BMC Public Health

Within South Africa, many low-income communities lack reliable waste management services. Within these contexts, absorbent hygiene product (AHP) waste, including nappies (diapers), are not recycled, and are often dumped, ending up in watercourses and polluting the local environment. The structural barriers to collection which have been well explored, however the behavioural determinants of safe disposal for AHPs remains poorly understood. The purpose of this study is to determine the psycho-social factors driving AHP disposal behaviour for caregivers, while identifying potential underlying mechanisms (such as mental health), which may be influencing disposal behaviour, with the intention of informing a future, contextually appropriate and sustainable, collection system. The cross-sectional study was conducted within three low-income communities located within eThekwini Municipality (Durban), South Africa. The study included a pre-study and a quantitative survey of 452 caregivers, utilising the RANAS approach of behaviour change. The quantitative questionnaire was based on the RANAS model to measure psycho-social factors underlying sanitary disposal of AHPs. Mental health was assessed using the Self-Reporting Questionnaire (SRQ-20). Statistical analysis involved regressing psycho-social factors onto disposal behaviour and exploring their interaction with mental health through a moderation model. Our findings suggest that one third of caregivers do not dispose of nappies sanitarily, despite intent (86.9%). Regression analysis revealed ten psycho-social factors which significantly predict the desired behavioural outcome, the sanitary disposal of AHPs. Caregivers with poor mental health were less likely to dispose of AHP sanitarily, which reflects previous research linking poor mental health and the impairment of health-related daily activities, particularly within vulnerable groups. Specifically, several psycho-social factors underlying were moderated by poor mental health, the prevalence of sanitary disposal of AHPs depended on mental condition of caregiver. Our findings confirmed the link between poor mental health and unsanitary AHPs disposal. This is especially relevant because poor mental health is common within South Africa. Addressing mental health problems within these communities is an essential step to providing sustainable waste management services. The findings informed an intervention strategy to implement a future collection system for these communities, and similar low-income or informal contexts within South Africa.

Abstract Background Pooled estimates of air pollution health effects are important drivers of environmental risk communications and political willingness. In China, there is a lack of review studies to provide such estimates for health impact assessments. Methods We systematically searched the MEDLINE database using keywords of 80 major Chinese cities in Mainland China, Hong Kong and Taiwan on 30 June 2012, yielding 350 abstracts with 48 non-duplicated reports either in English or Chinese after screening. We pooled the relative risks (RR) per 10 μg/m3 of particulate matter (PM10), nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3). Results For short-term effects, the pooled RR (p < 0.05) ranges were: 1.0031 (PM10) to 1.0140 (NO2) for all-cause mortality, 1.0034 (cardiopulmonary, PM10) to 1.0235 (influenza and pneumonia, SO2) for 9 specific-causes mortality, 1.0021 (cardiovascular, PM10) to 1.0162 (asthma, O3) for 5 specific-causes hospital admissions. For birth outcomes, the RR (p < 0.05) ranged from 1.0051 (stillbirth, O3) to 1.1189 (preterm-birth, SO2) and for long-term effect on mortality from 1.0150 (respiratory, SO2) to 1.0297 (respiratory, NO2). Publication bias was absent (Egger test: p = 0.326 to 0.624). Annual PM10 and NO2 concentrations were inversely associated with RR of mortality (p = 0.017-0.028). Conclusions Evidence on short-term effects of air pollution is consistent and sufficient for health impact assessment but that on long-term effects is still insufficient.

Self-medication is a public health concern that may create several problems such as increase in drug resistance, raise in drug use per capita, and creating side effects. This study was conducted to determine predictors of self-medication based on the theory of planned behavior (TPB) among the Iranian women. This was a cross sectional study. A sample of married women completed a validated, anonymous, self-administered questionnaire. The questionnaire included items on demographic variables, knowledge, and TPB structures, and the checklist of women’s self-medication practices. The study was conducted in six urban health centers of Shush and Zarandieh in Iran during January to July 2016. Data were analyzed using SPSS 23.0 applying t-test and logistic regression. A total of 360 women took part in the study. The results showed that 76% of women had a history of self-medication and 98.9% stored drugs at home. The most important reasons for self-medication were perceived self-medication harmless (41%), having history of a disease (35.5%), and availability of medications at home (34%). The most frequent diseases for self-medication were fatigue, weakness, and anxiety (24%), and fever (20%). The results obtained form logistic regression analysis indicated that age, place of residence, education level, health insurance status, as well as all constructs of the TPB were significant predictors for self-medication. The findings indicated that the prevalence of self-medication among Iranian women was high. Since women have important role in shaping the family health, the issue of high prevalence among this population should be considered as a serious problem in Iran. In this regard, it is recommended to consider factors affecting self-medication among women to reduce this health threatening factors.

To study the mortality pattern of Norwegian doctors, people in human service occupations, other graduates and the general population during the period 1960-2000 by decade, gender and age. The total number of deaths in the study population was 1 583 559. Census data from 1960, 1970, 1980 and 1990 relating to education were linked to data on 14 main causes of death from Statistics Norway, followed up for two five-year periods after census, and analyzed as stratified incidence-rate data. Mortality rate ratios were computed as combined Mantel-Haenzel estimates for each sex, adjusting for both age and period when appropriate. The doctors had a lower mortality rate than the general population for all causes of death except suicide. The mortality rate ratios for other graduates and human service occupations were 0.7-0.8 compared with the general population. However, doctors have a higher mortality than other graduates. The lowest estimates of mortality for doctors were for endocrine, nutritional and metabolic diseases, diseases in the urogenital tract or genitalia, digestive diseases and sudden death, for which the numbers were nearly half of those for the general population. The differences in mortality between doctors and the general population increased during the periods. Between 1960 and 2000 mortality for doctors converged towards the mortality for other university graduates and for people in human service occupations. However, there was a parallel increase in the gap between these groups and the rest of the population. The slightly higher mortality for doctors compared with mortality for other university graduates may be explained by the higher suicide rate for doctors.

In Germany, over-the-counter (OTC) drugs are normally reimbursed up to the age of 12 years only. The aim of this study was to analyse prices of over-the-counter drugs used by adolescents in Germany and their association with socioeconomic factors. Based on the German GINIplus and LISAplus birth cohorts, data on drug utilization among 15-year-old adolescents (n = 4677) were collected using a self-administered questionnaire. The reported drugs were subdivided into prescription drugs and OTC drugs. The drugs’ prices were tracked by the pharmaceutical identification numbers. Overall, 1499 OTC drugs with clearly identifiable prices were eligible for analysis. Their mean price was €9.75 (95% confidence interval: €9.27–10.22). About 75% of the OTC drugs cost less than €10. Higher mean prices were associated with residing in Munich (€10.74; 95% confidence interval: €9.97–11.52) and with higher paternal education (e.g. highest education level: €10.17; 95% confidence interval: €9.47–10.86). Adolescents residing in Munich (in comparison with the less wealthy region of Wesel) and adolescents with higher educated fathers were also significantly more likely to use OTC drugs costing ≥ €10 or ≥ €25, respectively. The price of €10 for non-reimbursable OTC drugs may represent a (psychological) threshold. Higher prices could discourage especially adolescents from a lower socioeconomic background from taking medically advisable but non-reimbursable OTC drugs.

Several studies have reported an association between improvements in hand hygiene and the reductions in rates of intestinal parasitic diseases. However, only a some have addressed its link to the frequency of influenza-like illness. The current study aimed to find the correlation between personal hygiene habits and the frequency of influenza-like illness. A cross-sectional study targeting 3000 participants conducted in Riyadh city, Saudi Arabia. A systematic random sampling methodology was applied for participant from different part of Riyadh city using a computer generating system. The researcher first started by calling each participant. A full explanation was given to each participant in details (from the purpose of the research, consent to answer the questionnaire, to the explanation of the outcome definition). Each point of the questionnaire was explained to them to make sure they had excellent comprehension, and therefore, respond accurately. Descriptive statistics and Odds Ratio and its 95% confidence intervals were used to determine the association between frequency of influenza-like illness and the studied variables. Two thousand eighty-two (69.4%) completed the questionnaire. The participants who spent 5–10 s in handwashing with soap and rubbing were at increased risk of more frequent influenza-like illness (odds ratio = 1.37, 1.08–1.75). Handwashing with soap and rubbing after handshaking is an independent protective habit against frequent influenza-like illness (adjusted OR = 0.59, 0.37–0.94). The decrease of the frequency of influenza-like illness could be done through the following: getting the influenza vaccine annually, washing hands with soap and hand rubbing not less than 15 s after getting out of the bathroom, before and after handshaking and before eating. Soap companies should invent soaps that take less rubbing time to kill bacteria, and subsequently may maximize compliance in the community.

It is true that Chronic obstructive pulmonary disease (COPD) will increase social burden, especially in developing countries. Urban-rural differences in the lagged effects of PM2.5 and PM10 on COPD mortality remain unclear, in Chongqing, China. In this study, a distributed lag non-linear model (DLNMs) was established to describe the urban-rural differences in the lagged effects of PM2.5, PM10 and COPD mortality in Chongqing, using 312,917 deaths between 2015 and 2020. According to the DLNMs results, COPD mortality in Chongqing increases with increasing PM2.5 and PM10 concentrations, and the relative risk (RR) of the overall 7-day cumulative effect is higher in rural areas than in urban areas. High values of RR in urban areas occurred at the beginning of exposure (Lag 0 ~ Lag 1). High values of RR in rural areas occur mainly during Lag 1 to Lag 2 and Lag 6 to Lag 7. Exposure to PM2.5 and PM10 is associated with an increased risk of COPD mortality in Chongqing, China. COPD mortality in urban areas has a high risk of increase in the initial phase of PM2.5 and PM10 exposure. There is a stronger lagging effect at high concentrations of PM2.5 and PM10 exposure in rural areas, which may further exacerbate inequalities in levels of health and urbanization.

In the backdroup of a rapidly increasing burden of diabetes in Nepal, a community-based diabetes management program is implemented involving female community health volunteers (FCHVs) under the government run FCHVs program. FCHVs received an intensive one-week training workshop on prevention, control and management of diabetes. The training program was implemented and evaluated to enhance diabetes knowledge of FCHVs and matched according to their literacy level. A range of teaching methods were applied, including desk review, active participation, lectures, presentations, discussions, role plays, demonstration and field test. Evaluation of the knowledge attained was done by testing before and after the workshop. Major milestones in the development of the training module were presented from desk review and ending in stakeholder’s participation in reviewing and revising the training package. The qualitative interview transcripts of FCHVs were analyzed thematically. A 5-day training package was developed through a desk review of interventions using community health workers (CHWs) on diabetes management from similar settings. Training module included home-based blood glucose monitoring and home-based health education on life style counselling delivered through a participatory learning approach. There were 20 participants with a mean age of 47 years (SD ± 5.7). The overall assessment of knowledge of diabetes before-after the training, evaluated by the Diabetes Knowledge Questionnaire (DKQ) showed increases in mean score from 40.4% before training to a mean score of 63.3% after training (Paired t-test: t = − 11.1, P < 0.001, and Wilcoxon test for paired samples: z = − 3.930, P = 0.0001). Focus group discussions (FGDs) revealed that FCHVs had a favorable perception of the training program’s effectiveness. If FCHVs are appropriately trained they may be instrumental in providing counseling and screening for diabetes management in their communities.