Showing papers in "Journal of Public Health Research in 2019"

Vaccine hesitancy: An overview on parents' opinions about vaccination and possible reasons of vaccine refusal

Abstract: Background. Vaccine hesitancy has increased worldwide with a subsequent decreasing of vaccination rates and outbreaks of vaccine-preventable diseases (i.e. measles, poliomyelitis and pertussis) in several developed countries, including Italy. Design and Methods. We conducted a survey to investigate the attitudes of a parents' sample about vaccinations by the distribution of questionnaires in six lower secondary schools of the Italian city of Messina. Results. Regarding vaccinations carried out on children, the declared vaccination coverage rates ranged widely between good coverage percentages for some vaccinations (Measles-Mumps-Rubella, Diphtheria-Tetanus-Pertussis), and very low coverage rates for others, especially for "new" vaccinations (HPV, meningococcal, pneumococcal). The vaccinations carried out correlated negatively with both parents' age and their level of education. Moreover, a favourable parents' opinion was strongly influenced by a favourable opinion of the physician, while an unfavourable parents' opinion seemed conditioned by a direct or indirect knowledge of people harmed by vaccines. In addition, our data show that parents do not often know or partially know the real composition of the vaccines and the diseases prevented by vaccinations. Conclusions. Data analysis shows that parents are, theoretically, favourable towards vaccinations but have little knowledge of such practices, sometimes not being unaware of the types of vaccines administrated to their children. Health education and communication of correct information are certainly the cornerstones to improve the situation and to fight the widespread and non-grounded fears about vaccines.

Comparison of the performance of machine learning algorithms in breast cancer screening and detection: A protocol.

Abstract: Background: Breast Cancer (BC) is a known global crisis. The World Health Organization reports a global 2.09 million incidences and 627,000 deaths in 2018 relating to BC. The traditional BC screening method in developed countries is mammography, whilst developing countries employ breast self-examination and clinical breast examination. The prominent gold standard for BC detection is triple assessment: i) clinical examination, ii) mammography and/or ultrasonography; and iii) Fine Needle Aspirate Cytology. However, the introduction of cheaper, efficient and noninvasive methods of BC screening and detection would be beneficial. Design and methods: We propose the use of eight machine learning algorithms: i) Logistic Regression; ii) Support Vector Machine; iii) K-Nearest Neighbors; iv) Decision Tree; v) Random Forest; vi) Adaptive Boosting; vii) Gradient Boosting; viii) eXtreme Gradient Boosting, and blood test results using BC Coimbra Dataset (BCCD) from University of California Irvine online database to create models for BC prediction. To ensure the models’ robustness, we will employ: i) Stratified k-fold Cross- Validation; ii) Correlation-based Feature Selection (CFS); and iii) parameter tuning. The models will be validated on validation and test sets of BCCD for full features and reduced features. Feature reduction has an impact on algorithm performance. Seven metrics will be used for model evaluation, including accuracy. Expected impact of the study for public health: The CFS together with highest performing model(s) can serve to identify important specific blood tests that point towards BC, which may serve as an important BC biomarker. Highest performing model(s) may eventually be used to create an Artificial Intelligence tool to assist clinicians in BC screening and detection. Significance for public health This study could potentially identify important Breast Cancer (BC) biomarkers based on patients’ routine anthropometric blood data. This will be attempted using correlation-based feature selection algorithm, together with highest performing machine learning model(s) from this study, and publicly available BC Coimbra Dataset from University of California Irvine database. The biomarkers may provide direction for clinicians to explore in future BC clinical trials. Trials will serve to validate biomarkers from this study and could be introduced in clinical settings globally as an easy, cost-effective first step for BC screening and detection. An Artificial Intelligence tool can eventually be created using highest performing model(s). Clinicians can input patient-specific biomarkers into the tool. The tool would output the likelihood of patients having BC, with a certain level of accuracy. This envisioned process could serve to eventually revolutionize the early prediction of BC in patients and consequently, a reduction in BC mortality rate.

Where else would I look for it? A five-country qualitative study on purposes, strategies, and consequences of online health information seeking.

Abstract: Background Online health information (OHI) is widely available and consulted by many people in Western countries to gain health advice. The main goal of the present study is to provide a detailed account of the experiences among people from various demographic backgrounds living in high-income countries, who have used OHI. Design and methods Thematic analysis of 165 qualitative semi-structured interviews conducted among OHI users residing in Australia, Israel, the Netherlands, Norway, and Switzerland was performed. Results The lived experience of people using OHI seem not to differ across countries. The interviews show that searches for OHI are motivated from curiosity, sharing of experiences, or affirmation for actions already taken. Most people find it difficult to appraise the information, leading them to cross-check sources or discuss OHI with others. OHI seems to impact mostly some specific types of health behaviors, such as changes in diet or physical activity, while it only plays a complementary role for more serious health concerns. Participants often check OHI before seeing their GP, but are reluctant to discuss online content with health care personnel due to expected negative reception. Conclusions This study adds to the body of knowledge on eHealth literacy by demonstrating how OHI affects overall health behavior, strengthens patients' ability to understand, live with, and prepare themselves for diverse health challenges. The increasing digitalization of health communication and health care calls for further research on digital divides and patient-professional relations. Health care professionals should acknowledge OHI seeking and engage in discussions with patients to enable them to appreciate OHI, and to support shared decision making in health care. The professionals can utilize patient's desire to learn as a resource for health prevention, promotion or treatment, and empowerment.

Patient and clinician engagement with health information in the primary care waiting room: A mixed methods case study.

Abstract: Background. Primary care waiting rooms can be sites of health promotion and health literacy development through the provision of readily accessible health information. To date, few studies have considered patient engagement with televised health messages in the waiting room, nor have studies investigated whether patients ask their clinicians about this information. The aim of this study was therefore to examine patient (or accompanying person) and clinician engagement with waiting room health information, including televised health messages. Design and methods. The mixed methods case study was undertaken in a regional general practice in Victoria, Australia, utilising patient questionnaires, waiting room observations, and clinician logbooks and interviews. The qualitative data were analysed by content analysis; the questionnaire data were analysed using descriptive statistics. Results. Patients engaged with a range of health information in the waiting room and reportedly received health messages from this information. 44% of the questionnaire respondents (33 of 74) reported watching the television health program, and half of these reported receiving a take home health message from this source. Only one of the clinicians (N=9) recalled a patient asking about the televised health program. Conclusions. The general practice waiting room remains a site where people engage with the available health information, with a televised health 'infotainment' program receiving most attention from patients. Our study showed that consumption of health information was primarily passive and tended not to activate patient discussions with clinicians. Future studies could investigate any link between the health infotainment program and behaviour change.

Neighborhood crime is differentially associated with cardiovascular risk factors as a function of race and sex

Abstract: Background: Neighborhood crime may be an important factor contributing to cardiovascular health disparities, and these relations may vary by race and sex. The present investigation evaluated (a) potential differential associations between neighborhood crime and cardiovascular disease (CVD) risk factors within subgroups of African American (AA) and White men and women, and (b) potential mediation by negative affect. Design and Methods: Participants were 1,718 AAs and Whites (58% AA; 54% female; 59% above poverty; ages 30-64 years) living Baltimore, Maryland who completed the first wave of the Healthy Aging in Neighborhoods of Diversity across the Life Span study from 2004-2009. CVD risk factors included body mass index, total serum cholesterol, glucose, and systolic and diastolic blood pressure. A negative affect composite was comprised of self-reported depression, anxiety, anger, vigilance, and perceived stress. Hierarchical multiple regression analyses were used to examine associations between per capita overall and violent crime rates, negative affect, and CVD risk factors. Results: There were significant associations of greater overall crime rate with higher fasting glucose (b=.192, P<0.05), and greater violent crime rate with higher systolic (b=86.50, P<0.05) and diastolic (b=60.12, P<0.05) blood pressure in AA women, but not men. These associations were not explained by negative affect. In Whites, there were no significant associations of overall or violent crime rates with cardiovascular risk factors. Conclusions: AA women may be particularly vulnerable to the negative impact of crime on cardiovascular risk. Preventative efforts aimed toward this group may help to deter the detrimental effects that living in a high crime area may have on one's cardiovascular health.

Monitoring for airborne respiratory viruses in a general pediatric ward in Singapore.

Abstract: There is an increasing body of evidence suggesting that transmission of respiratory viruses occurs through the inhalation of virus-laden particles. Our study describes the use of an aerosol sampling system to monitor the prevalence of airborne viruses in a hospital setting. Using SKC AirCheck Touch pumps, with National Institute for Occupational Safety and Health (NIOSH) bioaerosol samplers and SKC filter cassette blanks, 28 aerosol samples were collected in a hospital ward in Singapore. Following DNA/RNA extraction, real-time RT-PCR/PCR was used for the detection of influenza A, B and D viruses, coronaviruses, enteroviruses, and adenoviruses. Airborne virus was detected in nine (32%) of 28 samples. Among the nine positive samples, eight were PCR-positive for adenovirus and one for influenza A virus. Our data suggest that bioaerosol sampling could be valuable in monitoring for airborne respiratory viruses in clinical environments to better understand the risk of infection during a hospital visit.

Understanding beverage taxation: Perspective on the Philadelphia Beverage Tax's novel approach.

Abstract: Despite the growing global trend of sugar-sweetened beverage (SSB) taxes for their potential as an untapped source of revenue and as a public health boon, these legislative efforts remain controversial. Multiple articles have reviewed this trend in recent years from modeling of long-term impacts to short-term empirical studies, yet most comprehensive, long-term health impact assessments remain forthcoming. These multi-faceted efficacy studies combined with case-based assessments of the policy process, descriptive pieces highlighting unique features of the policy and reflective perspectives targeting unanswered questions create a comprehensive body of literature to help inform present and future legislative efforts. The passage of the Philadelphia Beverage tax required a mix of political entrepreneurs, timing and context; while uniquely employing a nonpublic health frame, specific earmarking and a broadened scope with the inclusion of diet beverages. This perspective on the Philadelphia Beverage Tax will describe the passage and novel features of the Philadelphia Beverage Tax with a discussion of the ethical questions unique to this case. Significance for public health The prevalence of obesity and its related non-communicable diseases has continued its upward trajectory globally, despite our decades-long awareness of this trend. Excess caloric intake is a principle factor for this growing global burden of disease − with overconsumption of liquid calories in the form of sugar-sweetened beverages (SSB) a central component of this imbalance. A relatively recent public health response to reduce SSB consumption and increase revenue for public health spending has been the passage of beverage taxes at the local, state and national levels. However, there are many nuances in the design, passage and goals for these beverage taxes globally. The Philadelphia Beverage Tax’s use of a non-health frame, its specified earmarking and its scope by including diet beverages both allowed for its passage and create unique ethical questions that have yet to be completely addressed by the literature. These ethical considerations in the context of the Philadelphia Beverage Tax’s passage are important for other public health professionals, policy-makers and advocates working towards their own legislative efforts.

The importance of financial recession for mental health among students: short- and long-term analyses from an ecosocial perspective.

Abstract: Background and aim: Referring to the ecosocial theory and utilising the 'natural experiment' setting provided by the global recession at the beginning of 1990s, the aim of our study was to analyse ...

Migrants' health: Building migrant-sensitive health systems.

Abstract: Not available

Decisional issues in antibiotic prescribing in French nursing homes: An ethnographic study.

Abstract: Background:Medication prescription is generally the responsibility of doctors. In nursing homes, the nursing staff is often the first to suspect an infection. Today, physicians are more confident with nursing assessment, relying primarily on nursing staff information. Very few studies have investigated the nurses' influence on decision of medical prescription. This study investigates the role of nurses in antibiotic prescribing for the treatment of suspected infections in nursing home residents. Design and methods:An ethnographic study based on semi-structured interviews and participant observations was conducted. Sixteen nurses and five doctors working in five nursing homes in Paris, France participated between October 2015 and January 2016. Results:Given their proximity to elderly residents, registered nurses at the nursing homes occasionally assisted doctors in their medical diagnostic. However, nurses who are theoretically incompetent have met difficulties in their ability to participate in their decisions to prescribe antibiotics when managing residents' infections. Conclusion: if proximity and nursing skills reinforce the relevance of the clinical judgment of nurses, the effective and collaborative communication between the nurse and the doctor may help the nurse to enhance their role in the antibiotic prescribing in nursing homes, which would enhance antimicrobial stewardship efficiency.

Six shades of grey: Identifying drinking culture and potentially risky drinking behaviour in the grey zone between work and leisure. The WIRUS culture study

Abstract: Objectives: The aim of this study was to explore drinking culture and drinking situations that employers and employees encounter in the grey zone between work and leisure, and identify what might affect employees' risky drinking behaviour. Methods: We used eight focus groups to interview 61 core company informants from eight Norwegian companies (private and public sector) participating in the WIRUS - Workplace-based interventions preventing risky alcohol use and sick leave - project. The informants represented employers and employees with a diversity of roles at multiple organisational levels. The transcribed interviews were analysed by applying a phenomenological hermeneutical approach. Results: The analysis revealed six dimensions of drinking culture representing potentially risky drinking behaviour in situations that fall in the grey zone between work and leisure: (1) "Who invited me?" (Degree of obligation towards inviter), (2) "Do I have to participate?" (Degree of participation volunteerism), (3) "To drink or not to drink?" (Degree of drinking volunteerism), (4) "Work talk or small talk?" (Degree of work-related conversation), (5) "Are there any drinking rules to follow?" (Degree of regulation), and (6) "The influence of being away from home" (degree of distance to home). Conclusions: The findings reveal that employers and employees' experience of drinking culture can be categorised as six different "shades of grey". The grey zone is shaded from light to dark grey, indicating how risky the informants perceive the grey zone to be. The findings may be useful when designing workplace health promotion programmes and alcohol regulations in the workplace.

Addressing non-communicable diseases in the Western Cape, South Africa

Abstract: Background: Chronic non-communicable diseases (CNCDs) are increasing with grave consequences to countries' development. The purpose of this study was three-fold: (1) to determine challenges PURE study participants faced regarding CNCD interventions and what they required from a CNCD intervention programme, and (2) to explore courses of action Department of Health (DoH) officials thought would perform best, as well as (3) to determine what DoH officials perceive to be obstacles in addressing the CNCD epidemic. Design and methods: A subsample of 300 participants from the Prospective Urban and Rural Epidemiological study's Western Cape urban cohort and six key officers from the DoH were recruited to participate in this cross-sectional study. Questionnaires were used in face-to-face interviews with the PURE study participants and DoH officials, together with the multi-criteria mapper (MCM) interviewing method with the latter. Results: Most PURE participants were overweight/obese, but not keen to participate in weight loss interventions. They sought education on foods associated with weight gain, shopping lists, cooking lessons and recipes from CNCD intervention programmes. Department of Health officials regarded the integration of health services, community participation, amongst others as the most favourable options to address the CNCD epidemic. Conclusions: The integration of health services, community participation, food taxation and improving inter-sectoral partnerships were viewed as the most feasible options to address the CNCD epidemic according to the DoH officials. At community level, the needs for education and practical hints were expressed. Current CNCD interventions should be adapted to include the context-based needs of communities.

Changing trends in adolescent alcohol use among Czech school-aged children from 1994 to 2014.

Abstract: Background For an efficient planning of public health policy, the regular monitoring over health-related behaviors among vulnerable population groups is necessary. The aim of this study is to examine the temporal trends in alcohol use among the Czech adolescent population. Design and methods Data from the Health Behaviour in Schoolaged Children (HBSC) project conducted in Czechia from 1994 to 2014 were used. Adolescent alcohol use was assessed via two indicators: i) weekly alcohol use (beer, wine, and/or spirit), ii) repeated lifetime drunkenness (having been drunk on two or more occasions in life). Trends in alcohol use were modelled separately for boys and girls. Binary logistic regression was conducted with survey period as an independent predictor of the alcohol indicator. Results There were significant changes in adolescent alcohol use since 1994. Between 1994 and 2010, there was a gradual upward in the prevalence. However, in the recent period of 2014, an unprecedented drop in alcohol use was recorded. Conclusions Despite the significant drop in the prevalence of alcohol use among the Czech youth in recent years, alcohol drinking in adolescence remains an important challenge for the national health policy. Further research will show whether these changes in adolescent health-related behavior are of a temporary or a permanent nature.

Care of acute conditions and chronic diseases in Canada and the United States: Rapid systematic review and meta-analysis.

Abstract: This study tested the hypothesis that socioeconomically vulnerable Canadians with diverse acute conditions or chronic diseases have health care access and survival advantages over their counterparts in the USA. A rapid systematic review retrieved 25 studies (34 independent cohorts) published between 2003 and 2018. They were synthesized with a streamlined meta-analysis. Very low-income Canadian patients were consistently and highly advantaged in terms of health care access and survival compared with their counterparts in the USA who lived in poverty and/or were uninsured or underinsured. In aggregate and controlling for specific conditions or diseases and typically 4 to 9 comorbid factors or biomarkers, Canadians' chances of receiving better health care were estimated to be 36% greater than their American counterparts (RR=1.36, 95% CI 1.35-1.37). This estimate was significantly larger than that based on general patient or non-vulnerable population comparisons (RR=1.09, 95% CI 1.08-1.10). Contrary to prevalent political rhetoric, three studies observed that Americans experience more than twice the risk of long waits for breast or colon cancer care or of dying while they wait for an organ transplant (RR=2.36, 95% CI 2.09-2.66). These findings were replicated across externally valid national studies and more internally valid, metropolitan or provincial/state comparisons. Socioeconomically vulnerable Canadians are consistently and highly advantaged on health care access and outcomes compared to their American counterparts. Less vulnerable comparisons found more modest Canadian advantages. The Affordable Care Act ought to be fully supported including the expansion of Medicaid across all states. Canada's single payer system ought to be maintained and strengthened, but not through privatization.

Online media scans: Applying systematic review techniques to assess statewide human papillomavirus vaccination activities.

Abstract: Background. Although the human papillomavirus (HPV) vaccine has been approved for use in adolescents in the US for over a decade, vaccination uptake remains low. Of concern, HPV vaccine coverage is below the national average in Minnesota, USA. To understand the reach of current HPV programming and research, we use an online media scan; this method may be applied to other jurisdictions to gain insight about various public health issues. Design and Methods. This online media scan describes the nature and scope of ongoing activities to increase HPV vaccination in Minnesota. The media scan included: a) structured internet searches of HPV vaccine health education/promotion activities ongoing in Minnesota since 2013, and b) searches in research databases of the published literature on HPV vaccination in Minnesota from 2013 to 2018. Results. Searches resulted in 880 online and 142 research article matches, with 40 and 36 meeting selection criteria. Results were categorized by activities focusing on race/ethnicity, sex, health providers, parents, lesbian, gay, bisexual, transgender and queer or questioning (LGBTQ) populations, geographic location, catchup vaccination, and insurance status. Most activities were statewide (52% health education/promotion and 35% research), followed by activities located in entirely urban areas (15% health education/promotion and 41% research) with only 6% of health education/promotion activities and 2% of research activities carried out in entirely rural areas. Conclusions. A range of local and statewide HPV vaccine health education/promotion and research activities were identified in Minnesota. Several efforts partnered with American Indian and Somali/Somali-American communities, but fewer activities focused on HPV vaccination among LGBTQ youth and HPV vaccination in rural areas.

Advance care directives: Citizens, patients, doctors, institutions.

Abstract: Italian Law no. 219/2017 established the advance care directives ("Disposizioni anticipate di trattamento" - DAT), a legal document specifying the person's wishes in relation to health, drawn up in case of the possible future incapacity to make informed decisions. DAT are an important instrument of empowerment for a person who is not necessarily a "patient" and enable the dialogue between healthcare providers and patient to continue when the latter is no longer able to take part consciously. DAT can only be implemented by guaranteeing the fundamental rights of the person, i.e. by ensuring the "non-complicated" use of this instrument and easy access to the DAT whenever it may be necessary. Furthermore, on the one hand, the requirement of adequate prior medical information has to contend with the fact that the wishes expressed in the document may have been formed outside of the therapeutic relationship; on the other hand, institutions must ensure that DAT are collected and recorded in such a way as to ensure their availability whenever and wherever necessary.

Sample selection and reasons for non-participation in the PRedictors and Outcomes of incident FRACtures (PROFRAC) study.

Abstract: Background. Fragility fractures, associated with osteoporosis, are an escalating public health problem. We aim to describe sample selection, recruitment methods and reasons for non-participation in The PRedictors and Outcomes of incident FRACtures (PROFRAC) study. Design and Methods. Barwon Statistical Division residents aged 20+ years, with a radiologically-confirmed fracture between June 1st 2012 and May 31st 2013, were eligible. Individuals identified as fracture cases were invited by mail to complete a questionnaire. Reasons for non-participation were documented. Logistic regression techniques were used to determine odds ratios for participation and non-participation reasons. Results. A total of 1,458 of 2,155 (67.7%) adults with fracture (48.7% men) participated. Individuals were excluded due to inability to give informed consent, death, no knowledge of fracture, or inability to be contacted. The odds of participation decreased with age (OR 0.99, 95%CI 0.99-0.99, P=0.011) and increased among specific fracture groups [clavicle/scapula (OR 2.50, 1.30-4.68, P=0.006), forearm/humerus (OR 2.00, 1.22-3.27, P=0.006), wrist (OR 2.08, 1.31-3.32, P=0.002), hip (OR 2.12, 1.20-3.75, P=0.009), ankle (OR 1.85, 1.20-2.87, P=0.001), compared to face/skull fractures]. The odds of reporting disinterest, time constraints or personal reasons as the reason for non-participation decreased with age, whereas the odds of reporting frailty, language-related issues or illness as the reason for non-participation increased with of age [disinterest (OR 0.98, 0.97-0.98, P<0.001), time constraints (OR 0.97, 0.96-0.98, P<0.001), personal reasons (OR 0.98, 0.97-0.99, P=0.007), frailty (OR 1.12, 1.09-1.15, P<0.001), language-related issues (OR 1.02, 1.01-1.04, P<0.001), illness (OR 1.03, 1.02-1.05, P<0.001)]. Conclusions. Understanding drivers of research participation can inform study design to achieve optimal participation in health research.

In utero exposure to endocrine disrupting chemicals, micro-RNA profiles, and fetal growth: a pilot study protocol.

Abstract: Background: The developing fetus is particularly vulnerable to the effects of endocrine disrupting chemicals (EDCs). Molecular fingerprints of EDCs can be identified via microRNA (miRNA) expression profiles and may be etiologically implicated in the developmental origin of disease (DOHaD). Methods/design: This pilot study includes pregnant women at high risk (smoking at conception), and low risk (non-smoking at conception) for SGA birth (birthweight<10th percentile for gestational age). We have randomly selected 12 mothers (3 high-risk SGA birth, 3 low-risk SGA birth, 3 high-risk non-SGA birth, 3 low-risk non-SGA birth), with EDC measurements from gestational week 17. All offspring are female. We aim to test the stability of our samples (maternal serum, cord blood, placenta tissue), observe the differential expression of miRNA profiles over time (gestational weeks 17, 25, 33, 37, birth), and study the consistency between maternal EDC measures and miRNA expression profiles across our repeated measures. Expected impact of the study for Public Health: Results from this pilot study will inform the development of a larger cohort wide analysis, and will impact the current state of knowledge in the fields of public health, epigenetics, and the DOHaD.