Health Promotion Services

BackgroundMemory loss is a core feature of typical Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI). Standard memory tests such as word lists assess verbal episodic memory with delayed recall and recognition. However, actual memory fidelity is likely variable, continuous, and has a subjective component.ObjectiveWe investigated dual-processing models of episodic memory (recollection versus familiarity) using confidence ratings in a "judgment of knowing" paradigm (JOK).MethodsThis paradigm was applied to the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) memory test as part of neuropsychological evaluation at University of Pittsburgh Alzheimer's Disease Research Center (ADRC), to generate novel indices of memory function to improve sensitivity to early memory problems and provide a memory awareness metric. On recognition testing, participants rated how sure they were of their yes/no responses to each item. We derived novel variables related to memory and metacognition, including an Accuracy-Certainty Index and the Relative Certainty Index.ResultsIn this sample of 347 participants (185 with AD, 55 with MCI, 111 cognitively unimpaired), CERAD Delayed Recall was the best single variable for discriminating groups, although multiple certainty variables also discriminated groups well.ConclusionsThe addition of certainty indices to a standard verbal memory task increased discriminative power between groups, particularly between cognitively normal controls and MCI or AD.

Although self-sampling could help address anal cancer screening barriers, no studies have investigated annual engagement with this method or compared it with annual screening with a provider. Building on our baseline article, we compared annual anal screening engagement between home-based self-sampling and clinic-based clinician sampling. The Prevent Anal Cancer Self-Swab Study recruited and randomized sexual and gender minority individuals 25 years and older who have sex with men to a home or clinic arm. Home-based participants were mailed an anal human papillomavirus self-sampling kit at baseline and 12 months, whereas clinic-based participants were asked to schedule and attend 1 of 5 participating clinics at baseline and 12 months. Using Poisson regression, we conducted an intention-to-treat analysis of 240 randomized participants who were invited to screen at both timepoints. More than half (58.8%) of participants completed annual (median = 370 days) anal screening. In the home arm, 65.0% of participants engaged in annual screening compared with 52.5% of clinic-based participants ( P = 0.049). When stratified by HIV status, persons living with HIV had a higher proportion of home (71.1%) versus clinic (22.2%) annual screening ( P < 0.001). Non-Hispanic Black participants participated more in home-based annual anal screening (73.1%) than annual clinic screening (31.6%; P = 0.01). Overall, annual screening engagement was significantly higher among participants who had heard of anal cancer from an LGBTQ organization, reported "some" prior anal cancer knowledge, preferred an insertive anal sex position, and reported any prior cancer diagnosis. Annual screening engagement among those at disproportionate anal cancer risk was higher in the home arm.

ObjectiveAlthough Brazil became the first country worldwide to ban the sale of all tobacco products with any additive that could alter their flavours and tastes in 2012, its implementation was effectively halted by tobacco industry lawsuits, including a constitutional challenge filed in the Federal Supreme Court in 2013. This study aimed at examining, for the first time in the country, the evolution over time of the new registrations of tobacco products with additives that would have been banned if not for the tobacco industry’s interference (’counterfactual scenario’).MethodsWe used the newly available public database on the registration of tobacco products developed by the Health Regulatory Agency (from 2008 onwards). All types of tobacco products intended for the domestic market that contained ‘banned additives in a counterfactual scenario’ and were registered between January 1 and December 31 of each year were selected.ResultsBetween 2012 and 2023, a total of 1112 new registrations of tobacco products with ‘banned additives’ were recorded. The spread of hookah tobacco registrations started in 2014, and by 2023, the cumulative incidence of registrations containing ‘banned additives’ was 641. Both manufactured cigarettes and hookah products reached their peaks in new registrations in 2020.ConclusionsAfter 12 years since the resolution intended to ban all additives that change the aroma and taste of tobacco products in Brazil, primarily to prevent smoking initiation, the tobacco industry’s interference continues to successfully block its implementation. Countries facing similar challenges in tobacco control could consider generating comparable national data that might help expose the adverse impacts of tobacco industry interference on public health.

Objectives: This paper describes trends in youth e-cigarette (EC) and tobacco cigarette (TC) purchasing behaviors in Canada, England, and the United States (US) in relationship to changing minimum legal age (MLA) laws. Methods: Data are from eight cross-sectional online surveys among national samples of 16- to 19-year-olds in Canada, England, and the US conducted from 2017 to 2022 (N = 104,467). Average wave percentage change in EC and TC purchasing prevalence and purchase locations were estimated using Joinpoint regressions. Results: EC purchasing increased between 2017 and 2022, although the pattern of change differed by country. EC purchasing plateaued in 2019 for the US and in 2020 for Canada, while increasing through 2022 for England. TC purchasing declined sharply in the US, with purchasing from traditional retail locations declining, while purchasing from social sources increased. Vape shops were the most common location for EC purchasing, although declining in England and the US. Conclusion: Trends in EC and TC purchasing trends in the US are consistent with the expected impact of the federal MLA law increasing the legal age to 21years in December 2019.

IntroductionThe EVALUA GPS project aims to evaluate the impact of the implementation of the National Institute for Health Care and Excellence (NICE) guideline ‘Community engagement: improving health and well-being and reducing health inequalities’ adapted to the Spanish context.Methods and analysisPhase I: A tool will be designed to evaluate the impact of implementing the recommendations of the adapted NICE guideline. The tool will be developed through a review of the literature on implementation of public health guidelines between 2000 and 2021 and an expert’s panel consensus. Phase II: The developed tool will be implemented in 16 community-based programmes, acting as intervention sites, and 4 controls through a quasi-experimental pre–post study. Phase III: A final online web tool, based on all previously collected information, will be developed to support the implementation of the adapted NICE guidelines recommendations in other contexts and programmes.Data collection and analysisData will be collected through surveys and semistructured interviews. Quantitative and qualitative data will be analysed to identify implementation scenarios, changes in community engagement approaches, and barriers and facilitators to the implementation of the recommendations. All this information will be further synthesised to develop the online tool.Ethics and disseminationThe proposed research has been approved by the Clinical Research Ethics Committee of Aragon. Results will be presented at national and international conferences and published in peer-reviewed open access journals. The interactive online tool (phase III) will include examples of its application from the fieldwork.

Health systems are increasingly investing in social determinants of health (SDoH), but there is limited research on how such efforts impact health care resource use. This study presents pilot work on an SDoH screening and referral platform recently implemented in South Carolina's largest private nonprofit health system. To assess the feasibility and sustainability of SDoH screening and SDoH-related referrals in a large health system and examine how they affect health resource use. Observational study using electronic medical records and SDoH screening data from June 1, 2019 to December 31, 2020. Patients (18 y+) engaged in community health, inpatient case management, or ambulatory care and condition management programs. We describe the use of SDoH screening by providers (community health workers, nurse case managers, and social workers) and SDoH referral volumes among patients. We use multivariate analyses to predict changes in emergency department visits, inpatient admission s (length of stay and volume), and primary care visits from referral volume, SDoH screening question responses, and patient characteristics (eg, comorbidities). Of 2687 patients, 662 (24.6%) screened positive for 1 or more SDoH domains. SDoH screening performance remained consistent among providers over time. Six hundred fifty-eight (24.5%) patients received SDoH referrals. Patients receiving an increasing volume of referrals had decreasing primary care visits but their comorbidities moderated this effect. The study provides initial descriptive information on SDoH needs, implementation of referrals and resource use, guiding SDoH screening implementation in population health, and care management programs.

Abstract Purpose: Against the backdrop of the ever-increasing aging population in Sri Lanka and the scarcity of local evidence on quality of life (QoL) among rural elderly, this study was conducted to assess the QoL of the community-dwelling older adults in rural Sri Lanka.Methods: This cross-sectional study was conducted among community-dwelling older adults (60-74 years) in a selected rural setting in Sri Lanka. Statistically significant associations of QoL were determined by using the K-means cluster analysis followed by multivariable analysis.Results: The final sample consisted of 3573 community-dwelling older adults (response rate 97.8%). The mean (SD) age of the sample was 66.7 (4.3) years and the majority were females (n=2130, 59.6%). Amongst the six QoL domains assessed (physical, psychological, social, functional, environmental and spiritual domains), the highest and the lowest mean (SD) scores were reported for the functional [63.4(16.9)] and the physical [52.9(15.0)] domains respectively. Aged 70 years or more, either unmarried/widowed/divorced, lower educational levels and having chronic illnesses were statistically significant associations of QoL (p&lt;0.05).Conclusion: The QoL among community-dwelling older adults in rural Sri Lanka is moderate. As having social support, absence of chronic diseases and good education level were found to be associated with better QoL, strengthening community-based interventions to improve these aspects is recommended.

Given the history of racism and systemic oppression of Indigenous communities, examining and addressing health inequities in in Indigenous continues to be relevant and important. An increasing number of healthcare problems are emerging from Indigenous communities.1,2 Canadian First Nations women and men have lower life expectancies and increasing rates of chronic conditions, such as diabetes, cardiovascular diseases, heart disease, and obesity.1 Some evidence suggests that the burden of cancer is lower among Indigenous communities than the overall population.3 However, there is much data indicating that this rate in increasing and that members of Indigenous communities have increased mortality rates when compared to non-Indigenous groups for cancers of the cervix, breast, gallbladder, lip and oropharynx, liver, lung, prostate and stomach.4,5 This paper discusses cancer incidence, risk factors, screening, and detection of cancers among Indigenous communities. This is followed by a discussion of potential interventions that may reduce the burden-related morbidity and mortality of cancer on these communities. Indigenous communities continue to experience unique barriers to accessing appropriate cancer care and preventive services and steps to minimize health inequalities should be taken.

Mosquito-borne diseases are a concern of global public health and safety. Risk of mosquitoborne illness varies greatly with occupation, age, ethnicity, gender, income status, travel frequency, and climate change. Those at most risk of being infected by a mosquito-borne disease include frequent travelers, healthcare personnel, laboratory workers, and those whose occupation is mostly conducted outside or in wooded areas. Many people become sick after being bitten by an infected mosquito. Some people have mild short-term illness and in cases some people experience long-term illnesses. Severe cases of mosquito-borne diseases have resulted in death. Recommendations include investing in climate change, increasing the availability of vaccines globally, the use of health and mosquito surveillance systems, and forming regional and international action plans for disease control in the case of an endemic, epidemic, or a pandemic.