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Aim: To examine the risk of non-steroidal anti-inflammatory drug-induced heart failure in patients with chronic kidney disease. Methods: Embase, Medline, CENTRAL, Web of Science, and Google Scholar were searched for papers published in English between 1st January 1999 and 31st May 2020. Papers were included if some participants had chronic kidney disease, were exposed to non-steroidal anti-inflammatory drugs, and where heart failure was measured as an outcome. Papers were assessed for risk of bias using the Cochrane Risk of Bias 2 tool for randomised controlled trials, and ROBINS-I for observational studies. Results: A total of 2480 independent papers were retrieved. Following abstract screening, 165 full texts were reviewed to identify seven eligible papers: two randomised controlled trials, four cohort studies, and one case-control study. For chronic kidney disease (stage 3–5), relative risk for heart failure ranged from 0.3 to 1.9 with 95% confidence interval 0.04 to 15.1. Results were not pooled due to study heterogeneity. We attributed bias to heterogenous populations studied, probable confounding due to partially adjusted risk estimates, and heterogenous measurement of the heart failure outcome. Conclusion: Overall, there are only a few studies to refute or support an increased risk of heart failure associated with taking non-steroidal anti-inflammatory drugs in patients with chronic kidney disease, and therefore no robust evidence was available. [ABSTRACT FROM AUTHOR]

Aim: Designing financial incentives for health behaviour change requires choices across several domains, including value (the size of the incentive), frequency of incentives, and direction (gain or loss). However, the rationale underlying complex incentive design is infrequently reported. Transparent reporting is important if we want to understand and improve the incentive development process. This paper describes a mixed methods approach for designing financial incentives for health behaviour change which involves stakeholders throughout the design process. Subject and methods: The mixed methods approach focuses on incentives for weight loss for men with obesity living in areas with high levels of disadvantage. The approach involves: (a) using an existing framework to identify all domains of a financial incentive scheme for which choices need to be made, deciding what criteria are relevant (such as effectiveness, acceptability and uptake) and making choices on each domain on the basis of the criteria; (b) conducting a survey of target population preferences to inform choices for domains and to design the incentive scheme; and (c) making final decisions at a stakeholder consensus workshop. Results: The approach was implemented and an incentive scheme for weight loss for men living with obesity was developed. Qualitative interview data from men receiving the incentives in a feasibility trial endorses our approach. Conclusion: This paper demonstrates that a mixed methods approach with stakeholder involvement can be used to design financial incentives for health behaviour change such as weight loss. Trial registration number: NCT03040518. Date: 2 February 2017. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the impact, trends, and impact levels of factors affecting Pediculus capitis infestation in primary school students. Subject and methods: Among the papers reviewed, 226 were selected, as they contained information that suited the study objectives. Results: The factors whose trends have higher gradients have a higher impact on the infestation level. In order of impact, the gradients of hair washing frequency, health instructor involvement, bathing frequency, mother's and father's education, existence of bathing facility, family size, hairstyle, and family income trends are higher than hair length, and age and education trends. As a result, the factor impacts are diminished from the beginning to the end. The importance of the family size, father's and mother's education, bathing facility existence, health instructor involvement, and bathing and hair washing frequency factors, whose trends increased over time, is higher than family income, hairstyle and length, and age and education, whose trends remained constant or decreased. Based on the gradient of the factor level impact trends, it seems that hair washing frequency, father's and mother's education, and health instructor involvement are the factors with the greatest effects on infestation level, in that order. These are followed by the influence of family income and size, and hairstyle factors. The existence of bathing facilities, bathing frequency, hair length, and education factors have weaker effects. Conclusion: This work provides the importance and impact levels of factors affecting Pediculus capitis infestation levels in primary school students, which will help meet the needs of policymakers. [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]

Background: According to the World Population Outlook (2019), people over 65, usually accompanied by various chronic diseases, will make up 16% of the population in 2050. Therefore, the health problems of middle-aged and elderly people are becoming the focus of current global attention. Some scholars have found that the health of middle-aged and elderly people is related to the childhood socio-economic environment. Methods: Using the China Health and Retirement Longitudinal Study (CHARLS) data, this paper innovatively constructed four measurement dimensions of health (namely, self-rated health, physical health, emotional health, and mental health). Moreover, logistic regression was used to explore the impact of childhood socio-economic environment (such as parent's education level, work experience, etc.) on the health status of middle-aged and elderly people. Results: Compared with a poor childhood social-economic environment, a good childhood socio-economic environment is more advantageous to the self-rated health of middle-aged and elderly people, especially a childhood socio-economic environment close to the medium level; the psychological health of middle-aged and elderly people who have experienced an adverse childhood socio-economic environment was better than those who did not; the childhood socio-economic environment has no apparent impact on the cognitive situation of middle-aged and elderly people. Conclusions: Some policy implications can be drawn. For example, the government should vigorously introduce policies to help migrant workers' children receive education in cities and provide special education guarantees for migrant workers' children. Societies and families should also pay more attention to the childhood socio-economic environment. [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]

Background: Limited data regarding the effects of school-based obesity prevention programs focusing on the changes in obesity-related knowledge and behaviors in China are available. The objective of this paper was to evaluate the effects of a school-based comprehensive lifestyle intervention among Chinese kids against obesity (CLICK-Obesity) in primary schools in Nanjing. Methods: We designed a cluster randomized controlled trial in eight randomly selected urban primary schools among 4th graders between May 2011 to April 2012 in Jianye, an urban district of Nanjing. Each school was randomly assigned to either the intervention or control group (four schools in each group). Mixed regression models and generalized estimating equations (GEE) were used to adjust for individual-level covariates under cluster randomization. Results: In this study, 1178 students (96.2%; 665 boys and 513 girls, 544 in control and 634 in intervention) participated in the baseline survey with mean age 10.2 ± 0.5 years. At the end of one-year intervention, 1125 students (91.8%; 628 boys and 497 girls, 513 in control and 612 in intervention) were reassessed. Notably, we found that the intervention group improved the knowledge and awareness of obesity-related risk factors, presented a lower increase of consumption of red/white meat (with a mean difference of −180.9 g/week, 95% CI: −350.6 to −11.2, p = 0.040), a larger increase in the time spent playing ball (with a mean difference of 24.2 min/week, 95% CI: −5.3 to 53.7, p = 0.090), and a significant reduction in screen time (with a mean difference of −71.0 min/week, 95% CI: −125.3 to −16.6, p = 0.020) compared to the control group after cluster (school) adjustment. Conclusion: The school-based integrated intervention was successful to modify unhealthy lifestyle behaviors and had a potential effect on childhood obesity prevention in urban China. However, the long-term effects and cost-effectiveness need to be evaluated in through further study. [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]

Aim: Owing to the COVID-19 pandemic, many companies shifted to telework, with few insights into its implementation, organisational conditions or the role of workplace health promotion and management. This study focused on a multifactorial investigation of conditions in companies which implemented and evaluated telework during the first lockdown in 2020 as well as on their future intentions to facilitate teleworking under health-promoting working conditions. Subject and methods: The research hypotheses relate to an extended technology acceptance model. In a mixed-methods design, expert interviews were fed into the development of an online questionnaire. Out of 1858 contacted companies representing a broad range of Austrian businesses, 192 responses (general management, workplace health managers, etc.) were analysed using descriptive and multivariate statistics. Results: The degree of implementation and claim to teleworking increased significantly during the first lockdown and did not return to pre-pandemic levels afterwards. Changes depended on preparation and experience: evaluation of teleworking and willingness to continue offering teleworking were conditional on preparation and the degree of implementation. Prerequisites for future intentions to implement health-promoting teleworking included readiness, general willingness and existing workplace health promotion/management structures. Conclusion: This paper demonstrates the potential of health-promoting organisational cultures for development processes – particularly in times of crisis. Anchoring health-focused structures in companies helps to create health-promoting frameworks. Health-promoting teleworking can be developed from workplace health promotion/management using established approaches. It is essential to build on in-house capacities and competencies to develop awareness for a holistic culture for health-promoting (tele)work and to encourage deliberations about potential measures. [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: Prostate cancer (PCa) globally impacts men of African descent disproportionately more than any other ethnicity. Studies focusing on PCa among the U.S.-based Nigerian immigrant men (NIM) are limited. The purpose of this study was to investigate the predictive effects of health beliefs on NIM's prostate cancer screening intention using select constructs of two health behavior models. Subjects and methods: This study consisted of (N = 130) U.S. NIM, aged 40 years and older, who were recruited from local nonprofit associations in New Jersey. Pen-and-paper questionnaire data were gathered using the Behavioral Intention Scale and the modified version of the Champion's Health Belief Model Scale for Prostate Cancer, along with demographic questions. Data were analyzed in SPSS 25.0. Multiple regression analysis was conducted to evaluate how well perceived susceptibility, benefits, and barriers predicted the intention to undergo screening for prostate cancer. Results: The model was significantly related to intention (R2 = 0.22, F (4,125) = 9.02, p < 0.001). Beta weights indicated that only perceived susceptibility and perceived benefit shared in the 22% of intention variability. Perceived susceptibility (β = 0.61, p < 0.001) and perceived benefits (β = 0.41, p < 0.001) were thus the variables that significantly contributed to the model. Conclusion: Continuous education and awareness of prostate cancer and the importance of screening, as well as a better understanding of health belief perceptions, remain strategies healthcare providers can utilize to reach at-risk minority populations. [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]

Background: The ongoing Boko Haram insurgency in northeastern Nigeria has depleted the country's capability to deliver quality healthcare to her citizenry. The ailing health sector is overwhelmed with a rising incidence and prevalence of infectious and non-communicable diseases. Aim: The aim of this paper was to determine the trend of kidney disease, end-stage renal disease (ESRD), anaemia, malnutrition and human immunodeficiency virus (HIV) in northeastern Nigeria. Materials and methods: Data covering different periods between 1999 and 2017 were obtained from the University of Maiduguri Teaching Hospital (UMTH), Maiduguri in northeastern Nigeria. This hospital is the largest tertiary healthcare facility in the region. The data were demographic in nature, i.e. sex, age or simply the registered cases. A quadratic model of time-series analysis was used to create the various trends of the respective diseases with the aid of Minitab software (version 18.0). t-Tests and analysis of variance (ANOVA) were also performed, with a p-value of less than or equal to 0.05 being considered significant. Results: About three out of every five patients treated for kidney disease were male, while three out of every five patients treated for HIV were female. Patients between the ages of 31 and 50 years were at the greatest risk of developing kidney disease. The mean distribution of disease incidence was the same for both sexes for kidney disease, anaemia, malnutrition and HIV. The mean distribution disease incidence was different between age groups for kidney disease but the same for anaemia. The incidence of anaemia and malnutrition reported was almost the same for both sexes. Children under the age of 10 years old were at the most risk of anaemia, with the distribution decreasing with increasing age. The trend analysis of the incidence of kidney disease, ESRD, anaemia and malnutrition showed that these ailments were on the increase, while the number of patients that were on antiretroviral therapy (ART) was on the decline in northeastern Nigeria. Conclusion: These increasing trends are evidences of the effect of Boko Haram on the public health of the people of northeastern Nigeria and will continue to be a public health concern for the region and the country as a whole. [ABSTRACT FROM AUTHOR]

Aim: Non-pharmaceutical interventions such as lockdowns have played a critical role in preventing the spread of the Covid-19 pandemic, but may increase psychological burden. This study sought to examine emotions reflected in social media discourse following the introduction of social contact restrictions in Central Europe. Subjects and methods: German-language Twitter posts containing '#corona' and '#covid-19' were collected between 2020/03/18 – 2020/04/24. A total of 79,760 tweets were included in the final analysis. Rates of expressions of positive emotion, anxiety, sadness and anger were compared over time. Bi-term topic models were applied to extract topics of discussion and examine association with emotions. Results: Rates of anxiety, sadness and positive emotion decreased in the period following the introduction of social contact restrictions. A total of 16 topics were associated with emotions, which related to four general themes: social contact restrictions, life during lockdown, infection-related issues, and impact of the pandemic on public and private life. Several unique patterns of association between topics and emotions emerged. Conclusion: Results suggest decreasing polarity of emotions among the public following the introduction of social contact restrictions. Monitoring of social media activity may prove beneficial for an adaptive understanding of changing public concerns during the Covid-19 pandemic. [ABSTRACT FROM AUTHOR]

Aim: Risky sexual behaviours (RSB) among adolescents is one of the major public health concerns globally. These behaviours–RSB have adverse effects on their future health and well-being. Therefore, in this paper, our aim was to assess the determinants of RSB among in-school Namibian adolescents using the 2013 Global School-based Health Survey. Methods: The data was extracted and analysed with STATA version 14.2. Both bivariate and multivariable analyses were done to generate results that infomed the discussion. The results were presented as odds ratios and adjusted odds ratios (AOR) with their respective 95% confidence intervals (CI). Level of statistical significance was declared at a p-value of < 0.05. Results: Our results showed that of the 2846 adolescents surveyed, 51.8% reported they have ever had sexual intercourse. Fifty-eight percent reported having multiple sexual partners and 23.2% reported not using a condom during their last sexual intercourse. The multivariable analysis showed that age [AOR = 2.50; CI = 1.99–3.14], sex [AOR = 0.40; CI = 0.34–0.47], grade [AOR = 1.80; CI =1.38–2.36], suicidal ideation [AOR = 1.44; CI =1.16–1.79], bullying [AOR = 1.36; CI = 1.15–1.62], hunger [AOR = 1.39; CI = 1.17–1.64], alcohol use [AOR = 1.57; CI = 1.31–1.89], marijuana use [AOR = 1.98; CI = 1.14–3.45] and parental knowledge of activity [AOR = 0.82; CI = 0.68–0.99] showed statistically significant influence on sexual experience. Sex [AOR = 0.43; CI = 0.33–0.55], grade [AOR = 1.58; CI = 1.15–2.18], alcohol use [AOR = 1.37; CI =1.07–1.75], marijuana use [AOR = 2.23; CI = 1.11–4.46] and parental supervision [AOR = 0.76; CI = 0.59–0.98] were associated with multiple sexual partners. There was also statistically significant association between age [AOR = 0.32; CI = 0.21–0.48], loneliness [AOR = 1.49; CI = 1.04–2.14], number of close friends [AOR = 0.60; CI = 0.37–0.96] and parental supervision [AOR = 0.43; CI = 0.32–0.60] on non-condom use. Conclusion: These findings underscore the need for a pragmatic approach in addressing RSB among adolescents by adopting substance use prevention and mental health promotion programmes and by encouraging more parental involvement in activities of their adolescents. [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]

Background: This paper examined the connection between residential histories and obesity in Ghana. In the last two decades, low- and middle-income countries (LMICs) have witnessed the fastest growth in obesity incidence. These obesity trends in many LMICs including Ghana are associated with rapid economic growth and urbanisation. Features of the urban food and built environments contribute to obesity in LMICs in many ways, including exposure to unhealthy foods, sedentary lifestyles, and passive transportation. Methods: The analytical sample consisted of 4368 adults (aged 18 and above) drawn from the World Health Organisation's Study on Global Ageing and Health in Ghana. We employed descriptive statistics and multivariate regression models to examine the relationship between residential histories and obesity in later life using STATA 14. Results: Significant differences were observed among respondents, based on their childhood and adult residential histories. For instance, 44% of respondents who spent their childhood and adult life in the same urban area were obese, compared to 18% of those who spent their childhood and adulthood in the same rural area. Multivariable analysis revealed that cumulative exposure to urban environment was significantly associated with obesity. For example, respondents who spent their childhood and adulthood in different urban areas and childhood and adulthood in the same urban area were significantly more likely to be obese than respondents who lived in rural areas during childhood and adulthood (OR = 2.37, p < 0.001 and OR = 1.44, p < 0.001, respectively). Conclusion: Our findings show that urban residence during childhood and later in life may present cumulative risks for adult obesity. Locally appropriate public health strategies that encourage healthy lifestyles among urban dwellers will be critical in the fight against obesity. [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]

Objective: Problematic access to and use of sexual and reproductive health (SRH) services potentially endanger the well-being of adolescents and retards progress towards attainment of United Nations health-related Sustainable Development Goals. Drawing on a qualitative research approach, this paper examines the level of SRH-related knowledge, service access and use among school-going adolescents in Kumasi Metropolis, Ghana.Methods: We conducted 12 focus group discussions and 18 in-depth interviews with 132 in-school adolescents and six healthcare providers in the metropolis. A thematic analytical framework was used to analyse the data.Results: Findings suggest that the majority of adolescents had good knowledge about the available SRH services, with an emphasis on the different forms of contraceptives. However, the use of the various SRH services was challenging and reduced to counselling services. Adolescents were faced with various difficulties in their bid to access SRH services, including social stigma, attitude of service providers, fear of teachers and the anticipated negative response of parents due to the complex socio-cultural structure of Ghanaian society. Discussion with elders about SRH issues was considered a taboo.Conclusion: Whilst social negotiation with parents, teachers and SRH service providers as well as school curricula alignment could arrest the barriers to adolescents’ access to SRH services, eHealth services such as the ‘Bisa’ Health App could potentially provide easy and cost-effective access to SRH information among in-school adolescents. [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]

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: Meteorological factors play a role in respiratory and cardiovascular diseases. However, previous studies demonstrated inconsistent results regarding their associations. This paper aims to evaluate their relationships to facilitate anticipatory care for patients with respiratory and cardiovascular diseases. Subject and methods: A retrospective time-series study, controlling for air pollution, was adopted to examine the effects of various meteorological factors on emergency hospital admission for chronic respiratory and cardiovascular diseases from 2007 to 2010 in a Hong Kong hospital. Impact of weather was examined up to 3 weeks to account for the possible delayed effects of meteorological factors. Results: Barometric pressure was positively associated with hospital admission in a linear fashion, while temperature demonstrated a linear negative association. Delayed effects of air pressure were noted up to lag weeks 2 and 3 for cardiovascular and respiratory admission respectively. Temperature also showed a progressive reduction in lag effects on respiratory and cardiovascular diseases admission up to lag week 3. Relative humidity, global solar radiation and wind speed demonstrated no significant associations with hospital admission. Conclusion: Anticipatory care to prevent exacerbations of chronic respiratory and cardiovascular diseases, hence to reduce related admission, might be achieved by the provision of targeted advice triggered by forecasts of low temperature and high barometric pressure. [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]

Aims: The aims of this paper are (1) to assess if perceptions of the food environment are associated with select dietary intake by neighborhood, and (2) to map neighborhood-specific findings, demonstrating a method for policy-relevant research. Methods: Using pre-collected data from a Philadelphia, PA community health survey, we aggregated individual-level data ( n = 4,434 respondents) to neighborhoods ( n = 381 census tracts), adjusting for conceptually-relevant socio-demographic factors. We estimated Spearman correlations between multivariable adjusted food-environment perceptions (perceived produce availability, supermarket accessibility, grocery quality) and select dietary intake (reported fruit-and-vegetable and fast-food consumption), and mapped variables by neighborhood using geographic information systems (GIS). Results: Difficulty finding fruits and vegetables, having to travel outside of one's neighborhood to get to a supermarket, and poor grocery quality were each directly correlated with fast-food intake (rho = 0.21, 0.34, 0.64 respectively; p values <0.001); and inversely correlated with fruit-and-vegetable intake (rho = -0.35, -0.54, -0.56 respectively; p values <0.001). Maps identified neighborhoods within the city with the worst food-environment perceptions and poorest dietary intakes. Conclusion: Negative perceptions of the food environment were strongly correlated with less-healthy eating in neighborhoods. Maps showed the geographic areas of greatest concern. Our findings demonstrate a method that might be used prospectively in public health for policy planning (e.g. to identify neighborhoods most in need), or retrospectively for policy assessment (e.g. to identify changes in neighborhoods after policy implementation). [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: The incidence of inflammatory bowel disease (IBD) is increasing worldwide. The Saxon Pediatric IBD Registry was founded in 2000 to describe the epidemiology of pediatric IBD in Germany. The aim of this study was to determinate the completeness of this registry for children and adolescents younger than 15 years and to make this approach transparent. Results of this completeness update have broad implications for further scientific publications from the registry dataset. Method: The capture–recapture method with two data sources was used to ascertain completeness. A second data source was collected in 2019 for the observation period 2008–2014 from all pediatricians, gastroenterologists, and internists working in practices in a predefined region in Saxony, Germany. Results: A total of 23 patients with IBD were reported who fulfilled the inclusion criteria. One of them was not recorded in the registry. Therefore, the completeness of the registry was estimated at 95.7% (95% CI 90.2–100). Initial analysis of the Saxon Pediatric IBD Registry over the 15-year period 2000–2014 includes 532 patients, 312 (58.6%) male and 220 (41.4%) female. The distribution of single IBD diseases in the registry was as follows: Crohn's disease 338 patients (63.5%), ulcerative colitis 176 patients (33.1%), and unclassified IBD 18 patients (3.4%). Evaluations by sex and by disease in age groups and by age at onset were tabulated. Conclusion: This study demonstrates that the completeness level of the Saxon Pediatric IBD Registry is high (95.7%), and thus the epidemiological data of the registry are reliable. [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: Population-level prevention initiatives are the cornerstone of public health practice. However, despite this normative practice, sexual health programming within public health has not utilized this approach to the same extent as other public health programs. Understanding requirements to put a population-level approach into practice is needed. The objective of this study was to explore the barriers and facilitators experienced by sexual health programs and services within public health when implementing a population health approach. Subject design and methods: The principles of qualitative description guided all sampling, data collection and analysis decisions. Data collection involved in-depth semi-structured interviews with 12 sexual health managers and/or supervisors from ten Ontario public health units. Directed content analysis was used to code and synthesize the data. Data collection and analysis was guided using constructs from the Consolidated Framework for Implementation Research. Results: Factors that served as either barriers and facilitators to implementing a population health approach, were mainly in the inner and outer setting domains of the Consolidated Framework for Implementation Research. Participants identified the presence of community partnerships, adequate staff training on population health, and access to data on population health served as facilitators. In comparison, barriers to implementation included a lack of resources (human, financial) and clinicians' value of and preferences for delivering services at the individual clinic level. Conclusion: Some clear barriers and facilitators influenced if staff in sexual health programs and services could implement a population health approach. Results indicate where public health resources need to be enhanced to move toward a population health approach and provide insight into what worked and should be considered by public health organizations. [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: The current study aims to qualitatively identify determinants, barriers and facilitators of physical activity among a population with mental health disorders. Subject and methods: Seventeen participants with moderate mental disorders were recruited. Semi-structured interviews were conducted to identify physical activity facilitators and barriers. Data were organized and analysed in ATLAS.ti, mainly based on a generic qualitative research approach. Results: Most participants found physical activity important and expressed a positive attitude towards it. In general, higher self-efficacy and more social support were beneficial for participants' physical activity levels. Reasons/facilitating factors to be more physically active were: having fun, good weather, progress, routine, self-compassion and a stimulating environment. Barriers were not having fun, being busy, mental complaints, lack of energy, procrastination and physical complaints. Conclusion: Future interventions could promote physical activity among people with moderate mental disorders to help them identify and overcome barriers. The newly identified determinant 'self-compassion' could be an interesting target for promoting physical activity in this group of people with moderate mental disorders. [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]

Aim: The purpose of this scoping review is to summarise the techniques used for network analysis of multimorbidity to inform development of a standard methodology. Subject and method: Multimorbidity is the presence of two or more health conditions. Many techniques have been applied to investigate the relationships between health conditions in people with multimorbidity, including network analysis. Network analysis finds patterns in a complex set of variables and displays them in a visualization or network map. There is currently no recommended standard method for calculating and displaying networks in multimorbidity. Studies were included if they used a network analysis method to investigate the relationships between multiple illnesses in a population sample, without reference to a specific health condition. Results: A total of 15 articles were found meeting inclusion criteria of which six were published in 2020. Not all articles defined multimorbidity or referred to multimorbidity. Several techniques were used to measure the association between conditions, including correlation coefficients and observed/expected ratios. R and Stata were the most popular software packages used. Some articles did not define their measure of association or mention which software package they used. Conclusion: There is a need for a greater level of detail and transparency when reporting methodology and software used for network analysis of multimorbidity, and a formally recognised definition of multimorbidity. Further investigation into the most appropriate measure of association for use in network analysis in the context of multimorbidity is required to improve techniques investigating interactions between multiple health conditions. [ABSTRACT FROM AUTHOR]

Aim: Healthcare resource allocation varies worldwide. It is integral that countries identify optimal allocation methods to distribute healthcare resources to ensure and sustain good population heath. This study examines the association between healthcare resource allocation and perception of health status across countries. Subject and methods: Data from OECD Health Statistics and OECD Health Care Resources is analyzed with visual analytics methodology. Results: Findings show that the relationship between factors that influence resource allocation and health status differ based on the development status and geographic location of countries. In developing countries, there is a significant relationship between the number of hospitals and absence from work due to perceived poor health. Medical resource allocation is positively associated with health status perception in countries where the allocation is proportional to incidence of diseases. Among the various medical resources, medical personnel are the most important factor in both developing and developed countries in influencing the positive perceived health status of the population. Conclusions: With more healthcare resources people's life expectancy should increase, and overall mortality should decline. This study offers several implications for the future. Governments can take differential actions based on their citizens' needs to improve their perceived health status. In general, there should be an emphasis on allocation of human medical resources, rather than medical equipment. Businesses should invest more in healthcare education to be able to implement and administer government health policies. Strategic investments in key healthcare resources can boost revenue and offer sufficient incentives for development of innovative medical technology. [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: The COVID-19 pandemic brought quick, severe and unexpected changes to our everyday life and also changed the traditional education pattern of Semmelweis University in the middle of academic year 2019–2020. We explored adaptive changes in Hungarian students' behaviour and their time-budget in order to determine whether quarantine and/or fear of infection were responsible for these changes. Methods: A self-administered online questionnaire was distributed to all students in the Hungarian language program (N = 7436) of Semmelweis University. Information was collected on basic demographic data, knowledge and attitude about COVID-19, methods of prevention as well as the students' behaviour before, during and after the first wave of the pandemic. Statistical analyses were processed using the IBM-SPSS 25.0 software package. Results: The overall response rate was 11% (N = 816). Only complete responses were processed (55%, N = 447). Among these responders, 83% did not fear the pandemic. Those who greatly feared COVID-19 infection strictly kept all regulations. The number of non-smokers increased by the end of the first wave. The nutrition of 100 students (21%) became healthier and the lockdown reduced the level of physical activity. Conclusion: Social and health-related behaviour of medical students changed basically during the first wave of the pandemic and some changes remained after it in tobacco smoking, nutrition and sleeping habits. Time-budget of students changed significantly during the pandemic and did not return to the baseline values. Results of this study justify future multiple systematic research to analyse and better understand the short- and long-term effects of the current crisis. [ABSTRACT FROM AUTHOR]

Aim: Previous studies have suggested variable levels of associations between work–family conflict (W_F_C) and its antecedents in different populations. We aimed to assess the antecedents of this conflict and its two types; work-to-family (WFC) and family-to-work (FWC) among Egyptian civil workers. Subjects and methods: In a convenience sample of 3134 Egyptian civil workers, we assessed the W_F_C using the National Study of Midlife Development in the US and attributed it, by logistic and linear regression analyses, to several sociodemographic, work/family situational, behavioral, and health-related variables which were collected by a questionnaire survey between October 2019 and January 2020. Results: W_F_C was prevalent in 56% of the sample (51% for WFC and 62% for FWC). The work and family situational factors were the most significant antecedents of the W_F_C and its two types; partial R2 was 0.71. Both the health-related and behavioral clusters of antecedents were also predictors of W_F_C, while the sociodemographic antecedents contributed minimally to the FWC. The multivariable odds ratios (95% CIs) for high W_F_C in those with high vs low work demands, job control, social support at work, and family were 4.11 (2.89–7.03), 0.0 (0.66–0.90), 0.86 (0.62–0.98), and 0.74 (0.59–0.94), respectively. Conclusions: Work and family situational factors were the most significant antecedents of the levels of W_F_C in Egyptian civil workers. The Egyptian authorities could reduce the civil workers' W_F_C by improving the work environment, finding ways to relieve the workload demands, and helping the civil workers to have more job control and social support. [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: Process evaluations for social and behavioral interventions are increasingly important as interventions become more complex and multi-faceted. Conducting process evaluations in low-resource international settings can be challenging. Process evaluations in low-resource international settings can help inform and improve the quality of ongoing intervention implementation. We conducted a process evaluation of a cluster-randomized controlled trial to assess the efficacy of a microfinance and health leadership program on sexually transmitted infections and intimate partner violence perpetration among young men in Tanzania. Subject and methods: Our trial included 1491 participants and the intervention lasted 2 years. We collected process data on microfinance loan uptake and repayment, and health leaders' health conversations with peers to monitor intervention reach and dose received. We developed a database system that allowed offline data collection and synced to a central database when internet was accessible. Research staff in the USA accessed data from the central database to analyze and create regular implementation reports. Results: Process graphical reports facilitated identification of implementation challenges and enabled us to resolve issues before they worsened. For example, from a group with low microfinance loan repayment we learned area participants perceived the loan to be a grant, and then we clarified the misinformation with participants. Conclusions: The process evaluation helped inform ongoing intervention implementation, including approaches to improve reach and uptake of interventions. Field staff time was protected by systemizing the sharing of data processing and analyses across the global team. [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: 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]

Aims: The first aim was to determine if four lifestyle behaviors (i.e., vegetable/fruit intake, physical activity, tobacco use, and alcohol use) predicted depressive symptoms among permanent supportive housing (PSH) residents. The second aim was to determine if the effect of lifestyle factors on depressive symptoms depended on the participants' level of social support. Subject and methods: Participants were 420 adults enrolled in a technology-assisted health coaching program for PSH residents with symptoms of a mental health condition. A longitudinal analysis was conducted utilizing the screening/baseline, six-month, and twelve-month visit timepoints. The four lifestyle behaviors were included as predictors, and depressive symptoms (Patient Health Questionnaire [PHQ-9] scores) was the outcome variable. Potential confounding variables included social support and satisfaction with leisure activities. Additional covariates included age, sex, race, and visit timepoint. Social support was also evaluated as a potential effect modifier. Results: In the adjusted analysis, moderate alcohol consumption predicted lower depressive symptoms compared with heavy alcohol consumption (b = −1.54, p =.01). However, the difference in depressive symptoms between non-consumption and heavy consumption of alcohol was not statistically significant (b = −0.76, p =.07). Vegetable and fruit intake, physical activity, and tobacco use were not statistically significant predictors of depressive symptoms. Social support was not a statistically significant effect modifier. Conclusion: Moderate alcohol consumption may reduce the risk of having depressive symptoms among PSH residents. Interventions among PSH residents should consider approaches to reduce heavy alcohol consumption to moderate alcohol consumption to lower depressive symptoms in this population. [ABSTRACT FROM AUTHOR]

Aim: Alcohol, tobacco and cannabis use, early sexual debut and suicidality among young people are public health issues. This study sought to explore associations between health-risk behaviours (use of alcohol, tobacco and cannabis, mental health and suicidality) and protective factors among in-school Himalayan secondary students from Bhutan and Nepal. Subjects and methods: Secondary analyses of WHO Global School Health Survey data obtained from the cross-sectional surveys of in-school Himalayan secondary students from Bhutan (2016, n = 7576) and Nepal (2015, n = 6529). Results: Findings showed a concerning level of suicidality in both countries, early commencement of alcohol use, higher prevalence of current cannabis and alcohol use in Bhutan, and low condom use overall. Conclusion: Preventive health activities that target students at younger ages, males in particular, need strengthening, as do risk reduction efforts to delay onset of substance use and sexual debut and strategies to increase protective factors such as retention and participation in education. [ABSTRACT FROM AUTHOR]

In Poland, no statistical data are available concerning the analysis of the incidence of pneumonia in inpatient children. The requirement for these data results mainly from the need to prepare systemic and economic solutions. Aim: This study aimed to use reported data for evaluating pneumonia incidence rates among hospitalised children and other parameters in various age groups. Subject and methods: A detailed analysis was performed as part of the Operational Programme Knowledge Education Development co-financed by the European Social Fund. Services reported to the National Health Fund in 2014 were considered, including pneumonia incidence among hospitalised children and mortality in specific age groups. Results: In 2014, a total of 68,543 children were hospitalised for pneumonia (68% of all hospitalisations for acute respiratory diseases). Within each of the analysed age groups, boys were hospitalised more frequently. Irrespective of the place of residence, infants were most commonly hospitalised. It was observed that there was a significant difference between the incidence rate of pneumonia among hospitalised children in all analysed groups depending on the province. The average length of stay was 7.29 days, with infants requiring the longest stays (7.96 days), and 1.8% of children were rehospitalised within 30 days due to recurrence of pneumonia. The most commonly coded pathogens responsible for pneumonia included Mycoplasma pneumoniae, Streptococcus pneumoniae and Chlamydia spp. A total of 19 inpatient hospital deaths in the course of pneumonia were reported. Conclusions: Based on our findings, it is warranted to utilize epidemiological knowledge for the planning of an appropriate level of service commissioned both in outpatient and inpatient facilities as well as for the estimation of institutional and staff needs necessary to secure these services. [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]