Journal of Public Health Research https://www.jphres.org/index.php/jphres <p><strong>The Journal of Public Health Research</strong> is an online Open Access, peer-reviewed scholarly journal in the field of public health science. The aim of the journal is to stimulate debate and dissemination of knowledge in the public health field in order to improve efficacy, effectiveness and efficiency of public health interventions to improve health outcomes of populations. This aim can only be achieved by adopting a global and multidisciplinary approach. <br><br> <strong>The Journal of Public Health Research </strong>publishes contributions from both the 'traditional' disciplines of public health, including hygiene, epidemiology, health education, environmental health, occupational health, health policy, hospital management, health economics, law and ethics as well as from the area of new health care fields including social science, communication science, eHealth and mHealth philosophy, health technology assessment, genetics research implications, population-mental health, gender and disparity issues, global and migration-related themes. In support of this approach, the Journal of Public Health Research strongly encourages the use of real multidisciplinary approaches and analyses in the manuscripts submitted to the journal. In addition to <em>Original research</em>, <em>Systematic Review,</em> <em>Meta-analysis</em>, <em>Meta-synthesis</em> and <em>Perspectives</em> and <em>Debate</em> articles, the Journal of Public Health Research publishes newsworthy <em>Brief</em> <em>Reports</em>, <em>Letters</em> and <em>Study Protocols</em> related to public health and public health management activities.</p> PAGEPress Scientific Publications, Pavia, Italy en-US Journal of Public Health Research 2279-9028 <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="http://creativecommons.org/licenses/by-nc/4.0/" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li class="show">the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li class="show">a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li class="show">Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li class="show">Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li class="show">Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> Neighborhood crime is differentially associated with cardiovascular risk factors as a function of race and sex https://www.jphres.org/index.php/jphres/article/view/1643 <p><em>Background:</em> Neighborhood crime may be an important factor contributing to cardiovascular health disparities, and these relations may vary by race and sex. The present investigation evaluated (a) potential differential associations between neighborhood crime and cardiovascular disease (CVD) risk factors within subgroups of African American (AA) and White men and women, and (b) potential mediation by negative affect.</p> <p><em>Design and Methods: </em>Participants were 1,718 AAs and Whites (58% AA; 54% female; 59% above poverty; ages 30-64 years) living Baltimore, Maryland who completed the first wave of the Healthy Aging in Neighborhoods of Diversity across the Life Span study from 2004-2009. CVD risk factors included body mass index, total serum cholesterol, glucose, and systolic and diastolic blood pressure. A negative affect composite was comprised of self-reported depression, anxiety, anger, vigilance, and perceived stress. Hierarchical multiple regression analyses were used to examine associations between per capita overall and violent crime rates, negative affect, and CVD risk factors.</p> <p><em>Results:</em> There were significant associations of greater overall crime rate with higher fasting glucose (b=.192, P&lt;0.05), and greater violent crime rate with higher systolic (b=86.50, P&lt;0.05) and diastolic (b=60.12, P&lt;0.05) blood pressure in AA women, but not men. These associations were not explained by negative affect. In Whites, there were no significant associations of overall or violent crime rates with cardiovascular risk factors.</p> <p><em>Conclusions:</em> AA women may be particularly vulnerable to the negative impact of crime on cardiovascular risk. Preventative efforts aimed toward this group may help to deter the detrimental effects that living in a high crime area may have on one’s cardiovascular health.</p> Mollie R. Sprung Lauren M.D. Faulkner Michele K. Evans Alan B. Zonderman Shari R. Waldstein ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-12-05 2019-12-05 8 3 10.4081/jphr.2019.1643 Comparison of the performance of machine learning algorithms in breast cancer screening and detection: A protocol https://www.jphres.org/index.php/jphres/article/view/1677 <p><em>Background:</em> Breast Cancer (BC) is a known global crisis. TheWorld Health Organization reports a global 2.09 million inci-dences and 627,000 deaths in 2018 relating to BC. The traditionalBC screening method in developed countries is mammography,whilst developing countries employ breast self-examination andclinical breast examination. The prominent gold standard for BCdetection is triple assessment: i) clinical examination, ii) mam-mography and/or ultrasonography; and iii) Fine Needle AspirateCytology. However, the introduction of cheaper, efficient and non-invasive methods of BC screening and detection would be benefi-cial.</p> <p>Design and methods: We propose the use of eight machinelearning algorithms: i) Logistic Regression; ii) Support VectorMachine; iii) <em>K</em>-Nearest Neighbors; iv) Decision Tree; v) RandomForest; vi) Adaptive Boosting; vii) Gradient Boosting; viii)eXtreme Gradient Boosting, and blood test results using BCCoimbra Dataset (BCCD) from University of California Irvineonline database to create models for BC prediction. To ensure themodels’ robustness, we will employ: i) Stratified <em>k</em>-fold Cross-Validation; ii) Correlation-based Feature Selection (CFS); and iii)parameter tuning. The models will be validated on validation andtest sets of BCCD for full features and reduced features. Featurereduction has an impact on algorithm performance. Seven metricswill be used for model evaluation, including accuracy.</p> <p><em>Expected impact of the study for public health:</em> The CFStogether with highest performing model(s) can serve to identifyimportant specific blood tests that point towards BC, which mayserve as an important BC biomarker. Highest performing model(s)may eventually be used to create an Artificial Intelligence tool toassist clinicians in BC screening and detection.</p> Zakia Salod Yashik Singh ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-12-04 2019-12-04 8 3 10.4081/jphr.2019.1677 Monitoring for airborne respiratory viruses in a general pediatric ward in Singapore https://www.jphres.org/index.php/jphres/article/view/1407 <p>There is an increasing body of evidence suggesting that transmission of respiratory viruses occurs through the inhalation of virus-laden particles. Our study describes the use of an aerosol sampling system to monitor the prevalence of airborne viruses in a hospital setting. Using SKC AirCheck Touch pumps, with National Institute for Occupational Safety and Health (NIOSH) bioaerosol samplers and SKC filter cassette blanks, 28 aerosol samples were collected in a hospital ward in Singapore. Following DNA/RNA extraction, real-time RT-PCR/PCR was used for the detection of influenza A, B and D viruses, coronaviruses, enteroviruses, and adenoviruses. Airborne virus was detected in nine (32%) of 28 samples. Among the nine positive samples, eight were PCR-positive for adenovirus and one for influenza A virus. Our data suggest that bioaerosol sampling could be valuable in monitoring for airborne respiratory viruses in clinical environments to better understand the risk of infection during a hospital visit.</p> Su Yadana Kristen Kelli Coleman, PhD Tham Thi Nguyen Christophe Hansen-Estruch Shirin Kalimuddin Koh Cheng Thoon Jenny Guek Hong Low Gregory Charles Gray ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-12-04 2019-12-04 8 3 10.4081/jphr.2019.1407 Advance care directives: Citizens, patients, doctors, institutions https://www.jphres.org/index.php/jphres/article/view/1675 <p>Italian Law no. 219/2017 established the advance care directives (“Disposizioni anticipate di trattamento” – DAT), a legal document specifying the person’s wishes in relation to health, drawn up in case of the possible future incapacity to make informed decisions. DAT are an important instrument of empowerment for a person who is not necessarily a “patient” and enable the dialogue between healthcare providers and patient to continue when the latter is no longer able to take part consciously. DAT can only be implemented by guaranteeing the fundamental rights of the person, <em>i.e.</em> by ensuring the “non-complicated” use of this instrument and easy access to the DAT whenever it may be necessary. Furthermore, on the one hand, the requirement of adequate prior medical information has to contend with the fact that the wishes expressed in the document may have been formed outside of the therapeutic relationship; on the other hand, institutions must ensure that DAT are collected and recorded in such a way as to ensure their availability whenever and wherever necessary.</p> Paola Delbon Simona Cacace Adelaide Conti ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-12-04 2019-12-04 8 3 10.4081/jphr.2019.1675 Decisional issues in antibiotic prescribing in French nursing homes: An ethnographic study https://www.jphres.org/index.php/jphres/article/view/1533 <p><em>Background:</em> Medication prescription is generally the responsibility of doctors. In nursing homes, the nursing staff is often the first to suspect an infection. Today, physicians are more confident with nursing assessment, relying primarily on nursing staff information. Very few studies have investigated the nurses’ influence on decision of medical prescription. This study investigates the role of nurses in antibiotic prescribing for the treatment of suspected infections in nursing home residents. <br><em>Design and methods:</em> An ethnographic study based on semi-structured interviews and participant observations was conducted. Sixteen nurses and five doctors working in five nursing homes in Paris, France participated between October 2015 and January 2016. <br><em>Results:</em> Given their proximity to elderly residents, registered nurses at the nursing homes occasionally assisted doctors in their medical diagnostic. However, nurses who are theoretically incompetent have met difficulties in their ability to participate in their decisions to prescribe antibiotics when managing residents’ <em>infections.</em><br><em>Conclusion:</em> if proximity and nursing skills reinforce the relevance of the clinical judgment of nurses, the effective and collaborative communication between the nurse and the doctor may help the nurse to enhance their role in the antibiotic prescribing in nursing homes, which would enhance antimicrobial stewardship efficiency.</p> Taghrid Chaaban Mathieu Ahouah Pierre Lombrail Hélene Le Febvre Adnan Mourad Jean-Manuel Morvillers Monique Rothan-Tondeur ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-11-04 2019-11-04 8 3 10.4081/jphr.2019.1533 Addressing non-communicable diseases in the Western Cape, South Africa https://www.jphres.org/index.php/jphres/article/view/1534 <p><em>Background:</em> Chronic non-communicable diseases (CNCDs) are increasing with grave consequences to countries’ development. The purpose of this study was three-fold: (1) to determine challenges PURE study participants faced regarding CNCD interventions and what they required from a CNCD intervention programme, and (2) to explore courses of action Department of Health (DoH) officials thought would perform best, as well as (3) to determine what DoH officials perceive to be obstacles in addressing the CNCD epidemic. <br><em>Design and methods</em>: A subsample of 300 participants from the Prospective Urban and Rural Epidemiological study’s Western Cape urban cohort and six key officers from the DoH were recruited to participate in this cross-sectional study. Questionnaires were used in face-to-face interviews with the PURE study participants and DoH officials, together with the multi-criteria mapper (MCM) interviewing method with the latter. <br><em>Results:</em> Most PURE participants were overweight/obese, but not keen to participate in weight loss interventions. They sought education on foods associated with weight gain, shopping lists, cooking lessons and recipes from CNCD intervention programmes. Department of Health officials regarded the integration of health services, community participation, amongst others as the most favourable options to address the CNCD <em>epidemic.</em><br><em>Conclusions:</em> The integration of health services, community participation, food taxation and improving inter-sectoral partnerships were viewed as the most feasible options to address the CNCD epidemic according to the DoH officials. At community level, the needs for education and practical hints were expressed. Current CNCD interventions should be adapted to include the context-based needs of communities.</p> Nasheetah Solomons H. Salome Kruger Thandi R. Pouane ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-09-25 2019-09-25 8 3 10.4081/jphr.2019.1534 The importance of financial recession for mental health among students: short- and long-term analyses from an ecosocial perspective https://www.jphres.org/index.php/jphres/article/view/1504 <p><em>Background and aim:</em> Referring to the ecosocial theory and utilising the ‘natural experiment’ setting provided by the global recession at the beginning of 1990s, the aim of our study was to analyse the short- and long-term associations between trade and mental health in young students followed until mid-adulthood. <br><em>Method:</em> The study was based on two prospective cohort studies, the older and the younger Northern Swedish Cohort which both consisted of all pupils in a middle-sized industrial town in Northern Sweden. At age 21, the younger cohort entered the labour market during the deep recession of the early 1990s, while the older cohort entered the labour market during the boom of the 1980s. Both cohorts were followed up with a high response rate in mid adulthood. For this study, all students were selected at age 21. <br><em>Results:</em> At age 21, those who studied during recession had more depressive and functional somatic symptoms than those who studied during boom. The cohort differences did not remain over age: by the follow-up in early middle age the differences between the cohorts were non-significant, most notably due to decreased depressive symptoms in the younger cohort and increase of functional somatic symptoms in the older cohort. <br><em>Conclusions:</em> The short-term mental health consequences of the business cycle seem to be more extensive than limited only to those who are unemployed, even though the possible long-term consequences seem to be more complex. Thus, the macrolevel had a great short-term impact on the individual level in relation to the microlevel setting of university/school. The chronosystem was also of major importance. Future research would benefit from taking the context into account.</p> Anne Hammarström Pekka Virtanen ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-09-16 2019-09-16 8 3 10.4081/jphr.2019.1504 Online media scans: Applying systematic review techniques to assess statewide human papillomavirus vaccination activities https://www.jphres.org/index.php/jphres/article/view/1623 <p><em>Background.</em> Although the human papillomavirus (HPV) vaccine has been approved for use in adolescents in the US for over a decade, vaccination uptake remains low. Of concern, HPV vaccine coverage is below the national average in Minnesota, USA. To understand the reach of current HPV programming and research, we use an online media scan; this method may be applied to other jurisdictions to gain insight about various public health issues.<br><em>Design and Methods.</em> This online media scan describes the nature and scope of ongoing activities to increase HPV vaccination in Minnesota. The media scan included: a) structured internet searches of HPV vaccine health education/promotion activities ongoing in Minnesota since 2013, and b) searches in research databases of the published literature on HPV vaccination in Minnesota from 2013 to 2018. <br><em>Results.</em> Searches resulted in 880 online and 142 research article matches, with 40 and 36 meeting selection criteria. Results were categorized by activities focusing on race/ethnicity, sex, health providers, parents, lesbian, gay, bisexual, transgender and queer or questioning (LGBTQ) populations, geographic location, catchup vaccination, and insurance status. Most activities were statewide (52% health education/promotion and 35% research), followed by activities located in entirely urban areas (15% health education/promotion and 41% research) with only 6% of health education/promotion activities and 2% of research activities carried out in entirely rural <em>areas.</em><br><em>Conclusions.</em> A range of local and statewide HPV vaccine health education/promotion and research activities were identified in Minnesota. Several efforts partnered with American Indian and Somali/Somali-American communities, but fewer activities focused on HPV vaccination among LGBTQ youth and HPV vaccination in rural areas.</p> Emily Ann Groene Inari Mohammed Keith Horvath Nicole E. Basta Nicholas Yared Shalini Kulasingam ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-09-05 2019-09-05 8 3 10.4081/jphr.2019.1623 Six shades of grey: Identifying drinking culture and potentially risky drinking behaviour in the grey zone between work and leisure. The WIRUS culture study https://www.jphres.org/index.php/jphres/article/view/1585 <p><em>Objectives:</em> The aim of this study was to explore drinking culture and drinking situations that employers and employees encounter in the grey zone between work and leisure, and identify what might affect employees’ risky drinking behaviour. <br><em>Methods:</em> We used eight focus groups to interview 61 core company informants from eight Norwegian companies (private and public sector) participating in the WIRUS – Workplace-based interventions preventing risky alcohol use and sick leave – project. The informants represented employers and employees with a diversity of roles at multiple organisational levels. The transcribed interviews were analysed by applying a phenomenological hermeneutical approach. <br><em>Results:</em> The analysis revealed six dimensions of drinking culture representing potentially risky drinking behaviour in situations that fall in the grey zone between work and leisure: (1) “Who invited me?” (Degree of obligation towards inviter), (2) “Do I have to participate?” (Degree of participation volunteerism), (3) “To drink or not to drink?” (Degree of drinking volunteerism), (4) “Work talk or small talk?” (Degree of work-related conversation), (5) “Are there any drinking rules to follow?” (Degree of regulation), and (6) “The influence of being away from home” (degree of distance to home). <br><em>Conclusions:</em> The findings reveal that employers and employees’ experience of drinking culture can be categorised as six different “shades of grey”. The grey zone is shaded from light to dark grey, indicating how risky the informants perceive the grey zone to be. The findings may be useful when designing workplace health promotion programmes and alcohol regulations in the workplace.</p> Hildegunn Sagvaag Silje Lill Rimstad Liv Grethe Kinn Randi Wågø Aas ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-09-05 2019-09-05 8 3 10.4081/jphr.2019.1585 In utero exposure to endocrine disrupting chemicals, micro-RNA profiles, and fetal growth: a pilot study protocol https://www.jphres.org/index.php/jphres/article/view/1550 <p><em>Background:</em> The developing fetus is particularly vulnerable to the effects of endocrine disrupting chemicals (EDCs). Molecular fingerprints of EDCs can be identified via microRNA (miRNA) expression profiles and may be etiologically implicated in the developmental origin of disease (DOHaD). <br><em>Methods/design</em>: This pilot study includes pregnant women at high risk (smoking at conception), and low risk (non-smoking at conception) for SGA birth (birthweight&lt;10th percentile for gestational age). We have randomly selected 12 mothers (3 high-risk SGA birth, 3 low-risk SGA birth, 3 high-risk non-SGA birth, 3 low-risk non-SGA birth), with EDC measurements from gestational week 17. All offspring are female. We aim to test the stability of our samples (maternal serum, cord blood, placenta tissue), observe the differential expression of miRNA profiles over time (gestational weeks 17, 25, 33, 37, birth), and study the consistency between maternal EDC measures and miRNA expression profiles across our repeated measures. <br><em>Expected impact of the study for Public Health:</em> Results from this pilot study will inform the development of a larger cohort wide analysis, and will impact the current state of knowledge in the fields of public health, epigenetics, and the DOHaD.</p> Tricia L. Larose Pål Sætrom Marit P. Martinussen Håkon Skogseth Torkjel M. Sandanger Ghislaine Scelo Cliona M. McHale Geir W. Jacobsen Martyn T. Smith ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-09-05 2019-09-05 8 3 10.4081/jphr.2019.1550