1.
BMC Public Health. 2020 Mar 30;20(1):408. doi: 10.1186/s12889-020-8448-8.
Barriers of effective health insurance coverage for rural-to-urban migrant workers in China: a systematic review and policy gap analysis.
Chen S1, Chen Y2, Feng Z3, Chen X4, Wang Z5,6, Zhu J7, Jin J8, Yao Q9, Xiang L3, Yao L3,10, Sun J9, Zhao L11, Fung H12, Wong EL12, Dong D13.
Abstract
BACKGROUND:
More than 90% of the Chinese population was covered by its three basic social health insurances. However, the Chinese rural-to-urban migrant workers (RUMWs), accounting for about one-fifth of China's total population, seem to be put on a disadvantaged position under the current health insurance schemes. The purpose of this study is to identify the current barriers and to provide policy suggestions to the ineffective health insurance coverage of RUMWs in China.
METHODS:
A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included PubMed, Embase, Medline, Web of Science, PsycINFO, Maternity and Infant Care Database MIDIRS, the Cochrane Library, WHO Library Database (WHOLIS), WHO Global Health Library, World Bank eLibrary, OpenGrey, CNKI, and Wanfang. In total, 70 articles were reviewed.
RESULTS:
(1) Chinese RUMWs have high work mobility and low job stability; (2) Barriers faced by RUMWs in obtaining effective health insurance coverage are primarily due to the reluctance of employers to provide insurance for all employees and the disadvantaged position held by RUMWs when negotiating with their employers; (3) Fissures among existing health insurance schemes leaves no room for RUMWs to meet their primary needs; and (4) Recent efforts in improving the portability and transferability of insurance across borders and schemes are not enough to solve the barriers.
CONCLUSION:
It is argued that the Chinese central government must deal with the fragmentation of healthcare system in China and promote effective coverage by: (1) playing a more active role in coordinating different healthcare and social welfare schemes across the country, (2) increasing the health insurance portability, (3) making the healthcare policies more compatible with RUMW's characteristics to meet their primary health needs, (4) strengthening supervision of employers, and (5) providing more vocational training and other support to increase RUMW's job stability.
KEYWORDS:
China; Rural-to-urban migrant workers; Systematic review; Universal health coverage
2.
BMC Public Health. 2020 Mar 30;20(1):414. doi: 10.1186/s12889-020-08553-4.
Knowledge level of cancer symptoms and risk factors in the Gaza Strip: a cross-sectional study.
Elshami M1,2, Elshami A3, Alshorbassi N3, Alkhatib M3, Ismail I3, Abu-Nemer K3, Hana M3, Qandeel A3, Abdelwahed A3, Yazji H3, Abuamro H3, Matar G3, Alsahhar A3, Abolamzi A3, Baraka O3, Elblbessy M3, Samra T3, Bottcher B3.
Abstract
BACKGROUND:
In low-income settings, cancer is often diagnosed in advanced stages due to late presentation. Good public awareness of cancer signs and symptoms has a positive impact on the time patients take before they present to healthcare professionals. Therefore, this study examined public knowledge of cancer signs and symptoms as well as risk factors in Gaza.
METHODS:
This was a cross-sectional study. Participants were recruited from adult visitors (≥18 years) to governmental hospitals covering all five governorates of Gaza, and adolescent students (15 to 17 years) from 10 high schools in corresponding locations. An Arabic version of the Cancer Awareness Measure (CAM) was completed in a face-to-face interview. It described demographic data and knowledge of: cancer prevalence, age-related risk, signs and symptoms as well as risk factors both in recall and recognition questions.
RESULTS:
Of 3033 participants invited, 2886 completed the CAM (response rate = 95.2%). Adult mean age ± standard deviation was 33.7 ± 11.7 years and that of adolescents was 16.3 ± 0.8 years. Half of the participants (n = 1457, 50.5%) were adolescent (781 females; 53.6%) and 1429 (49.5%) were adult (702 females; 49.1%). About two thirds (n = 1885) thought about cancer as unrelated to age. Only 196 participants (6.8%) identified colorectal cancer as the most common cancer among men. Awareness of cancer signs/symptoms was poor to fair, where 'lump' was most commonly recognized (n = 2227, 77.2%) and 'change of bowel habit' the least (n = 670, 23.2%). Only 217 participants (7.5%) had a good level of recognizing risk factors with 'smoking' being the most identified and 'eating less than five portions of fruits and vegetables a day' the least. There was a higher likelihood for adults to identify most cancer signs/symptoms and risk factors than adolescents, except for recalling 'unexplained pain', 'persistent cough/hoarseness', 'non-healing ulcer', 'smoking', and 'eating less than five portions of fruits and vegetables a day'.
CONCLUSION:
Public awareness of cancer signs/symptoms and risk factors needs to improve to facilitate early presentation and diagnosis in Gaza. Combining the delivery of public campaigns with tailored education to population groups, including the youth, may increase their knowledge and maintain its impact.
KEYWORDS:
Adolescent health; Cancer awareness; Cancer risk factors; Cancer signs and symptoms; Early presentation; Gaza; Low- and middle-income countries; Palestine
3.
BMC Public Health. 2020 Mar 30;20(1):412. doi: 10.1186/s12889-020-08556-1.
Epidemiological study on animal bite cases referred to Haji Daii health Center in Kermanshah province, Iran during 2013-2017.
Abstract
BACKGROUND:
Over thousands of animal bite cases are reported annually worldwide and in Iran placing a large financial burden on the health and economy. The aim of this study was to evaluate the epidemiology of animal bite cases in Kermanshah, Iran through 2013-2017.
METHODS:
In this cross-sectional study, 5618 animal bite cases in Kermanshah from 2013 to 2017 were studied. Data were analyzed using descriptive and inferential statistics.
RESULTS:
In the study period, 5618 animal bite cases were found. The prevalence of animal bites was estimated between 42.55-45.66 per100000 populations during 2013-2017. An increasing significant trend was found for prevalence of animal bites (Average annual percent change [AAPC] + 4.9, P-trend< 0.001) over a 5-years' time period. The mean age of the subjects was 32.7 ± 18.3 years. Of the studied subjects 76.3% were male, and 34% had non-governmental jobs. Dogs were found as the cause of animal bites in 72% of the cases. Of the studied cases, 82% had received rabies vaccination for three times.
CONCLUSION:
The results showed an increasing significant trend for animal bites in Kermanshah. Development of interventional programs, such as limiting stray dogs, vaccination of dogs and raising public awareness are essential.
KEYWORDS:
Animals; Bite; Epidemiology; Iran
4.
BMC Public Health. 2020 Mar 30;20(1):418. doi: 10.1186/s12889-020-08551-6.
Cumulative lifetime violence severity scale: development and initial testing among men.
Abstract
BACKGROUND:
Knowledge of the relationship between men's health and violence is flawed by narrow and faulty conceptualization and measurement of violence that often results in attribution of health problems to one form or type of violence without consideration of other exposures. Our purpose is to describe the development and initial testing of the Cumulative Lifetime Violence Severity scale designed for use in health research to measure men's perceptions of the severity of their cumulative lifetime violence.
METHODS:
We framed the dimensions of violence severity as: type (physical, psychological, sexual), timing (childhood, adulthood), focus (perpetrator, target), context, frequency, and degree of distress. Items reflecting these dimensions were vetted by local experts including individuals who identified as men, with particular attention to meaningful language for men. The measure was pretested, revised to 64 items, and tested for test-retest reliability prior to use in a study of 685 English-speaking Eastern Canadian men, ages 19 to 65 years. We used Principal Components Analysis to illuminate the underlying dimensionality of the items.
RESULTS:
Principal Components Analysis yielded a 44-item 11 component solution that accounted for 64.06% of variance with good model fit and a Cronbach's alpha of .92. All dimensions of our conceptualization of violence severity were reflected in the components, except Adult Target Sexual Violence. Convergent validity between the Cumulative Lifetime Violence Severity-44 Scale and a global lifetime violence rating scale was r = .750 (p < .001) and concurrent validity was moderate and significant between the Cumulative Lifetime Violence Severity-44 scale and measures of mental health problems commonly experienced by people with violence histories.
CONCLUSIONS:
The Cumulative Lifetime Violence Severity-44 scale shows promise as the first comprehensive measure of cumulative lifetime violence for health research that considers gender, individual distress and experiences as both perpetrator and target. Next steps include further exploratory analysis with a more diverse sample of men and confirmatory factor analysis.
KEYWORDS:
Cumulative lifetime violence severity; Health; Men; Scale development
5.
BMC Public Health. 2020 Mar 30;20(1):411. doi: 10.1186/s12889-020-8416-3.
The impact of health vs. non-health goals on individuals' lifestyle program choices: a discrete choice experiment approach.
Abstract
BACKGROUND:
Goals play an important role in the choices that individuals make. Yet, there is no clear approach of how to incorporate goals in discrete choice experiments. In this paper, we present such an approach and illustrate it in the context of lifestyle programs. Furthermore, we investigate how non-health vs. health goals affect individuals' choices via non-goal attributes.
METHODS:
We used an unlabeled discrete choice experiment about lifestyle programs based on two experimental conditions in which either a non-health goal (i.e., looking better) or a health goal (i.e., increasing life expectancy) was presented to respondents as a fixed attribute level for the goal attribute. Respondents were randomly distributed over the experimental conditions. Eventually, we used data from 407 Dutch adults who reported to be overweight (n = 212 for the non-health goal, and n = 195 for the health goal).
RESULTS:
Random parameter logit model estimates show that the type of goal significantly (p < 0.05) moderates the effect that the attribute diet has on lifestyle program choice, but that this is not the case for the attributes exercise per week and expected weight loss.
CONCLUSIONS:
A flexible diet is more important for individuals with a non-health goal than for individuals with a health goal. Therefore, we advise policy makers to use information on goal interactions for developing new policies and communication strategies to target population segments that have different goals. Furthermore, we recommend researchers to consider the impact of goals when designing discrete choice experiments.
KEYWORDS:
Discrete choice experiment; Goals; Lifestyle program; Preferences
6.
BMC Public Health. 2020 Mar 30;20(1):423. doi: 10.1186/s12889-020-08564-1.
Caries experience and oral health related quality of life in a cohort of Ugandan HIV-1 exposed uninfected children compared with a matched cohort of HIV unexposed uninfected children.
Birungi N1, Fadnes LT2,3, Engebretsen IMS4, Lie SA2, Tumwine JK5, Åstrøm AN2; ANRS 12174 and 12341 study groups.
Abstract
BACKGROUND:
Very few studies consider the oral health status and quality of life in HIV-1 exposed uninfected (HEU) children. The aim of this study was to estimate the prevalence of caries in primary teeth and its oral health related quality of life impacts in HEU children compared to HIV-unexposed-uninfected (HUU) children, whilst adjusting for confounding covariates.
METHODS:
This study uses data from the Ugandan site of the ANRS 121741 PROMISE- PEP trial (ClinicalTrials.gov, number NCT00640263) conducted in 2009-2013 that recruited mothers with HIV-1 and their uninfected children. Of 244 HEU-children-caretaker pairs available at the end of the one-year trial, 166 were re-enrolled in the ANRS 12341 PROMISE-PEP M&S study at 5-7 years and 164 were included in this study. These were age and sex-matched with 181 HUU children-caretaker comparators. Caries experience was recorded using World Health Organization's Decayed, Missed and Filled teeth (dmft/DMFT) indices. The Early Childhood Oral health Impact Scale (ECOHIS) was used for assessment of oral health related quality of life. Mixed effects logistic regression was conducted with dmft and ECOHIS scores as outcomes and HIV-1 exposure status as the main exposure.
RESULTS:
Forty-eight percent of HEU children and 60% of HUU had dmft> 0. Corresponding figures for ECOHIS> 0 were 12% of HEU and 22% of HUU. The crude analysis showed differences related to HIV-1 exposure in caries experience and oral health related quality of life. Mixed effect logistic regression analyses were not significant when adjusted for use of dental care and toothache. If caregivers' DMFT> 0, the adjusted odds ratio for caries experience (dmft> 0) was 1.6 (95% CI: 1.0-2.8) while if dmft> 0 the adjusted odds ratio for quality of life impacts (ECOHIS> 0) was 4.6 (95% CI: 2.0-10.6).
CONCLUSION:
The prevalence of untreated caries in primary teeth and quality of life impacts was high in this study population. HIV-1 exposed uninfected children were not more likely than HUU children to experience dental caries or have impaired oral health related quality of life. Given the global expansion of the HEU child population, the present findings indicating no adverse effect of pre- and post-natal HIV-1 exposure on caries in deciduous teeth are reassuring.
KEYWORDS:
Children; Dental caries; HIV unexposed infected; Oral health; Quality of life
7.
BMC Public Health. 2020 Mar 30;20(1):410. doi: 10.1186/s12889-020-8445-y.
Regional differences in the global burden of age-related macular degeneration.
Abstract
BACKGROUND:
Age-related Macular Degeneration (AMD) is the leading cause of blindness. This study aims to analyze regional differences on the global burden of AMD and help direct related policy making.
METHODS:
Disability-adjusted life years (DALY) data were collected from the Global Burden of Disease Study (GBD) 2017 to estimate the AMD burden. Mean education years, human development index (HDI) and Public Health Expenditure were extracted from the Human Development Report 2018, and latitude data were obtained from the Google Earth. These four factors were analyzed to see their importance in regional differences of AMD burden, using Kruskal-Wallis test, Dunn's multiple comparisons test as well as regression analysis.
RESULTS:
Global age-standardized DALY rates have decreased since 2011. Based on the WHO region system, age-standardized DALY rates in African and Eastern Mediterranean region were significantly lower than those of other four regions. Linear regression analysis indicated that age-standardized DALY rates were inversely related to HDI and mean education years.
CONCLUSIONS:
The age-standardized AMD burden had a decreasing tendency recently. Lower socioeconomic status and fewer education years were associated with higher AMD burden. The finding of this study may highlight the importance of national development and education on relieving AMD burden.
KEYWORDS:
Disability-adjusted life years; Global burden of disease; Macular degeneration
8.
BMC Public Health. 2020 Mar 30;20(1):415. doi: 10.1186/s12889-020-08522-x.
Health behaviours associated with video gaming in adolescent men: a cross-sectional population-based MOPO study.
Abstract
BACKGROUND:
Playing video games, a form of sedentary behaviour, is associated with poor well-being and increased risk of morbidity due to chronic disease. However, the association between health behaviours and video gaming is poorly understood. The purpose of this population-based study was to reveal the differences in dietary habits and physical activity for adolescent men with high amount of video games on weekdays, as compared to their peers who play less often.
METHODS:
Seven hundred ninety-six adolescent men (age: mean = 17.8, SD = 0.6) attended compulsory conscription for military service in 2013 and completed a questionnaire regarding the amount and frequency of their video gaming. They also participated in a medical examination and underwent physiological measurements. The participants who played video games more than 3 h/d on weekdays were compared with those who played 3h/d or less. The association between health behaviours and the amount of playing video gaming was analysed using multivariable logistic regression analysis.
RESULTS:
24.1% (n = 192) of the participants reported video gaming in excess of 3 h/d. This group had higher incidence of having low physical fitness, having poor eating habits, and being obese. No differences were found in smoking or alcohol drinking habits. Other factors, including low leisure-time physical activity (OR = 1.94; 95% CI, 1.29-2.91), low consumption of vegetables and fruits (OR = 0.83; 95% CI, 0.72-0.97), high consumption of sweetened soft drinks (OR = 1.28; 95% CI, 1.06-1.55) and high amount of sitting time (OR = 1.40; 95% CI, 1.28-1.52), explained one-fourth of the difference.
CONCLUSION:
In this population-based study, adolescent men who played video games a lot on weekdays had lower physical fitness, were more often obese, and had poorer dietary habits, as compared to their peers who played less often. Because playing video games typically adds to a person's total sedentary time, this activity may be associated with adverse health outcomes at a very young age- especially in combination with poor health behaviours. The results of this study can be utilized to promote health interventions targeted at adolescent men so as to raise their awareness of the disadvantages of excessive video gaming.
KEYWORDS:
Adolescent; Eating habits; Gaming; Health behaviour; Male; Physical activity; Video games
9.
BMC Public Health. 2020 Mar 30;20(1):417. doi: 10.1186/s12889-020-08534-7.
Breast cancer incidence and mammography screening among resettlers in Germany.
Kaucher S1, Khil L2, Kajüter H2, Becher H3,4, Reder M5,6, Kolip P6, Spallek J7, Winkler V3, Berens EM8.
Abstract
BACKGROUND:
European studies showed that women with a migration background are less likely to participate in mammography screenings than autochthonous women. However, the participation in the German mammography screening programme (MSP) among ethnic German migrants from countries of the former Soviet Union (called resettlers) is unclear so far. The aim of this study was to identify possible differences regarding MSP participation between resettlers from the FSU and the general German population.
METHODS:
Data from two independent, complementary studies from North Rhine-Westphalia, Germany (a retrospective cohort study 1994-2013; a cross-sectional study 2013/14) were used for comparisons between resettlers and the general population: Odds Ratios (ORs) for MSP participation utilizing the cross-sectional data and time trends of breast cancer incidence rates as well as Chi-Square tests for breast cancer stages utilizing the cohort data.
RESULTS:
Resettlers showed higher Odds to participate in the MSP than the general population (OR 2.42, 95% CI 1.08-5.42). Among resettlers, a large increase in incidence rates was observed during the MSP implementation (2005-2009), resulting in stable and comparable incidence rates after the implementation. Furthermore, pre-MSP implementation, the proportion of advanced breast cancer stages was higher among resettlers than in the German population, post-MSP implementation the proportion was comparable.
CONCLUSIONS:
MSP participating seems surprisingly high among resettlers. An explanation for the increased willingness to participate might be the structured invitation procedure of the MSP. However, the exact reasons remain unclear and future research is needed to confirm this hypothesis and rule out the possibility of selection bias in the cross-sectional study.
KEYWORDS:
Breast cancer; Mammography screening programme; Migrants; Participation; Resettlers; Stage at diagnosis
10.
BMC Public Health. 2020 Mar 30;20(1):409. doi: 10.1186/s12889-020-08470-6.
A pilot randomised trial comparing a mindfulness-based stress reduction course, a locally-developed stress reduction intervention and a waiting list control group in a real-life municipal health care setting.
Abstract
BACKGROUND:
The purpose of the present study was to conduct a pilot randomised controlled trial (RCT) to lend support to a larger effectiveness RCT comparing Mindfulness-Based Stress Reduction (MBSR), a locally-developed stress reduction intervention (LSR) and a waiting list control group in a Danish municipal health care center setting.
METHODS:
A three-armed parallel pilot RCT was conducted among 71 adults who contacted a Danish municipal health care center due to stress-related problems. Recruitment was made between January and April 2018 and followed usual procedures.
EXCLUSION CRITERIA:
1) acute treatment-demanding clinical depression or diagnosis of psychosis or schizophrenia, 2) abuse of alcohol, drugs, medicine, 3) pregnancy. Randomisation was performed by an independent data manager using the REDCap electronic data capture tool. The primary outcome was a description of RCT feasibility (recruitment and retention rates regarding intervention participation and 12-week follow-up). Secondary outcomes were completion rates regarding questionnaire data and proposed effect-estimates of outcome measures considered to be used in the following real RCT. Type of intervention and outcome assessment were not blinded.
RESULTS:
We recruited 71 of 129 eligible individuals from the target population (55, 95%CI: 46-64). Forty-two (59%) were females. Median age: 44 years (1-quartile:34, 3-quartile:50). Twenty-nine (41%) had < 16 years of education. Forty-eight (68%) were employed; 30 of these 48 (63%) were on sick leave. Mean scores for perceived stress (PSS): 25.4 ± 5.3; symptoms of anxiety and depression (SCL-5): 2.9 ± 0.6, and well-being (WHO-5): 31.7 ± 8.5 indicated a need for intervention. 16/24 (67, 95%CI: 45 to 84) who were allocated to MBSR and 17/23 (74, 95%CI: 52 to 90) who were allocated to LSR participated in ≥5 sessions. The loss to follow-up at 12 weeks: MBSR: 5 (21% (95% CI: 7 to 42), LSR: 5 (22% (95% CI: 7 to 44) and waiting list: 4 (17% (95% CI: 5 to 37). This was acceptable and evenly distributed. The results indicated MBSR to be superior.
CONCLUSIONS:
An RCT assessing the effectiveness of stress reduction interventions in a real-life municipal health care setting is feasible among adults with a clear need for stress reduction interventions based on scores on mental health.
TRIAL REGISTRATION:
ClinicalTrials.gov. Identifier: NCT03663244. Registered September 10, 2018.
KEYWORDS:
ACT Acceptance and commitment therapy; ARSQ The Amsterdam Resting State Questionnaire; Abbreviations; BRS Brief resilience scale; CI Confidence interval; Community Mental Health Services (MeSH); EQ Experiences questionnaire - decentering sub scale; Effectiveness; FFMQ The five facet mindfulness questionnaire; Feasibility studies (MeSH); LSR Locally developed stress reduction intervention; MBSR; MBSR Mindfulness-based stress reduction; Mindfulness; Mindfulness-based Stress Reduction; PSS Perceived stress scale; Pilot Projects (MeSH); Pragmatic Clinical Trial (MeSH); RCT Randomised controlled trial; SCL-5 Hopkins Symptom Check List-5; SCS Self-compassion scale; Stress, Psychological (MeSH); WHO World Health Organization; WHO-5 WHO-5-wellbeing scale
11.
BMC Public Health. 2020 Mar 30;20(1):420. doi: 10.1186/s12889-020-08568-x.
Effects of a transtheoretical model - based intervention and motivational interviewing on the management of depression in hospitalized patients with coronary heart disease: a randomized controlled trial.
Abstract
BACKGROUND:
Depression is a major risk factor for the morbidity and mortality of cardiovascular disease. A transtheoretical model-based intervention and motivational interviewing have been used to change health risk behaviors and have demonstrated positive effects. To our knowledge, no studies of patients with coronary heart disease (CHD) have used a transtheoretical model-based intervention and motivational interviewing as an intervention to provide dynamic education. Therefore, this study aimed to determine the effects of the transtheoretical model-based intervention and motivational interviewing on the management of depression in hospitalized patients with CHD.
METHOD:
A randomized controlled trial was designed. A total of 110 participants were randomly divided into an intervention group (n = 55) and a control group (n = 55). The Hamilton Rating Scale for Depression and the Depression Prevention & Management Survey items (stages of change, perceived benefits, perceived barriers, process of change and self-efficacy) were used to collect data at all time points. Analysis of covariance, chi-square test and repeated measures analysis of variance were used to analyze the data.
RESULTS:
After the intervention, there were more positive changes in stages of change, higher scores for the cognitive and behavioral levels, the perceived benefits, and self-efficacy, and lower perceived barriers and depression in the intervention group than in the control group. Finally, there were statistically significant differences in the depression scores at different time points in the intervention group (F = 17.814, p = 0.000 < 0.01).
CONCLUSIONS:
The study showed that a transtheoretical model-based intervention and motivational interviewing exert positive effects on the management of depression in hospitalized patients with CHD.
TRIAL REGISTRATION:
Clinicaltrials.gov, NCT03953924 (Date assigned: 16/5/2019). Retrospectively registered.
KEYWORDS:
Coronary heart disease; Depression; Motivational interviewing; Transtheoretical model
12.
BMC Public Health. 2020 Mar 30;20(1):425. doi: 10.1186/s12889-020-08535-6.
PEBRA trial - effect of a peer-educator coordinated preference-based ART service delivery model on viral suppression among adolescents and young adults living with HIV: protocol of a cluster-randomized clinical trial in rural Lesotho.
Lejone TI1, Kopo M1, Bachmann N2,3, Brown JA2,3,4, Glass TR2,3, Muhairwe J1, Matsela T5, Scherrer R2,3, Chere L6, Namane T7, Labhardt ND2,3,8, Amstutz A9,10,11.
Abstract
BACKGROUND:
Despite tremendous progress in controlling the HIV epidemic in sub-Saharan Africa, HIV-related mortality continues to increase among adolescents and young people living with HIV (AYPLHIV). Globally, sub-Saharan Africa accounts for 85% of the AYPLHIV. Overall outcomes along the HIV care cascade are worse among AYPLHIV as compared to all other age groups due to various challenges in accessing and adhering to antiretroviral therapy (ART). New, innovative multicomponent packages of differentiated service delivery (DSD) models, are required to address the specific needs of AYPLHIV. This study aims to evaluate the feasibility and effectiveness of a multicomponent DSD model (PEBRA model) designed for AYPLHIV and coordinated by a peer-educator.
METHODS:
PEBRA (Peer-Educator Based Refill of ART) is a cluster randomized, open-label, superiority trial conducted at 20 health facilities in three districts of Lesotho, Southern Africa. The clusters (health facilities) are randomly assigned to either the PEBRA model or standard of care in a 1:1 ratio, stratified by district. AYPLHIV aged 15-24 years old in care and on ART at one of the clusters are eligible. In the PEBRA model, a peer-educator coordinates the antiretroviral therapy (ART) services - such as medication pick-up, SMS notifications and support options - according to the preferences of the AYPLHIV. The peer-educator delivers this personalized model using a tablet-based application called PEBRApp. The control clusters continue to offer standard of care: ART services coordinated by the nurse. The primary endpoint is viral suppression at 12 months. Secondary endpoints include self-reported adherence to ART, quality of life, satisfaction with care and engagement in care. The target sample size is 300 AYPLHIV. Statistical analyses are conducted and reported in line with CONSORT guidelines for cluster randomized trials.
DISCUSSION:
The PEBRA trial will provide evidence on the feasibility and effectiveness of an inclusive, holistic and preference-based DSD model for AYPLHIV that is coordinated by a peer-educator. Many countries in SSA have an existing peer-educator program. If proven effective, the PEBRA model and PEBRApp have the potential to be scaled up to similar settings.
TRIAL REGISTRATION:
Clinicaltrials.gov, NCT03969030. Registered on 31 May 2019. More information: www.pebra.info.
KEYWORDS:
Adolescent; Antiretroviral therapy, differentiated service delivery; HIV; Lesotho, Africa, southern; Peer group; Randomized controlled trial
13.
BMC Public Health. 2020 Mar 30;20(1):419. doi: 10.1186/s12889-020-08499-7.
Dental problems and chronic diseases in mentally ill homeless adults: a cross-sectional study.
Mejia-Lancheros C1, Lachaud J2, Nisenbaum R2,3, Wang A2, Stergiopoulos V2,4,5, Hwang SW2,6, O'Campo P2,7.
Abstract
BACKGROUND:
Dental problems (DPs) and physical chronic diseases (CDs) are highly prevalent and incident in people with low socioeconomic status such as homeless individuals. Yet, evidence on the association between DPs and physical CDs in this population is limited. In the present study, we assessed the association between DPs and type and number of CDs in individuals experienced chronic homelessness and serious mental health problems.
METHODS:
We analyzed cross-sectional baseline data from 575 homeless adults with serious mental health problems participating in the Toronto site of the At Home/Chez Soi randomized controlled trial. Chronic DPs (lasting at least 6 months) were the primary exposure variable. Presence of self-reported CDs, including heart disease, effect of stroke, hypertension, diabetes, asthma, chronic bronchitis/emphysema, stomach or intestinal ulcer, inflammatory bowel disease, migraine, thyroid problems, arthritis, kidney/bladder problems, liver disease (other than hepatitis), and iron-deficiency anemia, were the primary outcomes. The total number of CDs was also analyzed as a secondary outcome. Logistic regression models were used to assess the association between DPs with each of the studied CDs, and negative binomial regression was used to test the association between DPs with the number of CDs.
RESULTS:
In our 575 homeless participants (68.5% males) with mean age 40.3 (11.8) years, a high proportion had DPs (42.5%). The presence of DPs was positively associated with heart disease (adjusted odds ratio (AOR):4.19,1.67-10.52), diabetes (AOR:2.17,1.13-4.17), chronic bronchitis (AOR:2.34,1.28-4.29), stomach or intestinal ulcer (AOR:3.48,1.80-6.73), inflammatory bowel disease (AOR:2.52,1.38-4.60), migraine (AOR:1.80,1.20-2.72), arthritis (AOR:2.71,1.71-4.29), kidney/bladder problems (AOR:2.43,1.30-4.54), and iron-deficiency anemia (AOR:3.28,1.90-5.65). DPs were also associated with a higher number of CDs (IRR: 1.62,1.38-1.90).
CONCLUSION:
Dental health problems in homeless individuals with serious mental disorders are associated with several CDs. Dental care should be better integrated into existing social and health programs serving this population to improve their overall health status. The AH/CS study is registered with the International Standard Randomized Control Trial Number Register (ISRCTN42520374).
KEYWORDS:
Chronic diseases; Dental health services; Homeless persons; Inflammation; Mouth diseases; Multiple chronic conditions; Oral health; Preventive health service
14.
BMC Public Health. 2020 Mar 30;20(1):413. doi: 10.1186/s12889-020-08544-5.
Cost-effectiveness of mandatory bicycle helmet use to prevent traumatic brain injuries and death.
Abstract
BACKGROUND:
Traumatic brain injury (TBI) is the main cause of mortality and severe morbidity in cyclists admitted to Dutch emergency departments (EDs). Although the use of bicycle helmets is an effective way of preventing TBI, this is uncommon in the Netherlands. An option to increase its use is through a legal enforcement. However, little is known about the cost-effectiveness of such mandatory use of helmets in the Dutch context. The current study aimed to assess the cost-effectiveness of a law that enforces helmet use to reduce TBI and TBI-related mortality.
METHODS:
The cost-effectiveness was estimated through decision tree modelling. In this study, wearing bicycle helmets enforced by law was compared with the current situation of infrequent voluntary helmet use. The total Dutch cycling population, consisting of 13.5 million people, was included in the model. Model data and parameters were obtained from Statistics Netherlands, the National Road Traffic Database, Dutch Injury Surveillance System, and literature. Effects included were numbers of TBI, death, and disability-adjusted life years (DALY). Costs included were healthcare costs, costs of productivity losses, and helmet costs. Sensitivity analysis was performed to assess which parameter had the largest influence on the incremental cost-effectiveness ratio (ICER).
RESULTS:
The intervention would lead to an estimated reduction of 2942 cases of TBI and 46 deaths. Overall, the incremental costs per 1) death averted, 2) per TBI averted, and 3) per DALY averted were estimated at 1) € 2,002,766, 2) € 31,028 and 3) € 28,465, respectively. Most favorable were the incremental costs per DALY in the 65+ age group: € 17,775.
CONCLUSIONS:
The overall costs per DALY averted surpassed the Dutch willingness to pay threshold value of € 20,000 for cost-effectiveness of preventive interventions. However, the cost per DALY averted for the elderly was below this threshold, indicating that in this age group largest effects can be reached. If the price of a helmet would reduce by 20%, which is non-hypothetical in a situation of large-scale purchases and use of these helmets, the introduction of this regulation would result in an intervention that is almost cost-effective in all age groups.
KEYWORDS:
Bicycle helmet use; Cost-effectiveness; Economic evaluation; The Netherlands; Traumatic brain injury
15.
BMC Public Health. 2020 Mar 30;20(1):416. doi: 10.1186/s12889-020-08530-x.
Modelling immune deterioration, immune recovery and state-specific duration of HIV-infected women with viral load adjustment: using parametric multistate model.
Abstract
BACKGROUND:
CD4 cell and viral load count are highly correlated surrogate markers of human immunodeficiency virus (HIV) disease progression. In modelling the progression of HIV, previous studies mostly dealt with either CD4 cell counts or viral load alone. In this work, both biomarkers are in included one model, in order to study possible factors that affect the intensities of immune deterioration, immune recovery and state-specific duration of HIV-infected women.
METHODS:
The data is from an ongoing prospective cohort study conducted among antiretroviral treatment (ART) naïve HIV-infected women in the province of KwaZulu-Natal, South Africa. Participants were enrolled in the acute HIV infection phase, then followed-up during chronic infection up to ART initiation. Full-parametric and semi-parametric Markov models were applied. Furthermore, the effect of the inclusion and exclusion viral load in the model was assessed.
RESULTS:
Inclusion of a viral load component improves the efficiency of the model. The analysis results showed that patients who reported a stable sexual partner, having a higher educational level, higher physical health score and having a high mononuclear component score are more likely to spend more time in a good HIV state (particularly normal disease state). Patients with TB co-infection, with anemia, having a high liver abnormality score and patients who reported many sexual partners, had a significant increase in the intensities of immunological deterioration transitions. On the other hand, having high weight, higher education level, higher quality of life score, having high RBC parameters, high granulocyte component scores and high mononuclear component scores, significantly increased the intensities of immunological recovery transitions.
CONCLUSION:
Inclusion of both CD4 cell count based disease progression states and viral load, in the time-homogeneous Markov model, assisted in modeling the complete disease progression of HIV/AIDS. Higher quality of life (QoL) domain scores, good clinical characteristics, stable sexual partner and higher educational level were found to be predictive factors for transition and length of stay in sequential adversity of HIV/AIDS.
KEYWORDS:
Latent variables; Markov Chain; Orthogonal variable; Quality of life domain; Transition and waiting probabilities
16.
BMC Public Health. 2020 Mar 30;20(1):421. doi: 10.1186/s12889-020-08538-3.
HIV care continuum characteristics among people with opioid use disorder and HIV in Vietnam: baseline results from the BRAVO study.
Abstract
BACKGROUND:
Little is known about patient characteristics that contribute to initiating antiretroviral therapy (ART) and achieving viral suppression among HIV people with opioid use disorder in Vietnam. The primary objective of this analysis was to evaluate associations between participant characteristics and the critical steps in the HIV care continuum of ART initiation and HIV viral suppression among people with opioid use disorder and HIV in Vietnam.
METHODS:
We assessed baseline participant characteristics, ART status, and HIV viral suppression (HIV RNA PCR < 200 copies/mL) enrolled in a clinical trial of HIV clinic-based buprenorphine versus referral for methadone among people with opioid use disorder in Vietnam. We developed logistic regression models to identify characteristics associated with ART status and HIV viral suppression.
RESULTS:
Among 283 study participants, 191 (67.5%) were prescribed ART at baseline, and 168 of those on ART (90%) were virally suppressed. Years since HIV diagnosis (aOR = 1.12, 95% CI 1.06, 1.19) and being married (aOR = 2.83, 95% CI 1.51, 5.34) were associated with an increased likelihood of current prescription for ART at baseline. Greater depression symptoms were negatively associated with receipt of ART (aOR = 0.97, 95% CI = (0.94, 0.9963)). In the HIV suppression model, once adjusting for all included covariates, only receipt of ART was associated with viral suppression (aOR = 25.9, 95% CI = (12.5, 53.8). In bivariate analyses, methamphetamine was negatively correlated with ART prescription (p = 0.07) and viral suppression (p = 0.08).
CONCLUSION:
While fewer than 90% of participants had received ART, 90% of those on ART had achieved HIV viral suppression at baseline, suggesting that interventions to improve uptake of ART in Vietnam are essential for achieving UNAIDS 90-90-90 goals in people who use heroin in Vietnam. Social determinants of health associated with ART and HIV viral suppression suggest that social support may be a key to facilitating both of these steps in the HIV care continuum.
KEYWORDS:
Anti-retroviral medication; HIV care continuum; HIV viral suppression; Opioid use; Vietnam
17.
BMC Public Health. 2020 Mar 30;20(1):422. doi: 10.1186/s12889-020-08537-4.
Comparing hemoglobin distributions between population-based surveys matched by country and time.
Abstract
BACKGROUND:
Valid measurement of hemoglobin is important for tracking and targeting interventions. This study compares hemoglobin distributions between surveys matched by country and time from The Demographic and Health Survey (DHS) Program and the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project.
METHODS:
Four pairs of nationally representative surveys measuring hemoglobin using HemoCue® with capillary (DHS) or venous (BRINDA) blood were matched by country and time. Data included 17,719 children (6-59 months) and 21,594 non-pregnant women (15-49 y). Across paired surveys, we compared distributional statistics and anemia prevalence.
RESULTS:
Surveys from three of the four countries showed substantial differences in anemia estimates (9 to 31 percentage point differences) which were consistently lower in BRINDA compared to DHS (2 to 31 points for children, 1 to 16 points for women).
CONCLUSION:
We identify substantial differences in anemia estimates from surveys of similar populations. Further work is needed to identify the cause of these differences to improve the robustness of anemia estimates for comparing populations and tracking improvements over time.
KEYWORDS:
Anemia; Biomarkers reflecting inflammation and nutritional determinants of Anemia; Blood collection; Data quality; Demographic and health surveys; Hemoglobin; Micronutrient surveys; Nutrition surveys
18.
BMC Public Health. 2020 Mar 30;20(1):424. doi: 10.1186/s12889-020-08542-7.
Study protocol of a co-created primary organizational-level intervention with the aim to improve organizational and social working conditions and decrease stress within the construction industry - a controlled trial.
Abstract
BACKGROUND:
Within construction industry, physical work exposures have long been recognized as possible determinants for musculoskeletal disorders, but less attention has been given the increasing organizational and social work hazards and stress within this industry. There is to date a lack of knowledge about how to improve organizational and social working conditions and decrease stress within the construction industry.
METHODS:
This paper outlines the design of a controlled trial to evaluate the effectiveness of a co-created organizational-level intervention with the aim to improve role clarity, quantitative demands, staffing, planning, team effectiveness, psychosocial safety climate and stress. Two regions (> 700 employees) within one large construction company in Sweden will participate as intervention and control group. Further we present the design of the process evaluation assessing fidelity, support from managers, readiness for change and contextual factors. We will utilize questionnaires, semi-structured interviews, observations and documentation as means for data collection, hence a mixed methods approach is applied.
DISCUSSION:
The study is expected to contribute to the understanding of how adverse organizational and social working conditions and stress can be improved within the construction industry. By applying co-creation we wish to develop an intervention and implementation strategies that fit to the context, are in line with the needs of end-users and are supported by all management levels - all of which are highlighted features in successful workplace interventions.
TRIAL REGISTRATION:
ISRCTN, ISRCTN16548039. Registered 12/02/20. Retrospectively registered.
KEYWORDS:
Co-creation; Construction industry; Effectiveness evaluation; Occupational health; Organizational level intervention; Process evaluation
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