Preventive medicine
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Preventive medicine · May 2021
Classes of lifetime adversity in emerging adult women and men and their associations with weight status.
The aim of this paper was to better understand how child and adult adversities cluster together into classes, and how these classes relate to body weight and obesity. Analyses included 2015 and 2018 data from emerging adults (18-25 years old) who participated in a state surveillance system of 2- and 4-year college students in Minnesota (N = 7475 in 2015 and N = 6683 in 2018). Latent Class Analyses (LCA) of 12 child and adult adversities were run stratified by gender and replicated between 2015 and 2018. ⋯ The pattern was similar for obesity. These results indicate that specific classes of child and adult adversities are strongly associated with BMI and obesity, particularly in women. A key contribution of LCA appeared to be identification of small classes at high risk for excess weight.
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Preventive medicine · May 2021
Active school transportation and the built environment across Canadian cities: Findings from the child active transportation safety and the environment (CHASE) study.
Walking and bicycling to school (active school transportation, AST) has been in decline for decades in North America and globally with the rise of automobility. This cross-sectional study estimated associations between the built environment and AST in seven Canadian communities. We observed the travel behaviours of almost 118,000 students at 552 schools. ⋯ Overall, several modifiable road design features were associated with AST, including the presence of school crossing guards, cycling infrastructure, Walk Score® and traffic signal density. There was variability in the directionality and statistical significance of associations with design variables across cities, suggesting that the local context and directed local interventions are important to support AST. Natural experiment studies are necessary to examine local approaches related to the built environment to increase AST and ensure appropriate new policy and program interventions are developed.
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Preventive medicine · May 2021
A nationwide post-marketing survey of knowledge, attitudes and recommendations towards human papillomavirus vaccines among healthcare providers in China.
Since licensure of human papillomavirus (HPV) vaccine in mainland China, little research has been conducted about healthcare providers' (HCPs) understanding and recommendation of HPV vaccine. A multi-stage convenience sample of Chinese HCPs (N = 5270) were surveyed, involving obstetrician-gynecologists, HCPs from Division of Expanded Program on Immunization (DEPI), Community Health Center (CHC) and other non-HPV closely related professions. Binary logistic regression was conducted to explore factors associated with knowledge and recommendation behaviors. ⋯ Besides being key predictors of recommendation practice (2.74, 95% CI: 2.34-3.21), knowledge shared independent determinants with recommendation behavior on age and ethnicity and additionally associated with education and title by itself. Findings highlight overall and profession-specific gaps on HPV and HPV vaccine knowledge and recommendation practice. Future education and training efforts should be profession-niche-targeting and focus much on HCPs with lower title or education background and from minorities.
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Preventive medicine · May 2021
Gaps between recommendations and their implementation: A register-based study of follow-up after abnormalities in cervical cancer screening.
Follow-up after screen-detected abnormalities is crucial for the success of cervical cancer screening programs but is usually not closely monitored in official screening statistics. We determined how the follow-up deviated from the recommendations in the Danish organized program. Using Danish nationwide population-based registers, the follow-up pathways of 60,199 women aged 23-59 with non-negative screening samples from 2012 to 2014 were mapped until end of 2018. ⋯ These proportions varied by screening diagnosis, woman's age, type of health care provider, region, and history of abnormalities. On average, women underwent more tests of each type than recommended by the guidelines. Deviations from follow-up recommendations are very frequent even in organized cervical screening programs and should be routinely monitored by screening program statistics.
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Preventive medicine · May 2021
Community health workers and non-clinical patient navigators: A critical COVID-19 pandemic workforce.
The COVID-19 pandemic has resulted in substantial morbidity and mortality and challenged public health agencies and healthcare systems worldwide. In the U. S., physical distancing orders and other restrictions have had severe economic and societal consequences. ⋯ Members of this workforce are more than prepared to conduct contact tracing. State, local, tribal, and territorial public health agencies and healthcare systems should be collaborating with national, state, and local organizations that represent and employ CHWs/non-clinical patient navigators to determine how to better mobilize this workforce to address the COVID-19 pandemic. Furthermore, Congress, the Centers for Medicare & Medicaid Services (CMS), and individual states need to adopt policies to sustainably fund their critically needed services in the long term.