. There is an urgent need for comprehensive smoke-free laws to protect the public from exposure to deadly tobacco smoke in both urban and rural areas. The high support among Chinese smokers for such a law demonstrates that public support is not a barrier for action.
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Affiliation(s)
- Genevieve Sansone
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Mi Yan
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Steve S Xu
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Changbao Wu
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Guoze Feng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuan Jiang
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
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Abstract
BACKGROUND Injuries are among the top 10 leading causes of death in Canada. However, the types and rates of injuries vary between rural versus urban settings. Injury rates increase with rurality, particularly those related to motor vehicle collisions. Factors such as type of work, hazardous environments and longer driving distances contribute to the difference in rural and urban injury rates. Further examination of injuries comparing rural and urban settings with increased granularity in the nature of injuries and severity is needed. METHODS The study population consisted of records from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) from between 2011 and July 2017. Rural and urban status was determined based on postal codes as defined by Canada Post. Proportionate injury ratios (PIRs) were calculated to compare rural and urban injury rates by nature and severity of injury and sex, among other factors. RESULTS Rural injuries were more likely to involve multiple injuries (PIR = 1.66 for 3 injuries) and crush injuries (PIR = 1.72). More modestly elevated PIRs for rural settings were found for animal bites (1.14), burns (1.22), eye injuries (1.32), fractures (1.20) and muscle or soft tissue injuries (1.11). Injuries in rural areas were more severe, with a higher likelihood of cases being admitted to hospital (1.97), and they were more likely to be due to a motor vehicle collision (2.12). CONCLUSION The nature of injuries in rural settings differ from those in urban settings. This suggests a need to evaluate current injury prevention efforts in rural settings with the aim to close the gap between rural and urban injury rates.
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Affiliation(s)
- Felix Bang
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Steven McFaull
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - James Cheesman
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Minh T Do
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
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Zhao G, Okoro CA, Hsia J, Garvin WS, Town M. Prevalence of Disability and Disability Types by Urban-Rural County Classification-U.S., 2016. Am J Prev Med 2019; 57:749-756. [PMID: 31753256 PMCID: PMC10939996 DOI: 10.1016/j.amepre.2019.07.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION In the U.S., disability affects approximately 61.4 million (25.7%) adults, with mobility disability being the most prevalent type, affecting about 1 in 7 U.S. adults. However, little is known about the prevalence of disability and functional disability types by urbanization level. METHODS Data from the 2016 Behavioral Risk Factor Surveillance System were analyzed. The prevalences of disability, overall and by functional disability type, were estimated among U.S. adults across 6 levels of urban-rural county categories based on the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. Adjusted prevalence ratios with 95% CIs were estimated by conducting log-linear regression analyses with robust variance estimator while adjusting for study covariates. Data analyses were conducted in 2018. RESULTS The prevalences of having any disability, functional disability type, or multiple disabilities were lowest in large metropolitan centers and fringe metropolitan counties and highest in noncore (rural) counties. After controlling for age, sex, race/ethnicity, education, and federal poverty level, adults living in noncore counties were 9% more likely to report having any disability, 24% more likely to report having 3 or more disabilities, and 7% (cognition) to 35% (hearing) more likely to report specific disability types than the adults living in large metropolitan centers. CONCLUSIONS Results of this study suggest that significant disparities in the prevalence of disability exist by level of urbanization, with rural U.S. residents having the highest prevalence of disability. Public health interventions to reduce health disparities could include people with disabilities, particularly in rural counties.
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Affiliation(s)
- Guixiang Zhao
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia.
| | - Catherine A Okoro
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jason Hsia
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - William S Garvin
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Machell Town
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
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Abstract
OBJECTIVE To examine the association between social capital and the health of male and female left-behind older adults in rural China. STUDY DESIGN This cross-sectional study among the left-behind older adults aged 60 and older and with all their children working outside of Hubei, Shaanxi and Guangdong provinces in China was conducted in 2017-2018. A total of 1106 questionnaires were collected (participation rate=100.0%), and questionnaires from 1016 participants were used (effective rate=91.9%). METHODS An ordinary least squares model was used to evaluate the association between social capital and health. Social capital included family trust, friend/neighbour trust, stranger trust, social participation, and network size and density. Health outcomes included basic and instrumental activities of daily living (BADL and IADL) and depression. RESULTS Elevated family trust, friend/neighbour trust, stranger trust, high-level participation and middle-level network density were associated with reduced depression (b=-3.23, p<0.001; b=-0.41, p<0.001; b=-0.76, p<0.01; b=-1.04, p<0.05; b=-0.74, p<0.05, respectively). High-level participation and network density were also associated with elevated BADL (b=0.16, p<0.05; b=0.24, p<0.05, respectively). Elevated family trust (b=-2.86, p<0.05 in men; b=-3.86, p<0.001 in women), stranger trust (b=-0.68, p<0.05 in men; b=-0.80, p<0.05 in women) and high-level participation (b=-0.92, p<0.05 in men; b=-1.22, p<0.01 in women) were associated with reduced depression in both sexes. By contrast, elevated friend/neighbour trust was associated with reduced depression (b=-0.56, p<0.001) in women, high-level participation was associated with elevated BADL (b=0.19, p<0.05) and IADL (b=0.43, p<0.05) in men, and high-level network density was associated with elevated BADL (b=0.44, p<0.05) and IADL (b=0.57, p<0.05) and reduced depression (b=-1.05, p<0.05) in women. CONCLUSIONS Social capital is closely related to left-behind older adults' health in rural China. More attention should be paid to increasing the stock of social capital in this special population, with a particular focus on the sex disparity.
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Affiliation(s)
- Yan Ke
- School of Literature, Law and Economics, Wuhan University of Science and Technology, Wuhan, China
| | - Junfeng Jiang
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Yu Chen
- School of Literature, Law and Economics, Wuhan University of Science and Technology, Wuhan, China
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Steinholt M, Ha SO, Houy C, Odland JØ, Odland ML. An Increased Risk of Stunting among Newborns in Poorer Rural Settings: A Cross-Sectional Pilot Study among Pregnant Women at Selected Sites in Rural Cambodia. Int J Environ Res Public Health 2019; 16:ijerph16214170. [PMID: 31671791 PMCID: PMC6861886 DOI: 10.3390/ijerph16214170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/26/2019] [Accepted: 10/27/2019] [Indexed: 02/01/2023]
Abstract
We conducted an observational study of 194 pregnant women from two different study sites in rural Cambodia. Socioeconomic and anthropometric data was obtained from the women and their newborns. In addition, we collected blood and urine samples from the women for further analyses in planned papers. There were significant differences between the two study groups for clinical outcomes. The mothers from the poorer area were shorter and weighed less at the time of inclusion. Their babies had significantly smaller head circumferences and a lower ponderal index. Conclusion: There are significant anthropometric differences between women and their newborns from two separate study sites in Cambodia. Possible associations between stunting and exposure to Persistent Toxic Substances (PTS) as organochlorines and toxic trace elements will be investigated in future studies.
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Affiliation(s)
- Margit Steinholt
- Helgelandssykehuset, 8801 Sandnessjoen, Norland, Norway.
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | - Sam Ol Ha
- Trauma Care Foundation, Battambang, Cambodia.
| | - Chandy Houy
- Trauma Care Foundation, Battambang, Cambodia.
| | - Jon Øyvind Odland
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | - Maria Lisa Odland
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
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Zhao M, Liu B, Shan L, Li C, Wu Q, Hao Y, Chen Z, Lan L, Kang Z, Liang L, Ning N, Jiao M. Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China. BMC Health Serv Res 2019; 19:654. [PMID: 31500617 PMCID: PMC6734466 DOI: 10.1186/s12913-019-4480-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 08/28/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Integration of medical insurance schemes has been prioritized as one of the key strategies to address inequity in China's health system. The first pilot attempt to integrate started in 2003 and later expanded nationwide. This study aims to assess its intended impact on inequity in inpatient service utilization and identify the main determinants contributing to its ineffectiveness. METHODS A total of 49,365 respondents in the pilot integrated area and 77,165 respondents in the non-integration area were extracted from the Fifth National Health Services Survey. A comparative analysis was conducted between two types of areas. We calculate a concentration index (CI) and horizontal inequity index (HI) in inpatient service utilization and decompose the two indices. RESULTS Insurance integration played a positive role in reducing inequality in inpatient service utilization to some extent. A 13.23% lower in HI, a decrease in unmet inpatient care and financial barriers to inpatient care in the pilot integrated area compared with the non-integration area; decomposition analysis showed that the Urban-Rural Residents Basic Medical Insurance, a type of integrated insurance, contributed 37.49% to reducing inequality in inpatient service utilization. However, it still could not offset the strong negative effect of income and other insurance schemes that have increased inequality. CONCLUSIONS The earlier pilot attempt for integrating medical insurance was not enough to counteract the influence of factors which increased the inequality in inpatient service utilization. Further efforts to address the inequality should focus on widening access to financing, upgrading the risk pool, reducing gaps within and between insurance schemes, and providing broader chronic disease benefit packages. Social policies that target the needs of the poor with coordinated efforts from various levels and agencies of the government are urgently needed.
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Affiliation(s)
- Miaomiao Zhao
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
- Department of Health Management, School of Public Health, Nantong University, 9 Seyuan Road, Chongchuan District, Nantong, 226019, Jiangsu, China
| | - Baohua Liu
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Linghan Shan
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Cui Li
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
| | - Yanhua Hao
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
| | - Zhuo Chen
- Department of Health Policy and Management College of Public Health, University of Georgia, Athens, GA, 30602, USA
- School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo, 199 Taikang East Road, Ningbo, Zhejiang, 315100, China
| | - Lan Lan
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Zheng Kang
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Libo Liang
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Ning Ning
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Mingli Jiao
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
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Fan C, Ouyang W, Tian L, Song Y, Miao W. Elderly Health Inequality in China and its Determinants: A Geographical Perspective. Int J Environ Res Public Health 2019; 16:E2953. [PMID: 31426371 PMCID: PMC6719074 DOI: 10.3390/ijerph16162953] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/20/2019] [Accepted: 07/31/2019] [Indexed: 11/16/2022]
Abstract
Inter-regional health differences and apparent inequalities in China have recently received significant attention. By collecting health status data and individual socio-economic information from the 2015 fourth sampling survey of the elderly population in China (4th SSEP), this paper uses the geographical differentiation index to reveal the spatial differentiation of health inequality among Chinese provinces. We test the determinants of inequalities by multilevel regression models at the provincial and individual levels, and find three main conclusions: 1) There were significant health differences on an inter-provincial level. For example, provinces with a very good or good health rating formed a good health hot-spot region in the Yangtze River Delta, versus elderly people living in Gansu and Hainan provinces, who had a poor health status. 2) Nearly 2.4% of the health differences in the elderly population were caused by inter-provincial inequalities; access (or lack of access) to economic, medical and educational resources was the main reason for health inequalities. 3) At the individual level, inequalities in annual income served to deepen elderly health differences, and elderly living in less developed areas were more vulnerable to urban vs. rural-related health inequalities.
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Affiliation(s)
- Chenjing Fan
- School of Architecture, Tsinghua University, Beijing 100084, China
- College of Landscape Architecture, Nanjing Forestry University, Nanjing 210037, China
| | - Wei Ouyang
- School of Public Administration, Renmin University of China, Beijing 100872, China
| | - Li Tian
- School of Architecture, Tsinghua University, Beijing 100084, China.
| | - Yan Song
- Department of City and Regional Planning, University of North Carolina at Chapel Hill, NC 27599-3140, USA
| | - Wensheng Miao
- China Research Center on Aging, Beijing 100054, China
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Modjadji P, Madiba S. The double burden of malnutrition in a rural health and demographic surveillance system site in South Africa: a study of primary schoolchildren and their mothers. BMC Public Health 2019; 19:1087. [PMID: 31399048 PMCID: PMC6689169 DOI: 10.1186/s12889-019-7412-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In South Africa, the occurrence of the double burden of malnutrition is on the rise at a household level predisposing children and their mothers to negative health outcomes. However, few studies have been conducted at a household level. Therefore, we studied a double burden of malnutrition using child-mother pairs in a rural setting. METHODS A cross-sectional quantitative survey was conducted among 508 child-mother pairs selected from primary schools using a multistage sampling in a rural Dikgale Health and Demographic Site in Limpopo Province, South Africa. Anthropometric measurements of children and mothers, and socio-demographic data were collected. WHO AnthroPlus was used to generate body-mass-index z-scores of children and the BMI was used to indicate overweight and obesity among the mothers. Mann Whitney test was used to compare the means of variables between sexes and age groups, while the prevalence of thinness and overweight/obesity were compared using a chi-square. Multivariate logistic regression with a stepwise backward elimination procedure, controlling for confounding, was used to determine the association between the thinness and overweight/obesity and the covariates. RESULTS Twenty five percent (25%) of the children were thin, 4% were overweight and 1% obese, while mothers were overweight (27.4%) and 42.3% obesity (42.3%) were observed among the mothers. The odds of being thin were higher in boys than in girls (AOR = 1.53, 95%CI: 1.01-2.35). Overweight/obese mothers were more likely to have thin children (AOR = 1.48, 95% CI: 1.01-2.18) and less likely to have overweight/obese children (AOR = 0.18, 95%CI: 0.07-0.46). CONCLUSION A double burden of malnutrition was observed on a household level with thinness among children and overweight/obesity among mothers. A need to address the dual problems of undernutrition and rapidly rising trends of overweight/obesity cannot be over-emphasized.
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Affiliation(s)
- Perpetua Modjadji
- Department of Public Health, Sefako Makgatho Health Sciences University, School of Health Care Sciences, P O Box 215, Ga-Rankuwa, MEDUNSA, 0204, South Africa.
| | - Sphiwe Madiba
- Department of Public Health, Sefako Makgatho Health Sciences University, School of Health Care Sciences, P O Box 215, Ga-Rankuwa, MEDUNSA, 0204, South Africa
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Altaf A, Iqbal S, Shah SA. A third major human immunodeficiency viruses (HIV) outbreak in Larkana, Pakistan: caused by unsafe injection practices. J PAK MED ASSOC 2019; 69:1068-1069. [PMID: 31431753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Shen G, Ru M, Du W, Zhu X, Zhong Q, Chen Y, Shen H, Yun X, Meng W, Liu J, Cheng H, Hu J, Guan D, Tao S. Impacts of air pollutants from rural Chinese households under the rapid residential energy transition. Nat Commun 2019; 10:3405. [PMID: 31363099 PMCID: PMC6667435 DOI: 10.1038/s41467-019-11453-w] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 07/16/2019] [Indexed: 12/25/2022] Open
Abstract
Rural residential energy consumption in China is experiencing a rapid transition towards clean energy, nevertheless, solid fuel combustion remains an important emission source. Here we quantitatively evaluate the contribution of rural residential emissions to PM2.5 (particulate matter with an aerodynamic diameter less than 2.5 μm) and the impacts on health and climate. The clean energy transitions result in remarkable reductions in the contributions to ambient PM2.5, avoiding 130,000 (90,000-160,000) premature deaths associated with PM2.5 exposure. The climate forcing associated with this sector declines from 0.057 ± 0.016 W/m2 in 1992 to 0.031 ± 0.008 W/m2 in 2012. Despite this, the large remaining quantities of solid fuels still contributed 14 ± 10 μg/m3 to population-weighted PM2.5 in 2012, which comprises 21 ± 14% of the overall population-weighted PM2.5 from all sources. Rural residential emissions affect not only rural but urban air quality, and the impacts are highly seasonal and location dependent.
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Affiliation(s)
- Guofeng Shen
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Peking University, 100871, Beijing, China
| | - Muye Ru
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Peking University, 100871, Beijing, China
- Nicholas school of the Environment, Duke University, Durham, NC, 27705, USA
| | - Wei Du
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Peking University, 100871, Beijing, China
| | - Xi Zhu
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Peking University, 100871, Beijing, China
| | - Qirui Zhong
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Peking University, 100871, Beijing, China
| | - Yilin Chen
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Peking University, 100871, Beijing, China
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Huizhong Shen
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Peking University, 100871, Beijing, China
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Xiao Yun
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Peking University, 100871, Beijing, China
| | - Wenjun Meng
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Peking University, 100871, Beijing, China
| | - Junfeng Liu
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Peking University, 100871, Beijing, China
| | - Hefa Cheng
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Peking University, 100871, Beijing, China
| | - Jianying Hu
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Peking University, 100871, Beijing, China
| | - Dabo Guan
- School of International Development, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Shu Tao
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Peking University, 100871, Beijing, China.
- Sino-French Institute for Earth System Science, Peking University, 100871, Beijing, China.
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Zapata ME, Rovirosa A, Carmuega E. [Urban and rural: differences in the diet of Argentine households according to income level and area of residence]. Salud Colect 2019; 15:e2201. [PMID: 31829400 DOI: 10.18294/sc.2019.2201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 11/24/2022] Open
Abstract
The environment and the socioeconomic level are determinants of eating behavior because they affect availability, accessibility and food preferences. In order to describe the apparent consumption of food and the availability of energy and nutrients in urban and rural households in Argentina according to their income level, the 2004-2005 National Household Expenditure Survey was analyzed. The average apparent consumption of food and beverages was calculated in grams or milliliters of net weight per adult equivalent per day, for urban and rural households, and by household income per capita quintiles. Rural households made up 7% of the sample, and had a higher proportion of low-income families than urban households. There is different pattern of apparent consumption of food and beverages among rural and urban households in Argentina, and there are also differences between households according to the level of income in both environments. Knowing the content and magnitude of these contrasts is of great use in looking for strategies to improve the population's diet.
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Affiliation(s)
- María Elisa Zapata
- Magíster en Nutrición Humana y Calidad de los Alimentos. Investigadora adjunta, Centro de Estudios sobre Nutrición Infantil Dr. Alejandro O'Donnell (CESNI), Ciudad Autónoma de Buenos Aires, Argentina.
| | - Alicia Rovirosa
- Bioquímica. Investigadora adjunta, Centro de Estudios sobre Nutrición Infantil Dr. Alejandro O'Donnell (CESNI), Ciudad Autónoma de Buenos Aires, Argentina.
| | - Esteban Carmuega
- Médico Pediatra. Director, Centro de Estudios sobre Nutrición Infantil Dr. Alejandro O'Donnell (CESNI), Ciudad Autónoma de Buenos Aires, Argentina.
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Dullie L, Meland E, Hetlevik Ø, Mildestvedt T, Kasenda S, Kantema C, Gjesdal S. Performance of primary care in different healthcare facilities: a cross-sectional study of patients' experiences in Southern Malawi. BMJ Open 2019; 9:e029579. [PMID: 31324683 PMCID: PMC6661549 DOI: 10.1136/bmjopen-2019-029579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In most African countries, primary care is delivered through a district health system. Many factors, including staffing levels, staff experience, availability of equipment and facility management, affect the quality of primary care between and within countries. The purpose of this study was to assess the quality of primary care in different types of public health facilities in Southern Malawi. STUDY DESIGN This was a cross-sectional quantitative study. SETTING The study was conducted in 12 public primary care facilities in Neno, Blantyre and Thyolo districts in July 2018. PARTICIPANTS Patients aged ≥18 years, excluding the severely ill, were selected to participate in the study. PRIMARY OUTCOMES We used the Malawian primary care assessment tool to conduct face-to-face interviews. Analysis of variance at 0.05 significance level was performed to compare primary care dimension means and total primary care scores. Linear regression models at 95% CI were used to assess associations between primary care dimension scores, patients' characteristics and healthcare setting. RESULTS The final number of respondents was 962 representing 96.1% response rate. Patients in Neno hospitals scored 3.77 points higher than those in Thyolo health centres, and 2.87 higher than those in Blantyre health centres in total primary care performance. Primary care performance in health centres and in hospital clinics was similar in Neno (20.9 vs 19.0, p=0.608) while in Thyolo, it was higher at the hospital than at the health centres (19.9 vs 15.2, p<0.001). Urban and rural facilities showed a similar pattern of performance. CONCLUSION These results showed considerable variation in experiences among primary care users in the public health facilities in Malawi. Factors such as funding, policy and clinic-level interventions influence patients' reports of primary care performance. These factors should be further examined in longitudinal and experimental settings.
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Affiliation(s)
- Luckson Dullie
- Global Public Health and Primary Care, Universitetet i Bergen Det medisinsk-odontologiske fakultet, Bergen, Norway
| | - Eivind Meland
- Department of Family Medicine, School of Family Medicine and Public Health, University of Malawi, Malawi
| | | | - Thomas Mildestvedt
- Department of Family Medicine, School of Family Medicine and Public Health, University of Malawi, Malawi
| | - Stephen Kasenda
- Department of Health, Blantyre District Health Office, Blantyre, Malawi
| | - Constance Kantema
- Department of Education, Lilongwe Urban Education Office, Lilongwe, Malawi
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Ma J, Pei T, Dong F, Dong Y, Yang Z, Chen J, Guo S, Zhao Q, Wang S, Ma J, Zhang Z. Spatial and demographic disparities in short stature among school children aged 7-18 years: a nation-wide survey in China, 2014. BMJ Open 2019; 9:e026634. [PMID: 31315860 PMCID: PMC6661596 DOI: 10.1136/bmjopen-2018-026634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To identify spatial disparities and demographic characteristics of short stature, we analysed the prevalence of short stature collected in a nationwide health survey. SETTINGS Data were obtained from the 2014 Chinese National Survey on Students Constitution and Health (a cross-sectional study of China). Participants came from 30 provinces, autonomous regions, and municipalities (except Tibet, Hong Kong, Macao, and Taiwan). PARTICIPANTS There were 213 795 Han school children between 7 and 18 years old enrolled in our study. All participants were sampled by stratified cluster. PRIMARY AND SECONDARY OUTCOME MEASURES Short stature; Chinese and WHO age-specific and gender-specific height growth references were used for short stature assessment. RESULTS The age-standardised and age-gender-standardised prevalence of short stature nationwide was 3.70% and 2.69% according to Chinese and WHO growth references, respectively. The short stature prevalence differed significantly among age groups, urban and rural areas, and regions with different socioeconomic development levels (all p<0.0001). The prevalence was 2.23% in urban versus 5.12% in rural areas (p<0.001). The prevalence was 2.60% in developed, 3.72% in intermediately developed, and 4.69% in underdeveloped regions (p<0.0001). These values were all according to China's growth reference, but similar patterns were observed on prevalence based on the WHO reference. The spatial distribution of prevalence of short stature presented a clustered pattern. Moran's I value was 0.474 (p<0.001) and 0.478 (p<0.001) according to the Chinese and WHO growth references, respectively. The southwest part of China showed a higher prevalence of short stature, whereas lower prevalence of short stature was observed mainly in the northeast part of China. CONCLUSIONS There is an appreciably high prevalence of short stature in rural, underdeveloped areas of China. There are high prevalence spatial clusters of short stature in southwestern China. This provides corroborating evidence for a tailored strategy on short stature prevention and reduction in special areas.
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Affiliation(s)
- Jia Ma
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Tao Pei
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Fen Dong
- Institute of Clinical Medical Sciences, China‐Japan Friendship Hospital, Beijing, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China
| | - Zhaogeng Yang
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China
| | - Jie Chen
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Sihui Guo
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Qiuling Zhao
- Department of Pediatrics, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, China
| | - Shunan Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China
| | - Zhixin Zhang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
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Tsang C, Sokal-Gutierrez K, Patel P, Lewis B, Huang D, Ronsin K, Baral A, Bhatta A, Khadka N, Barkan H, Gurung S. Early Childhood Oral Health and Nutrition in Urban and Rural Nepal. IJERPH 2019; 16:ijerph16142456. [PMID: 31295932 PMCID: PMC6678585 DOI: 10.3390/ijerph16142456] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/16/2022]
Abstract
Globalization and urbanization in Nepal have driven a nutritional transition from an agricultural-based diet to an ultra-processed, sugary diet. This study assessed the nutrition and oral health of 836 children age 6 months to 6 years and their families in rural and urban Nepal. Mothers were interviewed about maternal–child oral health and nutrition, and children received dental exams and height and weight measurements. Analyses utilized SPSS statistical software. Most families lived within a 5-minute walk to a store selling ultra-processed snacks and sugary drinks. While most mothers knew sweets caused tooth decay, half of the children were given sweets daily, and 58.2% of children had dental caries. Caries began in the first 2 years and increased in prevalence and severity to age 6, when 74.3% had caries and 20% experienced mouth pain. Despite greater health knowledge and resources among urban mothers, urban children’s increased access to junk food and frequency of consumption was associated with higher prevalence and severity of caries compared to rural children. Severe caries was associated with malnutrition, especially in rural children. Preventive strategies are needed in early childhood to incorporate nutrition and oral health education and dental care into maternal–child health services, and develop policies to prohibit the sale of junk food around schools.
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Affiliation(s)
- Chloe Tsang
- University of California Berkeley, Berkeley, CA 94720, USA
- School of Dentistry and Oral Health, A.T. Still University Arizona, Mesa, AZ 85206, USA
| | - Karen Sokal-Gutierrez
- University of California Berkeley, Berkeley, CA 94720, USA.
- School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA.
| | - Priya Patel
- University of California Berkeley, Berkeley, CA 94720, USA
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Brett Lewis
- University of California Berkeley, Berkeley, CA 94720, USA
- School of Medicine, Oregon Health and Science University, Portland, OR 97239, USA
| | - Debbie Huang
- University of California Berkeley, Berkeley, CA 94720, USA
- School of Public Health, Columbia University Mailman, New York, NY 10032, USA
| | - Kristina Ronsin
- University of California Berkeley, Berkeley, CA 94720, USA
- World Health Organization, Copenhagen, 2100 Capital Region, Denmark
| | - Ashmita Baral
- University of California Berkeley, Berkeley, CA 94720, USA
| | | | - Nehaa Khadka
- University of California Berkeley, Berkeley, CA 94720, USA
- School of Public Health, University of California Los Angeles Fielding, Los Angeles, CA 90095, USA
| | - Howard Barkan
- University of California Berkeley, Berkeley, CA 94720, USA
| | - Sidhanta Gurung
- University of California Berkeley, Berkeley, CA 94720, USA
- University of Texas McGovern Medical School, Houston, TX 77030, USA
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Weatherspoon DD, Miller S, Ngabitsinze JC, Weatherspoon LJ, Oehmke JF. Stunting, food security, markets and food policy in Rwanda. BMC Public Health 2019; 19:882. [PMID: 31272435 PMCID: PMC6610945 DOI: 10.1186/s12889-019-7208-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/20/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Over the past two decades, Rwanda has experienced impressive economic growth, resulting in considerable improvements in living standards and poverty reduction. Despite these gains, progress on reducing the level of stunting in smallholder rural children, particularly boys, continues to be a serious concern. METHODS Policies, dietary diversity and socio-economic factors that may influence stunting in rural Rwandan children were evaluated using a logit model with clustered variance-covariance estimators based on village membership of the household. RESULTS Stunting of rural children was found to be multidimensionally related to the child's gender, weight and age; the dietary diversity, marriage status and education level of the head of household; mother's height; presence of a family garden or if they owned livestock; environmental factors such as altitude and soil fertility and location relative to a main road en route to a market; and a policy that promoted food production. CONCLUSIONS Findings suggest that agricultural policies may be subsidizing poor dietary behavior in that the aggregation of production encourages households to sell high quality nutritious food such as fruit and vegetables, for more voluminous amounts of nutritionally substandard goods, hence low dietary diversity. However, it is less clear if rural food markets are capable of supplying diverse and nutritious foods at affordable prices on a consistent basis, resulting in a lack of diversity and hence, low nutrient quality diets. Rwanda's next round of food security policies should focus on nutrition insecurity with special emphasis on the lack of protein, micronutrients and calories. Multipronged policies and programs focused on income growth, food security, enhanced access to markets and gender-related nutrition risks from inception through 2 years of age in the rural areas are required to improve rural household health outcomes, stunting in particular.
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Affiliation(s)
- Dave D. Weatherspoon
- Agricultural, Food & Resource Economics Department, Michigan State University, Rm. 213C Morrill Hall of Agriculture, 446 W. Circle Dr, East Lansing, MI 48824 USA
| | - Steve Miller
- Agricultural, Food & Resource Economics Department, Rm. 81 Morrill Hall of Agriculture, 446 W. Circle Dr, East Lansing, MI 48824 USA
| | - Jean Chrysostome Ngabitsinze
- Department of Rural Development and Agricultural Economics, College of Agriculture, Animal Sciences and Veterinary Medicine, University of Rwanda, P.O. Box 210, Musanze, 3971 Rwanda
| | - Lorraine J. Weatherspoon
- Department of Food Science and Human Nutrition, Michigan State University, 469 Wilson Road, Rm 140 Trout Food Science Bldg, East Lansing, MI 48824-1224 USA
| | - James F. Oehmke
- United States Agency for International Development, Bureau For Food Security, Ronald Reagan Bldg., 1300 Pennsylvania Ave. NW, Washington, DC 20229 USA
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Wu DY, Qiao D, Zhang X, Zhang HQ, Luo ZC, Wang Y, Pan J, Wang C. Lipid profiles as potential mediators linking body mass index to osteoporosis among Chinese adults: the Henan Rural Cohort Study. Osteoporos Int 2019; 30:1413-1422. [PMID: 30834945 DOI: 10.1007/s00198-019-04878-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/24/2019] [Indexed: 12/17/2022]
Abstract
UNLABELLED This study is to examine the relationship between body mass index (BMI) and osteoporosis in rural areas of China, and then explore whether this association was mediated by lipid profiles. Results showed that with the increasing of BMI, the risk of osteoporosis was reduced, and lipid profiles mediate this association. INTRODUCTION To examine the relationship between BMI and osteoporosis, and explore whether this association was mediated by lipid profiles. METHODS A total of 8272 participants (18-79 years) were enrolled from the Henan Rural Cohort Study. The bone mineral density of the calcaneus was measured using an ultrasonic bone density apparatus. Logistic regression and restricted cubic splines were used to evaluate the odds ratio (OR) and 95% confidence intervals (95% CI). Mediation analysis using bootstrap was performed to examine the contribution of lipid profiles to BMI-related osteoporosis. RESULTS The crude and age-standardized prevalence of osteoporosis were 15.93% and 11.77%, respectively. The mean BMIs were 24.12 kg/m2 for participants with osteoporosis and 25.06 kg/m2 for non-osteoporosis participants (P < 0.001). After adjusting for potential confounders, subjects with obesity had a lower OR of osteoporosis (0.493 [95% CI: 0.405-0.600], Ptrend < 0.001) compared with normal-weight individuals. Mediation analysis showed that lipid profile partly mediated the relationship between BMI and osteoporosis with indirect effect OR (95% CI) of 0.985 (0.978-0.992), and the proportion explained of BMI was 15.48% for lipid profile. CONCLUSION With the increasing of BMI, the risk of osteoporosis was reduced in the Chinese adult population, and lipid profiles may be a potential mediator linking reduced risk of osteoporosis. Elucidating the underlying mechanisms will facilitate developing feasible preventive and therapeutic measures for osteoporosis. Chinese clinical trial register: ChiCTR-OOC-15006699.
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Affiliation(s)
- D Y Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
- The Second Clinical Medical School, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - D Qiao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - X Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - H Q Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Z C Luo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Y Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - J Pan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
- The Second Clinical Medical School, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
| | - C Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China.
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Crouch E, Probst JC, Radcliff E, Bennett KJ, McKinney SH. Prevalence of adverse childhood experiences (ACEs) among US children. Child Abuse Negl 2019; 92:209-218. [PMID: 31003066 DOI: 10.1016/j.chiabu.2019.04.010] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of this study was to estimate the prevalence of adverse childhood experiences (ACEs) among children in the United States and to examine the relationship between child and family characteristics and the likelihood of reported exposure to ACEs. METHODS Data were drawn from the nationally representative 2016 National Survey of Children's Health (NSCH). Parent-reported child ACE exposure was measured using counts of those reporting zero ACEs, one to three ACEs, and four or more ACEs. RESULTS The study sample included 45,287 children. The most prevalent types of ACE exposure experienced by children were economic hardship (22.5%) and parent or guardian divorce or separation (21.9%). Older children (34.7%), Non-Hispanic African American children (34.7%), children with special health care needs (SHCN; 36.3%), children living in poverty (37.2%), and children living in rural areas (30.5%) were more likely to be exposed to parental divorce or separation than their counterparts. Five cross-cutting factors emerged as important across outcomes: child's age, family structure, poverty, type of health insurance, and SHCN status. CONCLUSIONS We found high prevalence rates of economic hardship on a national level. Our findings of higher prevalence among rural children further suggest the importance of the intersection of place and ACEs. Therefore, the geographic component of ACEs must be considered by policymakers. The identification of predictive factors related to high ACE exposure can inform early interventions at the national level.
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Affiliation(s)
- Elizabeth Crouch
- South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States.
| | - Janice C Probst
- South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Elizabeth Radcliff
- South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Kevin J Bennett
- University of South Carolina School of Medicine, Columbia, South Carolina, United States
| | - Selina Hunt McKinney
- University of South Carolina College of Nursing, Columbia, South Carolina, United States
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Lin WD, Deng H, Guo P, Liu FZ, Chen RY, Fang XH, Zhan XZ, Liao HT, Huang WX, Liu Y, Wang F, Zheng MR, Liu HZ, Huang J, Wei W, Xue YM, Wu SL. High prevalence of hyperuricaemia and its impact on non-valvular atrial fibrillation: the cross-sectional Guangzhou (China) Heart Study. BMJ Open 2019; 9:e028007. [PMID: 31147367 PMCID: PMC6549638 DOI: 10.1136/bmjopen-2018-028007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES There are country and regional variations in the prevalence of hyperuricaemia (HUA). The prevalence of HUA and non-valvular atrial fibrillation (NVAF) in southern China is unknown. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS A total of 11 488 permanent residents aged 35 or older from urban and rural areas of Guangzhou, China were enrolled. A questionnaire was used to compile each participant's demographic information and relevant epidemiological factors for HUA and NVAF. All participants were assessed using a panel of blood tests and single-lead 24-hour ECG. MAIN OUTCOME MEASURES HUA was defined as serum uric acid level >420 μmol/L in men and >360 μmol/L in women. NVAF was diagnosed as per guidelines. RESULTS The prevalence of HUA was 39.6% (44.8% in men and 36.7% in women), and 144 residents (1.25%) had NVAF. Prevalence of HUA increased with age in women but remained stably high in men. After adjusting for potential confounders, age, living in urban areas, alcohol consumption, central obesity, elevated fasting plasma glucose level, elevated blood pressure, lower high-density lipoprotein cholesterol level and elevated triglycerides level were associated with increased risk of HUA. Residents with HUA were at higher risk for NVAF. Serum uric acid level had a modest predictive value for NVAF in women but not men. CONCLUSIONS HUA was highly prevalent among citizens of southern China and was a predictor of NVAF among women.
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Affiliation(s)
- Wei-dong Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Fang-zhou Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ru-yin Chen
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Xian-hong Fang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xian-zhang Zhan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hong-tao Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-xiang Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yang Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Feng Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mu-rui Zheng
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Hua-zhang Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jun Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-mei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shu-lin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Abstract
PURPOSE OF REVIEW Cognitive disorders remain a major global burden with an estimated 47 million people living with dementia worldwide. Rates of cognitive disorders are expected to grow, especially as the global population ages. Global trends also indicate that about half of the global population lives in urban settings. To help guide future research, as well as the development of targeted and tailored interventions to prevent and care for people living with cognitive disorders, we present an up-to-date review and summary of the literature examining cognitive disorders and urbanization. RECENT FINDINGS We reviewed the literature between January 2017 and September 2018 on cognitive disorders and urbanization. We found that rates of dementia among urban dwellers tends to be lower than those of rural dwellers. Leading theories explaining this difference tend to focus on better access to higher quality education, as well as public and health services among urban dwellers. We also found that greater exposure to air and noise pollutants may negatively impact cognition. SUMMARY The reasons why older adults living in urban settings appear to have lower rates of dementia and better performance on cognitive measures are not well understood. Furthermore, the definitions of urban and rural and cognitive disorder, as well as how they are measured vary greatly between studies, making comparisons difficult.
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Affiliation(s)
- Reuben N. Robbins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY, USA
| | - Travis Scott
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - John A. Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Hetta Gouse
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Abstract
Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3-6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.
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Chen Z, Wen G, Cao X, Li S, Wang X, Yao Z, Wu C, Ye X. Group B streptococcus colonisation and associated risk factors among pregnant women: A hospital-based study and implications for primary care. Int J Clin Pract 2019; 73:e13276. [PMID: 30273994 DOI: 10.1111/ijcp.13276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 09/18/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Group B streptococcus (GBS), which asymptomatically colonises the vaginal and rectal areas of women, is a leading cause of neonatal mortality and morbidity. This study aimed to determine the prevalence and factors associated with GBS colonisation among pregnant women in Shenzhen, China. METHODS A hospital-based cross-sectional survey was conducted, using a multistage sampling method. Pregnant women at ≥28 weeks' gestation completed a questionnaire and vaginal swabs were obtained for GBS analysis. Data were analysed by chi-squared tests and logistic regression models. RESULTS The colonisation rate of GBS among pregnant women was 4.9%. The influencing factors associated with GBS colonisation included body mass index before pregnancy (odds ratio [OR] = 3.79, 95% CI 1.28-11.26), gestational age (OR = 5.81, 95% CI 1.20-28.15), induced abortion (OR = 0.63, 95% CI 0.40-0.98) and lotion use before pregnancy (OR = 1.59, 95% CI 1.04-2.44). CONCLUSIONS Our findings suggest that obesity, gestational age, induced abortion and lotion use were significantly associated with GBS colonisation. Further longitudinal research is needed to establish the causal relationship and its biological mechanisms.
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Affiliation(s)
- Zhiyao Chen
- Laboratory of Molecular Epidemiology, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Guoming Wen
- Women Health Care, Maternal and Child Healthcare Hospital of Longhua District, Shenzhen, China
| | - Xuelian Cao
- Women Health Care, Maternal and Child Healthcare Hospital of Longhua District, Shenzhen, China
| | - Shunming Li
- Laboratory of Molecular Epidemiology, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiaolin Wang
- Laboratory of Molecular Epidemiology, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhenjiang Yao
- Laboratory of Molecular Epidemiology, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Chuan'an Wu
- Women Health Care, Maternal and Child Healthcare Hospital of Longhua District, Shenzhen, China
| | - Xiaohua Ye
- Laboratory of Molecular Epidemiology, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
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Miao N, Zheng H, Sun X, Shen L, Wang F, Cui F, Yin Z, Zhang G, Wang F. Enhanced sentinel surveillance for hepatitis B infection in 200 counties in China, 2013-2016. PLoS One 2019; 14:e0215580. [PMID: 31013293 PMCID: PMC6478295 DOI: 10.1371/journal.pone.0215580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/05/2019] [Indexed: 11/30/2022] Open
Abstract
Hepatitis B infection is a major public health challenge in China. Clinicians report hepatitis B cases to the National Notifiable Disease Reporting System. A 2007 study found that only 35% of hepatitis B cases that had been reported as acute infections met a rigorous case definition of acute hepatitis B, implying overreporting of new-onset infections. To increase the accuracy of reported acute hepatitis B infections, in 2013, we initiated enhanced hepatitis B surveillance in 200 sentinel counties. We compared incidences and proportions of different stages of hepatitis B infection before and after implementation of enhanced surveillance. We checked the accuracy of reported data and re-diagnosed hepatitis B cases reported as acute infection according to the enhanced diagnostic criteria and calculated positive predictive value(PPV) of acute hepatitis B reports. Compared to previous surveillance, with enhanced surveillance, the incidence of reported acute hepatitis B infection decreased by 53.7% and the proportion of unclassified hepatitis B infection was reduced by 79.4%. From 2013 to 2016, the PPV of acute hepatitis B increased (55.8% to 71.0%); PPV rates in western and rural areas were lower than in other areas. We recommend enhancing hepatitis B surveillance nationwide using these new standards, and raising western and rural areas clinicians’ diagnostic and reporting capacity, and ensuring sufficient resources for IgM anti-HBc testing.
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Affiliation(s)
- Ning Miao
- Chinese Center for Disease Control and Prevention, Beijing,China
| | - Hui Zheng
- Chinese Center for Disease Control and Prevention, Beijing,China
| | - Xiaojin Sun
- Chinese Center for Disease Control and Prevention, Beijing,China
| | - Liping Shen
- Chinese Center for Disease Control and Prevention, Beijing,China
| | - Feng Wang
- Chinese Center for Disease Control and Prevention, Beijing,China
| | - Fuqiang Cui
- School of Public Health, Peking University, Beijing, China
| | - Zundong Yin
- Chinese Center for Disease Control and Prevention, Beijing,China
| | - Guomin Zhang
- Chinese Center for Disease Control and Prevention, Beijing,China
- * E-mail: , (GZ); (FW)
| | - Fuzhen Wang
- Chinese Center for Disease Control and Prevention, Beijing,China
- * E-mail: , (GZ); (FW)
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Gevera P, Mouri H, Maronga G. Occurrence of fluorosis in a population living in a high-fluoride groundwater area: Nakuru area in the Central Kenyan Rift Valley. Environ Geochem Health 2019; 41:829-840. [PMID: 30173366 DOI: 10.1007/s10653-018-0180-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
Endemic fluorosis caused by the consumption of high-fluoride groundwater is a public health problem in Nakuru, in the Kenyan Rift Valley. The present study was carried out during the period January-February 2017 to determine the prevalence and severity of dental fluorosis among patients of two Nakuru healthcare facilities, namely St. Mary's Hospital-Gilgil and Egerton University-Njoro Dental Clinic. The patients consisted of both young and old members of the Nakuru population served with groundwater containing high levels of fluoride ranging from 0.1 to 72 mg/l. The Thylstrup-Fejerskov (TF) index was used to estimate the severity of dental fluorosis. Among the patients of St. Mary's Hospital-Gilgil, the prevalence of dental fluorosis was 86% (n = 100), whereby 54% of the patients were found to have mild to moderate dental fluorosis and 32% had severe dental fluorosis. Whereas the prevalence of dental fluorosis in patients below the age of 14 years was higher (92%) than in older patients (85.56%), severity was reversed (average TF = 3.77 for older patients; average TF = 2.18 for younger patients). No significant variation in severity and prevalence of dental fluorosis was recorded with respect to both genders of the patients. The dental fluorosis prevalence rate amongst the patients of the Egerton University-Njoro Dental Clinic was found to be 79.49% (n = 73). However, a comparative analysis of the two age groups revealed a much higher prevalence rate of 100% for patients below the age of 14 relative to the older patients (79.49%). While a high number of cases of dental fluorosis from both healthcare facilities were reported in patients residing in Njoro, Nakuru town, Gilgil and Bahati, the fewer cases were from Solai and Rongai. The results seem to suggest a much higher occurrence of dental fluorosis within the younger population group. This implies that rapid population growth and urbanization puts more pressure on public water resources which leads to a strong reliance on fluoride contaminated groundwater and the concomitant increased cases of dental fluorosis. Therefore, there is a need for a change of local government policy to enhance access to safe water and public education on fluorosis in the areas that were under investigation.
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Affiliation(s)
- Patrick Gevera
- Department of Geology, University of Johannesburg, Johannesburg, 2006, South Africa
| | - Hassina Mouri
- Department of Geology, University of Johannesburg, Johannesburg, 2006, South Africa.
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