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Introduction: Chronic kidney disease of uncertain etiology (CKDu) has been found at high frequency in several lowland agricultural areas including Meso-America and Sri Lanka. Whether CKDu also occurs in other countries with large agricultural populations remains uncertain, primarily due to lack of systematic data on kidney function. Hemoglobin (Hgb) levels could be an ancillary marker for presence of kidney dysfunction. Our goal is to estimate the causal effect of agricultural work on Hgb level in men. A causal effect may indicate the presence of CKDu. Methods: We use Demographic and Health Surveys (DHS) data from seven African and Asian countries (Ethiopia, Lesotho, Namibia, Senegal, Uganda, Zimbabwe, and India). We use optimal full matching and permutation inference to estimate the causal effect of agricultural work on altitude-adjusted Hgb levels after adjusting for six known confounders. To assess potential bias due to unmeasured socioeconomic differences, we use multiple control groups that differ in non-agricultural occupation. We then conduct sensitivity analyses to assess the robustness of our causal conclusions to unmeasured confounding. Results: Data were available for 41,180 agricultural workers and 55,705 non-agricultural workers in seven countries. On average, Hgb levels were 0.09 g/dL (95% CI [-0.12, -0.07]) lower among agricultural workers compared to matched controls. Significant effects were observed in Ethiopia, India, Lesotho, Senegal, and Uganda, with effects from 0.10 to 0.32 g/dL lower hemoglobin among agricultural workers. The effect was not attenuated in sensitivity analyses involving both better-off and worse-off occupational controls. Discussion: We find evidence that men engaged in agricultural work in five of the seven countries studied have modestly lower Hgb levels compared with other men living in rural areas. Since underlying kidney disease could be a potential explanation for this finding, our data support consideration to integrating kidney function assessments within DHS surveys and other population-based surveys.

Objective Using data from the Ministry of Health of Colombia, we performed an analysis of prevalence and general demographic characteristics of patients with inflammatory myopathies, with data from 2012 to 2018. Design A descriptive cross-sectional study based on data from the Ministry of Health of Colombia. We used as key terms the diagnostic codes of the International Manual of Diseases related to the diagnosis of inflammatory myopathies. Results We founded 12,401 individuals with a diagnosis of inflammatory myopathy and estimated an overall prevalence of 25.7 cases per 100,000 inhabitants. This diagnosis is more common in the age group of 65–69 years, and in the female population (64%), with a female-to-male ratio 1.79:1. In addition, we calculated a prevalence of 15.1 cases per 100,000 inhabitants for dermatomyositis and 7.3 cases per 100,000 inhabitants for polymyositis (based on a total population of 48,203). There is little information on the epidemiology of myopathies in Latin America, and records are essential to know their behaviour in populations. In Colombia, the Ministry of Health collects information from the health system, which has nearly universal coverage (around 95%). This information makes it possible to carry out epidemiological studies on different diseases. For the present study we analysed the available data on inflammatory myopathies in Colombia. Conclusion The present work describes for the first time the demographic characteristics of inflammatory myopathies in the Colombian population based on official data from the Ministry of Health, where the most frequent was dermatomyositis and a predominance in the female population was evidenced.

Objectives. To describe health-related behaviors or indicators associated with overall health and well-being using the Global Assessment Tool (GAT), a health behavior and psychosocial questionnaire completed annually by US Army personnel. Methods. We analyzed GAT responses from 2014 to 2018, consisting of 367 000 to 449 000 respondents per year. We used generalized estimating equations to predict the presence of each health behavior or indicator, aggregated by year and stratified on various demographics. Results. Key findings included decreases from 2014 to 2018 in risky health behaviors such as hazardous drinking (7.5% decrease) and tobacco use (7.9% decrease), dietary supplement use (5.0% to 10.6% decrease, depending on type), self-reported musculoskeletal injury (5.1% decrease), and pain interference (3.6% decrease). Physical activity, sleep, and nutritional habits largely remained consistent over time. Conclusions. In the Army, tobacco, alcohol, and risky dietary supplement usage appears to be declining, whereas lifestyle health behaviors have been stable. Whether these trends reflect responses to health education is unknown. The GAT provides useful insights into the health of the Army, which can be leveraged when developing health-related educational programs and policies. Public Health Implications. Health behaviors that have changed less over time (e.g., nutrition, sleep) may require novel approaches compared with those that changed more (e.g., dietary supplement use, drinking). (Am J Public Health. 2021;111(11):2064–2074. https://doi.org/10.2105/AJPH.2021.306456 )

The current population-based study examines the association between county-level ambient air pollution and childhood asthma. Data from the nationally representative 2010–2015 National Health Interview Survey were linked to nationwide fine particulate matter (PM2.5) air pollution data at the county-level from the National Environmental Public Health Tracking Network which utilizes air quality monitoring stations and modeled PM2.5 measurements (Downscaler model data) and adjusted by county-level socioeconomic characteristics data from the 2010–2015 American Community Survey. Multilevel modeling techniques were used to assess the association between PM2.5 annual concentrations (quartiles < 8.11, 8.11–9.50, 9.51–10.59, ≥ 10.60 µg/m3) and current childhood asthma along with two asthma outcomes (episode in the past year, emergency room (ER) visit due to asthma). From 2010 to 2015, there were significant declines in PM2.5 concentrations and asthma outcomes. In unadjusted models, children living in areas with higher PM2.5 concentrations were more likely to have current asthma, ≥1 asthma episode in the past year, and ≥1 ER visit due to asthma compared with children living in areas with the lowest quartile (< 8.11 µg/m3). After adjusting for characteristics at the county, geographic, and child and family-level, significant associations remained for asthma episode, and ER visit among children living in areas with PM2.5 annual concentrations between 9.51 and 10.59 µg/m3 (3rd quartile) compared with children living in areas with the lowest quartile. This study adds to the limited literature by incorporating nationally representative county-, child-, and family-level data to provide a multi-level analysis of the associations between air pollution and childhood asthma in the U.S.

Understanding factors related to suboptimal adherence to antiretroviral therapy (ART) and detectable viral load (VL), especially among vulnerable populations, is needed to improve HIV outcomes. The Caribbean is highly impacted by HIV and socioeconomic inequalities, but few studies have been conducted there to explore food insecurity among people with HIV and factors associated with viral suppression in this vulnerable population. Using baseline data from a pilot intervention trial among people living with HIV and food insecurity in the Dominican Republic, we examined psychosocial and behavioral factors associated with viral suppression, ART adherence, and competing needs. Among participants (n = 115), 61% had a detectable VL; the strongest factor associated with detectable VL was having missed taking ART in the last six months due to not having food (OR = 2.68, p = 0.02). Greater odds of reporting missed ART doses due to not having food were associated with severe food insecurity (OR = 4.60, p = 0.006), clinical depression (OR = 2.76, p = 0.018), Haitian background (OR = 6.62 p = 0.017), and internalized HIV stigma (OR = 1.09, p = 0.041), while lower odds were associated with social support (OR = 0.89, p = 0.03) and having health insurance (OR = 0.27, p = 0.017). Ensuring that people with HIV and food insecurity have food to take with their ART is essential for viral suppression.

Objectives. To describe excess mortality during the COVID-19 pandemic in Guatemala during 2020 by week, age, sex, and place of death. Methods. We used mortality data from 2015 to 2020, gathered through the vital registration system of Guatemala. We calculated weekly mortality rates, overall and stratified by age, sex, and place of death. We fitted a generalized additive model to calculate excess deaths, adjusting for seasonality and secular trends and compared excess deaths to the official COVID-19 mortality count. Results. We found an initial decline of 26% in mortality rates during the first weeks of the pandemic in 2020, compared with 2015 to 2019. These declines were sustained through October 2020 for the population younger than 20 years and for deaths in public spaces and returned to normal from July onward in the population aged 20 to 39 years. We found a peak of 73% excess mortality in mid-July, especially in the population aged 40 years or older. We estimated a total of 8036 excess deaths (95% confidence interval = 7935, 8137) in 2020, 46% higher than the official COVID-19 mortality count. Conclusions. The extent of this health crisis is underestimated when COVID-19 confirmed death counts are used. (Am J Public Health. 2021;111(10): 1839–1846. https://doi.org/10.2105/AJPH.2021.306452)

Objectives. To examine temporal trends in the classification of opioid-involved overdose deaths (OODs) and racial variation in the classification of specific types of opioids used. Methods. We analyzed OODs coded as other or unspecified narcotics from 1999 to 2018 in the United States using data from the National Vital Statistics System and the Centers for Disease Control and Prevention. Results. The total proportion of OODs from unspecified narcotics decreased from 32.4% in 1999 to 1.9% in 2018. The proportion of OODs from unspecified narcotics among African American persons was approximately 2-fold greater than that of non-Hispanic White persons until 2012. Similarly, the proportion of OODs from unspecified narcotics among Hispanic persons was greater than that of White persons until 2015. After we controlled for death investigation system, African American persons had a higher incidence rate of OODs from unspecified narcotics compared with White persons. Conclusions. There have been significant improvements in the specification OODs over the past 20 years, and there has been significant racial disparity in the classification of OODs until about 2015. The findings suggest a health data disparity; the excessive misclassification of OODs is likely attributable to the race/ethnicity of the decedent.

Abstract. As a follow-up to an earlier study demonstrating healthier cardiometabolic profiles among long-term multiple dietary supplement (LTMDS) users, we examined if cardiometabolic health benefits associated with LTMDS use persisted with aging. The study is based on LTMDS users from North America and 2007–2010 NHANES participants who were used for comparison to the LTMDS users. NHANES subjects were classified as non-dietary supplement (NS) users, single supplement/single purpose supplement (SS) users, multivitamin/mineral supplement (MVMS) users, and multiple dietary supplement (MDS) users. Supplement groups were compared for total, HDL and LDL cholesterol; triglycerides; glucose; insulin; CRP and HbA1c ≥ 6.5%, adjusting for age, sex, income, education, BMI, history of CVD, and medications for hypercholesterolemia and diabetes. Geometric mean (95% confidence interval) LDL cholesterol was significantly lower (P

Purpose: To assess whether the COVID-19 pandemic has inequitably impacted key social determinants of health (SDoH), specifically employment, housing, and health care, for U.S. transgender populatio...

BackgroundWorldwide, binge drinking (BD) today follows being a public health concern among adolescents. This study sought to assess the cost-effectiveness and cost-utility of a web-based computer-tailored intervention to prevent BD in adolescence.MethodsThe sample was drawn from a study evaluating the Alerta Alcohol programme. The population consisted of adolescents aged 15–19. Decision tree analysis was used to estimate costs and health outcomes, as measured by number of BD occasions and quality-adjusted life years (QALYs). Incremental Cost-Effectiveness and Cost-Utility Ratios were also calculated from National Health Service (NHS) and societal perspective and for a time horizon of four months. Multivariate deterministic sensitivity analysis of best/worst scenarios by subgroups was used to account for uncertainty.ResultsThe intervention was dominant from the societal perspective resulting in savings of €7,986.37 by one BD occasion averted per month. With regard to Incremental Cost-Utility Ratios, the intervention resulted in an incremental cost of €71.05 per QALY gained from NHS perspective and this was dominant, from societal perspective, resulting in savings of €34,126.64 per QALY gained in comparison with the control group. Subgroup analyses showed that the intervention resulted dominant for girls from both perspectives, and for those who were older (17 years or more) from NHS perspective.ConclusionComputer-tailored feedback is a cost-effective way to reduce BD and to increase QALYs among adolescents. However, long-term follow-up would probably be needed to capture major changes both in reduction of BD and in increasing of health-related quality of life.Trial registration(ClinicalTrials.gov): NCT03288896. Registration date: September 20, 2017. “Retrospectively registered”.

Malaria, Zika virus, West Nile virus, Dengue fever, and Lyme disease are common causes of morbidity and mortality around the world. While arthropod bites may cause local inflammation and discomfort, a greater concern is the potential to develop deadly systemic infection. The use of insect repellents (IR) to prevent systemic infections constitutes a fundamental public health effort. Cost-effectiveness, availability, and high-efficacy against arthropod vectors are key characteristics of an ideal IR. Currently, numerous IRs are available on the market, with DEET (N,N-diethyl-3-methylbenzamide) being the most widely used. DEET has an excellent safety profile and remarkable protection against mosquitoes and various other arthropods. Other EPA-registered IR ingredients (permethrin, picaridin, IR3535, oil of lemon eucalyptus, oil of citronella, catnip oil, and 2-undecanone) are alternative IRs of great interest due to some having efficacies comparable to that of DEET. These alternative IRs possess low toxicity and favorable customer experiences in utilization (e.g., cosmetically pleasant, naturally occurring). This review summarizes currently available EPA-registered IRs: the origins, mechanisms of action, side effect profiles, and available formulations will be discussed. This review will enable the clinician to select the best IR option to meet patients' needs and provide the greatest protection from arthropod bites and sequelae.

Neurodevelopmental disorder, communication problems, and repetitive/stereotypic behaviour are all characteristics of autism, a severe developmental disorder. Even though the pathophysiological causes of autism are still unclear and contested in many cases, genetic and environmental factors (and their interactions) have been identified as contributing factors. While it is widely acknowledged that various factors can cause autism, environmental factors have received a great deal of attention recently. A large part of the international debate has focused on neurotoxins such as Lead, Iron, and Cadmium, with some arguing that these and other toxic metals have a role in the development of the condition. Methods: Between March and December 2020, the study is being performed in Iraq's Al-Anbar province. 75 autistic children and 20 volunteers children served as controls in the study, all of whom had confirmed DSM-V diagnoses. An atomic absorption spectrophotometer is used to test hair samples. Two heavy elements (Lead and Iron) and one trace element (Cadmium) are measured. The results are shown as significant high in Lead ,and Iron concentrations in Autistic compared with Control, and International Normal Value, more than Lead, and Iron considered as risk environment factor for ASD, While a cadmium concentration is expressed significant high in autism and slightly in control compare with International Normal Value, and considered no risk environmental factor in Iraqi populations. It could be due to the pollution of the Iraqi environment.

Nursing homes and other long-term care facilities in the United States have experienced severe COVID-19 outbreaks and elevated mortality rates, often following upon the inadvertent introduction of SARS-CoV-2. Following FDA emergency use approval, widespread distribution of vaccines has resulted in rapid reduction in COVID-19 cases in vulnerable, older populations. Yet, vaccination coverage remains incomplete amongst residents and healthcare workers. As such, mitigation and prevention strategies are needed to reduce the ongoing risk of transmission and mortality amongst vulnerable, nursing home populations. One such strategy is that of ‘shield immunity’, in which recovered individuals increase their contact rates and therefore shield individuals who remain susceptible to infection. Here, we adapt recent population-scale shield immunity models to a network context. To do so, we evaluate network-based shield immunity by evaluating how restructured interactions in a bipartite network (e.g., between healthcare workers and long-term care residents) affects SARS-CoV-2 epidemic dynamics. First, we identify a series of rewiring principles that leverage viral testing, antibody testing, and vaccination information to reassign immunized healthcare workers to care for infected residents while retaining workload balance amidst an outbreak. We find a significant reduction in outbreak size when using infection and immune-based cohorting as a weekly intervention. Second, we also identify a preventative strategy using shield-immunity rewiring principles, by assigning susceptible healthcare workers to care for cohorts of immunized residents; this strategy reduces the risk that an inadvertent introduction of SARS-CoV-2 into the facility via a healthcare worker spreads to susceptible residents. Network-based epidemic modeling reveals that preventative rewiring can control the size of outbreaks at levels similar to that of isolation of infectious healthcare workers. Overall, this assessment of shield immunity provides further support for leveraging infection and immune status in network-based interventions to control and prevent the spread of COVID-19.

BackgroundDespite a high burden, there is limited training available in non-communicable disease research in Nepal. In order to understand research capacity gap in non-communicable diseases in the country, we conducted a needs assessment. We aimed to assess existing research training capacity in academic health institutions of Nepal for the prevention and control of non-communicable diseases, identify gaps in research training in these institutions, and explore the feasibility of developing research training program in Nepal targeting non-communicable diseases and their risk factors. MethodsWe did qualitative and quantitative research and reviewed academic institution curricula review and scientific literature. We conducted 14 Focus Group Discussions with bachelor and Masters level students of public health and community medicine; 25 In-depth Interviews with department heads and faculties, and government stakeholders. We surveyed medical and public health students on their research knowledge and skills development. Further, we reviewed university curricula of bachelors in medicine and public health Masters in community medicine and public health. We also reviewed non-communicable disease related scientific articles authored by Nepali researchers. ResultsWe found that the research methodology component was addressed differently across academic programs. One-third (33.7%) of students expressed lack of skills for analysis and interpretation of data. They felt that there is a wide scope and career-interest in non-communicable diseases research in Nepal. However, specific objectives in the curriculum and practical aspects regarding non-communicable diseases were lacking. Most of the non-communicable diseases research in Nepal are prevalence studies. Most of the studies did not have any financial support. Lack of funding, conflicting priorities with curative services, and inadequate training for advanced research tools were reported as major barriers. Likewise, availability of trained human resources and international funding for non-communicable diseases research were perceived facilitators.ConclusionsNepal must strengthen the whole spectrum of research capacity: epidemiological skills, research management, and fund generation. University curricula should match up with the disease burden and must emphasize on applied practical research projects. Generation of a critical mass of non-communicable disease researchers must go together with improved funding from the government, non-governmental organizations, and external funding organizations.

Summary Background & aims Coronavirus disease 2019 (COVID-19) is an ongoing pandemic outbreak leading to more than 1 million deaths worldwide as reported in 2020. Several risk assessment tools, including individual vulnerability to COVID-19, have been developed. The present study aimed to characterize a high-risk population using such a tool and examine risk factors and nutritional status in the national survey data and estimate the region-specific population size. Methods The study included 17,540 Korean adults who participated in the Korea National Health and Nutrition Examination Survey (KNHANES). The risk scores for individual vulnerability to COVID-19 were calculated based on age, sex, smoking status, and comorbidities, and a high-risk population was defined as having risk scores ≥11. Nutritional status was compared between the high-risk population and the remaining participants in the KNHANES data. The region-specific population size was estimated using national statistics. Results The proportion of the high-risk population was estimated to be 10.5%, which corresponds to approximately 4.6 million adults in South Korea. About 20% of them had inadequate intake of all of vitamins A, B1, B2, B3, and C below the estimated average requirement. The high-risk population showed 1.65 [95% confidence interval: 1.39, 1.96] higher odds of inadequate intake of multiple vitamins than the remaining participants. In the ecological analysis, the region-specific numbers of the high-risk population correlated significantly with the actual numbers of deaths due to COVID-19 (P value = 0.013). Conclusions These results suggest that individuals vulnerable to COVID-19, in particular those are living in densely populated regions, should pay particular attention to the protection against this pandemic and have adequate nutritional status, which may support optimal immune function.

Introduction: The aim of the study was to assess the effect of lead concentration and shift work on the occurrence of insomnia in the employees of the Zinc Steelworks in Miasteczko Śląskie in Poland. Materials and Methods : The study group consisted of 240 employees of the zinc smelter, reporting periodic and control examinations to the Occupational Medicine Clinic. Respondents were asked to complete a questionnaire consisting of the Athens Insomnia Scale and questions about the place and nature of work. Results: Analyzing the results of lead and zinc proporphiryn( ZPP) levels in the shift and non-shift subgroups of the study group, a slightly higher mean level of lead and ZPP was found in the shift subgroup. Using logistic regression, the probability of insomnia was determined depending on the concentration of lead and ZPP in the organism. As the level of lead and ZPP increases in the study group, the probability of insomnia increases. It is the largest among the examined group working in shifts. Conclusions: As the blood lead level increases, the likelihood of insomnia in steel plant workers increases.

Air pollution is a rapidly growing major health concern around the world. Atmospheric particulate matter that has a diameter of less than 2.5 µm (PM2.5) refers to an air pollutant composed of particles and chemical compounds that originate from various sources. While epidemiological studies have established the association between PM2.5 exposure and cardiovascular diseases, the precise cellular and molecular mechanisms by which PM2.5 promotes cardiovascular complications are yet to be fully elucidated. In this review, we summarize the various sources of PM2.5, its components, and the concentrations of ambient PM2.5 in various settings. We discuss the experimental findings to date that evaluate the potential adverse effects of PM2.5 on cardiovascular homeostasis and function, and the possible therapeutic options that may alleviate PM2.5-driven cardiovascular damage.

Background: This research investigated and identified significant spatial clusters of asthma and chronic obstructive pulmonary disease (COPD)-related emergency department (ED) visits and in-patient...

Alcohol use presents a serious risk to women's health. Of particular interest is the association of harmful alcohol consumption and risky behaviors, such as drinking before sexual intercourse, an understudied phenomenon in the Mexican population. AIM The aim of this study was to identify whether the harmful use of alcohol is associated with an increased probability of presex drinking in Mexican young women. METHOD This was a study with a predictive design. Multiple logistic regressions were performed in a random sample of 304 young college women (between the ages of 18 and 24 years) from Guanajuato and Tamaulipas, Mexico. Participants completed a sociodemographic data survey and the Alcohol Use Disorders Identification Test questionnaire. RESULTS Women with a pattern of harmful use of alcohol were more likely to report drinking before sex (adjusted odds ratio = 4.679, 95% confidence interval [1.619, 13.520], McFadden's pseudo R2 = 25.5%). Further analyses revealed that presex drinking by partners was an even stronger predictor of alcohol use before sexual intercourse in women (adjusted odds ratio = 12.749, 95% confidence interval [4.714, 34.483], McFadden's pseudo R2 = 34.7%). CONCLUSIONS The findings demand additional nursing studies to corroborate-and to better understand-the relationship between harmful use of alcohol in Mexican women, their partners' drinking behavior, and unhealthy behaviors like drinking before sexual intercourse.

Coffee and tea are amongst the most consumed beverages worldwide, and are the main source of caffeine in adults. In this review we present findings on the effects of habitual coffee and tea consumption on cardiovascular disease (CVD) prevention. Mild-moderate coffee/ caffeine consumption, at 2-3 cups/day, is associated with beneficial effects on metabolic syndrome, including hypertension and diabetes mellitus, although may elevate lipid levels. Furthermore, coffee consumption reduces the risk of coronary heart disease, heart failure, arrhythmia, stroke, CVD and all cause mortality. Higher tea consumption, in particular green tea, confers similar cardiovascular benefits to coffee with 3 cups/day associated with improved survival in population based studies.

Aim: The aim of this study is to reduce the biosafety risks of laboratory exhaust air due to SARS-CoV-2 at a biosafety level-3 laboratory used for vaccine development against COVID-19 pandemic. Materials and Methods: In this study, the infrastructure and the organisation of the containment laboratory, which aimed to be used to struggle with pandemic, was used for risk assessment. Assessment of the laboratory exhaust air procedure as a component of the heating-ventilation-air conditioning system, which is significant for high-level biosafety laboratories, was conducted through a risk assessment matrix.

Background The beneficial effects of urban open green space on residential health had few investigations in Taiwan. Methods A total of 40,375 participants older than 30-year-old attended the health screening program during 2007–2009 in the Metropolitan area in the New Taipei City. We defined urban open green spaces (UOGS) if land use belongs to parks, green, plaza, public schools and sport venues. Small public urban open space (SPUOS) is defined as UOGS with area less than 1 hector and with at least three of the followings: vegetations, sport facilities and benches. Greenness is defined as the mean Normalized Difference Vegetation Index (NDVI). Air quality was accessed by land use regression model. Logistic regression model was used to calculate odds ratios of diseases for proximity to UOGS or greenness. Results We found that CKD was significantly associated with proximity to SPUOS. No relationship was found between proximity to UOGS or NDVI and overweight or diabetes. The adjusted odds ratio of CKD comparing distance to SPUOS >200 m and ≤200 m was 1.144 (95% CI, 1.059–1.237). The effect of open space on CKD was similar if we incorporated public schools to SPUOS. Greenness was not associated with CKD. Subgroups analyses revealed the effect of SPUOS on CKD was more prominent in health residents, including in those who never smoke, no hypertension, no diabetes and no hypertriglyceridemia. Conclusion Proximity to SPUOS or schools is associated with lower risk of CKD for adults living in the Metropolitan area in New Taipei City.

Background Cancer risk is determined by specific factors, including body weight and dietary patterns. Accordingly, the World Cancer Research Fund/American Institute for Cancer Research published updated cancer prevention recommendations in 2018 based on comprehensive reviews of modifiable behaviors associated with cancer risk. Objective The objective of this study was to determine the extent to which US adults meet these evidence-based recommendations and how adherence differs by weight status. Design This was a cross-sectional study using nationally representative data from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). Participants/setting Dietary intake data for 30,888 adults 18 years and older with normal body mass index (BMI), overweight, or obesity were analyzed. Main outcome measures Differences in dietary intakes and the proportion of adults meeting guidelines were compared across BMI categories. Statistical analyses performed Logistic regression and 1-way analysis of covariance were used to analyze differences in adherence to recommendations, controlling for age, sex, race/ethnicity, and family income as a percent of the federal poverty rate. Results Regarding fruit and nonstarchy vegetables, 62.8% of adults with normal BMI, 64.5% with overweight, and 70.1% with obesity fell short of recommendations. Regarding whole grains, 67.9% of adults with normal BMI, 70.2% with overweight, and 73.1% with obesity did not meet the recommendation. Regarding red meat, 36.7% of adults with normal BMI, 41.6% with overweight, and 43.5% with obesity consumed >18 oz/week, with a significant difference in mean intakes between adults with normal BMI and obesity (P Conclusions Few U.S. adults meet cancer prevention recommendations; adults with obesity are significantly less likely to do so. Future research should evaluate compounded risk resulting from obesity and poor dietary patterns inconsistent with current evidence-based guidelines, and inform targeted interventions to address these issues.

Burns, an endemic public health problem has had a dynamic epidemiology in India, in sync with economic and social changes. In the last decade a major shift of kitchen fuel usage from kerosene to the Liquefied Petroleum Gas has resulted in an increase in the incidence of burns from LPG mishaps. This prospective descriptive study conducted in a tertiary care burn centre in an urban area aims to determine the causes of LPG related burns, its injury profile, identify the population at risk and also to determine the level of knowledge of users regarding the safety issue with LPG usage. In the study LPG burns accounted for 52.3% of the admitted flame burns. On the whole there were 33 incidents of LPG mishaps involving multiple victims. Most common age group affected was 26–50 years. Leakage from larger cylinders was more common and malfunction of valve/regulator was the most common cause. Level of knowledge was dismally low across all socioeconomic strata. Our study highlights impact of changing socioeconomic pattern of the country on burns epidemiology and the glaring lack of public awareness regarding safe management principles.

Background Workplace absenteeism increases significantly during influenza epidemics. Sick leave records may facilitate more timely detection of influenza outbreaks, as trends in increased sick leave may precede alerts issued by sentinel surveillance systems by days or weeks. Sick leave data have not been comprehensively evaluated in comparison to traditional surveillance methods. The aim of this paper is to study the performance and the feasibility of using a detection system based on sick leave data to detect influenza outbreaks. Methods Sick leave records were extracted from private French health insurance data, covering on average 209,932 companies per year across a wide range of sizes and sectors. We used linear regression to estimate the weekly number of new sick leave spells between 2016 and 2017 in 12 French regions, adjusting for trend, seasonality and worker leaves on historical data from 2010 to 2015. Outbreaks were detected using a 95%-prediction interval. This method was compared to results from the French Sentinelles network, a gold-standard primary care surveillance system currently in place. Results Using sick leave data, we detected 92% of reported influenza outbreaks between 2016 and 2017, on average 5.88 weeks prior to outbreak peaks. Compared to the existing Sentinelles model, our method had high sensitivity (89%) and positive predictive value (86%), and detected outbreaks on average 2.5 weeks earlier. Conclusion Sick leave surveillance could be a sensitive, specific and timely tool for detection of influenza outbreaks.

Objective Pregnant women are at increased risk of serious complications from influenza and are recommended to receive an influenza vaccination during pregnancy. The objective of this study was to assess trends, timing patterns, and associated factors of influenza vaccination among pregnant women. Methods We used 2010-2018 MarketScan data on 1 286 749 pregnant women aged 15-49 who were privately insured to examine trends and timing patterns of influenza vaccination coverage. We examined descriptive statistics and identified factors associated with vaccination uptake by using multivariate log-binomial and Cox proportional hazard models. Results In-plan influenza vaccination coverage before delivery increased from 22.0% during the 2010-2011 influenza season to 33.2% during the 2017-2018 influenza season. About two-thirds of vaccinated women received the vaccine in September or October during each influenza season. For women who delivered in September through May, influenza vaccination coverage increased rapidly at the beginning of influenza season and flattened after October. For women who delivered in June through August, influenza vaccination coverage increased gradually until February and flattened thereafter. Most vaccinated women who delivered before January received the vaccine in the third trimester. Increased likelihood of being vaccinated was associated with age 31-40, living in a metropolitan statistical area, living outside the South, enrollment in a consumer-driven or high-deductible health plan, being spouses or dependents of policy holders, and delivery in November through January. Conclusions Despite increases during the past several years, vaccination uptake is still suboptimal, particularly after October. Health care provider education on timing of vaccination and recommendations throughout influenza seasons are needed to improve influenza vaccination coverage among pregnant women.

Objectives Racial and socioeconomic disparities in the incidence of Legionnaires’ disease have been documented for the past 2 decades; however, the social determinants of health (SDH) that contribute to these disparities are not well studied. The objective of this narrative review was to characterize SDH to inform efforts to reduce disparities in the incidence of Legionnaires’ disease. Methods We conducted a narrative review of articles published from January 1979 through October 2019 that focused on disparities in the incidence of Legionnaires’ disease and pneumonia (inclusive of bacterial pneumonia and/or community-acquired pneumonia) among adults and children (excluding articles that were limited to people aged Results Of the 19 articles reviewed, multiple articles examined disparities in incidence of Legionnaires’ disease and pneumonia related to economic stability/income (n = 13) and comorbidities (n = 10), and fewer articles incorporated SDH variables related to education (n = 3), social support (none), health care access (n = 1), and neighborhood and built environment (n = 6) in their analyses. Conclusions Neighborhood and built-environment factors such as housing, drinking water infrastructure, and pollutant exposures represent critical partnership and research opportunities. More research that incorporates SDH and multilevel, cross-sector interventions is needed to address disparities in Legionnaires’ disease incidence.

Background: Efforts to regulate tobacco products and reduce consumption in the European Union (EU) include the European Tobacco Products Directive (TPD), which went into force in May 2016. Despite the initial discussion to include a ban on sale of slim cigarettes, it was excluded in the final TPD. The main goal of this study was to examine support for a ban on slim cigarettes among smokers in six European Countries. Methods: Data from the 2018 (Wave 2) International Tobacco Control Policy Evaluation Project 6 European Country (ITC 6E) EUREST-PLUS project survey, a cross sectional study of adult smokers (n=5592) from Germany, Greece, Hungary, Poland, Romania, and Spain, was analysed. Descriptive statistics were used to estimate support for a ban on slim cigarettes by sociodemographic characteristics and smoking behaviors. Logistic regression analysis was used to examine factors associated with support for a ban on slim cigarettes and perceptions of harm. Results: Support for a ban on slims varied across countries, with highest support in Romania (33.8%), and lowest in Greece (18.0%). Female smokers (OR=0.77; 95%CI=0.66-0.90, daily smokers (OR=0.59; 95%CI=0.42-0.83), menthol smokers (OR=0.56; 95%CI=0.36-0.87), and smokers who did not have plans to quit within next six months (OR=0.45; 95%CI=0.36-0.57) had significantly lower odds of supporting a ban on slim cigarettes. Overall, 20% of smokers perceived slim cigarettes as less harmful than regular cigarettes. Conclusions: Support for a ban of slim cigarettes was relatively low among smokers, while misperceptions that slim cigarettes are less harmful is high, particularly among countries where slim cigarette use is more prevalent. Findings support a ban on slim cigarettes to reduce misperceptions around slim cigarettes being less harmful.

Theoretical literature predicts that asymmetric information in insurance markets generate inefficient outcomes and literature have mostly focus on adverse selection and moral hazard caused by information advantage in insurance market. Adverse selection is the likelihood of those who anticipate more need of health care due to enhanced health risk to purchase health insurance. Therefore, this study investigates adverse selection in health insurance in Nigeria. Contract theory provided the framework for the study. The insurance-demand equation was derived from the solution to the optimality condition of insurance decision equation which gives the Marshallian insurance-demand equation. The model to measure the determinants of the demand for health insurance was a linear probability demand model. Health insurance model captured adverse selection and was estimated with probit and instrumental variable probit regressions. A positive coefficient for health status and health insurance status indicate the presence of adverse selection. Adverse selection was evident in health insurance, social and private health insurance with coefficients of 0.44, 0.25 and 0.24 respectively. Insurance income elasticity was also positive in health insurance, social health insurance and private health insurance with coefficients of 0.15, 0.23 and 0.05. There is a need for mechanisms of optimal mix of people with poor and good health status that may require working out different premium for different set of people based on the type and nature of their work and regulating the behaviour of the insured, HMO’s and health provider as health insurance market grows in Nigeria.

DMT2 is the most common type of diabetes in the world. In developed countries, dia¬betes affects people over 65 years old. However, in Asia, the younger generation is also affected and the age onset of diabetes has declined. Several factors that may lead to early diabetes is changes in consumption and activity patterns. However, that should be noted that pestisides expusure by food and environmental pollutants can even be the reason behind the increasing incidence of type-2 diabetes mellitus. This study aims to provide a systematic review of the impact of pesticide exposure on the incidence of type-2 diabetes, especially at a young age. We performed articles search using Science Direct, Spinger Link, ProQuest, Pubmed and Scopus databases published since 2010 until 2020. In total, 10 scientific articles included in this study. Pesticide exposure is determined by the nature of the sources. Most studies showed a strong association between organochlorine pesticides and also the incidence of diabetes. The average age of the entire study was 43 years this has proven that there is a decrease in the onset of age of people with DMT2 in Asia. The results show that organochlorine pesticides had an impact on the incidence of DMT2 at a younger age. Someone with high levels of organochlorines serum will had a high blood glucose levels. Race may also effect the incidence of diabetes, it need to be assessed experimentally.

Malnutrition is a health disorder due to a lack or imbalance of nutrients needed for growth, thinking activities and all things related to life. One of the efforts made to help meet the nutritional needs of malnourished children under five is the Recovery Supplementary Feeding (PMT) program. The purpose of this study was to analyze whether the effect of supplementary feeding with local ingredients on changes in body weight of undernourished children under five. The type of research used is pre-experimental research design with one group pre and post-test design. This research was conducted in the working area of the Nanga Public Health Center. The population in this study were all underweight children under five in the working area of the Nanga Health Center as many as 30 people, the sampling technique in this study was total sampling. Data processing is done by editing, coding, entry, tabulating and cleaning. Data analysis in this study was bivariate with Paired Test. The results showed that there was an effect of providing local-based supplementary food to changes in body weight of undernourished children under five as indicated by a p value of 0.000 < 0.05, with a pre-test Mean value (9.744) < Post-test Mean (10.022). and the value of t-count (7.409) > t-table (2005). Based on these results, it can be concluded that the provision of local-based supplementary food is effective in increasing the weight of undernourished children under five.

Central obesity is influenced by many factors such as changes in age, gender, economic status, life habits including lack of physical activity, low fiber consumption, consumption of simple carbohydrates, consumption of fatty foods, and smoking behavior. Smoking behavior is thought to be a significant factor in forming central obesity in adult males. The purpose of this study was to determine the relationship between smoking behavior and central obesity in healthy adults. This study used an analytic observational design with a cross-sectional research design. The research was conducted in Suradadi Village, Suradadi District, Tegal Regency. Sampling was carried out by stratified sampling in November 2020 – January 2021. The sample size was 90 men aged 25-60 years. Data were collected by measuring the waist circumference of the respondents and recording other personal data such as age, occupation, and smoking status. Data processing is done descriptively and cross-tabulation. Testing the relationship between smoking behavior and obesity was carried out using the chi-square statistical test with the help of the SPSS version 22 application. The majority of respondents in this study had a smoking status of 68.9% and did not have central obesity 64.4%. The results of the test of the relationship between smoking status and central obesity got a p-value of 0.813. There is no significant relationship between smoking status and central obesity.

We propose a new summary measure of population health (SMPH), the well-being-adjusted health expectancy (WAHE). WAHE belongs to a subgroup of health-adjusted life expectancy indicators and gives the number of life years equivalent to full health. WAHE combines health and mortality information into a single indicator with weights that quantify the reduction in well-being associated with decreased health. WAHE's advantage over other SMPHs lies in its ability to differentiate between the consequences of health limitations at various levels of severity and its transparent, simple valuation function. Following the guidelines of a Committee on Summary Measures of Population Health, we discuss WAHE's validity, universality, feasibility sensitivity and ensure its reproducibility. We evaluate WAHE's performance compared to life expectancy, the most commonly used indicators of health expectancy (HE) and disability-adjusted life expectancy (DALE) in an empirical application for 29 European countries. Data on health and well-being are taken from the 2018 EU-SILC, and the life tables are from Eurostat. DALE is taken from the database of the Global Burden of Disease Programme. WAHE's sensitivity to univariate and multivariate state specifications is studied using the three Minimum European Health Module health dimensions: chronic morbidity, limitations in activities of daily living, and self-rated health. The empirical tests of the indicators' correspondence reveal that WAHE has the strongest correlation with the other SMPHs. Moreover, WAHE estimates are in agreement with all other SMPHs. Additionally, WAHE and all other SMPHs form a group of reliable indicators for studying population health in European countries. Finally, WAHE estimates are robust, regardless of whether health is defined across one or multiple simultaneous dimensions of health. We conclude that WAHE is a useful and reliable indicator of population health and performs at least as well as other commonly used SMPHs.The online version contains supplementary material available at 10.1007/s10680-022-09628-1.

Background: Despite increasing global attention to the national human papillomavirus (HPV) immunization program, this program is controversial in Iran. Evidence indicate that HPV vaccination is not cost-effective in Iran. Using cost-effectiveness analysis for decision-making about public health interventions such as vaccination is debated, because its potential benefits may not fit this framework. Our objective was to evaluate economic effects of HPV vaccination by cost-benefit analysis (CBA). In this case, we used bivalent and quadrivalent in Iran in 2020. Methods: We performed a CBA from a societal perspective. We used two approaches of the vaccine's economic benefit: willingness to pay by discrete choice experiment; and cost of illness. Costs only included the vaccine cost. Results: The cost of two doses of bivalent and quadrivalent vaccines were US $ 29 and US $ 151, respectively (US $1 =IRR 42,000). The benefits of bivalent and quadrivalent vaccines were US $ -432, and US $ 380 per person using willingness to pay approach and they were US $ 7,375 and US $ 6,590 thorough cost-of-illness approach. The cost-benefit ratio (CBR) of bivalent and quadrivalent vaccines was -15.114 and 2.512 by willingness to pay approach, and it was 258.12 and 43.51, by cost of illness approach. Conclusions: This study confirms the benefit of both the national bivalent and quadrivalent vaccination program and provide reliable evidence for policy-makers when programming HPV vaccination.

Background Malnutrition is a factor associated with mortality, particularly for older residents in long-term care facilities. Aim This study aimed to evaluate the Minimum Data Set-based Screening for Nutritional Problem (MDS-SNP) and Mini Nutritional Assessment (MNA) in screening malnutrition among institutionalised older adults in Taiwan. Methods A cross-sectional research design was employed and data from 131 residents were collected in northern Taiwan. Demographic and clinical variables such as cognitive function, activities of daily living, depression status, MDS-SNP, MNA, and dietary habits were obtained from residents’ profiles. Findings The prevalence of malnutrition and risk of malnutrition defined by MNA were 32.8% (n = 43) and 30.5% (n = 40), respectively and 59.5% (n = 78) was at risk of malnutrition according to MDS-SNP. Multivariate logistic regression disclosed that some of the MDS-SNP items such as BMI and complaints of hunger, were significantly associated with MNA-defined risk and malnutrition but none of these were considered as trigger items in MDS-SNP. Discussion Our study suggested that the MDS-SNP may be considered as an appropriate malnutrition screening tool. Screening nutritional status of older people is important because of its significant association with chronic conditions and function as well as quality of life. Conclusion A modified MDS-based malnutrition screening tool in long-term care settings which considered BMI, complaints of hunger and nutritional approaches to deliver food as predictors is warranted.

With the surge of COVID-19 cases worldwide, vaccines against COVID-19 are also developing across the countries. However, the acceptability of COVID-19 vaccination among general people is questionable. The availability of several vaccines' options against COVID-19 has perplexed people regarding individual vaccines' efficacy and safety. Therefore, we aim to determine the acceptance, preferences, impact factors of future COVID-19 vaccines in Malaysia and the factors influencing the COVID-19 vaccination acceptance among vaccine demand and vaccine delay groups.An online-based cross-sectional survey was conducted among Malaysian residents 18 years and above of either gender using the snowball sampling technique. A self-administered questionnaire was made available to participants through various social media networks, email, and telegram. The data obtained from the survey were analyzed using SPSS version 25.0. Association between background characteristics and respondents were analyzed using the Chi-square test in the vaccine delay group and vaccine acceptance group.Total of 1282 responses were considered for the study, mainly from male respondents (71%). Among the respondents, 95.9% thought that vaccination would be an effective way to prevent and control COVID-19, and 96% would accept vaccination if the COVID-19 vaccine were successfully developed and approved for listing in the future. Essential factors influencing vaccination decisions were vaccine convenience (95.7%) and doctor's recommendation (97.3%). Bivariate analysis revealed that age less than 24 years, Malay race, living in urban areas, tertiary education, students, single marital status, family income (Malaysian ringgits) RM 4,850 to RM 10,959 andRM 10,960 were significantly associated with vaccine acceptance of COVID19 vaccination.All the factors influencing COVID-19 vaccine acceptance rates throughout the country should be studied on a larger scale, and appropriate steps to ensure vaccine acceptance among the public should be meticulously devised by the government and related authorities.Con el aumento de casos de COVID-19 en todo el mundo, las vacunas contra la COVID-19 también están en desarrollo en todos los países. Sin embargo, la aceptabilidad de la vacuna COVID-19 entre la gente en general es cuestionable. La disponibilidad de varias opciones de vacunas contra COVID-19 ha dejado perpleja a la gente con respecto a la eficacia y seguridad de las vacunas individuales. Por lo tanto, tenemos como objetivo determinar la aceptación, las preferencias y los factores de impacto de las futuras vacunas COVID-19 en Malasia y los factores que influyen en la aceptación de la vacunación COVID-19 entre la demanda de vacunas y los grupos de demora de la vacuna.Se realizó una encuesta transversal en línea entre residentes de Malasia de 18 años o más de cualquier género utilizando la técnica de muestreo de bola de nieve. Se puso a disposición de los participantes un cuestionario autoadministrado a través de varias redes sociales, correo electrónico y telegrama. Los datos obtenidos de la encuesta se analizaron con el programa SPSS versión 25.0. La asociación entre las características de fondo y los encuestados fueron analizados usando la prueba de χSe consideró un total de 1.282 respuestas para el estudio, principalmente de hombres encuestados (71%). Entre los encuestados, el 95,9% pensó que la vacunación sería una forma eficaz de prevenir y controlar la COVID-19, y el 96% aceptaría la vacunación si la vacuna COVID-19 se desarrollara con éxito y se aprobara para su inclusión en el futuro. Factores esenciales que influyeron en las decisiones de vacunación fueron la conveniencia de la vacuna (95,7%) y la recomendación del médico (97,3%). El análisis bivariado reveló que la edad24 años, la raza malaya, la vida en áreas urbanas, educación terciaria, estudiantes, estado civil soltero, ingresos familiares RM 4,850 a RM 10,959 yRM 10,960 (enTodos los factores que influyen en las tasas de aceptación de la vacuna COVID-19 en todo el país deben estudiarse a mayor escala, y el gobierno y las autoridades relacionadas deben diseñar meticulosamente los pasos apropiados para asegurar la aceptación de la vacuna entre el público.

Background: Vaccination of children has played a significant role in reducing early childhood morbidity and mortality from vaccine-preventable diseases; however, some factors act as deterrents in achieving adequate coverage in this susceptible population. Aims & Objectives: The study, therefore, aimed to identify vaccine-related determinants of childhood vaccination as well as determine the relationship between childhood vaccination status and body weight, height, and a child’s body mass index (BMI). Methods: The study was conducted using a cross-sectional design in which 608 caregiver-child pair was recruited sequentially by using a two-stage sampling technique. Structured questionnaires based on the SAGE vaccine hesitancy model were used to interview the participants. Elicited data was analyzed and categorical variables were presented in tables and charts as frequencies, while a chi-square test was used to test the association between the independent and dependent variables. Pearson’s correlation analysis was also done to determine the correlation between vaccination status and weight, height, and BMI of children. Result: The study showed that vaccination coverage was suboptimal (70.56%) in children and was below the expected target of 80%. Although a few (183, 30.10%) of the respondents claimed they would prevent the vaccination of their children due to the fear of needles, the majority (87.50%) will be willing to accept more vaccine doses for their children if there were no pain. While factors such as the experience of adverse reaction (X2 = 13.22, df = 2, p Conclusion: Vaccination uptake and coverage can be significantly improved in children by designing and implementing interventional programs that target pharmaceutical and vaccine-specific factors acting as barriers in these rural communities.

Sedentary behavior (SB) and physical activity (PA) are important risk factors of cardiovascular disease morbidity and mortality. In addition to increasing the amount of moderate-to-vigorous PA (MVPA), the current PA guidelines recommend that adults should reduce SB, or any waking activity performed while sitting, reclining, or lying, with low energy expenditure. While mounting evidence has emphasized the benefits of increasing MVPA, little has focused on the effect of SB on health. Therefore, this review discusses the pathophysiological effects of SB and the potential physiological benefits of reducing/breaking up SB at the levels below the current guidelines for PA. Such knowledge is important, given that the majority of the United States population performs insufficient or no MVPA and is at high risk of being negatively impacted by SB. Interventions targeting sedentary time, such as breaking up SB by standing and moving, may be safe, feasible, and applicable to execute daily for a wide range of the population. This review also discusses the importance of monitoring SB in the era of the coronavirus disease 2019 (COVID-19) pandemic and the clinical implications of sitting less and moving more.

Background The health benefits of diets rich in fruits and vegetables (FV) are well established. Recent observational and intervention research suggests that FV consumption may also exert a positive effect on psychological well-being. Objective This study aimed to assess changes in mean Subjective Happiness Scale (SHS) scores in response to consuming DGA recommended types and amounts of vegetables. It was hypothesized that increased vegetable consumption would increase mean SHS scores. Design This study investigated a secondary outcome of a randomized, parallel, non-blinded controlled trial with a 1:1 allocation ratio to a provided vegetable intervention or attention control group. Participants/setting Men and women (n=75) aged 18-65 years, body mass index ≥25 kg/m2, with low habitual vegetable consumption were recruited from Grand Forks, ND, December 2016 to January 2018, for this community-based study. Intervention The vegetable intervention consisted of an 8-week feeding phase during which participants were provided with vegetables in DGA recommended types and amounts. The attention control group was not provided vegetables but completed the same testing schedule as the vegetable intervention group. Main outcome measure Mean SHS scores were assessed before and after the intervention. Statistical analyses Mean SHS scores were analyzed using a 2-way factorial mixed linear model analysis of variance. Results A significant interaction between treatment and visit (P=0.015) revealed greater mean SHS scores at week 8 than at baseline in the vegetable intervention group (+0.23 ± 0.11 (mean difference ± standard error of the difference) but no change in the attention control group (-0.15 ± 0.11). Conclusions Greater mean SHS scores were observed after increasing vegetable consumption to meet DGA recommendations, suggesting that adhering to DGA vegetable guidance may help promote psychological well-being.

Abstrct A composite Air Health Index (AHI) is helpful for separately emphasizing the health risks of multiple stimuli and communicating the overall risks of an adverse atmospheric environment to the public. We aimed to establish a new AHI by integrating daily mortality risks due to air pollution with those due to non-optimum temperature in China. Based on the exposure-response (E-R) coefficients obtained from time-series models, the new AHI was constructed as the sum of excess mortality risk associated with air pollutants and non-optimum temperature in 272 Chinese cities from 2013 to 2015. We examined the association between the “total AHI” (based on total mortality) and total mortality, and further compared the ability of the “total AHI” to predict specific cardiopulmonary mortality with that of “specific AHIs” (based on specific mortalities). On average, air pollution and non-optimum temperature were associated with 28.23% of daily excess mortality, of which 23.47% was associated with non-optimum temperature while the remainder was associated with fine particulate matter (PM2.5) (1.12%), NO2 (2.29%,), and O3 (2.29%). The new AHI uses a 10-point scale and shows an average across all 272 cities of 6 points. The E-R curve for AHI and mortality is approximately linear, without any thresholds. Each one unit increase in “total AHI” is associated with a 0.84% increase in all-cause mortality and 1.01%, 0.98%, 1.02%, 1.66%, and 1.71% increases in cardiovascular disease, coronary heart disease, stroke, respiratory diseases, and chronic obstructive pulmonary disease mortality, respectively. Cause-specific mortality risk estimates using the “total AHI” are similar to those predicted by “specific AHIs”. In conclusion, the “total AHI” proposed herein could be a promising tool for communicating health risks related to exposure to the ambient environment to the public.

The purpose of this study was to evaluate gender-specific differences in prevalence and risk factors for alcohol, tobacco, and marijuana use among 50- to 65-year-old Jamaicans. We performed secondary analysis of the 2016 Jamaica National Drug Use Prevalence Survey. The dependent variables were self-reported use of tobacco, alcohol, and marijuana in the 30 days before the survey. The independent variables included general, socioeconomic, and community characteristics and concomitant substance use. Gender-stratified multiple Poisson regressions were conducted. The survey included 1,099 individuals aged 50-65 years; 50.3% were men. Reported use was significantly higher in men than in women: alcohol (54.9% vs. 17.8%), marijuana (22.4% vs. 2.2%), and tobacco (19.2% vs. 3.9%). High income was associated with alcohol use in women, whereas low and middle incomes were associated with marijuana use among men. Being employed was associated with tobacco use among women and with alcohol use among men. Rural residence was associated with alcohol use in women and with marijuana use in men. High neighborhood disorder was associated with tobacco use in women and alcohol and marijuana use in men. Concomitant substance use increased the likelihood of alcohol, tobacco, and marijuana use in men and women. We conclude that gender-sensitive strategies to substance use prevention and treatment are needed in Jamaica.

The need for adherence to a healthy and sustainable dietary pattern in the pediatric stage is discussed worldwide, being linked to a progressive incidence of noncommunicable diseases in adulthood. The aims of this systematic review were to summarize the healthy and/or sustainable dietary patterns, defined a priori, described in the literature for use during the pediatric stage; to evaluate the adherence to these dietary patterns; and identify the health-related benefits associated with adherence to these patterns. A literature search was carried out on Medline, Scopus, and Web of Science from 2010 up to 2021, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 128 articles were included according to the following criteria: participants 2–17 y old, healthy and/or sustainable dietary patterns defined by an a priori methodology; articles written in English or Portuguese; and published since 2010. Fifty instruments with 14 adaptations that measure adherence to healthy and/or sustainable dietary patterns in children and adolescents were found. The Mediterranean Diet was the most studied dietary pattern. Adherence to healthy and/or sustainable dietary patterns has wide variations worldwide. Most of the instruments described have been little studied at pediatric ages, reducing the ability to extrapolate results. Higher adherence to these dietary patterns was associated with lower body fat, waist circumference, blood pressure, and metabolic risk. There is no consensus regarding the association with BMI. No studies have proofs of the sustainability characteristics of these instruments, it being necessary to produce a new sustainable instrument or test the association of the previous ones with, for example, the ecological footprint. Further validations of these instruments in each country and more prospective studies are needed to establish temporal relations with health-related outcomes. This systematic review was registered at www.crd.york.ac.uk/prospero/ as CRD42020221788.

The enormous loss of life, as well as economic loss, incurred by road traffic crashes means that rigorous research efforts, especially in developing countries, are needed to investigate risk factors that significantly influence crash severity. The objective of this study is to explore empirically the impact of driver and vehicle characteristics, environmental conditions and collision pattern on motorway (freeway) crash severity. The past 7 years’ worth of data (2009–2015) on motorway crashes, collected by the National Highway and Motorway Police Pakistan, are used in the study. An ordered probit model is estimated using four levels of injury severity: property damage only, minor injury, major injury and fatal injury. Ten explanatory variables show a significant association with crash severity on motorways. Major risk factors that are found to increase the propensity for severe injury are speeding, drowsiness, head-on collision due to driving the wrong way, illegal pedestrian crossing and increasing age of drivers. The model's predictive performance is also discussed. The study findings emphasise the need for enhanced road safety enforcement measures for reducing crash severity on high-speed limited-access facilities.

INTRODUCTION: Cardiovascular disease (CVD) continues to be one of the main causes of morbidity and mortality in the world. There are several risk factors for CVD, many of which are preventable, including sedentary lifestyles and poor diet. OBJECTIVE: To assess the influence of physical activity, adherence to the Mediterranean diet and sociodemographic variables such as age, sex and social class on the values of different cardiovascular risk scales. METHODS: A descriptive, cross-sectional study in 1584 Spanish workers in which the influence of different sociodemographic variables (age, sex, social class) and healthy habits (tobacco consumption, physical activity assessed with the IPAQ questionnaire, and adherence to the Mediterranean diet) on the values of different cardiovascular risk (CVR) scales (REGICOR, SCORE, DORICA, ERICE, heart age, and vascular age) was assessed. RESULTS: All the CVR scales showed better mean values as the level of physical activity increased, something similar occurring with the prevalence of altered values, in both sexes. High adherence to the Mediterranean diet also improved the mean values and prevalence of altered values in men and women. CONCLUSION: The Mediterranean diet and physical exercise decrease the probability of suffering a cardiovascular event and improve all the CVR scales analyzed in this study.

Background Food access is an important aspect of health promotion for the elderly. The aim of this study was to investigate the relationship between distance to the nearest food store and diet variety in rural community-dwelling elderly Japanese. Methods This cross-sectional study analyzed data from 1,103 elderly participants surveyed by mail in rural areas of Japan. Diversity of food intake was assessed by diet variety score (DVS). Street network distance from home to food store was calculated and categorized by quartile using a geographic information system and analyzed in relation to diet by multivariable regression with the primary outcome as low DVS. Sub-analysis of the association with DVS was conducted for each food store category (convenience store, supermarket and small food store). The association between intake frequency of each food group and distance was also analyzed. Results Participants in the fourth quartile of distance to food store had significantly higher prevalence ratio (1.15, 95% CI, 1.01-1.32) for low DVS than those in the first quartile. There was a significant tendency between greater distance to food store and lower DVS (p for trend = 0.033). Supermarkets and convenience stores, in particular, showed significant associations. Greater distance was significantly associated with lower frequency of meat and fruit intake. Conclusions There was significant association between distance to nearest food store and diet variety in rural Japanese elderly. These findings suggest the importance of interventions for areas at high risk of low diet variety, such as places far away from food stores.