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Aim: This paper aims to better understand the relationship between homicide and other public health outcomes, by studying their trends over time. Subject and methods: Research in both criminology and public health has long identified that crime and violence tend to cluster together with adverse phenomena in the social and health domains. However, such work has relied primarily on cross-sectional analyses. Here, we instead study trends over time. We take data from the Netherlands, between 2000 and 2020, and ask whether homicide shows similar trends over time as other public health phenomena – such as smoking behaviour, alcohol use, child mortality, adolescent pregnancies, and suicide. Results: We observe, first, that all of the phenomena – with the exception of suicide – declined over the period under study. We then employ a time series analysis to examine whether these trends arise independently, or whether they are the result of structural similarities between phenomena. Results showed that the decline in homicide rates is linked to a similar decline in adolescent pregnancies – the rates of these phenomena 'move together' during the period under study. Conclusion: This work shows that the phenomenon of homicide shares structural similarities with teenage pregnancies – a decline in one is linked to a similar decline in the other. More generally, the current work furthers our understanding of the place of homicide in the domain of (public) health. [ABSTRACT FROM AUTHOR]

Aim: To analyze the level of knowledge, attitudes, practices, and risk perception regarding COVID-19 among Chinese residents 1.5 years after the pandemic. Subject and methods: A cross-sectional study was carried out with both online and paper questionnaires. We included a variety of covariates that were characteristic-related factors such as age, gender, education level, and retirement status, as well as those closely associated with risk perception regarding COVID-19. Results: Participants (n = 3588), 53.49 ± 18.88 years old, from two provinces of China, of which 44.7% were male and 52.03% had a high school or greater level of education, answered the questions. More than 90% of participants had adequate background knowledge about COVID-19 and agreed or even strongly agreed with many attitude items related to the government's role in diagnosis, treatment, and dealing with COVID-19 infections. About three fifths of the participants reported fear of contracting COVID-19, but only a minority (18.63%) felt they were more susceptible than others. Respondents aged 45 years or younger were more likely to fear contracting the virus than those older than 45 years (adjusted OR = 1.464, 95% CI 1.196 to 1.794, P = 0.0002). High education level (adjusted OR = 1.503, 95% CI 1.187 to 1.904, P = 0.0007) and non-retired status (adjusted OR = 1.679, 95% CI 1.354 to 2.083, P < 0.0001) were associated with a higher perception of susceptibility to infection than others. Moreover, respondents who were not retired had a significantly reduced practice score (adjusted OR = 1.554, 95% CI 1.261 to 1.916, P < 0.0001). Age, retirement status, and education level were also associated with knowledge, attitude, and practice level. Conclusion: Our findings suggest that the public generally has trust in the COVID-19 vaccine and the government with regard to COVID-19 in China. We recommend that high-risk groups of communities, such as elders and patients with chronic diseases, be given greater consideration in the outbreaks. Health education campaigns combined with workplace preventive intervention should be aimed at improving COVID-19 knowledge and beliefs in order to encourage more optimistic attitudes and to maintain safe practices. [ABSTRACT FROM AUTHOR]

Female genital mutilation (FGM) involves the cutting of the external female genital organs for non-medical purposes. It is a widespread public health problem in Nigeria as it affects the health of women and girls. The views of women about FGM are widely researched and known; however, very little empirical research has been conducted to understand the views of men. Aim: This study therefore sought to examine men's views with regard to the continuation of FGM and its associated factors in a rural Igbo community in Nigeria. Subject and Method: This paper reports the results of a survey of 215 men aged 18 and above living in Isuikwuato Local Government Area, Uturu in Nigeria. Bivariate and binary logistic regression were performed on 215 completed and returned questionnaires (86% response rate) using the Statistical Package for Social Science. This is the first study to investigate Nigerian Igbo men's views of FGM. Results: Descriptive statistics revealed that almost two-thirds of the sample (63.7%) thought FGM should be discontinued. Logistic regression found that owning a television and/or a radio and holding a Christian faith significantly predicted favouring the discontinuation of FGM. Conclusion: This study provides evidence to suggest that some Nigerian Igbo men's attitudes about FGM appear to be generally less than favourable. The major implication of these findings is that policy makers must place greater emphasis on addressing the economic and social development of rural areas in Nigeria if the harmful practice of FGM is to be reduced. [ABSTRACT FROM AUTHOR]

Aim: This study aimed at comparing health literacy measures, and their correlates, for the district of Favoriten to those of Vienna and Austria. The Viennese district of Favoriten was of particular interest, due to present characteristics, such as its high cultural and ethnic diversity as well as a relatively high unemployment rate. Subject and methods: This study was set up as a cross-sectional, paper-based self-completion random sample survey. For each sample representing Favoriten, Vienna, and Austria, 500 adults were randomly drawn from the population register. Results: Out of 1500 surveys sent out, 160 (10.7%) were included in the analysis. Regarding general health literacy, the sample of Favoriten scored highest (33.9; CI 95% 31.5, 36.3), followed by the samples of Austria (32.5; CI 95% 30.9, 34.2) and Vienna (31.5; CI 95% 29.6, 33.4). Higher household income (r = 0.46, p < 0.01), better education (r = 0.31, p = 0.09) and migration status outside the EU (d = −0.56, p = 0.12) showed moderately effect-sized associations to general health literacy in the sample of Favoriten, which was not the case for other characteristics such as age, gender, and employment status. Conclusion: In the light of previous studies, reporting on associations of health literacy measures with social determinants, such as migration and employment status, the sample of Favoriten might well have been expected to result in impaired health literacy measures. Our results do not support this assumption, though. Despite the limited external validity of this study, policymakers and practitioners may be advised to design health literacy measures in such a way that specifically reaches out to the socially disadvantaged target population and not focus merely on pertinent districts or regions. [ABSTRACT FROM AUTHOR]

Aim: As individuals adjust to new 'norms' and ways of living during the COVID-19 lockdown, there is a continuing need for up-to-date information and guidance. Evidence suggests that frequent media exposure is related to a higher prevalence of mental health problems, especially anxiety and depression. The aim of this study was to determine whether COVID-19 related media consumption is associated with changes in mental health outcomes. Methods: This paper presents baseline data from the COVID-19 Psychological Wellbeing Study. The cross-sectional study data was collected using an online survey following the Generalised Anxiety Disorder scale (GAD-7) and the Patient Health Questionnaire (PHQ-9), with some other basic information collected. Logistic regression analysis was used to examine the influence of socio-demographic and media specific factors on anxiety and depression. Results: The study suggested that media usage is statistically significantly associated with anxiety and depression on the GAD-7 and PHQ-9 scales with excessive media exposure related to higher anxiety and depression scores. Conclusion: This study indicated that higher media consumption was associated with higher levels of anxiety and depression. Worldwide it should be acknowledged that excessive media consumption, particularly social media relating to COVID-19, can have an effect on mental health. However, as this was a cross-sectional study we cannot infer any directionality as we cannot infer cause and effect; therefore, future research involving longitudinal data collection and analyses of variables over time is warranted. [ABSTRACT FROM AUTHOR]

Background: Undernutrition among children is a primary concern in sub-Saharan African countries such as Ethiopia. The objective of this paper is to measure the magnitude of undernutrition and associated factors among children under 2 years of age in the Jimma Zone of Southwest Ethiopia. Methods: A community-based cross-sectional study with stratified multistage sampling was conducted. Data were collected using a semi-structured questionnaire and anthropometric measurements. Bivariate and multivariable logistic regression models were fitted using SPSS 20.0 for Windows. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to measure the strength of the association between dependent and associated variables at a p value <0.05. Results: Among the study participants, 142 (25.4%) were stunted, 73 (13.1%) were underweight, and 54 (9.7%) were wasted. Older child age [AOR = 1.1, 95% CI (1.1, 1.2)], male sex [AOR = 2.601, 95% CI (1.681, 4.025)], and residing in an urban area [AOR = 0.526, 95% CI (0.323, 0.857)] were significantly associated with stunting. Independent predictors of wasting were younger child age [AOR = 0.894, 95% CI (0.833, 0.96)], living in a lowland area [AOR = 3.3, 95% CI (1.4, 8.1)], and living a in poor household [AOR = 6.2, 95% CI (2.2, 17.7)]. Underweight was significantly associated with male sex [AOR = 2.09, 95% CI (1.179, 3.703)], delayed initiation of breastfeeding [AOR = 2.1, 95% CI (1.0, 4.2)], and living in a poor household [AOR = 2.2, 95% CI (1.0, 4.6)]. Conclusions: Child malnutrition was found to be a moderate public health problem in the study area. Urban dwellers had higher levels of undernutrition than rural dwellers. Children living in lowlands had higher undernutrition than those living in highland areas. [ABSTRACT FROM AUTHOR]

Aims: Access to healthcare, especially among adolescents, is a public health issue with long-lasting health and socio-economic consequences. Adolescence is a distinctive growing period for developing healthcare behaviour that can either improve or worsen future health conditions. Hence, the need for quality healthcare behaviour among adolescents who usually constitute a large proportion of any country's population, is imperative. This paper thus examines the impact of medical aid coverage and other socio-economic factors in determining South African adolescents' utilisation of either private or public healthcare facilities in the event of illness. By extension, the study investigates the effects of pertinent parental characteristics on South African adolescents' choices of either private or public healthcare facilities. Subject and methods: Data come from the population-weighted 2018 General Household Survey (GHS). Units of analysis include adolescents within the ages of 10 and 19 years. The empirical analysis relies primarily on a regressions-based model and instrumental variable approach. Results: Result indicates that younger adolescents are more likely to use public healthcare facilities in the event of illness than older adolescents. However, adolescents who are medically covered are less likely to utilise public healthcare facilities in the event of illness. Further findings suggest that the likelihood of using public healthcare facilities is higher among adolescents who are black Africans, live in relatively poor households, large households and rural areas. Conclusion: Further implementation and review of any national health policy such as the National Health Insurance (NHI) scheme needs to address and take into consideration adolescents' healthcare utlisation and socio-economic variations in their healthcare utilisation. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper was to investigate online health information seeking and health literacy among non-medical college students in Egypt and the differences between the two genders. Subjects and methods: A cross-sectional descriptive design was used to collect data from 600 students through a self-administered questionnaire. Results: Most of the students searched for health information on the internet (82.3%). 90.3% of them used their mobile phones and 97.8% sought data via Google. Skin and hair problems was the most searched for topic (83.3%), followed by reproductive health (79.7%). Students perceived that rapid and easy access to information were the main advantages of health information seeking online (98.5% and 95.5%, respectively), while the lack of reliability and scarcity of information in the Arabic language were the main disadvantages (78.2% and 60.5%, respectively). Only 31.2% of the sample achieved an adequate literacy level. Females in our sample had a higher frequency of online health information seeking and a higher level of health literacy. They also had a higher percentage of searching for health data on YouTube and seeking nutrition information. On the other hand, males used online health applications more frequently and were more interested in physical fitness and smoking. Females perceived the high cost as the main disadvantage of online health information seeking, while males were more concerned about the reliability of information. Health literacy was positively related to female gender and frequency of online health information seeking. Conclusion: Using the internet to deliver health information according to each gender's preferences and concerns can encourage students to search for health information online and, therefore, raise their health literacy level. [ABSTRACT FROM AUTHOR]

Aim: The present paper aims to understand the fear of falling (FOF) and risk factors associated with FOF in community-dwelling individuals aged over 60 years in Pune, India. Subjects and methods: The study examined a random sample of 351 community-dwelling older adults. Data on demographic characteristics, health conditions, history of falls, and psychological factors were collected using a pre-tested, structured questionnaire. The Falls Efficacy Scale International (FES-I) was used to measure FOF. Univariate and bivariate logistic regression analyses were carried out to examine associations between various factors and FOF. Results: A high FES-I score was significantly associated with older age, females, unmarried status, education less than 6 years, living alone, unstable balance and gait, hypertension, arthritis, previous falls, self-reported loss of confidence, and depression. Adults older than 70 years of age (odds ratio, OR = 2.411), those with a history of falls (OR = 2.285), those reporting loss of confidence in the past 6 months (OR = 6.766), who had answered yes to the direct question of FOF (OR = 4.632), and had unstable balance (OR = 2.522) were also more likely to have higher FES-I values. Conclusion: A large number of older adults expressed concerns about falling and we also found several factors to be associated with developing FOF, supporting the need for screening. Thus, further research is needed in order to understand the relationship between severity of FOF and actual fall events for developing preventive measures which can be implemented before FOF becomes a problem. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to track the efficacy of the Test and Treat model of human immunodeficiency virus (HIV) prevention adopted by the government of India, 2015-16, using the last two rounds of National Family Health Survey, providing community-based insights in the testing of HIV prevalence in 2005-06 and 2015-16.Methods: The survey collected information from a nationally representative sample of 69,751 men and 124,385 women in 2005-06 and 103,411 men and 121,118 women age 15-49 in 2015-16 respectively. Both descriptive and multivariate techniques have been used.Results: The 'test and treat' model of HIV in India portrays a women-centric effort to ensure HIV testing as part of their ANC, resulting in a substantial increase in ever being tested for HIV. Women who are educated, living in urban areas, and in economically better households are more prone to have ever undergone HIV testing, it is a welcome change given the existing HIV scenario, with a continuously narrowing gender gap in new HIV infections (NFHS-4). Women and men having positive attitude towards stigma and discrimination to people living with HIV (PLHIV) are in better agreement to ever being tested. Further, women and men having knowledge about antiretroviral therapy (ART) are 1.6 times (p < 0.001) and 1.8 times (p  < 0.001) more likely to have ever been tested for HIV.Conclusions: Despite an improvement in coverage of HIV testing, the existing disparities in HIV testing and treatment require policy instruments with an integrated approach. Government should work in close collaboration with communities/key stakeholders, and efficiently use their resources to provide evidence-based HIV prevention and treatment interventions. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking is an established cause of preventable death and often initiated during adolescence. We estimated the short- and long-term costs of cigarette smoking among currently smoking adolescents in Nigeria. Methods: A cross-sectional survey among adolescents in Oyo state, Nigeria and a review of mortality records of patients managed for lung cancer in a tertiary facility in Ibadan, Nigeria were conducted. Short-term costs estimated were: (a) average weekly costs of purchasing cigarettes by currently smoking adolescents, and (b) costs of managing at least an episode of chronic cough occurring within 12 months of the survey. Long-term costs were limited to: (a) life-time expenditure on purchasing cigarettes, and (b) direct medical and non-medical (transportation) costs of managing lung cancer. Long-term costs were first projected to the approximate year when the adolescents (mean age:16.0 ± 1.8 years) might be diagnosed with lung cancer based on the average age at presentation with symptoms of lung cancer obtained from the records (59.8 years), and then discounted to 2020 prices. This was estimated as 44 years from the base year (2020). Costs were reported in 2020 prices in Nigerian Naira (NGN) and US dollar (USD) equivalent using the Central Bank of Nigeria, June 2020 exchange rate of USD 1: NGN 360.50. Results: Approximately 3.8% of the adolescents were current cigarette smokers. Average weekly expenditure on cigarettes was NGN 306.82 ± 5.74 (USD 0.85 ± 0.02). About 26% had experienced at least an episode of chronic cough which cost them an average of NGN 1226.81 ± 6.18 (USD 3.40 ± 0.02) to manage. Total future costs of cigarette smoking in 2020 prices for the 43 adolescents who were current smokers in the event that they develop lung cancer were approximately NGN 175.7 million (USD 487.3 thousand), NGN 871.8 million (USD 2.4 million) and NGN 4.6 trillion (USD 12.7 million) at assumed annual inflation rates of 10%, 15%, and 20% respectively and discount rate of 4.25%. Conclusion: The estimated economic costs of smoking were very high. Efforts to prevent smoking initiation among adolescents in our study area should be intensified. Interventions to subsidize the medical cost of health-related consequences of cigarette smoking are also required, especially as treatment costs are currently largely borne out-of-pocket. [ABSTRACT FROM AUTHOR]

Aim: Keeping shared toilets clean is a key public health challenge household users face in urban slum settlements of most developing countries. This paper provides insights on the cleanliness of households' shared toilets and the factors that influence their cleanliness, as well as influencing the inclination of the users to keep them clean. Subjects and methods: This analysis is part of a cross-sectional study conducted in 50 randomly selected slums in Kampala, Uganda between October and November 2010. A total of 1,500 respondents were interviewed, using a semi-structured questionnaire. Results: Out of 1,019 respondents using shared toilets, less than 12 % reported having very clean toilets. Some of the significant factors influencing the cleanliness of shared toilets are: the ease or difficulty in keeping shared toilets clean, the number of households sharing a toilet room, effortful cleaning behaviour and cleaning intention on the part of the users. Conclusion: The findings show that most slum dwellers use toilets that are not hygienic. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study is to analyze the meaning of intergenerational educational transmission and intergenerational educational mobility on adolescents' obesity risk. In particular, the paper investigates if upward social mobility is a protective factor against obesity for children of lower educated parents. Subject and methods: Representative data was derived from a subsample (12-17 years, n = 5,111) of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Body height and weight were measured in a standardized way. Obesity (>97th percentile) was defined due to the national reference system that is based upon percentiles of the body mass index (BMI). Intergenerational educational mobility was defined as: stable high (parents and participant have high education), potentially upwardly mobile (participant's education is higher than parents' education), potentially downwardly mobile (participant's education is lower than parents' education), and stable low (parents and participant have low education). Results: The highest prevalence of obesity was found in adolescents with a stable low education, the lowest prevalence in adolescents with a stable high education. The educational gradient was steeper in girls than in boys. Compared to the 'stable high' reference category, potentially upwardly mobile adolescents had no significant increased risk of obesity, while the risk for potentially downwardly mobile adolescents was only significant in girls (OR 2.32; 95 % CI 1.23 -4.37). The obesity risk in boys and girls with a stable low education was significantly elevated (1.68; 1.04-2.73 and 3.06; 1.89-4.94). Conclusion: Parental education and adolescents' own educational status have cumulative effects on obesity risk. The fact that potentially upwardly mobile boys and girls are not more likely to be obese than adolescents with a stable high education and less often than adolescents with a stable low education can be interpreted as a protective effect of upward social mobility even though health selection might have played a role. [ABSTRACT FROM AUTHOR]

Aim: Knowledge about nurses' error perception is crucial for establishing a sustainable risk management. This paper presents categories and frequencies of errors as identified by nurses. The cross-sectional study results provide further knowledge for professional and organizational development. Subject and methods: Data from 1,100 German nurses working in 30 hospitals and 46 nursing homes were collected using a self-administered questionnaire. This paper firstly presents results from a content analysis of nurses' descriptions of errors and, secondly, results on frequencies of predefined nursing errors (closed-ended, ordinal frequency estimation). Thirdly, it compares the answers of hospital nurses with those of nurses employed in nursing homes and finally it compares answers of participant groups defined by sex or migration background. Results: In the open-ended section, errors described by 60.5 % of the participants concerned medical diagnosis/therapy. 20.7 % had experienced errors in hands-on care, while errors in communication with patients were noted by 3.7 %. In contrast, when offering predefined activities in the questionnaire's closed-ended part, indicated frequencies of errors stressed issues of hands-on care and documentation. Significant differences exist between participants from both settings regarding direct care and relationship building. Sex and migration background were related to frequency estimations. Conclusions: Findings point to shortened professional perspectives in the debates on risk and safety. This might lower nurses' compliance in risk management systems. The influence of health professionals' sex and migration background on their error perception needs further exploration. Field specific approaches for error prevention are needed. [ABSTRACT FROM AUTHOR]

Aim: This paper examines the pattern, growth and determinants of household health spending in India and compares the growth of per capita household health spending and per capita consumption expenditure over the last two decades. Subject and methods: The unit data of various rounds of the National Sample Survey (consumption expenditure surveys 1993-1994, 2004-2005 and 2011-2012 and morbidity and health care surveys 1995-1996 and 2004) along with data from other secondary sources are used in the analyses. The patterns and growth of health spending are analyzed by demographic, social and economic attributes and economic well-being is measured using per capita consumption expenditure. Household health spending is subdivided into age structure, population growth, real cost of medical care and increased hospitalization. Descriptive statistics, fixed effect models and simple decomposition methods are used in the analyses. Results: Results suggest that during 1993-2012, the annual growth rate of real per capita household health spending was twice (6.14 %) the real per capita consumption expenditure (2.60 %). On average, per capita household health spending among the richest consumption quintile was at least eight times higher than that of the poorest consumption quintile, linking household health spending to ability to pay. Household health spending was income inelastic. Though medicine accounts for a larger share of household health spending, household spending on medical tests is growing fast. We found a strong and positive gradient of age on per capita household health spending after controlling for income and other confounders. During 1995-2004, the age structure, hospitalization and real cost of hospitalization accounted for a 14, 42 and 26 % increase in the cost of hospitalization respectively. Conclusion: Household health spending is growing faster than the consumption expenditure (economic well being) of household and changing age structure is significantly affecting health spending in India. Increased public spending on health, upgrading the public health system and increasing access to health insurance can reduce the household health spending in India. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to investigate the level of physical activity of children and reveal a physical activity map in Northern Cyprus. Relevant factors, facilitators, and inhibitors for physical activity were also investigated. Methods: Sample size and pilot schools were determined for the cross-sectional population-based study. Region, school, class, age, and gender were recorded. The Physical Activity Questionnaire for Children (PAQ-C) was used as a self-report questionnaire. Time spent on screen-based activities and presence of a park were examined. Results: The data for 2283 (1131 = girls) children were used in the study. The mean PAQ-C score of all children was determined as 3.48 ± 0.71. Gender, age ,and region significantly changed the PAQ-C scores of the children (p < 0.05). The children who stated that their homes had neighbourhood park areas had higher PAQ-C levels than those who stated otherwise (p < 0.05). There was no significant difference between the levels of PA of the children who spent normal time and excess time for technological devices with screen (p > 0.05). Conclusion: Physical activity and related sociodemographic comparisons were indicated for the children living in Northern Cyprus. While park availability was found essential to support the physical activity levels as an opportunity, screen-based activities were not found to be have an effect on physical activity as a barrier. [ABSTRACT FROM AUTHOR]

Aim: Nurses constitute an important group in identifying and preventing errors and risks in health care, but research on their perception of errors is scarce. This paper presents results of a representative study on health care errors, focusing on factors causing and influencing the occurrence of errors as perceived by nurses. Subject and methods: The cross-sectional research design comprised descriptive and correlational parts. The sample consisted of 1,100 nurses employed at 30 hospitals and 46 nursing homes in Germany. Data were collected in 2008/2009 using a questionnaire listing 21 factors that can potentially cause or influence errors. Participants could choose up to three factors they deem the most important. Differences between the two settings and variables which might have an influence on the perception of error-causing factors were analyzed using cluster-adjusted methods. Results: High workload, staff shortage and excessive labour topped the list. Hospital nurses more often chose 'workload' and 'interruptions' while nursing home nurses more often ranked 'lack of knowledge' and 'lack of motivation' as the most important. There are some significant variables such as years of professional experience and migration background that could affect nurses' perception. Conclusion: The findings support other studies, pointing to workload issues and below-optimum work processes producing errors. Inter-sectoral differences suggest the necessity of sector-specific support in education and on-going training as well as risk and quality management. [ABSTRACT FROM AUTHOR]

Aim: The paper aims to study whether (1) abusive husbands demonstrate higher sexually transmitted infection (STI) infection prevalence compared with non-abusive husbands and (2) women's risk is due to their exposure to IPV as the predictor of adverse reproductive health outcomes including use of contraceptives and treatment seeking pattern. Subject and methods: A multi-centric study with analytical cross-sectional design was applied, covering 18 states in India including 14,507 women respondents. Multi-stage sampling and probability proportion to size was done. Results: STI has a significant association with women who have survived physical and sexual assaults. Interpersonal violence increases the risk of STI, less use of contraceptives and low treatment-seeking behavior. The reason for not seeking treatment in women with STIs was found to be stigma, embarrassment and lack of knowledge. Conclusion: Inspite of the Domestic Violence Act in India, the public health system in India is not accessible to the women subjected to violence for the treatment required. Similar research results would enable the creation of an environment where violence would be acknowledged and referral networks between healthcare providers and legal/government organizations would provide further redressal where needed. [ABSTRACT FROM AUTHOR]

im: The present paper is an original research that explores housing satisfaction and residents' ability to cope with day-to-day demands, taking into account other dimensions of housing and sociodemographic factors. Subjects and methods: A cross-sectional survey ( n = 562) was randomly administered to residents in three neighbourhoods (Labone, Asylum Down and Nima) in Accra, Ghana. The association between the outcome variables and housing attributes were analysed using logistic regression. Results: The findings indicate that housing satisfaction was significantly predicted by age, with older people more likely to be dissatisfied with their housing arrangement. Respondents were dissatisfied with housing arrangements if they lived in Nima [odds ratio (OR) = 2.75, p < .001], Asylum Down (OR = 1.72, p < .01), crowded households (OR = 1.158, p < .05) or in compound houses (OR = 2.50, p < .001). In the context of housing attribute variables, respondent's ability to cope with day-to-day demands was significantly associated to their income level. Odour annoyance as an indicator of housing condition emerged as a strong predictor of respondent's inability to cope with daily demands with OR ranging from 1.68 to 2.33. Those who were dissatisfied with the location of their home as a place to live also reported poor coping abilities (OR = 1.86, p < .01). Discussion and conclusions: From the findings, government policy on housing should encourage the construction of more affordable housing units to ease the crowding situation in Accra. There is also a need for the Accra City Council to provide clearer guidelines for both tenants and landlords in response to increasing tenancy disputes in context. [ABSTRACT FROM AUTHOR]

Aim: Sometimes treatment is not necessarily according to guidelines, which is partly due to attitudes rather than lack of knowledge. In Germany, regional differences concerning prevalence rates of ADHD exist without valid explanation. We contribute with our data to the question of attitudes toward ADHD among pediatricians in Germany. Method: A specially designed questionnaire based on the Knowledge of Attention Deficit Disorders Scale and previous surveys was sent to pediatricians. In addition to descriptive statistics, we performed factor analysis and multiple linear regression analysis. Results: The vast majority (85.5%) of 581 respondents have a positive attitude toward ADHD, i.e., ADHD exists and should be treated appropriately. Physicians with positive attitudes were older and more often had a neuropediatric specialization. Conclusion: Most of the pediatricians surveyed in Germany assess ADHD and treatment in line with medical guidelines and treat as part of multimodal therapy. [ABSTRACT FROM AUTHOR]

Background: Active transport to school (ATS) is an effective health-promoting intervention to integrate physical activity into children's everyday lives. While previous studies have examined environmental and behavioural determinants on ATS in urban areas, evidence on rural areas is rare. Method: This study examined whether environmental and psychosocial characteristics are associated with ATS in two rural communities in Austria. Participants from four schools (two primary / two secondary schools) returned a self-reported questionnaire on individual and environmental determinants of ATS consisting of one section for parents and one for children, with 382 of the 467 total responses being included in the analysis. Results: Bivariate analyses showed a significant association of psychosocial characteristics of parents and children (intention, attitude, social norm, perceived behavioural control: p < 0.001), one environmental item (walking and cycling network: p ≤ 0.001) as well as distance and duration for walking to/from school between ATS. In a multiple regression model, the chances of participating in ATS were higher among children who have higher perceived behavioural control, walk between 5 to 10 minutes to school, and whose parents have a higher commitment to ATS. Conclusions: Future initiatives to enhance ATS in rural areas should focus on the control beliefs of parents and children, and should involve parents in order to increase parents' commitment to ATS. Additionally, measures should explore the effects of active transport promotion in the context of public transport and school buses. Above all, further opportunities for ATS should be considered in spatial and community planning. [ABSTRACT FROM AUTHOR]

Aim: Even though students attending vocational school are very vulnerable to the development of mental health problems, few studies identify the correlation between suicidal ideations and vocational education. Therefore, this study aimed to identify the prevalence and associated risk factors for suicidal ideations among vocational students in Germany. Methods: We conducted a cross sectional survey with a total of 555 pupils. The pupils received a standardized questionnaire, assessing sociodemographic data, the use of protective factors, possible risk factors, traits for neuroticism and depressive symptoms. For our study, we excluded item 9 from the Beck depression index (BDI-II) to identify the prevalence of suicidal ideation. Results: Our results show that the prevalence of suicidal ideation among students attending vocational school is 23.2%. A combination of feeling lonely, male sex, low importance of religion, little time for hobbies and BMI scores outside the norm show the highest risk for suicidal ideation and can be identified as significant predictors. Conclusion: This cross-sectional study highlights the mental burden vocational students in Germany are confronted with and underlines the necessity of paying special attention to this group of young adults. Furthermore, it emphasizes the necessity of further studies on this topic, especially including larger student populations. The results should be used to decrease the significant loss of life caused by suicidal behavior in young adults. [ABSTRACT FROM AUTHOR]

Aim: This study compares the pattern of physical activity and sleep between shift and non-shift workers using a novel physical activity–sleep index. By drawing from a diverse occupational population, this research aims to reduce any occupational specific biases which are prevalent in shift-work research. Subject and methods: Current data included 7607 workers (shift workers n = 832) from the Household Income and Labour Dynamics of Australia cohort study. The combined physical activity–sleep index comprised three physical activity components and three sleep health components: achieving moderate (1pt) or high (2pts) IPAQ classification; accruing ≥30% of physical activity as vigorous intensity (1pt); meeting sleep duration recommendations on a work night (1pt); and non-work night (1pt); and reporting no insomnia symptoms (1pt) (higher score = healthy behaviour, max. 6). Generalised linear modelling was used to compare behaviours of shift and non-shift workers. Results: Findings showed shift workers reported significantly lower activity–sleep scores (3.59 vs 3.73, p < 0.001), lower sleep behaviour sub-score (2.01 vs. 2.22, p < 0.001) and were more likely to report insomnia symptoms (p < 0.001) compared to non-shift workers. No difference was reported for overall physical activity (shift = 1.58 vs. non-shift = 1.51, p = 0.383). Conclusion: When viewed in conjunction using the combined activity–sleep index, shift workers displayed significantly poorer combined behaviours when compared to non-shift workers. [ABSTRACT FROM AUTHOR]

Aim: The maintenance of physical activity (PA) over the life course is considered a hallmark for ageing well, but individuals who practice PA also often pursue lifestyles (e.g., smoking) that may inhibit the medicinal impact of PA on them. PA is said to protect against cardiovascular diseases (CVDs), but the literature has little to say about the impact of PA on the risk of CVDs when it is associated with lifestyle factors, comorbidities, and personal characteristics. This study aimed to assess the association between PA time and CVDs, with relevant lifestyle factors, comorbidities, and personal characteristics treated as covariates. Subject and methods: The study's population was retired and working older people aged 60 years or more in Accra, Ghana. A total of 686 individuals responded to self-reported questionnaires. Pearson's chi-square test and binary logistic regression were used to present findings. Results: The study found that the risk of having one or more CVDs increases as time spent in moderate and vigorous PA increases, whereas individuals who drank alcohol a few days a week or most days a week are respectively 2 (OR = 2.415; p = 0.037) and 22 (OR = 21.933; p = 0.000) times more likely to have one or more CVDs compared to those who never drank alcohol. Conclusion: Health education should not only encourage PA maintenance but should also make individuals aware of the need to avoid unhealthy behaviours to maximize the positive effect of PA on health. [ABSTRACT FROM AUTHOR]

Aim: We examined predictors of trust in the healthcare system during the COVID-19 pandemic in 27 European countries. Subjects and methods: We used population-based data drawn from the Living, working and COVID-19 survey (N = 21,884, 52% female, ages 18 to 92 years) covering 27 European countries dated June and July 2020. Multilevel linear regression, linear regression, and regression-tree analyses were conducted. Results: We found that most participants tended to trust the healthcare system, although a substantial part could still be classified as distrusting (approx. 21%). Multiple variables, including being middle-aged or of older age, being female, lower levels of education, unemployment, worse general health status, having income difficulties, having unmet needs for healthcare, no healthcare contact during the COVID-19 pandemic, higher mental distress, and loneliness, were significantly associated with lower levels of trust. Among these variables mental distress, income difficulties, and unmet needs for healthcare emerged as especially important and, across European regions and countries, consistent predictors for lower trust in the healthcare system during the COVID-19 pandemic. Conclusions: Medically vulnerable subgroups, such as individuals with unmet healthcare needs, higher levels of mental distress, and older age, as well as people living in socially and economically vulnerable situations, such as higher levels of loneliness and financial difficulties, were the least trusting of the healthcare system during the COVID-19 pandemic. As these vulnerable subgroups are also at highest risk for contracting COVID-19 and experiencing negative COVID-19-related outcomes, more targeted prevention and intervention efforts should be implemented in these groups. [ABSTRACT FROM AUTHOR]

Aim: The consumption of ultra-processed food (UPF) and its impact on diet quality has been extensively studied and reported in the literature, but only a few studies have focused on children and adolescents. The present study therefore aimed to describe UPF consumption in a representative sample of French children and adolescents and to evaluate its association with diet quality. Methods: The study included 1146 children and teenagers (3–17 years old) from the cross-sectional French Nutrition and Health Study 2006/2007 who completed three 24-hour food recalls over a period of 15 days. Food consumption was described using the NOVA classification. Regression models were used to estimate the association between UPF consumption and diet quality. Results: The UPF dietary share in children and adolescents represented 44.2% and 44.5% of total energy intake respectively. In both age groups, UPF consumption was positively associated with dietary energy density and total carbohydrate and free sugars content, but negatively associated with dietary contents of protein, fiber, and potassium. UPF consumption also showed a positive association with inadequate intakes of energy density, free sugars, fiber, and potassium among children, and inadequate consumption of fiber and free sugars among teenagers. Conclusion: Higher UPF consumption among French children and adolescents is associated with a lower quality diet. [ABSTRACT FROM AUTHOR]

Background: Numerous deaths in under-five children occur from preventable and treatable causes. Seeking medical care for a sick child is an important aspect of child health. Parents decide the type and frequency of health care service utilization for their children. A number of factors influence mothers'/caregivers' health care seeking behavior for sick children. This systematic review and meta-analysis aimed to estimate the pooled prevalence of health care seeking behavior and factors associated with common childhood illnesses in Ethiopia. Methods: Studies were accessed via electronic web-based searches of PubMed, Web of Science, African Journals Online, the Cochrane Library, HINARI (Health Inter-Network Access to Research Initiative), and Google Scholar. We included all studies reporting the prevalence of health care seeking behavior for common childhood illnesses in Ethiopia and published in the English language. The data were analyzed using Stata Version 14.1 software. A forest plot and I-squared test were carried out to assess the heterogeneity of the studies. A funnel plot and Egger's regression test were done to check the publication bias. A random effect model was used to estimate the pooled prevalence and subgroup analysis performed to identify the probable source of heterogeneity. Results: Twelve articles comprising 16,873) study participants, were included in this review. The pooled prevalence of health care seeking behavior for common childhood illnesses in Ethiopia was 46.6% (95% CI: 38.7, 54.4) with severe heterogeneity (I2 = 99.0%; p value <0.001) and significant publication bias. Being of the male sex (OR = 1.21; 95% CI: 1.02, 1.43), severity of the illness (OR = 4.04; 95% CI: 2.45, 6.66), rural place of residence (OR = 0.29; 95% CI: 0.13, 0.67), and having an educated mother/caregiver (OR = 1.15; 95% CI: 0.37, 3.65) were factors associated with health care seeking behavior for common childhood illnesses. Conclusion: Mothers'/caregivers' health care seeking behavior for common childhood illnesses was low in Ethiopia. The sex of the child, severity of the illness, place of residence, and maternal educational status were the major factors that determined the health care seeking behavior for common childhood illness. We recommend that awareness-raising activities should be strengthened, with a focus on rural residents and less educated mothers/caregivers. [ABSTRACT FROM AUTHOR]

Background and aim: Early action is important for promoting newly arrived migrants' health. Politicians are major actors in decision-making that affects health outcomes in the population. Therefore, the aim of this study was to explore local and regional politicians' considerations of newly arrived migrants' health in political decision-making: whether politicians reflect on or discuss the effects of decision-making specifically on newly arrived migrants' health, whether considerations differ between municipality and regional politicians, and how knowledge and attitudes are associated with such considerations. Subject and methods: A cross-sectional quantitative study was conducted. A total of 667 municipality and regional politicians from northern Sweden responded to a questionnaire developed based on interviews with politicians. Bivariate analyses were performed using χ2 tests, the independent samples t-test, and the Wilcoxon signed-rank test. Multivariate analysis was performed using binary logistic regression. Results: Politicians considered the effects on newly arrived migrants' health significantly less frequently than those on the total population's health. Regional politicians discussed such effects more often than municipality politicians. Knowledge (odds ratio [OR] = 1.343), attitude (OR = 5.962), previous experience working on public health issues (OR = 1.784), and female gender (OR = 1.787) were positively associated with considering effects on newly arrived migrants' health in decision-making. Conclusion: Politicians play important roles in health promotion, and most consider health-related effects in their decision-making. However, about a third do not consider such effects. General health-related knowledge and attitude are important factors that could be affected or changed during political assignments. [ABSTRACT FROM AUTHOR]

Background: In 2019, a migrant camp on the Greek island of Samos designed for 650 people was home to a growing population of over 5500. We aimed to quantitatively describe living conditions and health needs in the camp. Methods: A questionnaire was designed with reference to international humanitarian standards, following a consultative process with the asylum-seeker population. Domains assessed included demographics, living conditions, safety/vulnerability, and health. The questionnaire was piloted and then conducted in June 2019 on a sample of asylum seekers. Results: Five hundred participants, predominantly from Afghanistan and the Democratic Republic of Congo (DRC). Of these, 79.4% lived in tents. Respondents cared for a total of 570 children; 20.6% of women were pregnant, 35.4% had experienced violence, 83% psychological distress, 71% skin disease, 66% diarrhoea and vomiting, and 64% respiratory disease. Accommodation, sanitation, and nutrition fell below internationally recognised standards, and poor access to water was significantly associated (p < 0.001) with respiratory disease, diarrhoea and vomiting, skin disease ,and psychological distress. Conclusions: Living conditions in the Samos camp fall below basic humanitarian standards and are associated with poor health status. Further research is imperative to analyse and monitor the diverse, varying needs of asylum-seekers and inform policies to improve conditions. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate the association of the working environment noise with the psychosocial status and occupational stress level of the workers of an industrial company. Subject and methods: In this cross-sectional study, we enrolled all the employees at an industrial company. The Copenhagen Psychosocial Questionnaire was used to measure the workplace psychosocial factors and stress levels of the participants. Based on the sound level measurements, the company sections were divided into two areas: the areas with noise ≥85 dB (dB) A and the areas with noise <85 dB A. Then the participants were categorized into two groups based on the working area and the study variables were compared between the two groups. Results: We enrolled 401 workers from an industrial company. For 154 (38.4%) workers, the level of noise was equal to or above 85 dB A. According to the results of the Copenhagen Psychosocial Questionnaire, scores of the two groups were significantly different for scales related to cognitive, emotional, and sensory demands, possibilities for development, and predictability as well as workplace demand domain, which showed noise exposure level was significantly associated with perceived workplace demands (P = 0.002). Conclusion: This study showed a slight association between the psychosocial status and the level of noise in the workplace environment. [ABSTRACT FROM AUTHOR]

Aim: This study aimed at exploring the perception and experiences with regard to the COVID-19 pandemic among Bangladeshi urban young adults. Subject and methods: Using a mixed-method approach, an online cross-sectional survey among 315 participants and in-depth interviews (IDI) among 20 young adults were conducted from May 1 to May 25, 2020. Descriptive statistics and chi-square tests were performed for quantitative data, along with the thematic analysis for qualitative data. Results: The mean (± SD) age of the participants was 26.54 (± 3.05), and the majority were male (54.9%). About 81.6% of the participants reported COVID-19 as a viral disease, transmitted through droplets of sneezing and coughing, and close contact with another person (90.8%). Nearly 40% of participants reported news channels as a reliable source of information for COVID-19. Participants who were male were less likely to be aware than females in terms of mode of transmission of COVID-19 such as going outside of the home (82.7% male vs 90.8% female; p < 0.05). Male participants thought they were perfectly healthy and more reluctant to agree with maintaining social distance compared to female participants (72.8% male vs 90.1% female; p < 0.001). Participant's satisfaction level with services provided by the government was also significantly different and higher among females than male participants (39.9% male vs 53.5% female; p < 0.05). The majority of the participants reported suffering due to financial uncertainty, psychological distress, and inadequate health facilities. Dissatisfaction was reported with the existing health services as creating several misconceptions, lacking testing facilities, and debasement by the health professionals. Conclusion: This study found a better perception regarding COVID-19 among the young adults, but they had poor preventive practices. Health education intervention with the rapid response should be implemented targeting this vulnerable group to improve their preventive practices. [ABSTRACT FROM AUTHOR]

Aim: Scepticism and negative attitudes toward vaccination are growing, generating the risk of decreasing vaccination coverage, with potential impact on the individual and community. Our aim was to obtain the first reliable national assessment of attitudes regarding the effectiveness, safety, and importance of vaccination among Slovenia's general population and explore their socio-demographic determinants. Subject and methods: A cross-sectional survey was performed in a random sample of the general population. We used multivariable logistic regression analysis to identify factors independently associated with positive attitudes toward the effectiveness, safety, and importance of vaccination. Results: In our survey, 8590 individuals aged 25–74 years participated; the overall response rate was 55%. Approximately two-thirds of participants expressed positive attitudes toward the effectiveness and importance of vaccination (64.9% and 67.6%, respectively). However, almost one-third (31.0%) of them expressed a fear of vaccination because of side effects. Two predictors for positive attitudes toward the effectiveness and importance of vaccination were higher social class and participation in preventive examinations. Factors associated with lower odds for a positive attitude toward the safety of vaccination included female sex, minors in the household, and average assessment of health status. Conclusion: Our study contributed an important insight into the Slovenian attitude toward vaccination among the general population. It showed that there are some socio-demographic determinants that are related to attitudes regarding the effectiveness, safety, and importance of vaccination. There is a need to address public concerns regarding vaccination in order to increase and maintain optimal coverage rates by implementing comprehensive communication strategies. [ABSTRACT FROM AUTHOR]

Aim: Understanding how the utilization of walkable neighbourhoods to reduce sedentary behaviour is affected by social and demographic factors is important. Therefore, this study examined the moderating influences of active social networks, sedentary social networks and active social networks lost on the association between neighbourhood walkability and sedentary behaviour. Subject and Methods: Twelve hundred community-dwelling older adults (≥60 years old) in Accra, Ghana, participated in this study. From these, 863 returned completed questionnaires on their social networks and sedentary behaviours and were incorporated into the analysis using Pearson's correlation and hierarchical linear regression (HLR) models controlling for confounding variables identified using sensitivity analysis. Results: Low neighbourhood walkability was associated with sedentary behaviour after controlling for confounders (β = –0.09; t = –2.7; p < 0.05). The negative influence of neighbourhood walkability on sedentary behaviour was significantly increased by the number of social network members independently of their activity levels. Conclusion: Low neighbourhood walkability was associated with sedentary behaviour, and older adults ought to constantly replenish or at least retain their social networks and active social networks in particular as they age to reduce sedentary behaviour. [ABSTRACT FROM AUTHOR]

Aim: To investigate the prevalence of cognitive impairment and its predictors among the elderly in Bangladesh. Subject and Methods: We use a cross-sectional survey of 1015 older people (≥60 years) in Bangladesh collected jointly by the Sir William Beveridge Foundation (SWBF) and Aging Support Forum (ASF), Bangladesh. The Mini-Mental State Examination (MMSE) scale, adapted to the Bengali language, was used for assessing cognitive impairment, which was available for 111 participants. Logistic regression analysis was used to identify predictors of cognitive impairment. Multiple imputation under the missing-at-random (MAR) mechanism was used to deal with missing data. Results: Overall, 31 out of 111 (27.9%) participants had mild, moderate or severe cognitive impairment, with a higher proportion among women (33.3%, 17 out of 51) than men (23.3%, 14 out of 60). More precisely, 24 out of 111 (21.6%) and 7 out of 111 (6.3%) had mild/moderate and severe cognitive impairment, respectively, with a higher percentage among women (mild/moderate: 25.5%, severe: 7.8%) than men (mild/moderate: 18.3%, severe: 5.0%). Age (odds ratio, OR = 1.06, p = 0.046, 95% CI: 1.001 to 1.119) and social engagement (OR = 0.25, p = 0.033, 95% CI: 0.072 to 0.898) were found to be statistically significant predictors of cognitive impairment in this group of people. The effect of physical disability fell short of statistical significance at the 5% level but was significant at the 10% level (OR = 2.89, p = 0.099, 90% CI: 0.999 to 8.370). Conclusion: The prevalence of cognitive impairment in Bangladesh is alarming and is comparatively higher among elderly women, which seems to increase with age and the presence of any physical disability. Also, prevalence appears to be lower in people who are more socially engaged or active. [ABSTRACT FROM AUTHOR]

Objective: To determine whether sense of coherence acts as a mediator between perceived stress and depression in newly diagnosed breast cancer patients. Methods: A single face-to-face interview was administered to characterize sociodemographic, clinical, and psychological characteristics; perceived stress scale (PSS), sense of coherence scale (SOC) and Hamilton depression scale (HAMD). Part of the characterize sociodemographic information was extracted from the women's medical charts. The interview was with 1100 patients newly diagnosed with breast cancer from breast wards in Zhengzhou, Henan Province, China; 1046 respondents completed this survey from May 2018 to March 2019. A data analysis was conducted based on correlation analysis, multiple linear regression, and structural equation model. Results: The total score of the sense of coherence was negatively correlated with perceived stress (r = −0.595, p < 0.01) and depression (r = −0.821, p < 0.01), and the total scores of perceived stress and depression were positively correlated (r = 0.755, p < 0.01). As indicated from the structural equation model, sense of coherence had a partial mediation effect between perceived stress and depression, with the mediator effect of 0.566, taking up 63.1% of the total effect. Conclusions: Sense of coherence acted as a mediator between perceived stress and depression in newly diagnosed breast cancer patients, demonstrating that medical staff should actively assess patients' sense of coherence level to provide personalized interventions for patients. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the current situation and influencing factors of the nursing practice environment in Shenzhen, China, and provides suggestions for improving it. Background: Nursing shortage is an urgent global problem and also of concern in China. Studies have shown that better work environments are related to high job satisfaction and better patient outcomes. Methods: The 37-item Practice Environment Scale was used to assess the nursing practice environment. Respondents were 1116 nurses from five general tertiary hospitals in Shenzhen. Results: The mean satisfaction score for the nursing practice environment was 3.63 ± 0.72 (where 5 is the highest possible score). Position, being a specialist nurse, choice of nursing major, educational attainment, and night shifts significantly affected nurses' working environment satisfaction. Conclusion: The practice environment of nurses was satisfactory. We recommend reducing the workload and encouraging nurses to complete specialist training, and supporting nurses to expand their roles in hospitals and society to improve the nursing practice environment. [ABSTRACT FROM AUTHOR]

Background: Very little is known about the association of back pain with subjective health and well-being and sleep problems among the older population in middle-income countries. In this study, we examine the association of back pain with four health outcomes — poor self-rated health, impairments in activities of daily living (1+ADL), sleep problems and World Health Organization Quality of Life score (WHOQOL) — and to study what extent the association differs by age group. Methods: Nationally representative data from World Health Organization's Study on global AGEing and adult health (WHO-SAGE) consisting of 33,878 older adults aged 50 or above were analyzed. The linkages of back pain with poor self-rated health, impairments in activities of daily living (1+ADL), and sleep problems were examined using multivariate logistic regression analysis. Multivariate linear regression was used to assess the association between back pain and quality of life. Results: In the pooled analysis, the association of back pain with four health outcomes were significant. Older adults who reported low back pain were more likely to report poor self-rated health (OR=1.91; p <.001), impairments in activities of dailiy living (ADL) (OR=2.06; p <.001), and sleep problems (OR=2.04; p <.001), and had lower quality of life score (β = −3.23, p <.001). Furthermore, the association of back pain and poor self-rated health, impairments in ADL, and sleep problems was stronger for the 50–59 age group than the 80 or above age group, suggesting significant age interaction in the association. Conclusion: This study suggested the significant role of back pain in determining subjective health, wellbeing, and sleep problems. Measures to prevent back pain, particularly among those in the 50–59 age group, are important to enhance overall wellbeing of the growing older population in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Background: Antibiotic consumption is the primary driver of antimicrobial resistance (AMR). The non-prescribed use for self-perceived diseases is one of the chief contributing factors to the unwise use of antibiotics as it paves the way to the development, growth, and spread of AMR. We aimed at describing the underlying factors influencing self-medication with antibiotics (SMA) in Maputo city, Mozambique. Methodology: A qualitative cross sectional study was conducted between October 2018 and March 2019 with 32 participants. Using purposeful sampling, participants were recruited and interviewed after purchasing antibiotics without prescriptions from nine pharmacies in Maputo city. Out of 32 participants, 20 enrolled for individual in-depth interviews and 12 for focus group discussions that were audio-recorded, transcribed, coded, and analyzed using latent content analysis. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist by (Tong et al. Int J Qual Health Care 19:349–357, 2007) was performed. Results: The participants declared recurrent practices of SMA to treat self-perceived illnesses. The private pharmacies were the main platform to access the non-prescribed antibiotics (NPA). The main factors driving the pratices of SMA were the easy availability of antibiotics, previous experience with antibiotics, easy access to pharmacist's advice, long wait to access health care facilities, perceived poor quality of assistance at health care facilities, considering minor illness that do not need to seek professional health care, influencing role of the people from the social circle, cultural beliefs on the healing power of antibiotics, and time and financial constraints. Conclusion: The practices of SMA are influenced by various factors that flow from the health care system, to the participant's health-seeking behavior. These are reinforced by the public's cultural belief that "antibiotics heal all diseases," which determines the social representations of medicines shape the attitudes and behaviors of SMA. The culturally rooted behavior, the social representations of the health care system, and the therapeutic itineraries the public adopt are to be considered as having an ever-present effect on all different stages of the disease and healing process. Understanding the phenomenon of SMA to better address the promotion of rational use of antibiotics is urgently needed in Mozambique. [ABSTRACT FROM AUTHOR]

Background: Substance use is a serious public health problem in the world, and the relapse rate among abstinent substance users is very high. The purpose of this study was to clarify the factors affecting substance use relapse based on the ecological approach by reviewing the relevant literature. Methods: Applying different search strategies, we searched electronic databases, including Scopus, PubMed, Web of Science, Psychinfo, Embase, Science Direct as well as Magiran, Iran Medex, and SID up to June 2018. The Joanna Briggs Institute Critical Appraisal Checklist was employed for critical appraisal. All searches were limited to studies published in English and Persian. Results: The literature search identified 3481 articles. After screening titles, abstracts, and full texts, 39 studies met the inclusion criteria. The findings were classified based on ecological model (intrapersonal, interpersonal, organizational, environment, community, public policy). The most frequent factors affecting substance use relapse at any level of the ecological model included unpleasant emotion (at the intrapersonal level), addicted friends and family disputes (at the interpersonal level), poor follow up (at the organizational level), society rejection (at the community level), drug availability and unhealthy environment (at the environmental level). Conclusion: According to the findings of the present study, it is indicated that designing interventions approaches based on the ecological model to prevent relapse of substance use seems to be useful. [ABSTRACT FROM AUTHOR]

Aim: Neighborhood walking environment is an environmental issue affecting human health-related behaviors in China and worldwide. High school is a special period in China, during which students need to prepare for the college entrance examination and are physically inactive. Therefore, the influence of environment on high school students' physical activities is particularly prominent. The purpose of this study was to examine the relationship between neighborhood environment walkability and physical activity in Chinese youth. Subject and methods: We conducted a retrospective questionnaire study on 3424 freshmen from Tsinghua University in Beijing, China. The mean age at the moment of completing the questionnaire was 18.74 years (SD = 0.95) and the mean body mass index (BMI) was 21.37 kg/m2 (SD = 2.86). Participants were asked to look back on their usual weekly physical activity and perceived neighborhood environment during high school. Neighborhood environment was measured using the Neighbourhood Environment Walkability Scale for Youth (NEWS-Y). Physical activity data by the Global Physical Activity Questionnaire (GPAQ) were collected. The data were analyzed using multiple linear regression. Results: The mean scale total score of NEWS-Y was 14.66 (SD = 1.30). Participants on average engaged in 754.46 (SD = 844.69), 479.79 (SD = 687.24), 920.47 (SD = 994.92), and 2172.72 (SD = 1736.21) MET-minutes/week of travel physical activity (travel PA), moderate physical activity (MPA), vigorous physical activity (VPA), and total physical activity (total PA), respectively. A one scale score increases in neighborhood walkable environmental was associated with an increase in travel PA and MPA by 42.64 (P < 0.001) and 31.11 (P < 0.01) MET-minutes/week, respectively. Conclusion: A possibly positive correlation between neighborhood environment walkability and physical activity was found. Future studies are warranted to replicate this study's findings, as well as provide evidence for potential policies to make neighborhood environment conducive to physical activity. [ABSTRACT FROM AUTHOR]

Aim: Norway's health scheme provides no-cost HIV pre-exposure prophylaxis (PrEP) when prescribed by a specialist, typically preceded by a general practitioner's (GP) referral. The GP perspective with regard to PrEP implementation in Norway has yet to be captured. Subject and methods: We explored PrEP knowledge, attitudes, and clinical experience of GPs in the Norwegian capital of Oslo, where HIV incidence and PrEP demand are highest. An anonymous survey was designed and distributed between November 2019 and February 2020. Univariate and multivariate logistic regression analyses were performed to identify determinants of GPs' previous clinical PrEP experience (PrEP adoption). Results: One hundred and seventeen GPs responded to the survey. GP PrEP adopters were more likely to: identify as men (aOR 2.1; 95% CI: 1.0–4.5); identify as lesbian, gay, or bisexual (LGB) (aOR 4.4; 95% CI: 1.4–14.5); have ≥ 10 LGB identifying patients on their list (aOR 4.4; 95% CI:1.8–10.4); and self-report higher levels of PrEP knowledge (aOR 2.4; 95% CI: 1.3–4.4). Conclusion: Our findings suggest that GP PrEP knowledge is crucial to patient PrEP access. Educational interventions ought to be considered to enhance GP PrEP adoption capacities, such as easy-to-access PrEP guidelines and peer-based training opportunities in both online and in-person formats. [ABSTRACT FROM AUTHOR]

Aim: The prevalence of cesarean section (CS) delivery has been increasing dramatically in both developed and developing countries. South Asian countries, including Bangladesh, have recorded substantial increases in CS over the past decade. The objective of this study was to assess the prevalence and associated factors of cesarean delivery in Bangladesh. Subject and methods: Nationally representative cross-sectional secondary data was extracted from the Multiple Indicator Cluster Survey (MICS) 2019, Bangladesh. CS was measured in two categories with cesarean and non-cesarean responses obtained by interviewing the women aged 15–49 years with a live birth in the past 2 years. Chi-square test was used to examine the significant association of mode of delivery (cesarean or non-cesarean delivery). Binary logistic regression was used to assess the factors of CS. Analysis was carried out using STATA version 16. Results: The study showed that among 9208 respondents, 36.1% of women underwent CS. The multivariate analysis indicated that mothers who were over 30 years old [OR 1.02; (95% CI 0.85, 1.21)], had higher education [OR 3.80; (95% CI 2.92, 4.94)], had rich wealth indexes [OR 2.41; (95% CI 2.12, 2.75)], gave birth in private health facility [OR = 8.77; (95% CI 7.6, 10.2)], took antenatal care (ANC) more than three times [OR 4.84, (95% CI 4.02,5.83)], and also gave birth to a larger than average sized baby [OR 1.45; (95% CI 1.22, 1.73)] were significantly associated with CS delivery. Conclusion: Bangladesh's health system urgently needs policy guidelines to monitor clinical indications of CS delivery and prevent an exessive number of CS in private health facilities, which is an essential step to reduce the high prevalence of CS. [ABSTRACT FROM AUTHOR]

Aim: Work-related injuries and diseases are usually severe among informal sector workers (ISW) because they work under poor working conditions. However, there are scant studies on the role of demographic and socio-economic factors in predicting occupational injuries and diseases among ISW in Ghana. Subject and methods: The purpose of the study was to determine the demographic and socio-economic factors associated with exposure to occupational injuries and diseases among ISW in the Kumasi metropolis of Ghana. A cross-sectional survey design involving 350 ISW was employed for the study. Findings: The study revealed that 38.9% and 60.6% of the respondents were exposed to occupational injuries and diseases respectively in 2016. Females (AOR: 1.144; CI: 0.410–3.193; p = 0.007), those aged 50 years or above (AOR: 1.616; CI: 1.051–7.484; p = 0.014), and those who were not using personal protective devices (PPEs) (AOR: 1.062; CI: 0.604–1.867; p = 0.036) were significantly more likely to be exposed to occupational injuries. Further, females (AOR: 1.504; CI: 0.532–4.253; p = 0.041), those aged 50 years or over (AOR: 1.062, CI: 0.089–12.735; p = 0.032) and those who were not using PPE (AOR: 1.742, CI: 0.817–2.320; p = 0.10) have higher odds of being exposed to occupational diseases. Participants with more than 10 years of work experience were less likely to suffer from occupational diseases (AOR: 0.284, CI: 0.096–0.835, p = 0.022). Conclusion: This study suggests the need to consider demographic and socio-economic factors in the formulation and implementation of occupational health and safety policies that aim to lessen exposure to occupational injuries and diseases among ISW in Ghana. [ABSTRACT FROM AUTHOR]

Background: Despite measures to reduce the spread of COVID-19 in the world, it is increasing day by day. Countries that implement good prevention strategies are less likely to be infected with COVID-19 than those that do not. Therefore, the aim of this study was to assess knowledge, attitude, and preventive practices toward COVID-19 early in the outbreak among health workers in Northern Ethiopia. Methods: A health facility-based cross-sectional study was conducted among health professionals working in public health centers and hospitals from April to May 2020. A simple random sampling technique was employed to select study respondents. Data were entered in Epi-info 7.1 and exported to SPSS version 20.00 for analysis. Simple descriptive summary statistics were done. Binary logistic regression was used to evaluate the factors of the principal defense practice. Results: A total of 403 health workers were included in the study making a response rate of 96%. Of these, 79% and 87.9% of health care workers had good knowledge and a good attitude and 64.3% of health care practitioners had good practice in preventing COVID-19. Approximately 92.0% said that COVID-19 has no specific treatment and vaccine, while 54.8% of health care workers did not use the necessary personal protective equipment at all times. We found that being female [AOR 2.43, 95% CI (1.50–3.94)], work experience of 2–5 years [AOR 2.44, 95% CI (1.10–5.39)], news media as a source of information [AOR 7.11, 95% CI (3.07–16.49)], social media as a source of information [AOR 4.59, 95% CI (2.15–9.84)], and governmental website as a source of information [AOR 4.21, 95% CI (2.15–8.27)] were reported as protective factors, and being single marital status [AOR 0.15, 95% CI (0.03–0.75)] was reported as a risk factor toward the prevention of COVID-19. Conclusion: Most health workers scored good knowledge and attitude; nevertheless, a significant proportion of health workers had poor practice toward the prevention of COVID-19, including the use of PPE. Additionally, some groups of health professional had poor practices of implementing the public health measures, thus necessitating a call targeted at them to improve the prevention and control of COVID-19. [ABSTRACT FROM AUTHOR]

Aim: International health authorities suggest that individuals aged 65 years and above and people with underlying comorbidities such as hypertension, chronic lung disease, cardiovascular disease, cancer, diabetes, and obesity are at increased risk of severe Coronavirus Disease 2019 (COVID-19); however, the prevalence of risk factors is unknown in many countries. Therefore, we aimed to describe the distribution of these risk factors across Europe. Subject and methods: Prevalence of risk factors for severe COVID-19 was identified based on interviews from 73,274 Europeans aged 50+ participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2017. Burden of disease was estimated using population data from Eurostat. Results: A total of 75.3% of the study population (corresponding to approx. 60 million European men and 71 million women) had at least one risk factor for severe COVID-19, 45.9% (approx. 36 million men and 43 million women) had at least two factors, and 21.2% (approx. 17 million men and 20 million women) had at least three risk factors. The prevalence of underlying medical conditions ranged from 4.5% for cancer to 41.4% for hypertension, and the region-specific prevalence of having at least three risk factors ranged from 18.9% in Northern Europe to 24.6% in Eastern Europe. Conclusions: Information about the prevalence of risk factors might help authorities to identify the most vulnerable subpopulations with multiple risk factors of severe COVID-19 and thus to decide appropriate strategies to mitigate the pandemic. [ABSTRACT FROM AUTHOR]

Aims: Chronic kidney disease (CKD) poses a significant health burden in the United States (US). Although earlier studies investigated income disparities in other chronic diseases, limited research has been carried out for CKD in recent years. We investigated income disparities in the prevalence and trends of CKD among US adults. Subjects and methods: This cross-sectional study analyzed National Health and Nutrition Examination Survey 2003–18 data. Survey periods were grouped as 2003–06, 2007–10, 2011–14, and 2015–18. Using glomerular filtration rate and urinary albumin-creatinine ratio from CKD-epidemiology equation, individuals ≥20-year-old were classified into stages of CKD. Income was derived from family income to poverty ratio and equally stratified as low-, middle-, and high-income. Results: In all periods, a reduction in CKD prevalence was observed as income-level increased. In 2003–06, the prevalence (95% confidence interval [CI]) of CKD was 17.8% (15.6%–20.3%), 14.7% (13.1%–16.4%), and 11.5% (10.3%–12.9%) among low-, middle-, and high-income people, respectively. It remained similar in 2007–10 and 2011–14. In 2015–18, this prevalence (95% CI) was 17.9% (16.5%–19.5%), 15.9% (14.6%–17.2%), and 10.2% (8.8%–11.8%) among low-, middle, and high-income people, respectively. Similar differences were detected across most age, gender, and race/ethnicity categories. Income differences were also observed in prevalence of CKD risk factors, including diabetes, obesity, metabolic syndrome, and smoking. Conclusion: While there was no increase in overall CKD prevalence, there could be an association between CKD and income, and low- or middle-income people had higher prevalence of CKD than high-income people. Lifestyle intervention and chronic disease-related health service provision need to consider the income disparity in CKD burden to improve the health and wellbeing of the US population. [ABSTRACT FROM AUTHOR]

Aim: This study investigates the association between a previous history of cancer and adherence to dietary patterns in the United States. Subject and methods: This cross-sectional study included 13,751 adults ages 18 and older from the Third National Health and Nutrition Examination Survey (NHANES III). We used principal component analysis (PCA) to identify major dietary patterns. We used linear regression models to assess the association between previous cancer history and adherence to dietary patterns. Results: A previous history of cancer was not associated with adherence to the prudent dietary pattern. The western dietary pattern was positively related to a previous history of cancer (b = 0.13, CI 0.05 to 0.20, p = 0.001; badj = 0.23, CI 0.15 to 0.31, p = <0.001); and the traditional dietary pattern was negatively related to a previous history of cancer (b = − 0.58, CI −0.65 to –0.51, p = <0.001; badj = −0.22, CI −0.29 to –0.15, p = <0.001). The alcohol dietary pattern was positively associated with a previous history of cancer only before adjusting for possible confounders (b = 0.13, CI 0.06 to 0.20, p = <0.001; badj = 0.03, CI 0.03 to 0.10, p = <0.365). Conclusion: Our findings suggest that cancer survivors do not follow a healthy dietary pattern and need guidance to adopt and maintain a healthy diet. The promotion of healthy dietary behaviors may improve the length and the quality of life of this population. [ABSTRACT FROM AUTHOR]

Aim: The COVID-19 pandemic drove the Government of Bangladesh to shut down educational institutions, which had an enormous effect on the psychological health of students. This study aimed to assess the mental health status of Bangladeshi university students during the lockdown period. Subject and methods: Through an online-based questionnaire, information was collected from 509 university students of Bangladesh from June 19, 2020, to June 28, 2020, using convenient sampling. K-means clustering was applied to organize students according to their psychological health score, and confirmatory factor analysis (CFA) was also conducted to determine the association among the student's activities and their mental health during the pandemic. In addition, these associations were examined through chi-square test and ordinal logistic regression. Results: Students were categorized into four categories where 4.32% had mild, 72.7% had moderate, 12.57% had moderately severe, and 10.41% suffered from severe mental health imbalance. The results showed that having family members affected by the coronavirus, facing insecurity, using social media, and smoking habits increased the mental health imbalances of students; in contrast, being worried about studying, future career, spending more time with family members, and participation in household chores reduced the mental health disturbances of students. On the other hand, the results of the ordinal logistic regression indicated that sleeping time and participation in household chores were preventive factors for students. Conclusion: This study reveals that a large proportion of University students of Bangladesh suffered from mental health disturbances during the lockdown period. Implementing mental health plans and providing job security, improved communication approaches toward family members, not flattening illusive news, and preoccupation in household activities may assist to enhance the mental health status of the university students. The authors believe that this study's findings will be helpful to expedite the rate of attaining the sustainable development goal associated with health status in Bangladesh. [ABSTRACT FROM AUTHOR]

Aim: The period of adolescence (between ages 10 to 19) is characterized by a critical period of development and establishment of eating behaviors and preferences. Obesity and unhealthy eating remain important public health challenges among adolescents in Mississippi. This study seeks to uncover the major patterns of dietary habits in relation to physical activity of students using Association Rules Mining (ARM). Subject and methods: This is a cross-sectional, non-experimental study conducted at the Cleveland High School, located in Cleveland, Mississippi. Cluster analysis and Association Rules Mining (ARM) were used to identify dietary habits and physical activity behaviors that may be associated with being overweight. Results: Findings from cluster analysis and association rules mining (ARM) reveal that students have a combination of healthy and unhealthy food profiles, but students assigned to the second cluster tend to exercise more than others. Conclusion: It is imperative to broaden the implementation of and investment in effective health promotion to make students aware of the health implications associated with food consumption and eating patterns. Limiting exposure to fast food and sweetened, carbonated beverages could, therefore, have a large public health impact, especially among students who are overweight. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate quality of life levels and investigate the influence of social determinants on distribution of quality of life among individuals aged 18 years or over residing in urban areas of a municipality in southern Brazil. Subject and methods: This was a population-based cross-sectional study conducted on a random sample. The main outcome was quality of life which was assessed with the World Health Organization Quality of Life instrument, short version (WHOQOL-BREF), by face-to-face interviews. A total of 1295 participants were interviewed (response rate, 90.6%). Results: The mean score of quality of life was 70.6 (SD = 12.3, median = 71.6, range 15–100). After an adjusted analysis, the groups that presented with worse quality of life were female individuals, and those aged 40 to 59 years, with a maximum of eight years of formal education, who were poorer, with food insecurity, who perceived their neighbourhoods as violent, with poor or very poor sleep quality, with three or more morbidities and with more stress level. Conclusions: Quality of life was unevenly distributed, being worse for more disadvantaged subgroups. Intersectoral policies targeted to reduce social inequality may increase the population-level quality of life. [ABSTRACT FROM AUTHOR]