Welcome to the BMC Public Health Section Editors' Highlights page. Here, the Section Editors have chosen recent papers published in their section of the journal that are of particular importance or interest to highlight to a wider audience.
Section Editors' Highlights
Chronic disease epidemiology
Severity of depression, anxious distress and the risk of type 2 diabetes – a population-based cohort study in Sweden
Chosen by: Jianguang Ji
The established association between depression and type 2 diabetes calls for clinical attention, especially in recent decades with an increasing prevalence of depression. It is thus necessary to explore whether the observed association is causal and to explore the underlying mechanisms by using prospective longitudinal data and by stratifying the observed association by various severity of depression (dose-response relationship). A total of 10 thousand individuals who lived in Stockholm County, Sweden have answered the postal questionnaires on depression and factors related to mental health in 1998–2000 in which depression was evaluated using the Major Depression Inventory. These individuals were followed until 2015 to identify their subsequent type 2 diabetes by using a few national registers. Deleskog and her colleagues did find that individuals with depression were at 1.48 times higher risk of type 2 diabetes after adjusting for potential confounders. It should be noted that the risk of type 2 diabetes was increased to 1.72 for individuals with severe depression, suggesting a causal association. In addition, they found that individuals with depression and concurrent moderate/severe anxious distress had 1.73 times higher risk. This study added strong evidence that depression is a strong risk factor for developing type 2 diabetes. However, further studies are highly needed to understand underlying mechanisms, as the authors acknowledged.
Assessing the micro-scale environment using Google Street View: the Virtual Systematic Tool for Evaluating Pedestrian Streetscapes (Virtual-STEPS)
Chosen by: David Stieb
There is considerable recent interest in the impact of the built environment on physical activity. This study examines the performance of a Google Street-view based tool (Virtual-STEPS) for auditing microscale features of the built environment such as condition of sidewalks, traffic-calming features (e.g. stop signs), building setbacks, bus stops, bicycle lanes, and aesthetic qualities (e.g. graffiti), which have been found to be associated with physical activity in previous studies. The authors focused on these features because they are believed to be more readily amenable to intervention than macroscale features such as connectivity, land-use mix, and population density. Virtual-STEPS was found to be reliable in terms of inter-rater agreement and comparison to field auditing, and more time-efficient by eliminating travel time, based on evaluation of 60 street segments in Montreal, Canada. The tool may provide a cost-effective means of identifying microscale features of the built environment that are readily modifiable with the objective of promoting physical activity.
The monetary value of human lives lost through Ebola virus disease in the Democratic Republic of Congo in 2019
Chosen by: Tim Mackey
The current Ebola outbreak that originated in the Democratic Republic of Congo in 2018, now with over 3,200 total cases, serves as further example of the continued risks posed by emerging and re-emerging infectious disease outbreaks. Ebola has been particularly deadly with he West Africa 2015-2016 outbreak ending with a total of approximately 28,000 cases and 11,000 deaths across Guinea, Liberia, and Sierra Leone. Appropriately implementing interventions while also measuring the public health impact of these outbreaks is crucial, but equally important is assessing the economic losses associated with these health emergencies that could have implications for decades to come on economic development. In Kirigia et al.’s research article published in September, authors estimate the monetary value of human lives lost to Ebola between May 2018- May 2019 using the human capital approach at approximately Intl$17million (International dollars or purchasing power parity) or Intl$13,801 per death. Though this estimate places Ebola death as having a lower indirect costs per death than other global health issues such as maternal death, tuberculosis death, and child and neglected tropical disease death in Africa, it was larger than the indirect costs associated with NCD death in low-income African countries. Perhaps more important, the study provides critical evidence that these disease outbreaks can have substantial and lasting implications for already fragile economies and health systems (including disease surveillance systems). In fact, it is the vulnerability of health systems and other systems that address social determinants of health, that may make a country more susceptible to an outbreak that could have cross-border and even global repercussions. Further research and advocacy is needed to develop evidence-based policy for disease prevention and prioritizing strengthening of national health systems as a matter of global health security.
Health policies, systems and management in high-income countries
Chosen by: Summer Hawkins
As hospitals and accountable care organizations in the US are increasingly becoming more responsible for the health of their populations of patients, there is need to evaluate public health-clinical care delivery models that can prevent disease. Colorado Heart Healthy Solutions is a community health worker-based intervention that has previously been shown to reduce cardiovascular disease (CVD) among at-risk individuals. Smith and colleagues aimed to evaluate the cost-effectiveness of the intervention in reducing CVD burden and projected events. The program involved community health workers supporting patients in predominantly rural communities by making medical referrals and providing individualized support to modify CVD risk factors. They found that Colorado Heart Healthy Solutions was a cost-effective method of reducing CVD risk and increasing quality adjusted life years. These results suggest that population-based public health programs have the potential to complement traditional medical services in preventing CVD.
Infectious disease epidemiology
Chosen by: Giovanni Rezza
Little information is available on the epidemic dynamics of HIV infection among men who have sex with men (MSM) in west Africa. This study, conducted on a large sample of MSM recruited in several federal states in Nigeria, shows an increase of HIV prevalence from 14% in 2007 to 17% in 2010, and a further increase to 23% in 2014. Factors as older age, receptive anal sex, and history of sexually transmitted infections resulted associated with HIV infection. The results of the study are not only interesting from the research point of view but also important from the public health point of view, urging for more intensive and appropriate intervention.
Chosen by: Noriko Cable
Many countries protect their children from entering adulthood prematurely and unprepared, yet some countries impose that children be married even before the age of 18, depriving them of having a crucial transition developmental phase for them to build psychosocial and material resources. The effects of marrying young has been examined in the Western countries, but limited within the context of African countries. John, Edmeades and Murithi here have looked at adult married women as well as the head of their households in Niger (N=2,764) and Ethiopia (N=4,149) to examine the association between age of marriage and psychological well-being, indicated by the Psychological General Well-Being Index. Qualitative data were also collected from Ethiopian women.
In both countries, women were married earlier than 12 years of age, which was significantly negatively associated with their psychological well-being, reducing their psychological well-being by -7.41 points in Niger and -5.09 points in Ethiopia. Domestic violence also added to their poor psychological well-being, especially the aspects of self-control in both countries. Qualitative results in Ethiopia revealed unrealistic demands placed upon women as a child bride and their powerlessness over marital arrangement and more importantly how they lacked opportunities to gain education and employment.
Children entering their adolescence are the most vulnerable mentally and physically, not ready for adulthood or responsibilities, especially marriage and family formation. This study adds that early marriage is detrimental to women’s psychological well-being, even though the custom of child marriage is socially accepted in these countries.
Effects of occupational exposure to dust on chest radiograph, pulmonary function, blood pressure and electrocardiogram among coal miners in an eastern province, China
Chosen by: Youcheng Liu
Although coal workers pneumoconiosis is an old occupational disease, it is a big occupational health issue in China given coal mining remains a big industrial sector. While it is a cross-sectional measurement in nature using 2 years of surveillance data, this study has a large sample size (23,658 participants in total); the risk factors identified are therefore more meaningful. Additionally, the study has not only focused on pulmonary health, but also measured cardiovascular health of the participants. The authors find that abnormal lung and cardiovascular functions are most related to age and duration of coal dust exposure. Smoking as a risk factor contributed to the abnormalities. The type of work tasks and mining sizes also contributed to some of the abnormalities. The percentage of coal miners’ pneumoconiosis, 0.34%, for all miners in this study, is much higher than that of US data for underground miners (0.04%) averaged across all age groups) from 2013 to 20171. Although no actual exposure to dust was measured for the study participants, the risk factors identified highlight the need to improve preventive measures in China coal miners, i.e., to reduce dust exposures. In addition, general health promotion to reduce smoking, drinking and overweight in coal miners are also important preventive measures. Future studies should aim to follow up workers with periodic measurements of pulmonary function and cardiovascular health along with dust exposure levels so that the relative risk related to exposure dose can be quantified.
CDC. CWHSP: Percentage of examined underground miners with coal workers' pneumoconiosis (ILO category 1/0+) by tenure in mining, 1970-2017. Available at: https://wwwn.cdc.gov/eworld/Grouping/Coal_Workers_Pneumoconiosis/93. Accessed on Oct 20, 2019.
Psychosocial working conditions across working life may predict late-life physical function: a follow-up cohort study
Chosen by: Isabelle Niedhammer
In a context of increasing life expectancy and raising retirement age, this paper is offering us a highly topical subject. Exploring the associations between psychosocial work exposures, using a working life course approach, and late-life physical function appears indeed particularly pertinent and largely unexplored. The authors showed that exposure and particularly increasing exposure to high strain during working life were associated with limitation in late-life physical function. Although this study was not free from some biases (including residual confounding bias), it suggests that the psychosocial work environment and its exposures to work stress across working life may have an impact on health later in life. As these exposures are modifiable, this study, which is one of the first on this topic, opens the way to other research studies and potential interesting perspectives to improve the health among elderly people.