Journal of Preventive Medicine and Public Health

Volume 53(4); July 2020

COVID-19: Original Articles

Association of Comorbidities With Pneumonia and Death Among COVID-19 Patients in Mexico: A Nationwide Cross-sectional Study: Akram Hernández-Vásquez, Diego Azañedo, Rodrigo Vargas-Fernández, Guido Bendezu-Quispe; J Prev Med Public Health. 2020;53(4):211-219. Published online May 28, 2020; DOI: https://doi.org/10.3961/jpmph.20.186

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Objectives
The goal of this study was to identify chronic conditions and multimorbidity patterns in patients with coronavirus disease 2019 (COVID-19) and to examine their associations with pneumonia and death.
Methods
This cross-sectional study analyzed the official data of COVID-19 patients in Mexico through May 18, 2020 (released by the Secretaría de Salud de México). Adjusted logistic regression models were applied to assess the associations of comorbidities with pneumonia and death. The marginal effects were estimated, and the probability of pneumonia or death according to the number of comorbidities was graphed for each year of age.
Results
Of the 51 053 COVID-19 patients enrolled in the final analysis, 27 667 (54.2%) had no chronic conditions, while 13 652 (26.7%), 6518 (12.8%) and 3216 (6.3%) were reported to have 1, 2, and 3 or more simultaneous conditions, respectively. Overall, a significant incremental gradient was observed for the association between multimorbidity and pneumonia (p<0.001); for 2 chronic conditions, the adjusted odds ratio (aOR) was 2.07 (95% confidence interval [CI], 1.95 to 2.20), and for ≥3 conditions, the aOR was 2.40 (95% CI, 2.22 to 2.60). A significant incremental gradient was also found for the relationship between multimorbidity and death (p<0.001); an aOR of 2.51 (95% CI, 2.30 to 2.73) was found for 2 chronic conditions and an aOR of 3.49 (95% CI, 3.15 to 3.86) for ≥3 conditions.
Conclusions
Underlying chronic conditions and multimorbidity are associated with pneumonia and death in Mexican COVID-19 patients. Future investigation is necessary to clarify the pathophysiological processes behind this association, given the high burden of chronic diseases in various countries, including Mexico.

Summary

Citations

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Social Determinants of COVID-19 in Massachusetts, United States: An Ecological Study: Devan Hawkins; J Prev Med Public Health. 2020;53(4):220-227. Published online June 24, 2020; DOI: https://doi.org/10.3961/jpmph.20.256

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Abstract PDF Supplementary Material

Objectives
The aim of this study was to assess how different social determinants of health (SDoH) may be related to variability in coronavirus disease 2019 (COVID-19) rates in cities and towns in Massachusetts (MA).
Methods
Data about the total number of cases, tests, and rates of COVID-19 as of June 10, 2020 were obtained for cities and towns in MA. The data on COVID-19 were matched with data on various SDoH variables at the city and town level from the American Community Survey. These variables included information about income, poverty, employment, renting, and insurance coverage. We compared COVID-19 rates according to these SDoH variables.
Results
There were clear gradients in the rates of COVID-19 according to SDoH variables. Communities with more poverty, lower income, lower insurance coverage, more unemployment, and a higher percentage of the workforce employed in essential services, including healthcare, had higher rates of COVID-19. Most of these differences were not accounted for by different rates of testing in these cities and towns.
Conclusions
SDoH variables may explain some of the variability in the risk of COVID-19 across cities and towns in MA. Data about SDoH should be part of the standard surveillance for COVID-19. Efforts should be made to address social factors that may be putting communities at an elevated risk.

Summary

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COVID-19: Perspectives

The Pandemic League of COVID-19: Korea Versus the United States, With Lessons for the Entire World: Alwin Issac, Shine Stephen, Jaison Jacob, Vijay VR, Rakesh Vadakkethil Radhakrishnan, Nadiya Krishnan, Manju Dhandapani; J Prev Med Public Health. 2020;53(4):228-232. Published online May 25, 2020; DOI: https://doi.org/10.3961/jpmph.20.166

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Abstract PDF

Coronavirus disease 2019 (COVID-19) is inflicting a brutal blow on humankind, and no corner of the world has been exempted from its wrath. This study analyzes the chief control measures and the distinctive features of the responses implemented by Korea and the United States to contain COVID-19 with the goal of extracting lessons that can be applied globally. Even though both nations reported their index cases on the same day, Korea succeeded in flattening the curve, with 10 752 cases as of April 28, 2020, whereas the outbreak skyrocketed in the United States, which had more than 1 million cases at the same time. The prudent and timely execution of control strategies enabled Korea to tame the spread of the virus, whereas the United States paid a major price for its delay, although it is too early to render a conclusive verdict. Information pertaining to the number of people infected with the virus and measures instituted by the government to control the spread of COVID-19 was retrieved from the United States Centers for Disease Control and Prevention and the Korea Centers for Disease Control and Prevention websites and press releases. Drawing lessons from both nations, it is evident that the resolution to the COVID-19 pandemic lies in the prudent usage of available resources, proactive strategic planning, public participation, transparency in information sharing, abiding by the regulations that are put into place, and how well the plan of action is implemented.

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Unconventional Answers to Unprecedented Challenges: The Swedish Experience During the COVID-19 Outbreak: Giuseppe Valeriani, Iris Sarajlic Vukovic, Richard Mollica; J Prev Med Public Health. 2020;53(4):233-235. Published online July 22, 2020; DOI: https://doi.org/10.3961/jpmph.20.235

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Since its early stages, the coronavirus disease 2019 (COVID-19) pandemic has posed immense challenges in meeting the public health and healthcare and social care needs of migrants. In line with other reports from United Kingdom and United States, data from Sweden’s health authority show that migrants have been disproportionately affected by COVID-19. Following the World Health Organization’s statements, as well as the European Public Health Association’s call for action, several centres in Sweden’s most populated areas have activated tools to implement national plans for community outreach through initiatives targeting migrants and ethnic minority groups. Unconventional means should be promoted to mitigate the impact of COVID-19 on migrants and the health of the public at large.

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Original Articles

Healthcare Workers’ Knowledge and Attitudes Regarding the World Health Organization’s “My 5 Moments for Hand Hygiene”: Evidence From a Vietnamese Central General Hospital: Huy Van Nguyen, Hieu Trung Tran, Long Quynh Khuong, Thanh Van Nguyen, Na Thi Nhi Ho, An Thi Minh Dao, Minh Van Hoang; J Prev Med Public Health. 2020;53(4):236-244. Published online May 7, 2020; DOI: https://doi.org/10.3961/jpmph.19.319

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Abstract PDF

Objectives
Although the World Health Organization (WHO) initiative “My 5 Moments for Hand Hygiene” has been lauded as effective in preventing hospital-associated infections, little is known about healthcare workers (HCWs)’ hand hygiene behavior. In this study, we sought to assess knowledge and attitudes towards the concepts in this initiative, as well as associated factors, among Vietnamese HCWs at a general hospital.
Methods
A structured questionnaire was administered to HCWs at a central Vietnamese general hospital in 2015. Multiple logistic regression analysis was used to identify factors associated with HCWs’ knowledge and attitudes towards hand hygiene.
Results
Of 120 respondents, 65.8% and 67.5% demonstrated appropriate knowledge and a positive attitude, respectively, regarding all 5 hand hygiene moments. Logistic regression indicated better knowledge of hand hygiene in workers who were over 30 years old, who were direct HCWs (rather than managers), who had frequent access to clinical information, and who received their clinical information from training. Those who worked in infectious and tropical disease wards, who had frequent access to clinical information, and who received information from training were more likely to have a positive attitude towards hand hygiene than their counterparts.
Conclusions
Although many Vietnamese HCWs displayed moderate knowledge and positive attitudes towards the WHO hand hygiene guidelines, a key gap remained. Regular education and training programs are needed to increase knowledge and to improve attitudes and practices towards hand hygiene. Furthermore, a combination of multimodal strategies and locally-adapted interventions is needed for sustainable hand hygiene adherence.

Summary

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Assessing the incorporation of the 'Five Moments for Hand Hygiene' into nursing procedure textbooks
Adrijana Svenšek, Dominika Muršec, Nino Fijačko
Nurse Education in Practice.2024; 79: 104044. CrossRef
Health care workers’ knowledge and perceptions on WHO hand hygiene guidelines, and the perceived barriers to compliance with hand hygiene in Cyprus
Despo Constantinou, Ioannis Leontiou, Meropi Mpouzika, Koralia Michail, Nikos Middletton, Anastasios Merkouris
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Review on hospital healthcare-associated infections in Africa: Cross-sectional analyses, hygiene perspectives, risk factors and prevention strategies ‎
Talal Mohamed Abdoul-Latif, Tarik Ainane, Fatouma Mohamed Abdoul-Latif, Nadira Abdallah, Ayoub Ainane, Zineb Benhadi, Alaeddine Lakhrissi, Naoufal Himmouche, Abderraouf Hilali, Jawad Bouzid
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Hand Hygiene Knowledge and Perception Survey for Healthcare Workers in Government Hospitals (GHs) in Bahrain
Saleh F Sowar, Rommel Acunin, Harold C Cabanalan, Tamer T Abo Arisheh, Safa Alkhawaja
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Level of Complete Knowledge on Five Moments of Hand Hygiene among Nurses Working at Integrated Nursing Care Service Wards
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Individual-level Associations Between Indicators of Social Capital and Alcohol Use Disorders Identification Test Scores in Communities With High Mortality in Korea: Jang-Rak Kim, Baekgeun Jeong, Ki-Soo Park, Yune-Sik Kang; J Prev Med Public Health. 2020;53(4):245-255. Published online May 21, 2020; DOI: https://doi.org/10.3961/jpmph.19.336

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Abstract PDF

Objectives
This study examined associations among social capital indicators (social participation and generalized trust) at the individual level and alcohol use, which was quantified using Alcohol Use Disorders Identification Test (AUDIT) scores.
Methods
In total, there were 8800 participants in community health interviews, including 220 adults sampled systematically from a resident registration database of each of 40 sub-municipal administrative units of local (city or county) governments. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using polychotomous logistic regression.
Results
The aORs for abstainers versus people with AUDIT scores of 0-7, based on 3 questions on generalized trust, in comparison to those with no positive responses, were 1.15 (95% CI, 0.99 to 1.34) for 1 positive response, 1.16 (95% CI, 0.98 to 1.37) for 2 positive responses; and 1.39 (95% CI, 1.20 to 1.61) for 3 positive responses. The aORs for abstainers versus people with AUDIT scores of 0-7, in comparison to participation in no organizations, were 0.61 (95% CI, 0.54 to 0.69) for participation only in informal organizations; 2.16 (95% CI, 1.57 to 2.99) for participation only in religious organizations; 2.41 (95% CI, 1.10 to 5.29) for participation only in volunteer organizations; and 0.65 (95% CI, 0.57 to 0.74) for participation in formal organizations. Participants in formal social organizations, regardless of their participation in informal organizations, were more likely to have AUDIT scores of 8-15 (aOR, 1.29; 95% CI, 1.04 to 1.60) or ≥16 (aOR, 1.65; 95% CI, 1.22 to 2.23) than to have scores of 0-7.
Conclusions
Our findings may have implications for health policy to reduce alcohol problems.

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Religious and secular spirituality: Methodological implications of definitions for health research
Camila Chagas, Leonardo Breno Martins, Fatima Regina Machado, Welligton Zangari, José Carlos Fernandes Galduróz
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Comparison of Computed Tomography-based Abdominal Adiposity Indexes as Predictors of Non-alcoholic Fatty Liver Disease Among Middle-aged Korean Men and Women: Jongmin Baek, Sun Jae Jung, Jee-Seon Shim, Yong Woo Jeon, Eunsun Seo, Hyeon Chang Kim; J Prev Med Public Health. 2020;53(4):256-265. Published online June 18, 2020; DOI: https://doi.org/10.3961/jpmph.20.140

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Abstract PDF Supplementary Material

Objectives
We compared the associations of 3 computed tomography (CT)-based abdominal adiposity indexes with non-alcoholic fatty liver disease (NAFLD) among middle-aged Korean men and women.
Methods
The participants were 1366 men and 2480 women community-dwellers aged 30-64 years. Three abdominal adiposity indexes—visceral fat area (VFA), subcutaneous fat area (SFA), and visceral-to-subcutaneous fat ratio (VSR)—were calculated from abdominal CT scans. NAFLD was determined by calculating the Liver Fat Score from comorbidities and blood tests. An NAFLD prediction model that included waist circumference (WC) as a measure of abdominal adiposity was designated as the base model, to which VFA, SFA, and VSR were added in turn. The area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were calculated to quantify the additional predictive value of VFA, SFA, and VSR relative to WC.
Results
VFA and VSR were positively associated with NAFLD in both genders. SFA was not significantly associated with NAFLD in men, but it was negatively associated in women. When VFA, SFA, and VSR were added to the WC-based NAFLD prediction model, the AUC improved by 0.013 (p<0.001), 0.001 (p=0.434), and 0.009 (p=0.007) in men and by 0.044 (p<0.001), 0.017 (p<0.001), and 0.046 (p<0.001) in women, respectively. The IDI and NRI were increased the most by VFA in men and VSR in women.
Conclusions
Using CT-based abdominal adiposity indexes in addition to WC may improve the detection of NAFLD. The best predictive indicators were VFA in men and VSR in women.

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Ker Ming Seaw, Christiani Jeyakumar Henry, Xinyan Bi
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Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017: Akram Hernández-Vásquez, Carlos Rojas-Roque, Rodrigo Vargas-Fernández, Diego Rosselli; J Prev Med Public Health. 2020;53(4):266-274. Published online June 10, 2020; DOI: https://doi.org/10.3961/jpmph.20.035

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Abstract PDF Supplementary Material

Objectives
Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017.
Methods
We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index.
Results
The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05).
Conclusions
Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.

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Educational Intervention Based on the Health Belief Model to Modify Risk Factors of Cardiovascular Disease in Police Officers in Iran: A Quasi-experimental Study: Mohsen Saffari, Hormoz Sanaeinasab, Hassan Jafarzadeh, Mojtaba Sepandi, Keisha-Gaye N. O'Garo, Harold G. Koenig, Amir H. Pakpour; J Prev Med Public Health. 2020;53(4):275-284. Published online June 18, 2020; DOI: https://doi.org/10.3961/jpmph.20.095

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Abstract PDF Supplementary Material

Objectives
Police officers may be at a greater risk for cardiovascular disease (CVD) than the general population due to their highstress occupation. This study evaluated how an educational program based on the health belief model (HBM) may protect police officers from developing CVD.
Methods
In this single-group experimental study, 58 police officers in Iran participated in a 5-week intervention based on HBM principles. Outcomes included changes in scores on an HBM scale, time spent on moderate to vigorous physical activity (International Physical Activity Questionnaire), body mass index (BMI), blood lipid profile, blood glucose, and blood pressure. The intervention consisted of 5 HBM-based educational sessions. Follow-up was conducted at 3 months post-intervention. The paired t-test was used to examine differences between baseline and follow-up scores.
Results
All aspects of the HBM scale improved between baseline and follow-up (p<0.05), except the cues to action subscale. Self-efficacy and preventive behaviors improved the most. BMI decreased from 26.7±2.9 kg/m² at baseline to 25.8±2.4 kg/m² at follow-up. All components of the lipid profile, including triglycerides, cholesterol, high-density lipoprotein, and low-density lipoprotein, showed significant improvements post-intervention. Blood glucose and blood pressure also decreased, but not significantly. Nearly 25% of participants who were not physically active at baseline increased their physical activity above or beyond the healthy threshold.
Conclusions
A relatively brief educational intervention based on HBM principles led to a significant improvement in CVD risk factors among police officers. Further research is needed to corroborate the effectiveness of this intervention.

Summary

Citations

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Perspectives

Dilemmas Within the Korean Health Insurance System: Donghwi Park, Min Cheol Chang; J Prev Med Public Health. 2020;53(4):285-288. Published online July 1, 2020; DOI: https://doi.org/10.3961/jpmph.20.074

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Abstract PDF

The health insurance system in Korea is well-established and provides benefits for the entire national population. In Korea, when patients are treated at a hospital, the hospital receives a partial payment for the treatment from the patient, and the remaining amount is provided by the health insurance service. The Health Insurance Review and Assessment Service (HIRA) assesses whether the treatment was appropriate. If HIRA deems the treatment appropriate, the doctor can receive payment from the health insurance service. However, this system has several drawbacks. In this study, we aimed to provide examples of the problems that can occur in relation to HIRA assessments in Korea through actual clinical cases.

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Yemen’s Cholera Epidemic Is a One Health Issue: Qin Xiang Ng, Michelle Lee Zhi Qing De Deyn, Wayren Loke, Wee Song Yeo; J Prev Med Public Health. 2020;53(4):289-292. Published online June 10, 2020; DOI: https://doi.org/10.3961/jpmph.20.154

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Abstract PDF

Yemen has been faced with the worst cholera epidemic of modern times, with more than 1 million suspected cases and 3000 deaths at the time of writing. This problem is largely due to the longstanding civil war between pro-government forces and the Houthi armed movement, which has severely damaged already vulnerable sanitation and healthcare facilities and systems in the country. It is further compounded by a dire lack of basic amenities, chronic malnutrition, and unfavourable weather conditions. Another contributory component may be aerial transfer by cholera-infected chironomid insects. To contain the spread of cholera in Yemen, a nation-wide armistice should be negotiated, and national and local committees must be convened to coordinate efforts on the ground. Community isolation facilities with proper sanitation, reliable disposal systems, and a clean water supply should be set up to isolate and treat sick patients. The continuity of vaccination programmes should be ensured. Public health campaigns to educate local communities about good hygiene practices and nutrition are also necessary. The One Health paradigm emphasizes a multi-sectoral and transdisciplinary understanding and approach to prevent and mitigate the threat of communicable diseases. This paradigm is highly applicable to the ongoing cholera crisis in Yemen, as it demands a holistic and whole-of-society approach at the local, regional, and national levels. The key stakeholders and warring parties in Yemen must work towards a lasting ceasefire during these trying times, especially given the extra burden from the mounting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak worldwide.

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