Table of Contents
Editorial in Academic Publishing
Case Reports: The core of practice-based evidence
1 MD, MD, Department of Emergency, ASST Monza, PO Desio, Monza, Italy
Keywords: Academic publishing; case reports; case histories; evidence-based medicine; practice-based medicine.
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Viewpoint in Sociology and Public Health
The neoliberal roots of modern vaccine hesitancy
Authors: Chris Sanders1, Kristin Burnett2
1 PhD, Assistant Professor, Department of Sociology, Lakehead University, Ontario, Canada
2 PhD, Associate Professor, Indigenous Studies, Lakehead University, Ontario, Canada
Popular resistance to vaccines is not a new phenomenon and has been widely documented by medical historians. The latest iteration of this resistance, however, is popularly referred to as ‘vaccine hesitancy’ and reflects a host of beliefs and social and institutional influences. While it may be tempting to dismiss the views of those who resist vaccines, immunization policies and practice cannot be devised in isolation from the contemporary political and social landscape. Understanding the socio-political meanings that lay people assign to vaccines and the manner in which they communicate these concerns via media is essential for public health practitioners to consider when formulating immunization policy and education praxis. One such meaning that, to date, has received relatively less attention is the socio-political ideology of neoliberalism. We argue that the undercurrent of neoliberal sensibilities expressed in media stories points to another key social factor that must be considered when seeking public health solutions to the growing vaccine hesitancy movement.
Keywords: Antivaccination movement; neoliberalism; health care; history of medicine; vaccine hesitancy.
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Systematic Review in Occupational Health
Correlates of physical activity behavior among nursing professionals: A systematic search and literature review
Authors: Amanda H Wilkerson1, Hunter O Thomas2, Vinayak K Nahar3
1 PhD, Department of Health and Exercise Science, College of Arts and Sciences, University of Oklahoma, Norman, OK, USA.
2 BS, Department of Health and Exercise Science, College of Arts and Sciences, University of Oklahoma, Norman, OK, USA.
3 MD, PhD, MS, FRSPH, Center for Animal and Human Health in Appalachia, College of Veterinary Medicine, DeBusk College of Osteopathic Medicine, and School of Mathematics and Sciences, Lincoln Memorial University, Harrogate, TN, USA. Department of Dermatology, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Introduction: Physical activity (PA) has been shown to protect against adverse health outcomes, and factors influencing physical activity vary among different populations. Previous research suggests nurses have an increased risk of being physically inactive, which may contribute to increased risk of musculoskeletal disorders. The purpose of this investigation was to use a systematic search process to determine previously identified correlates of nurses’ physical activity.
Methods: The study utilized a systematic search process to identify studies for the review. The search was performed using three electronic databases: MEDLINE, CINAHL Complete, and Web of Science. The authors extracted and synthesized information regarding physical activity levels, significant correlates of physical activity, and measures of physical activity using a narrative approach.
Results: Twelve articles were included in this review. All had predominately female samples and reported statistically significant findings. The majority determined nurses’ physical activity using self-report methods (n = 11) and explored the relationship between nurses’ physical activity and individual-level variables (n = 7). Few studies explored the difference between leisure-time and work-related physical activity, and many did not assess muscle-strengthening physical activity. Discussion and Conclusions: Demographic and non-modifiable work-related factors were the most frequently assessed correlates of behaviour. The reviewed studies showed that demographic variables, such as age and BMI, were significantly associated with nursing professional’s PA. There is a need for more studies to assess factors influencing nursing professionals’ PA beyond the individual level, using theoretical designs, and including objective measures of PA. Future studies should also include assessments of nursing professionals’ muscle-strengthening PA and involve adequate representation of the United States nursing population. Practitioners and researchers working to improve nurses’ physical activity behaviour should target efforts to those more likely to engage in less physical activity, such as those with greater BMI, older age, and working night shifts, in order to tailor intervention efforts to high-risk groups.
Keywords: Health behavior; health promotion; nursing; occupational health; physical activity; primary health care; review; risk factors.
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Systematic Review in Public Health
Key health impacts and support systems for informal carers in the UK: A thematic review
Authors: Susanna A Cottagiri1, Peter Sykes2
1 MSc Applied Public Health., Junior research fellow at Indian Institute of Public Health, Public Health Foundation of India, Gandhinagar, Gujarat, India.
2 PhD, Associate Dean (Enterprise and Innovation) & Principal Lecturer at Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Wales, UK.
Introduction: The economic contributions made by informal carers in the UK per year mount up to £132 billion. This is equivalent to the total amount of the health care costs, yet the health and wellbeing of carers are often not prioritised. This review paper aims to determine the key health impacts of informal caregiving and evaluate support/control methods in the UK.
Methods: This thematic review was conducted in accordance with an adapted version of the PRISMA guidelines for systematic reviews. Of the 6,482 articles identified through Pubmed/Medline, CINAHL, SpringerLink, Summon, and grey literature, 38 studies were included in the review.
Results: The key health impacts of being an informal carer were identified as musculoskeletal disorders and psychological issues (such as depression, stress and anxiety), which were categorized as ‘high-risk impact’ areas. The review further identified cardiovascular disease and early mortality as ‘low to moderate risk impact’ areas and a thematic area that revolves around positive impacts on health of informal carers. Financial help, proper respite care, availability and accessibility of information and advice, provision of equipment in a timely manner and adequate support networks were found to be key factors useful in minimising musculoskeletal and psychological disorders.
Discussion and Conclusions: There is a need for policy makers and program implementers to recognize and accommodate the ever-changing role of carers on different stages of caring. There is also a need to review key health policy documents to include informal carers’ needs and improve support systems available. The lack of evidence-based research on the psycho-physical impacts of caring and the lack of evaluation of services that impact the health of carers also needs to be addressed with priority.
Keywords: Caregivers; control methods; informal carers, UK, health policy; systematic review; support systems; public health.
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Narrative Review in Epigenetics
Role of epigenetics in aetiology and therapies for Type 1 Diabetes Mellitus: A narrative review
Authors: Yahaya O Tajudeen1, Ufuoma B Shemishere2
1 PhD, Department of Biology, Federal University Birnin Kebbi, Nigeria.
2 MSc, Department of Biochemistry and Molecular Biology, Federal University Birnin Kebbi, Nigeria.
Introduction: Abundant literature has established the negative impact of traditional media on body image and disordered eating behaviors among young women. In the past few years, social media use has soared especially among youth, yet the influence of social media in relation to disordered eating has not been fully explored. The aim of this study was to assess the relationship between social media use and disordered eating outcomes among young Arab women.
Methods: A cross-sectional study was carried out using a probability sample of 1,418 undergraduate female students living in Qatar, a rapidly developing nation in the Middle East. Popular social media platforms were assessed including Instagram, Snapchat, Facebook, and Twitter. Other covariates assessed included body image, body mass index, and socioeconomic status. To assess the multivariate association between social media (main predictor or exposure variable), and disordered eating as measured by three levels of the 26-item Eating Attitudes Test (EAT-26) (dependent variable), stepwise backward ordinal regression models were fit to the data. Data analysis was performed using Stata 14 software.
Results: Findings confirmed that intensive use of social media, particularly Instagram, was positively associated with increased disordered eating behaviors among young women. Social media use intensity showed a significant association with increased disordered eating [(OR 1.207, SE (0.075), P < 0.01, 95% Confidential Interval [CI] 1.068 to 1.363)]. Among the four social media platforms measured, Instagram use had a significant association with disordered eating [OR 1.387, SE (0.186), P < 0.05, 95% CI 1.107 to 1.804)].
Discussion and Conclusions: This study highlights the significant role of social media on the behavior of young women, and supports the sociocultural theory linking media to disordered eating. Such an understanding of social media’s role is instrumental for the promotion and prevention of disordered eating among young women.
Keywords: β-cells; Diabetes Mellitus, Type 1; DNA methylation; epigenomics; genetic therapy; hyperglycemia; microRNAs.
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Original Article in Social Inequalities and Public Health
Health inequalities, welfare state regimes and economic crisis: A comparative analysis in Sweden, Greece and Poland
Author: Stefania Kalogeraki1
1 Assisstant Professor, Department of Sociology, University of Crete, Gallos Campus, Rethymnon, Crete, Greece
Introduction: The aim of this paper is to explore individual-level determinants of health inequalities across three European countries (Sweden, Greece and Poland) with different welfare systems and differently affected by the recent economic crisis.
Methods: The data derived from an original cross-national survey conducted in the context of the EU-funded LIVEWHAT project. The Chi-Square Test of Independence was used to examine potential differences in specific demographic traits, in socio-economic status and living conditions as well as in bridging and bonding social capital between individuals reporting poor health across Sweden, Greece and Poland. Binary logistic regression models were used to predict poor self-rated health based on the aforementioned predictors in the three countries under study.
Results: Poor self-rated health was more prevalent in Poland (42.8%), the lowest prevalence rate was in Sweden (30.4%) followed by Greece (31.9%). The Chi-Square Test of Independence indicated significant differences between respondents reporting having poor health across the three countries with respect to their demographic characteristics, socio-economic status, socio-economic living conditions, and bridging social capital. The binary logistic regression analysis showed that specific indicators of lower socio-economic status and of adverse living conditions were more strongly associated with poor self-rated health in Greece and Poland, whereas individual traits associated with socio-economic living conditions were less important in predicting poor self-rated health in Sweden when taking into account individuals’ bridging and bonding social capital. Overall the lack of different forms of social capital was more strongly related to poor self-rated health in Sweden than in the other two countries.
Discussion and Conclusion: Material explanations might be relatively more important in elucidating health outcomes in contexts with less generous welfare states, which were more severely affected by the recent economic crisis such as Greece and Poland, whereas social capital might be more decisive for health outcomes in a wealthy country with a universal welfare state such as Sweden.
Keywords: Self-rated health; inequality; welfare states; social capital; economic crisis; Europe.
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Original Article in Public Health
Towards the Universal Health Coverage in Ghana: An exploratory, cross-sectional study on the National Health Insurance Scheme
Authors: Richard Boateng1, Alfred E Yawson2
1 PhD, Ghana Institute of Journalism, Accra, Ghana
2 MD, Associate Professor, School of Public Health, University of Ghana, Accra, Ghana
Introduction: This study is aimed to analyze the progress towards the attainment of Universal Health Coverage (UHC) in Ghana after the establishment of the ‘National Health Insurance Scheme’ (NHIS), which is a universal health care system created in 2003 to guarantee the right of care for all.
Method: A cross-sectional survey was conducted in 2017 on 300 adult participants, who were recruited by a convenience random sampling from subscribers of the formal and informal sectors, living in Accra, Ghana. A questionnaire ad hoc was administered to study subscribers’ perceived quality of healthcare services delivered by NHIS and their perception about UHC and two discrete indicators of healthcare system performance such as Universal Healthcare Access (UHA) and Financial Risk Protection (FRP). Data analysis was conducted through SPSS 21 and AMOS 21, employing basic analysis such as reliability, principal component and model fit analysis. Additionally, the structural model analysis was conducted to examine the relationship between antecedent and outcomes variables.
Results: In our study, positive perception of NHIS services enjoyed during the last year was predictive of FRP (CR = 5.324, P < 0.001), UHA (CR = 3.736, P < 0.001) and UHC (CR = 4.159, P < 0.001) of NHIS. In addition, UHA and FRP were found to be good predictors in the relationship between perceived quality of healthcare services delivered by NHIS and UHC (CR = 5.823, P < 0.001 and CR = 2.097, P < 0.05, respectively).
Discussion and Conclusion: Findings of our study showed that perceived quality of healthcare services delivered by NHIS may play a certain role on the attainment of UHC both directly and by mediating effects of UHA and FRP. Therefore, good healthcare services provided by NHIS can promote universal healthcare access and financial risk protection as major catalysts towards the attainment of UHC in Ghana.
Keywords: Financial risk protection; health insurance; healthcare cost; moral hazard; universal care access; universal health coverage.
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Original Article in Public Health and Diabetology
Knowledge, attitude and predictors of diabetic retinopathy screening among patients with type 2 diabetes in Nairobi County, Kenya
Authors: Lagatt C Faith1, Harun Kimani2
1 PhD Student, Department of Community Health, Kenyatta University, Nairobi, Kenya
2 MD, Department of Community Health, Kenyatta University, Nairobi, Kenya
Introduction: Aim of this study was to explore the level of knowledge and attitude towards diabetic retinopathy screening as well as predictors of its utilization amongst People Living With Diabetes (PLWD) in Nairobi County, Kenya.
Methods: A mixed-method cross-sectional study design was employed. Multistage sampling technique was adopted for selecting persons with diabetes attending ‘level three’ health facilities. A questionnaire ad hoc was developed and used. Ordinal logistic regression models with stepwise method were employed on variables with statistical significance at chi square tests (P < 0.05) to determine the significant predictors of diabetic retinopathy screening.
Results: A total of 200 patients (rate of respondents: 96%) participated in the study. Our findings revealed a low utilization level (n = 21, 10.5%) of diabetic retinopathy screening by participants. Significant predictors of utilization of diabetic retinopathy screening were education level [(OR = 4.411; 95% Confidential Interval (CI) 1.504 to 28.636; P = 0.018)], presence of family history of diabetes (OR = 11.112; CI 1.554 to 59.444; P = 0.016), and primary clinician referral (OR = 3.263, CI 1.498 to 21.357; P = 0.027).
Discussion and Conclusion: There is poor knowledge by PLWD in Kenya on the recommended frequency of diabetic retinopathy screening. Moreover, PLWD showed poor attitude towards DR screening utilization, which could be attributed to insufficient knowledge on the importance of regular retinal examination. Educational messages developed by government and policymakers should focus on the recommended interval for eye examinations, importance of regular diabetic retinopathy screening and empowering PLWD to request/demand for eye examination. Target population should include PLWD, their families, health care providers and the general public.
Keywords: Attitude; diabetes complications; diabetes mellitus; diabetic retinopathy; Kenya; knowledge.
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Original Article in Public Health Policy
Health effects of the National Health Insurance Scheme (NHIS): A study among federal civil servants in Bayelsa State, Nigeria
Authors: Endurance Uzobo1, Aboluwaji D Ayinmoro2
1 MSc, Department of Sociology, Niger Delta University, Bayelsa State, Nigeria
2 MSc, Department of Sociology, University of Ibadan, Oyo State, Nigeria
Introduction: This study aimed to analyze the level of satisfaction and health effects of the National Health Insurance Scheme (NHIS) among federal civil servants employed in Bayelsa State, Southern Nigeria.
Methods: A cross-sectional survey was adopted using simple random sampling to recruit 337 federal employees living in the state. A structured questionnaire was used as data collection instrument to elicit socio-demographic information and types of services enjoyed under the scheme by the participants. Satisfaction levels and self-rated health were measured as continuous variables. Data was analysed using analysis of variance (ANOVA), multiple linear regression, and chi-square test. The level of statistical significance was set at P < 0.05.
Results: Satisfaction levels and self-rated health differed significantly by demographic variables and types of services enjoyed by the participants (P < 0.05). Our findings showed that malaria treatment (β = 0.737, P < 0.05), prescriptions of drugs (β = 0.187, P < 0.05) and vaccinations (β = 0.422, P < 0.05) were good predictors of satisfaction levels and self-rated health status. Malaria treatment was associated with the highest satisfaction level (β = 0.737, P < 0.05) compared to other services enjoyed under the scheme.
Discussion and Conclusion: In spite of the fact that most of the services under the scheme were associated with good self-reported health status and high satisfaction level by the participants, there are still some issues concerning supply of drugs and health facilities for federal employees living in Bayelsa State. The government and key stakeholders should ensure that NHIS provides adequate provisions of drugs, skilled health professionals and equipped healthcare facilities, as proper referral systems could mitigate the effects of health conditions affecting federal civil servants and promote the quality of health-care system.
Keywords: Bayelsa State; Federal Republic of Nigeria; health; health care system; national health policy; National Health Insurance Scheme (NHIS); quality of health care; satisfaction.
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Case Report in Emergency Medicine
A case of thyrotoxic paralysis caused by consumption of Iodocaseine
Authors: Antonio Villa1, Gabriella Nucera2
1 MD, Department of Emergency, ASST Monza, PO Desio, Monza, Italy
2 MD, Contract Professor, Faculty of Nursing, University of Milan. Department of Emergency Medicine, ASST Fatebenefratelli-Sacco, PO Fatebenefratelli, Milano, Italy
Acute hypokalaemic paralysis is a rare but treatable cause of acute limb weakness. Thyrotoxic paralysis is an uncommon, potentially life-threatening endocrine emergency and it is a rare complication of hyperthyroidism. The most common causes of hyperthyroidism include Graves’ disease, multinodular goiters or solitary thyroid nodule, and iodine-induced thyrotoxicosis (Jod-Basedow syndrome). Thyreotoxicosis factitia, which is caused by the excessive ingestion of exogenous thyroid hormone or iodine derivatives administration, has been rarely reported as a cause of thyrotoxic paralysis. We describe the case of a young Caucasian male with flaccid paralysis of all four limbs and severe hypokalaemia after inappropriate iodine derivatives (iodocasein) intake to show, in conclusion, how critical care physicians need to be aware of this rare but curable condition.
Keywords: Iodocaseine; hypokalaemia; thyrotoxic paralysis.
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