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Lyme disease is a growing public health problem in Québec. Its emergence over the last decade is caused by environmental and anthropological factors that favour the survival of Ixodes scapularis, the vector of Lyme disease transmission. The objective of this study was to estimate the speed and direction of Lyme disease emergence in Québec and to identify spatiotemporal risk patterns. A surface trend analysis was conducted to estimate the speed and direction of its emergence based upon the first detected case of Lyme disease in each municipality in Québec since 2004. A cluster analysis was also conducted to identify at-risk regions across space and time. These analyses were reproduced for the date of disease onset and date of notification for each case of Lyme disease. It was estimated that Lyme disease is spreading northward in Québec at a speed varying between 18 and 32 km/year according to the date of notification and the date of disease onset, respectively. A high rate of disease risk was found in seven clusters identified in the south-west of Québec in the sociosanitary regions of Montérégie and Estrie. The results obtained in this study improve our understanding of the spatiotemporal patterns of Lyme disease in Québec, which can be used for proactive, targeted interventions by public and clinical health authorities.

Objective. To compare the occurrence of suicide attempts across nationally representative samples of the Mexican adolescent population over the past 12 years, and to analyze its association with sociodemographic, lifestyle and mental-health indicators. Methodology. Data were drawn from the 2006, 2012 and 2018 National Health and Nutrition Surveys (n = 25,056, 21,509, and 17,925 adolescents, respectively). Estimates were based on standardized measurements. Results. The estimated lifetime prevalence rates of suicide attempts were 1.1% in 2006, 2.7% in 2012, and 3.9% in 2018, indicating a 3.4-fold increase. Across the three survey periods, women yielded rates nearly three times higher than men. Lifetime prevalence grew the most among adolescents aged 13–15 years. Compared to the other respondents, the odds of lifetime suicide attempts proved seven times as high for those who had been sexually abused during their childhood, five times as high for those who had been diagnosed with a depressive disorder, three times as high for those who had suffered physical aggression and twice as high for those who had smoked 100+ cigarettes in their lifetimes and those who consumed alcohol. Conclusion: The sharp increase in suicide attempts in Mexico calls for an urgent public-health response via universal and targeted interventions supported by national policy and sustained federal funding.

Background: Differential exposure to endocrine-disrupting chemicals, including phthalate diesters, may contribute to persistent racial/ethnic disparities in women’s reproductive health outcomes. We sought to characterize sources of gestational exposure to these agents that may differ according to maternal race. Methods: We enrolled pregnant Black (n = 198), including African American, and White (n = 197) women during the second trimester, and measured eight phthalate monoester metabolites in urine. We assessed confounder-adjusted associations between multiple food and beverage consumption habits, summarized using a principal component analysis, as predictors of maternal urinary phthalate metabolite levels, stratified by race. Results: Whites reported significantly greater unprocessed food consumption (42.5% vs. 32.0%, p &lt, 0.001) and storage of food in clear unbreakable plastic containers (66.5% vs. 49.3%, 0.001) than Blacks, while Blacks consumed more canned fruits and vegetables (23.5% vs. 12.2%, 0.001) than Whites. Using plastics for food storage, microwaving in plastic containers, and using hard plastic water bottles was associated with urinary phthalate concentrations, especially DEHP metabolites (e.g., mean difference = 5.13%, 95% CI: 3.05, 7.25). These associations were driven primarily by Black pregnant women. Conclusions: Targeted interventions to reduce maternal exposure to phthalates need to be designed with specific attention to differences in food and beverage consumption behaviors among Black and White women.

(1) Objectives: With an aging society in China, self-treatment now plays an important role in health care among older adults, but it can be problematic. This study aims to explore and compare the self-treatment behavior among empty and non-empty nesters. (2) Methods: Using a multi-stage stratified random cluster sampling method, a total of 4366 elderly people aged 60 and above from Shandong Province, China, were enrolled in this study. Data were collected through a structured questionnaire. Binary logistic regression was used to analyze the associated factors of self-treatment. (3) Results: The prevalence of self-treatment in empty nesters was significantly lower than that in non-empty ones (74.0% vs. 83.3%). Binary logistic regression analysis showed that higher educational level and poorer self-rated economic status were negatively associated with self-treatment in empty nesters, while unemployed and urban and rural residents&rsquo, basic medical insurance were positively associated with self-treatment in non-empty ones. (4) Conclusions: The study indicated that empty nesters had lower likelihood of self-treatment than non-empty ones. Empty nesters with better socioeconomic status were more likely to use self-treatment, by contrast, non-empty nesters with relatively poorer socioeconomic status were more inclined to self-treatment. Targeted interventions should be developed to maximize the effectiveness of self-treatment and reduce health risks.

Suicide rates worldwide are declining, however, less is known about the patterns and trends in mortality from suicide in sub-Saharan Africa. This study evaluates trends in suicide rates and years of potential life lost from death registration data in South Africa from 1997 to 2016. Suicide (X60&ndash, X84 and Y87) was coded using the 10th Revision of the International Classification of Diseases (ICD-10). Changes in mortality rate trends were analysed using joinpoint regression analysis. The 20-year study examines 8573 suicides in South Africa, comprising 0.1% of all deaths involving persons 15 years and older. Rates of suicide per 100,000 population were 2.07 in men and 0.49 in women. Joinpoint regression analyses showed that, while the overall mortality rate for male suicides remained stable, mortality rates due to hanging and poisoning increased by 3.9% and 3.5% per year, respectively. Female suicide mortality rates increased by 12.6% from 1997 to 2004 before stabilising, while rates due to hanging increased by 3.0% per year. The average annual YPLL due to suicide was 9559 in men and 2612 in women. The results show that suicide contributes substantially to premature death and demonstrates the need for targeted interventions, especially among young men in South Africa.

Reducing the 2015 level of malaria mortality by 90% by 2030 is a goal set by the World Health Organization (WHO). In Burkina Faso, several malaria control programs proven to be effective were implemented over the last decade. In parallel, the progressive strengthening of the health surveillance system is generating valuable data, which represents a great opportunity for analyzing the trends in malaria burden and assessing the effect of these control programs. Complementary programs were rolled out at different time points and paces, and the present work aims at investigating both the spatial and temporal pattern of malaria case fatality rate (mCFR) by considering the effect of combining specific and unspecific malaria control programs. To this end, data on severe malaria cases and malaria deaths, aggregated at health district level between January 2013 and December 2018, were extracted from the national health data repository (ENDOS-BF). A Bayesian spatiotemporal zero-inflated Poisson model was fitted to quantify the strength of the association of malaria control programs with monthly mCFR trends at health district level. The model was adjusted for contextual variables. We found that monthly mCFR decreased from 2.0 (95% IC 1.9&ndash, 2.1%) to 0.9 (95% IC 0.8&ndash, 1.0%) deaths for 100 severe malaria cases in 2013 and 2018, respectively. Health districts with high mCFR were identified in the northern, northwestern and southwestern parts of the country. The availability of malaria rapid diagnosis tests (IRR: 0.54, CrI: 0.47, 0.62) and treatment (IRR: 0.50, CrI: 0.41, 0.61) were significantly associated with a reduction in the mCFR. The risk of dying from malaria was lower in the period after the free healthcare policy compared with the period before (IRR: 0.47, CrI: 0.38, 0.58). Our findings highlighted locations that are most in need of targeted interventions and the necessity to sustain and strengthen the launched health programs to further reduce the malaria deaths in Burkina Faso.

Communication failures were a leading cause of sentinel events in the operation room due to frequently the communication breakdown occurs between physicians and nurses. This study explored the perspectives of surgical teams (nurses, physicians, and anaesthesiologists) on interprofessional collaboration and improvement strategies. A surgical team comprising eight perioperative nurses, four surgeons, and four anaesthesiologists from a university-affiliated hospital participated in this qualitative and phenomenological research from December 2018 to April 2019. Data were collected in in-depth interviews and were used in a thematic analysis according to Colaizzi to extract themes and categorised codes with the ATLAS.ti software. The result is presented in three generic categories: Barrier-like disruptive behaviours and lack of coordination of care, consequences by safety threats to the patient, overcoming barriers by shared decision making among professionals, flattened hierarchies, and teamwork/communication training. The conclusion is that different teams’ perspectives can facilitate genuine reflection, discussion, and implementation of targeted interventions to improve operating room interprofessional collaboration and overcome barriers and their consequences. Currently, there is a need to change towards interprofessional collaboration for optimal patient outcomes and to ensure all professionals’ expectations are met.

While previous studies have shown evidence of an association between school climate and aggression, few have explored the mechanisms behind this association. As such, this cross-sectional study focused on both the mediating effects of self-control and the moderating effects of the parent-child relationship on the association between school climate and aggression. Data were obtained through an anonymous survey conducted among 1030 Chinese elementary and middle school students (52.72% male, average age = 11.53 years), who responded to items on school climate, aggression, self-control, and the parent-child relationship. First, the results showed that school climate was negatively associated with aggression. Second, a mediation analysis showed that self-control significantly mediated the association between school climate and aggression. Third, a moderated mediation analysis showed that the parent-child relationship significantly moderated the first stage of the indirect path (school climate → self-control). Specifically, this association was notably stronger among children and adolescents with better parent-child relationships. In sum, these findings constitute a valuable reference for both improving self-control and in the context of targeted interventions aimed at preventing aggression in children and adolescents in China.

Epigenetics describes how both lifestyle and environment may affect human health through the modulation of genome functions and without any change to the DNA nucleotide sequence. The discovery of several epigenetic mechanisms and the possibility to deliver epigenetic marks in cells, gametes, and biological fluids has opened up new perspectives in the prevention, diagnosis, and treatment of human diseases. In this respect, the depth of knowledge of epigenetic mechanisms is fundamental to preserving health status and to developing targeted interventions. In this minireview, we summarize the epigenetic modulation of the KISS1 gene in order to provide an example of epigenetic regulation in health and disease.

To achieve a healthy lifestyle, adolescents must be physically active and meet physical activity (PA) guidelines. One of the most natural ways of increasing the amount of PA is active commuting (AC) to school. Recent reviews suggest that peer norms have the potential to shape PA during adolescence in particular. Thus, our primary aim was to investigate whether Czech adolescents misperceive their peers&rsquo, AC behaviors and attitudes towards AC. Our dataset comprised cross-sectional data on 1586 adolescents aged 11&ndash, 15 years. Basic descriptive statistics, chi-square tests, and correlation analyses were used to analyze the data. Regarding traveling to school, 68% of the Czech adolescents in this study are daily active commuters (walking, cycling, or riding a scooter or skateboard). Less than half of the respondents believed that most of their classmates were commuting to school actively almost daily. The students who believed that most of their classmates commuted to school actively had significantly higher chances of being regular active commuters themselves. The results showed that most of the Czech adolescents misperceived the AC norms of their peers. Thus, there could be potential in using a social norms approach aimed at increasing the level of AC in Czech adolescents through targeted interventions.

Psychological needs dissatisfaction has been identified as hindering adaptive development, in which autonomy need dissatisfaction, as one core component, may be associated with adolescents&rsquo, maladaptive online behaviors. Sporadic research has examined the association between autonomy need dissatisfaction and problematic mobile phone use (PMPU). Boredom proneness and mobile phone gaming were suggested to be linked to this association. This study aimed to examine the mediating effects of boredom proneness and mobile phone gaming in the association between autonomy need dissatisfaction and PMPU. A total of 358 secondary school students completed questionnaires at three waves, autonomy need dissatisfaction was measured in time 1 (T1), boredom proneness and mobile phone gaming were measured one year later (time 2, T2), PMPU was measured two years later (time 3, T3). The structural equation model results showed that T1 autonomy need dissatisfaction not only directly predicted T3 PMPU, but also exerted effects via the mediating role of T2 boredom proneness and the chain mediating role of T2 boredom proneness and T2 mobile phone gaming. These findings reveal the unique role of specific psychological need in engaging PMPU, which provides support to targeted interventions, such that promoting autonomy need satisfaction may be an instrumental procedure to prevent adolescents from addiction-like online behaviors.

High usage of emergency treatment and hospitalization has been reported among homeless individuals. Hence, this study aimed to identify the sociodemographic predictors associated with overnight and emergency hospital treatment among a sample of homeless adults. Participants were recruited from a shelter in Dallas, Texas (N = 354; Mage = 43.7 ± 11.7) and were predominantly uninsured, low-income men from various racial groups. The outcome variables were: (a) stayed overnight for treatment in a hospital; and (b) treated in a hospital emergency room. In logistic regression models, sex emerged as the only predictor of overnight treatment in a hospital (OR = 2.68, 95% CI = 1.61–4.47), and treatment in an emergency room (OR = 2.21, 95% CI = 1.34–3.65), such that women were more likely than men to be treated overnight and use emergency care. Targeted interventions and policies are needed to address homeless women’s primary care needs and reduce costlier treatment.

Background and Purpose: Fatigue is one of the most common symptoms reported in several studies, but few studies have concentrated on the male population, especially for the middle-aged and older men who are exposed to greater fatigue risk. The purpose of this study was to explore the prevalence of fatigue and identify the risk factors of fatigue among men aged 45 and older in China. Methods: This study was part of a cross-sectional study on community health in Shunde (Guangdong Province, China). A total sample of 1158 men aged 45 and older were included. Sociodemographic characteristics, health and lifestyle factors and the Chalder Fatigue Scale (CFS) were measured by structured questionnaires through face-to-face interviews. Multivariate logistic regression was applied to determine the risk factors of fatigue. Results: Approximately 30% of participants experienced fatigue. Older age (≥75 years: adjusted OR 3.88, 95% CI 2.09–7.18), single marital status (1.94, 1.04–3.62), unemployed status (1.68, 1.16–2.43), number of self-reported chronic diseases (≥2 chronic diseases: 2.83, 1.86–4.31), number of individuals’ children (≥4 children: 2.35, 1.33–4.15), hospitalization in the last year (1.61, 1.03–2.52) were all significantly associated with increased risk of fatigue, while regular exercise (0.46, 0.32–0.65) was a protective factor against fatigue. Conclusions: Fatigue was usual in males and several factors were associated with the fatigue. These findings may have implication in risk assessment of fatigue and help in developing and implementing targeted interventions in middle-aged and elderly males.

The aim of the paper is to quantify the burden and risk factors of fatal and non-fatal suicidal behaviors in rural Bangladesh. A census was carried out in seven sub-districts encompassing 1.16 million people. Face-to-face interviews were conducted at the household level. Descriptive analyses were done to quantify the burden and Poisson regression was run to determine on risk factors. The estimated rates of fatal and non-fatal suicide were 3.29 and 9.86 per 100,000 person years (PY) observed, respectively. The risk of suicide was significantly higher by 6.31 times among 15–17 and 4.04 times among 18–24 olds compared to 25–64 years old. Married adolescents were 22 times more likely to commit suicide compared to never-married people. Compared to Chandpur/Comilla district, the risk of suicide was significantly higher in Narshingdi. Students had significantly lower risk of non-fatal suicidal behavior compared to skilled laborers. The risk of non-fatal suicidal behavior was lower in Sherpur compared to Chandpur/Comilla. Among adolescents, unskilled laborers were 16 times more likely to attempt suicide than students. The common methods for fatal and non-fatal suicidal behaviors were hanging and poisoning. Suicide is a major public health problem in Bangladesh that needs to be addressed with targeted interventions.

It is crucial to provide updated knowledge about blood (non-)donors, as it is necessary to design targeted interventions with the aim of retaining blood donors and thus contributing to a functioning health system. This study investigates the prevalence and socio-demographic patterning of lifetime blood donation, assessing blood donation intention within the next 12 months and exploring personal motives and deterrents of blood donation qualitatively in the German population. A face-to-face cross-sectional survey with 2531 respondents was conducted, representative of the German population in terms of age, gender, and residency. Closed as well as open questions were asked. Qualitative content analysis was used for coding the qualitative material. Basic descriptive statistics were conducted to address our research questions. More than one-third of the participants reported that they have donated blood at least once in their lifetime. Motives and deterrents were assigned to 10 domains with 50 main categories and 65 sub-categories. The most frequently stated motives for blood donation were “altruism”, “social responsibility”, and “charity”, whereas the most frequently stated deterrents were “health status”, “age”, and “lack of time”. This study provides information to tailor recruitment and reactivation strategies to address donors at different career steps—from non-donor to loyal donor.

Asymptomatic malaria and anemia during pregnancy increase the risk of negative birth outcomes. This cross-sectional study investigated the prevalence and correlates of asymptomatic malaria and anemia during first antenatal care (ANC) visit among pregnant women in a rural district, Tanzania. HIV-uninfected pregnant women without symptoms of malaria (n = 819) attending their first ANC at Kibiti Health Centre were enrolled from February 2017 to February 2018. Asymptomatic malaria was detected by malaria rapid-diagnostic tests (mRDT) and real-time PCR. Hemoglobin concentration was determined by HemoCue Hemoglobin 201+. The study outcomes were the prevalence of asymptomatic malaria and anemia (Hemoglobin level 25% throughout the year, and the highest prevalence (40%) was recorded during the rainy season. Asymptomatic malaria was significantly associated with primigravida, younger maternal age, and anemia. The prevalence of anemia was 68.5% (95% CI: 65.2, 71.6). Asymptomatic malaria, primigravida, younger maternal age and low Body Mass Index were significant predictors of low hemoglobin concentration. We report high prevalence of asymptomatic malaria and anemia among pregnant women on the first ANC visit. Screening of malaria and anemia during the first ANC visit is recommended for targeted interventions.