BMC Public Health

Chen, Xinlin; Su, Dai; Chen, Xinlan; Chen, Yingchun

doi: 10.1186/s12889-021-11407-2pmid: 34261461

BackgroundThe strategy of successful ageing is an important means to deal with the challenges of the current ageing society. This paper aims to explore the effects of different intensities of physical activity on the successful ageing of the elderly.MethodsOur data were from wave 4 of the China Health and Retirement Longitudinal Survey (CHARLS), involving 9026 residents aged 60 years and older. The intensity of physical activity was divided into three levels: vigorous, moderate and mild. The concept of successful ageing adopted a four-dimensional model of life satisfaction added to the theoretical model of Rowe and Kahn’s. Propensity score matching (PSM) with controlling nine confounding factors were used to analyse the effects of different intensities of physical activity.ResultsThe percentage of successful ageing was 1.88% among all subjects. Among them, 30.26, 29.57 and 29.40% of the elderly often participated in vigorous, moderate and mild physical activity, respectively. The results of PSM showed that participation in moderate activity increased the probability of successful ageing of the elderly by 0.76–0.78% (P < 0.001), while participation in vigorous and mild physical activity had no significant effect on successful ageing (P > 0.05). Moderate physical activity had statistically significant effects on four components of successful aging, including major disease, physical function, life satisfaction, and social participation (P < 0.05).ConclusionModerate-intensity physical activity was most beneficial to the successful ageing of the elderly and should be promoted in the elderly population.

Cohen-Cline, Hannah; Li, Hsin-Fang; Gill, Monique; Rodriguez, Fatima; Hernandez-Boussard, Tina; Wolberg, Harry; Lippa, Jacob; Vartanian, Keri

doi: 10.1186/s12889-021-12171-zpmid: 34794421

BackgroundThe COVID-19 pandemic has further exposed inequities in our society, demonstrated by disproportionate COVID-19 infection rate and mortality in communities of color and low-income communities. One key area of inequity that has yet to be explored is disparities based on preferred language.MethodsWe conducted a retrospective cohort study of 164,368 adults tested for COVID-19 in a large healthcare system across Washington, Oregon, and California from March – July 2020. Using electronic health records, we constructed multi-level models that estimated the odds of testing positive for COVID-19 by preferred language, adjusting for age, race/ethnicity, and social factors. We further investigated interaction between preferred language and both race/ethnicity and state. Analysis was performed from October–December 2020.ResultsThose whose preferred language was not English had higher odds of having a COVID-19 positive test (OR 3.07, p < 0.001); this association remained significant after adjusting for age, race/ethnicity, and social factors. We found significant interaction between language and race/ethnicity and language and state, but the odds of COVID-19 test positivity remained greater for those whose preferred language was not English compared to those whose preferred language was English within each race/ethnicity and state.ConclusionsPeople whose preferred language is not English are at greater risk of testing positive for COVID-19 regardless of age, race/ethnicity, geography, or social factors – demonstrating a significant inequity. Research demonstrates that our public health and healthcare systems are centered on English speakers, creating structural and systemic barriers to health. Addressing these barriers are long overdue and urgent for COVID-19 prevention.

Pauly, Bernie; Revai, Tina; Marcellus, Lenora; Martin, Wanda; Easton, Kathy; MacDonald, Marjorie

doi: 10.1186/s12889-021-11594-ypmid: 34407781

BackgroundPublic health (PH) practitioners have a strong moral commitment to health equity and social justice. However, PH values often do not align with health systems values, making it challenging for PH practitioners to promote health equity. In spite of a growing range of PH ethics frameworks and theories, little is known about ethical concerns related to promotion of health equity in PH practice. The purpose of this paper is to examine the ethical concerns of PH practitioners in promoting health equity in the context of mental health promotion and prevention of harms of substance use.MethodsAs part of a broader program of public health systems and services research, we interviewed 32 PH practitioners.ResultsUsing constant comparative analysis, we identified four systemic ethical tensions: [1] biomedical versus social determinants of health agenda; [2] systems driven agendas versus situational care; [3] stigma and discrimination versus respect for persons; and [4] trust and autonomy versus surveillance and social control.ConclusionsNaming these tensions provides insights into the daily ethical challenges of PH practitioners and an opportunity to reflect on the relevance of PH frameworks. These findings highlight the value of relational ethics as a promising approach for developing ethical frameworks for PH practice.

Lampropoulos, Ioannis C.; Raptis, Dimitrios G.; Daniil, Zoe; Tasoulis, Sotirios K.; Plagianakos, Vassilis P.; Malli, Foteini; Gourgoulianis, Konstantinos I.

doi: 10.1186/s12889-021-10621-2pmid: 33743643

BackgroundPulmonary embolism (PE) epidemiological data about the disease prevalence in the general population are unclear. The present study aims to investigate the prevalence of PE in Greece and the associated temporal trends for the years 2013–2017.MethodsData on medical prescriptions for PE in the years 2013–2017 were provided by the Greek National Health Service Organization (EOPYY). Data on age, gender, specialty of the prescribing physician and prescription unit were provided as well.ResultsThe total number of medical prescriptions for PE for the study period was 101,426. Of the total prescriptions, 51% were issued by the Public Sector and 48% by the Private Sector. In 2013 the prevalence of PE was 5.43 cases per 100,000 citizens and increased constantly until 2017 with 23.79 cases per 100,000 population. Prevalence was higher in all years studied in the age group of 70–80 years. For the year 2017, we observed 69.35 cases per 100,000 population for subjects 70–80 years, followed by the ages 80–90 (60.58/100,000) and 60–70 years (56.47 /100,000). Females displayed higher PE prevalence than males and higher increasing trend.ConclusionPE prevalence has an increasing trend throughout the years 2013–2017 while prevalence in females is higher than males and displays a higher increasing trend. Our results may be used to appropriately organize nationwide health care campaigns aiming at the diagnosis, treatment and prevention of PE.

Okatch, Harriet; Pitts, Ebony; Ritchey, Emily; Givler, Kylie; Kuon, Madeline

doi: 10.1186/s12889-021-11944-wpmid: 34657616

BackgroundLead poisoning prevention efforts include preparing and disseminating informational materials such as brochures and pamphlets to increase awareness of lead poisoning, lead exposures and lead poisoning prevention. However, studies have demonstrated that patient education materials for diseases and health conditions are prepared at a reading level that is higher than the recommended 7th–8th grade reading level. This study, therefore, aims to assess the reading levels of lead poisoning informational materials.MethodsLead poisoning materials (N = 31) were accessed from three states; Michigan, New York and Pennsylvania. The readability levels of the materials were assessed using the Flesh Kincaid Grade Level readability test. The Kruskal-Wallis test was conducted to determine if the readability levels differed between the materials obtained from the different states. Thematic content analyses were carried out to assess the inclusion of four themes; definition of lead poisoning, risk factors and exposures, testing and referral and prevention covering 12 subtopics. The Wilcoxon rank sum test was used to examine if there was a difference in the number of subtopics by readability level (dichotomized to >8th grade and < 8th grade).ResultsThe median readability level of the informational materials was 6.7 (IQR: 5.1–8.1). However, there was variability in the readability levels of the materials (range 3.5 to 10.6); materials obtained from Michigan had the highest median reading level of 8.1 (IQR: 6.9–9.0) followed by Pennsylvania. Heterogeneity was observed in the content of the materials. Most of the materials (80%) from Michigan focused on water as a source of lead poisoning, whereas materials from New York and Pennsylvania focused on lead-based paint and other sources. The materials prepared at >8th grade reading level contained fewer topics than materials prepared at <8th grade reading level.ConclusionsWe find that the materials were often prepared at reading levels lower than the recommended 8th grade reading level. However, there is variability in the reading levels and in the content of the materials. While the materials met the general readability guidelines, they did not necessarily meet the needs of specific groups, especially groups at risk.

Lee, Linda Yin-king; Chan, Issac Chun-wing; Wong, Owen Pak-man; Ng, Yaki Hoi-ying; Ng, Crystal Kit-ying; Chan, Max Hin-wa; Ng, Joe Ka-chun; Koo, Hailey Hei-tung; Lam, Suk-ting; Chu, Ada Cho-wai; Wong, Rachel Yuen-shan; Leung, Heidi Po-ying; Pun, Angel Lok-ching

doi: 10.1186/s12889-021-11346-ypmid: 34187439

BackgroundDuring the COVID-19 pandemic, over 99% of adults in Hong Kong use face masks in public. With the limited supply of face masks in the market and the uncertainty about the future development of COVID-19, reusing face masks is a legitimate way to reduce usage. Although this practice is not recommended, reusing face masks is common in Hong Kong. This study aimed to examine the practice of reusing face masks among adults in Hong Kong during the COVID-19 pandemic and its association with their health beliefs toward this health crisis.MethodsA cross-sectional descriptive study was conducted. A quota sample of 1000 adults was recruited in Hong Kong in April 2020. Guided by the Health Belief Model, the subjects were invited to answer questions on their practice of reusing face masks and health beliefs toward COVID-19 through telephone interview. Their practice on reuse, storage, and decontamination of used face masks were summarized by descriptive statistics. The difference in health beliefs between the subjects who reused and did not reuse face masks was examined by conducting an independent t test. The association between health beliefs and reuse of face masks was determined by conducting a logistic regression analysis.ResultsOne-third (n = 345, 35.4%) of the subjects reused face masks in an average of 2.5 days. Among them, 207 subjects stored and 115 subjects decontaminated their used face masks by using various methods. The subjects who reused face masks significantly perceived having inadequate face masks (t = 3.905; p <  0.001). Having a higher level of perception of having inadequate face masks increased the likelihood of reusing face masks (OR = 0.784; CI 95%: 0.659–0.934; p = 0.006).ConclusionDespite having 90 face masks in stock, the adults who reused face masks significantly perceived that they had inadequate face masks. Concerted effort of health care professionals, community organizations, and the government will improve individuals’ practice in use of face masks and alleviate their actual and perceived feeling of having inadequate face masks, which lead them to reuse.

Pavlovic, Andjelka; DeFina, Laura F.; Natale, Breanna L.; Thiele, Shelby E.; Walker, Timothy J.; Craig, Derek W.; Vint, Georgina R.; Leonard, David; Haskell, William L.; Kohl, Harold W.

doi: 10.1186/s12889-021-10545-xpmid: 33706744

BackgroundThe purpose of this study was to: 1) examine the maintenance of Physical Education and physical activity during the distance learning time, 2) determine the resources educators are utilizing to deliver PE curricula, and 3) understand the challenges experienced by educators during distance learning.MethodsA survey was sent to a cohort of school-based fitness assessment software users. Respondents were largely school-based individuals including PE teachers (n = 1789), school (n = 62) and district administrators (n = 64), nurses (n = 3), and “other” (n = 522).ResultsOf 2440 respondents, most were from a city or suburb (69.7%), elementary or middle school (72.3%), and had Title 1 status (60.4%), an indicator of low socioeconomic status. Most campuses were closed during the COVID-19 pandemic (97.8%). Of the schools closed during the pandemic, only 2.8% had no prior PE requirements and that increased to 21% during the pandemic. In schools that remained open during the pandemic, 7.7% had no prior PE requirements and this increased to 60.5%. Importantly, 79% of respondents reported that students were either “significantly less” or “somewhat less” physically active during the closure. For closed schools, the most frequently cited challenges included “student access to online learning“, “teacher/student communication” and “teacher remote work arrangements”. For open schools, the most commonly reported challenges included “social distancing”, “access to gymnasium/equipment”, and “concern for personal health and wellbeing”.ConclusionThe COVID-19 pandemic has caused important reductions in PE requirements and time engaged in physical activity. Challenges experienced by teachers were identified for closed and open schools.

Guo, Menghan; Xu, Juan; Du, Jiayue

doi: 10.1186/s12889-021-11401-8pmid: 34229639

BackgroundWorldwide, cervical cancer is the second-most-common malignancy of the female reproductive system. Due to its large population, China accounted for 11.9% of cervical cancer deaths, and 12.3% of global cervical cancer DALYs in 2017. In 2009, China launched a nationwide screening program, yet mortality from cervical cancer has shown an upward trend in recent years. The aim of this study was to explore factors affecting cervical cancer mortality rates in China, and contribute to their future reduction.MethodsIn this descriptive study, a Joinpoint regression analysis and age-period-cohort (APC) model based on the intrinsic estimator (IE) algorithm were utilized. Data from the period 1989–2018 were extracted from the International Agency for Research on Cancer (IARC) Database of WHO (1989–2000) and China Health Statistical Yearbook database (2002–2018).ResultsOur study found mortality from cervical cancer to have initially declined, but increase thereafter over the entire observation period in both rural and urban China. The influence of age, period and cohort effect on the mortality rate had statistical significance. The effect of age increased with years, becoming a contributing factor in women aged over 45 years countrywide. Conversely, the cohort effect became a protective factor for women born after 1938 in urban areas, and for women born after 1958 in rural areas. The period effect was relatively less impactful.ConclusionsThe study indicates that organized cervical screening projects facilitated the identification of potential patients, or patients with comorbidities. Correspondingly, mortality was found to increase with incidence, particularly among elderly women, indicating that newly diagnosed patients were at an advanced stage of cervical cancer, or were not receiving appropriate treatment. Therefore, the coverage of cervical cancer screening should be improved, and women’s health awareness promoted. Early diagnosis and treatment is critical to reduce the disease burden and improve outcomes.

Geng, Jinsong; Chen, Xiaowei; Shi, Jianwei; Bao, Haini; Chen, Qian; Yu, Hao

doi: 10.1186/s12889-021-11947-7pmid: 34663271

BackgroundChina has successfully sustained its universal health insurance coverage over the past decade. Although patient satisfaction has been recognized as an important indicator to measure the performance of insurance programs in China, there is a lack of evidence on how patients with chronic diseases are satisfied with China’s public health insurance programs and whether their satisfaction differs by type of insurance. We aimed to fill the evidence gap.MethodsWe established a hypothetical model that comprised patients’ awareness of insurance policies, the fulfillment of patients’ expectations of insurance benefits, patients’ perceived value of health insurance coverage, patients’ satisfaction with health insurance programs, patients’ complaints, and trust in health insurance programs. We performed a confirmatory factor analysis by using a structural equation modeling (SEM) approach to examine the hypothesized model. A model-testing survey in 10 tertiary hospitals was conducted between June and October 2018, with a valid sample of 922 insured patients with chronic diseases.ResultsThe SEM model, with good fit indices, showed that patients’ awareness of health insurance policies, insurance program’s fulfillment of expectations, and patients’ perceived value of insurance coverage, positively predicted patient satisfaction (P < 0.01). The fulfillment of patients’ expectations of insurance benefits was the major predictor of satisfaction with health insurance (coefficient = 0.593, P < 0.001), while the patients’ perceived value of insurance coverage had the largest impact on their trust in health insurance (coefficient = 0.409, P < 0.01). Compared to patients with Urban-Rural Resident Basic Medical Insurance, Urban Employee Basic Medical Insurance enrollees had a higher degree of satisfaction with insurance on average (P < 0.01). Despite differences in the degree of satisfaction, the main findings from the SEM were also proved by the multi-group analysis.ConclusionsOur findings highlight the importance of incorporating patients’ perceived value as part of the ongoing efforts to increase satisfaction with health insurance by patients, especially those who have chronic diseases. Policymakers are also suggested to formulate evidence-informed reimbursement policies that meet patients’ expectations.

BAUDIN, Clémence; LEFÈVRE, Marie; CHAMPELOVIER, Patricia; LAMBERT, Jacques; LAUMON, Bernard; EVRARD, Anne-Sophie

doi: 10.1186/s12889-020-10138-0pmid: 33423666

BackgroundNoise is a major public health issue because of its negative impacts on health, including annoyance, sleep disturbance, cardiovascular diseases and altered cognitive performance among children. Self-rated health status (SRHS) can be considered as a reliable indicator of quality of life, morbidity and mortality but few studies have considered SRHS in relation to aircraft noise exposure. The present study aims to investigate the association between this exposure and SRHS of people living near airports in France, and to consider the mediating or moderating role of aircraft noise annoyance and noise sensitivity in this association.MethodsThis cross-sectional study included 1242 participants older than 18 and living near three major French airports. Information on their SRHS, aircraft noise annoyance, noise sensitivity and demographic, socioeconomic and lifestyle factors was collected during a face-to-face interview performed at home. Outdoor aircraft noise levels were estimated for each participant’s home address using noise maps. Logistic regressions with adjustment for potential confounders were used. The moderating and mediating effects of aircraft noise annoyance and noise sensitivity were investigated following Baron and Kenny’s recommendations.ResultsA significant association was shown between aircraft noise levels and a fair/poor SRHS, only in men (OR=1.55, 95%CI 1.01–2.39, for a 10 dB(A)-increase in Lden). This relationship was higher in men highly sensitive to noise (OR=3.26, 95%CI 1.19–8.88, for a 10 dB(A)-increase in Lden). Noise sensitivity was associated with a fair/poor SRHS significantly in women (OR=1.74, 95%CI 1.12–2.68) and at the borderline of significance in men (OR=1.68, 95% CI 0.94–3.00), whereas aircraft noise annoyance was associated with a fair/poor SRHS only in men (OR=1.81, 95%CI 1.00–3.27).ConclusionThe present study confirms findings in the small number of available studies to date suggesting a positive association between aircraft noise levels and a fair/poor SRHS. These results also support the hypothesis that noise sensitivity would moderate this association. However, a mediating effect of annoyance cannot be excluded.