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Original Articles
Environmental Health Literacy Regarding Fine Particulate Matter and Related Factors Among Village Health Volunteers in Upper Northern Thailand
Nattapon Pansakun, Warangkana Naksen, Waraporn Boonchieng, Parichat Ong-artborirak, Tippawan Prapamontol
Received September 29, 2023  Accepted December 28, 2023  Published online February 10, 2024  
DOI: https://doi.org/10.3961/jpmph.23.434    [Accepted]
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AbstractAbstract PDF
Objectives
Fine particulate matter pollution has emerged as a significant life-threatening issue in Thailand. Recognizing the importance of environmental health literacy (EHL) in disease prevention is crucial for protecting public health. This study investigated EHL levels and aimed to identify associated factors among village health volunteers (VHVs) in the upper northern region of Thailand. Methods: A cross-sectional study was conducted to collect data from 710 VHVs using the EHL assessment tool developed by the Department of Health, Thailand. Results: The overall EHL score was moderate (mean, 3.28 out of a possible 5.0), with the highest and lowest domain-specific mean score for the ability to make decisions (3.52) and the ability to access (3.03). Multiple linear regression revealed that the factors associated with EHL score were area of residence (urban areas in Chiang Mai, B=0.254; urban areas in Lampang, B=0.274; and rural areas in Lampang, B=0.250 compared to rural areas in Chiang Mai), higher education levels (senior high school, B=0.212; diploma/high vocational certificate, B=0.350; bachelor\'s degree or above, B=0.528 compared to elementary school or lower), having annual health check-ups compared to not having annual health check-ups (B=0.142), monthly family income (B=0.004), and individuals frequently facing air pollution issues around their residence (B=0.199) compared to those who reported no such issues. Conclusions: The VHVs exhibited moderate EHL associated with residence area, education, health check-ups, family income, and residential air pollution. Considering these factors is vital for enhancing VHVs\' EHL through strategic interventions.
Summary
Excess Deaths during the COVID-19 Pandemic in Southern Iran: Estimating the Absolute Count and Relative Risk Using Ecological DataAbstract
Mohammadreza Zakeri, Alireza Mirahmadizadeh, Habibollah Azarbakhsh, Seyed Sina Dehghani, Maryam Janfaday, Mohammad Javad Moradian, leila moftakhar, Mehdi Sharafi, Alireza Heiran
Received April 23, 2023  Accepted January 5, 2024  Published online February 7, 2024  
DOI: https://doi.org/10.3961/jpmph.23.198    [Accepted]
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AbstractAbstract PDF
Objectives
The coronavirus disease 2019 (COVID-19) pandemic led to increased mortality rates. To assess this impact, this ecological study aimed to estimate the excess death counts in southern Iran.
Methods
The study obtained weekly death counts by linking the National Death Registry and Medical Care Monitoring Center repositories. The P-score was initially estimated using a simple method that involved calculating the difference between the observed and expected death counts. The interrupted time series analysis was then used to calculate the mean relative risk (RR) of death during the first year of the pandemic.
Results
Our study found that there were 5,571 excess deaths from all causes (P-score=33.29%) during the first year of the COVID-19 pandemic, with 48.03% of these deaths directly related to COVID-19. The pandemic was found to increase the risk of death from all causes (RR=1.26; 95% confidence interval [CI], 1.19-1.33), as well as in specific age groups such as those aged 35-49 (RR=1.21; 95% CI, 1.12-1.32), 50-64 (RR=1.38; 95% CI, 1.28-1.49), and ≥ 65 (RR=1.29; 95% CI, 1.12-1.32) years old. Furthermore, there was an increased risk of death from cardiovascular diseases (RR=1.17; 95% CI, 1.11, 1.22).
Conclusions
There was a 26% increase in the death count in southern Iran during the COVID-19 pandemic. More than half of these excess deaths were not directly related to COVID-19, but rather other causes, with cardiovascular diseases being a major contributor.
Summary
Empowering Rural Housewives in Iran: Utilizing the Transtheoretical Model to Increase Physical Activity
Mahboobe Borhani, Zakieh Sadat Hosseini, Najme Shahabodin, Ali Mehri, Mohadese Kiani, Marzieh Abedi
Received October 16, 2023  Accepted January 11, 2024  Published online January 31, 2024  
DOI: https://doi.org/10.3961/jpmph.23.457    [Accepted]
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AbstractAbstract PDF
Objectives
Rural housewives are integral to household management and family care, yet their sedentary lifestyles present significant health risks. This study used the transtheoretical model (TTM) to investigate strategies that encourage and maintain regular exercise habits among rural housewives.
Methods
A semi-experimental study was conducted in 2021 with 114 housewives aged 30 to 59 who attended rural health centers in Gorgan, Iran. Participants were randomly assigned to 1 of 2 groups. Data collection involved a validated questionnaire that gathered demographic information and constructs of the TTM. The intervention group participated in a comprehensive educational program, which included four 60-minute sessions. Data were collected again 6 months post-intervention and analyzed using descriptive and inferential statistics in SPSS software version 19.
Results
The study encompassed women with an average age of 39.75 ± 6.05 years, the majority of whom had educational levels below a diploma, and over 90% were married. We observed strong correlations between the processes of change, self-efficacy, and decisional balance. At the outset, there were no significant differences in demographics or model structures between the 2 groups. However, 6 months post-intervention, the intervention group exhibited statistically significant differences in the mean scores of model structures, stages of change, and body mass index (p<0.05).
Conclusions
This study highlights the importance of physical activity training for rural housewives. The findings suggest that the educational intervention, which utilized the TTM, significantly impacted the participants\' model structures and their stages of change.
Summary
Understanding the Perspectives of Paediatric Physicians on Physiotherapy in Paediatric Rehabilitation in Chennai, India: A Qualitative Approach
Vadivelan Kanniappan, Abishek J R, Pearlyn Esther Padma, Subash Sundar
Received September 25, 2023  Accepted December 29, 2023  Published online January 21, 2024  
DOI: https://doi.org/10.3961/jpmph.23.426    [Accepted]
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AbstractAbstract PDF
Objectives
Children with disabilities may exhibit a multitude of symptoms, and treatment requires a multidisciplinary approach for a satisfactory outcome. Lack of awareness among physicians, lack of referral, and lack of inter-sectoral coordination have hindered paediatric practice in Tamil Nadu, a state in India with a striking childhood disability rate that warrants a timely interdisciplinary approach. However, the perspectives of paediatricians on paediatric physiotherapy are unknown. The aim of the study was to investigate the perspectives of practicing paediatric physicians in Chennai on the role of physiotherapy in paediatrics.
Methods
For an in-depth exploration, qualitative semi-structured interviews were conducted in person with 10 paediatricians. Audio from the sessions was recorded and transcribed, and data saturation was achieved through iterative analysis.
Results
A grounded theory analysis of the results yielded 5 domains under which the perspectives and expectations of the physicians were described, along with the barriers experienced by patients’ parents as explained by their paediatrician. The responses highlighted deficits in awareness, structural support, accessibility and direct communication between physicians and physiotherapists.
Conclusions
Paediatric physicians have different opinions, and some ignorance persists concerning paediatric physiotherapy. This study warrants a proper structure of the paediatric rehabilitation unit and regular interdisciplinary meetings and focus group discussions to increase access for parents and improve patient outcomes.
Summary
Alleviation of PM2.5-associated Risk of Daily Influenza Hospitalization by COVID-19 Lockdown Measures: A Time-series study in northeastern Thailand
Benjawan Roudreo, Sitthichok Puangthongthub
Received August 4, 2023  Accepted December 13, 2023  Published online January 19, 2024  
DOI: https://doi.org/10.3961/jpmph.23.349    [Accepted]
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AbstractAbstract PDF
Objectives
Abrupt changes in air pollution levels associated with the coronavirus disease 2019 (COVID-19) outbreak present a unique opportunity to evaluate the effects of air pollution on influenza risk, at a time when emission sources were less active and personal hygiene practices were more rigorous.
Methods
This time-series study examined the relationship between influenza cases (n=22,874) and air pollutant concentrations from 2018 to 2021, comparing the timeframes before and during the COVID-19 pandemic in and around Thailand’s Khon Kaen province. Poisson generalized additive modeling was employed to estimate the relative risk of hospitalization for influenza associated with air pollutant levels.
Results
Before the COVID-19 outbreak, both the average daily number of influenza hospitalizations and the ambient fine particulate matter (PM2.5) concentration exceeded those later observed during the pandemic (p<0.001). In single-pollutant models, a 10 μg/m3 increase in PM2.5 before COVID-19 was significantly associated with increased influenza risk upon exposure to cumulative-day lags, specifically lags 0-5 and 0-6 (p<0.005). After adjustment for co-pollutants, PM2.5 demonstrated the strongest effects at lags 0 and 4, with elevated risk found across all cumulative-day lags (0-1, 0-2, 0-3, 0-4, 0-5, and 0-6) and significantly greater risk in the winter and summer at lag 0-5 (p<0.005). However, the PM2.5 level was not significantly associated with influenza risk during the COVID-19 outbreak.
Conclusions
Lockdown measures implemented during the COVID-19 pandemic could mitigate the risk of PM2.5-induced influenza. Effective regulatory actions in the context of COVID-19 may decrease PM2.5 emissions and improve hygiene practices, thereby reducing influenza hospitalizations.
Summary

JPMPH : Journal of Preventive Medicine and Public Health