Forgoing healthcare during the COVID-19 pandemic in Geneva, Switzerland – a cross-sectional population-based study

AbstractBackgroundHealth systems around the world continue to navigate through operational challenges surfaced by the COVID-19 pandemic; these have implications for access to healthcare. In this study, we estimate the prevalence and reasons for forgoing healthcare during the pandemic in Geneva, Switzerland; a country with a universal and mandatory private health insurance coverage.MethodsParticipants from a randomly selected population-based sample of the adult population living in the Canton of Geneva completed an online socio-demographic and lifestyle questionnaire between November 2020 and January 2021. The prevalence and reasons for forgoing healthcare since the beginning of the COVID-19 pandemic were examined descriptively, and logistic regression models were used to assess determinants for forgoing healthcare.ResultsThe study included 5,397 participants, among which 8.0% reported having forgone healthcare since the beginning of the COVID-19 pandemic; participants with a disadvantaged financial situation (OR=2.04; 95% CI: 1.56-2.65), and those reporting an average (OR=2.55; 95% CI: 1.94-3.32) or poor health (OR=4.40; 95% CI: 2.40-7.68) were more likely to forgo healthcare. The most common reasons to forgo healthcare were appointment cancellations by healthcare providers (53.9%), fear of infection (35.3%), and personal organizational issues (11.1%).ConclusionOur paper highlights the effects of the COVID-19 pandemic on access to healthcare and identifies population sub-groups at-risk for forgoing healthcare. These results necessitate public health efforts to ensure equitable and accessible healthcare as the COVID-19 pandemic continues.Highlights8% of the Geneva, Switzerland, adults renounced healthcare in the COVID-19 pandemicMain forgoing healthcare reasons are appointment cancellation and fear of infectionUnderprivileged participants with poor health are more likely to forgo healthcare

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Prevalence of Self-Reported Chronic Diseases and Health Services Utilization by Ethnic Minorities in Manaus Metropolitan Region

Ethnicity & Disease ◽

10.18865/ed.28.1.49 ◽

2018 ◽

Vol 28 (1) ◽

pp. 49 ◽

Cited By ~ 4

Author(s):

Raquel Rodrigues Ferreira Rocha de Alencar ◽

Tais Freire Galvao ◽

Bruno Vianei Real Antonio ◽

Marcus Tolentino Silva

Keyword(s):

Health Insurance ◽

Chronic Diseases ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Population Based ◽

Metropolitan Region ◽

Care Utilization ◽

Cross Sectional ◽

Probabilistic Sampling ◽

Significant Difference

Objectives: To assess the prevalence of, and associated factors to, self-reported chronic diseases and health care utilization by ethnicity in the Manaus Metropolitan Region.Methods: We conducted a cross-sectional, population-based survey from May through August 2015. Using probabilistic sampling in three stages, we recruited adults aged ≥18 years. Ethnicity was self-identified as White, Black, Yellow, Brown (Brazilian mixed-race), and Indigenous. We calculated adjusted prevalence ratios (PR) and 95% CI of chronic diseases and health service utilization for each ethnic minority and compared the data using Poisson regression with data from White respondents.Results: In this study, we interviewed 4,001 people. Of these, 15.9% were White, 7.5% Black, 3.4% Yellow, 72.1% Brown, and 1.0% Indigenous. Indigenous respondents had the highest prevalence of self-reported hypertension (29.4%), diabetes (12.3%) and hypercholesterolemia (17.0%) among the ethnic respondent groups. Compared with the White population, Browns had less health insurance coverage (PR=.76; 95% CI: .62-.93) and reported hypertension (PR=.84; 95% CI: .72-0.98) and diabetes (PR=.69; 95% CI: .51-.94) less frequently. Yellows visited the doctor more frequently than Whites (PR=1.13; 95% CI: 1.04-1.22), with no significant difference in prevalence of diseases.Conclusions: Indigenous respondents had higher prevalence rates of the investigated diseases. Compared with Whites, Brown respondents had lower rates of self-reported arterial hypertension and diabetes, as well as lower rates of private health insurance coverage.Ethn Dis. 2018;28(1):49-54; doi:10.18865/ed.28.1.49

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Obesity and Prevalence of Latent Tuberculosis: A Population-Based Survey

Infectious Diseases Research and Treatment ◽

10.1177/1178633721994607 ◽

2021 ◽

Vol 14 ◽

pp. 117863372199460

Author(s):

Alaa Badawi ◽

Christina J Liu

Keyword(s):

Body Weight ◽

Risk Factor ◽

Adult Population ◽

Latent Tuberculosis ◽

Population Based ◽

Cross Sectional Study ◽

Cross Sectional ◽

Logistic Regression Models ◽

Cardiometabolic Risk Markers ◽

And Control

Objective: Diminution in body weight is a known risk factor that increases the burden of active tuberculosis (TB). However, conflicting evidence exists for the effect of body weight on the risk of latent tuberculosis infection (LTBI). The objective of the present study is to examine the prevalence of LTBI at different body weights, evaluate the extent of association between body mass index (BMI) and LTBI and identify factors mediating this relationship in an adult population. Methods: We conducted a cross-sectional study to estimate the relationship between BMI and LTBI in participants from the US-National Health and Nutrition Examination Survey (NHANES; 2012, n = 5156; 514 with LTBI and 4642 controls). Results: The association between BMI and levels of cardiometabolic risk markers in both LTBI and control groups had a similar profile. When adjusted for age and sex, BMI was significantly inversely correlated with the prevalence of LTBI ( r = −0.147, P < .001). Effect of BMI on the risk of LTBI was evaluated using multivariate logistic regression models adjusted for age, sex, diabetes, and level of education. In this model, increasing BMI was significantly associated with lower risk of LTBI (OR = 0.85; 95%CI: 0.77-0.96, P < .01). Conclusion: This study further establishes an inverse relationship between BMI and prevalence of LTBI. Decreased BMI can be considered as a risk factor in LTBI, the reservoir for active TB cases.

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PARTICIPATING IN HEALTH INSURANCE AND FACTORS AFFECTING AMONG PERSONS WHOSE ENROLMENT IS VOLUNTARY IN THUA THIEN HUE PROVINCE

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2015.4_5.12 ◽

2015 ◽

pp. 89-95

Author(s):

Thi Hoai Thuong Nguyen ◽

Hoang Lan Nguyen ◽

Mau Duyen Nguyen

Keyword(s):

Health Insurance ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Health Insurance Scheme ◽

Insurance Scheme ◽

Cross Sectional ◽

Factors Affecting ◽

The People ◽

Universal Health Insurance Coverage ◽

The Social

Background:To provide information helps building policy that meets the practical situation and needs of the people with the aim at achieving the goal of universal health insurance coverage, we conducted this study with two objectives (1) To determine the rate of participating health insurance among persons whose enrolment is voluntary in some districts of ThuaThien Hue province; (2) To investigate factor affecting their participation in health insurance. Materials and Methodology:A cross-sectional descriptive study was conducted in three districts / towns / city of ThuaThien Hue in 2014. 480 subjects in the voluntary participation group who were randomly selected from the study settings were directly interviewed to collect information on the social, economic, health insurance participation and knowledge of health insurance. Test χ2 was used to identify factors related to the participation in health insurance of the study subjects. Results:42.5% of respondents were covered by health insurance scheme. Factors related to their participation were the resident location (p = 0.042); gender (p = 0.004), age (p <0.001), chronic disease (p <0.001), economic conditions (p<0.001) and knowledge about health insurance (p <0.001). Conclusion: The rate of participating health insurance among study subjects was low at 42,5%. There was "adverse selection" in health insurance scheme among voluntary participating persons. Providing knowledge about health insurance should be one of solutions to improve effectively these problems. Key words: Health insurance, voluntary, Thua Thien Hue

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Stillbirth outcome capture and classification in population-based surveys: EN-INDEPTH study

Population Health Metrics ◽

10.1186/s12963-020-00239-8 ◽

2021 ◽

Vol 19 (S1) ◽

Cited By ~ 4

Author(s):

Hannah Blencowe ◽

◽

Matteo Bottecchia ◽

Doris Kwesiga ◽

Joseph Akuze ◽

...

Keyword(s):

Gestational Age ◽

A Priori ◽

Healthcare Providers ◽

Population Based ◽

Reproductive Age ◽

Group Discussions ◽

Cross Sectional ◽

Vital Status ◽

Neonatal Deaths ◽

Adverse Pregnancy

Abstract Background Household surveys remain important sources of stillbirth data, but omission and misclassification are common. Classifying adverse pregnancy outcomes as stillbirths requires accurate reporting of vital status at birth and gestational age or birthweight for every pregnancy. Further categorisation, e.g. by sex, or timing (intrapartum/antepartum) improves data to understand and prevent stillbirth. Methods We undertook a cross-sectional population-based survey of women of reproductive age in five health and demographic surveillance system sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017–2018). All women answered a full birth history with pregnancy loss questions (FBH+) or a full pregnancy history (FPH). A sub-sample across both groups were asked additional stillbirth questions. Questions were evaluated using descriptive measures. Using an interpretative paradigm and phenomenology methodology, focus group discussions with women exploring barriers to reporting birthweight for stillbirths were conducted. Thematic analysis was guided by an a priori codebook. Results Overall 69,176 women reported 98,483 livebirths (FBH+) and 102,873 pregnancies (FPH). Additional questions were asked for 1453 stillbirths, 1528 neonatal deaths and 12,620 surviving children born in the 5 years prior to the survey. Completeness was high (> 99%) for existing FBH+/FPH questions on signs of life at birth and gestational age (months). Discordant responses in signs of life at birth between different questions were common; nearly one-quarter classified as stillbirths on FBH+/FPH were reported born alive on additional questions. Availability of information on gestational age (weeks) (58.1%) and birthweight (13.2%) was low amongst stillbirths, and heaping was common. Most women (93.9%) were able to report the sex of their stillborn baby. Response completeness for stillbirth timing (18.3–95.1%) and estimated proportion intrapartum (15.6–90.0%) varied by question and site. Congenital malformations were reported in 3.1% stillbirths. Perceived value in weighing a stillborn baby varied and barriers to weighing at birth a nd knowing birthweight were common. Conclusions Improving stillbirth data in surveys will require investment in improving the measurement of vital status, gestational age and birthweight by healthcare providers, communication of these with women, and overcoming reporting barriers. Given the large burden and effect on families, improved data must be made available to end preventable stillbirths.

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The relationship between socioeconomic position and health literacy among urban and rural adults in regional China

BMC Public Health ◽

10.1186/s12889-021-10600-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wei Chen ◽

Hongfu Ren ◽

Na Wang ◽

Yaqing Xiong ◽

Fei Xu

Keyword(s):

Health Literacy ◽

Educational Attainment ◽

Socioeconomic Position ◽

Population Based ◽

Outcome Variable ◽

Average Income ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Logistic Regression Models ◽

Rural Adults

Abstract Background To examine associations of socioeconomic position (SEP), separately indicated by education, monthly family average income (FAI) and occupation, with health literacy (HL) among adults in regional China. Methods A cross-sectional survey was conducted among urban and rural adults (aged 25–69 years) who were randomly selected, using the probability proportionate to size sampling approach, from Nanjing municipality of China during October and December of 2016. HL, the outcome variable, was assessed using the Chinese Resident Health Literacy Scale. SEP, our independent variable, was separately measured with educational attainment, monthly family average income and occupation. Logistic regression models were introduced to examine SEP-HL association with odds ratio (OR) and 95% confidence interval (CI). Results Totally, 8698 participants completed the survey. The proportion of participants with unweighted and weighted adequate HL was 18.0% (95%CI = 17.2, 18.8%) and 19.9% (95%CI = 16.6, 23.6%), respectively, in this study. After adjustment for possible confounding factors, each SEP indicator was in significantly positive relation to both unweighted and weight HL level. Participants who obtained 13+ and 10–12 years educational attainment, respectively, had 2.41 (95%CI = 1.60, 3.64) and 1.68 (95%CI = 1.23, 2.29) times odds to record weighted adequate HL compared to their counterparts who were with 0–9 years education. Subjects within upper (OR = 1.92, 95%CI = 1.24, 2.98) and middle FAI tertile (OR = 1.59, 95%CI = 1.19, 2.13), respectively, were more likely to report weighted adequate HL relative to those who were within lower FAI tertile. White collars were more likely to have weighted adequate HL (OR = 1.33, 95%CI = 1.09, 1.61) than blue collars. Conclusions Each of education, FAI and occupation was positively associated with health literacy among urban and rural adults in China. The findings have important implications that different SEP indicators can be used to identify vulnerable residents in population-based health literacy promotion campaigns.

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Prevalence of systemic lupus erythematosus in Spain: higher than previously reported in other countries?

Rheumatology ◽

10.1093/rheumatology/kez668 ◽

2020 ◽

Vol 59 (9) ◽

pp. 2556-2562 ◽

Cited By ~ 4

Author(s):

Raúl Cortés Verdú ◽

José M Pego-Reigosa ◽

Daniel Seoane-Mato ◽

Mercedes Morcillo Valle ◽

Deseada Palma Sánchez ◽

...

Keyword(s):

Lupus Erythematosus ◽

Adult Population ◽

Geographical Area ◽

Geographic Origin ◽

The United States ◽

Epidemiological Studies ◽

Population Based ◽

Cross Sectional Study ◽

Medical Visit ◽

Cross Sectional

Abstract Objectives Prevalence of SLE varies among studies, being influenced by study design, geographical area and ethnicity. Data about the prevalence of SLE in Spain are scarce. In the EPISER2016 study, promoted by the Spanish Society of Rheumatology, the prevalence estimate of SLE in the general adult population in Spain has been updated and its association with sociodemographic, anthropometric and lifestyle variables has been explored. Methods Population-based multicentre cross-sectional study, with multistage stratified and cluster random sampling. Participants were contacted by telephone to carry out a questionnaire for the screening of SLE. Investigating rheumatologists evaluated positive results (review of medical records and/or telephone interview, with medical visit if needed) to confirm the diagnosis. To calculate the prevalence and its 95% CI, the sample design was taken into account and weighing was calculated considering age, sex and geographic origin. Multivariate logistic regression models were defined to analyse which sociodemographic, anthropometric and lifestyle variables included in the telephone questionnaire were associated with the presence of SLE. Results 4916 subjects aged 20 years or over were included. 16.52% (812/4916) had a positive screening result for SLE. 12 cases of SLE were detected. The estimated prevalence was 0.21% (95% CI: 0.11, 0.40). SLE was more prevalent in the rural municipalities, with an odds ratio (OR) = 4.041 (95% CI: 1.216, 13.424). Conclusion The estimated prevalence of SLE in Spain is higher than that described in most international epidemiological studies, but lower than that observed in ethnic minorities in the United States or the United Kingdom.

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Support for cigarette filter waste policies among US adults

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056451 ◽

2021 ◽

pp. tobaccocontrol-2020-056451

Author(s):

Minal Patel ◽

Alison F Cuccia ◽

Shanell Folger ◽

Adam F Benson ◽

Donna Vallone ◽

...

Keyword(s):

Smoking Status ◽

Population Based ◽

Tobacco Product ◽

Cross Sectional ◽

Cigarette Filter ◽

Logistic Regression Models ◽

Knowledge And Beliefs ◽

Cigarette Butts ◽

Using Data ◽

The Impact

IntroductionLittle is known on whether cigarette filter-related knowledge or beliefs are associated with support for policies to reduce their environmental impact.MethodsA cross-sectional, population-based sample of US adults aged 18–64 years (n=2979) was used to evaluate filter-related knowledge and beliefs by smoking status using data collected between 24 October 2018 and 17 December 2018. Multivariate logistic regression models explored whether these knowledge and belief items were associated with support for two policies, a US$0.75 litter fee and a ban on sales of filtered cigarettes, controlling for demographic characteristics and smoking status.ResultsRegardless of smoking status, 71% did not know plastic was a cigarette filter component and 20% believed filters were biodegradable. Overall, 23% believed filters reduce health harms and 60% believed filters make it easier to smoke; 90% believed cigarette butts are harmful to the environment. Individuals believing cigarette butts harmed the environment were more likely to support a litter fee (adjusted OR (aOR)=2.33, 95% CI: 1.71 to 3.17). Individuals believing that filters are not biodegradable had higher odds of supporting a litter fee (OR=1.47, 95% CI: 1.15 to 1.88). Respondents believing that filters do not make cigarettes less harmful were more likely to support a litter fee (aOR=1.50, 95% CI: 1.20 to 1.88) and filter ban (aOR=2.03, 95% CI: 1.64 to 2.50). Belief that filters make it easier to smoke was associated with decreased support for a filter ban (aOR=0.69, 95% CI: 0.58 to 0.83).ConclusionsComprehensive efforts are needed to educate the public about the impact of cigarette filters in order to build support for effective tobacco product waste policy.

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Absence of routine medical consultation among hypertensive and/or diabetic elders: an epidemiological study based on the Brazilian National Household Survey 2008

Revista Brasileira de Epidemiologia ◽

10.1590/1980-5497201500030005 ◽

2015 ◽

Vol 18 (3) ◽

pp. 578-594 ◽

Cited By ~ 5

Author(s):

Daniela Nice Ferreira ◽

Divane Leite Matos ◽

Antônio Ignácio de Loyola Filho

Keyword(s):

Insurance Coverage ◽

Household Survey ◽

Behavioral Model ◽

Health Insurance Coverage ◽

Population Based ◽

Geographic Region ◽

Medical Consultation ◽

International Studies ◽

Significance Level ◽

National Household Survey

OBJECTIVE: This exploratory study aimed to investigate the predisposing, enabling and health need characteristics associated with lack of medical visits in the last 12 months, among 23,620 elderly hypertensive and/or diabetic individuals. METHODS: In this research, we used the theoretical behavioral model of Andersen and Newman for use of health services. The data analyzed were produced by the health supplement of the Brazilian National Household Survey (PNAD) 2008, nationwide. To identify the associations, we used the Poisson regression model, which estimates the prevalence ratios and confidence intervals of 95%, considering the significance level of 5%. RESULTS: The results showed that 10.6% of the study population did not consult the doctor in the period considered, and the prevalence was higher among hypertensive subjects (10.5%) than among diabetic ones (7.1%). The lack of medical consultation was negatively associated with female sex and increasing age (predisposing characteristics), with health insurance coverage (enabling characteristic), worse self-rated health, chronic health conditions selected and the presence of hypertension associated with diabetes (health needs), while the fact of living in the Northeast, North and Midwest appeared positively associated with the event under investigation. CONCLUSION: These results corroborate those observed in national and international studies and show evidence of inequality and inequity in the use of medical consultation for this population, based on the findings related to health plan coverage and geographic region.

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Knowledge, attitudes and intention regarding mHealth in generation Y: evidence from a population based cross sectional study in Chakaria, Bangladesh

BMJ Open ◽

10.1136/bmjopen-2017-016217 ◽

2017 ◽

Vol 7 (11) ◽

pp. e016217 ◽

Cited By ~ 4

Author(s):

M Shafiqur Rahman ◽

Syed Hanifi ◽

Fatema Khatun ◽

Mohammad Iqbal ◽

Sabrina Rasheed ◽

...

Keyword(s):

Young People ◽

Sex Education ◽

Mobile Phones ◽

Generation Y ◽

Healthcare Providers ◽

Age Groups ◽

Household Survey ◽

Population Based ◽

Cross Sectional ◽

Level Of Knowledge

Background and objectivesmHealth offers a new opportunity to ensure access to qualified healthcare providers. Therefore, to better understand its potential in Bangladesh, it is important to understand how young people use mobile phones for healthcare. Here we examine the knowledge, attitudes and intentions to use mHealth services among young population.DesignPopulation based cross sectional household survey.Setting and participantsA total of 4909 respondents, aged 18 years and above, under the Chakaria Health and Demographic Surveillance System (HDSS) area, were interviewed during the period November 2012 to April 2013.MethodsParticipants younger than 30 years of age were defined as young (or generation Y). To examine the level of knowledge about and intention towards mHealth services in generation Y compared with their older counterparts, the percentage of the respective outcome measure from a 2×2 contingency table and adjusted odds ratio (aOR), which controls for potential confounders such as mobile ownership, sex, education, occupation and socioeconomic status, were estimated. The aOR was estimated using both the Cochran–Mantel–Haenszel approach and multivariable logistic regression models controlling for confounders.ResultsGeneration Y had significantly greater access to mobile phones (50%vs40%) and better knowledge about its use for healthcare (37.8%vs27.5%;aOR 1.6 (95% CI1.3 to 2.0)). Furthermore, the level of knowledge about two existing mHealth services in generation Y was significantly higher compared with their older counterparts, with aOR values of 3.2 (95% CI 2.6 to 5.5) and 1.5 (95% CI 1.1 to 1.8), respectively. Similarly, generation Y showed significantly greater intention towards future use of mHealth services compared with their older counterparts (aOR 1.3 (95% CI 1.1 to 1.4)). The observed associations were not modified by sociodemographic factors.ConclusionThere is a greater potential for mHealth services in the future among young people compared with older age groups. However, given the low overall use of mHealth, appropriate policy measures need to be formulated to enhance availability, access, utilisation and effectiveness of mHealth services.

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Association of Dietary and Lifestyle Inflammation Score With Metabolic Syndrome in a Sample of Iranian Adults

Frontiers in Nutrition ◽

10.3389/fnut.2021.735174 ◽

2021 ◽

Vol 8 ◽

Author(s):

Fatemeh Dehghani Firouzabadi ◽

Ahmad Jayedi ◽

Elaheh Asgari ◽

Zahra Akbarzadeh ◽

Nasim Janbozorgi ◽

...

Keyword(s):

Metabolic Syndrome ◽

Adult Population ◽

Positive Association ◽

Population Based ◽

Cross Sectional Study ◽

Significant Positive Association ◽

Cross Sectional ◽

General Adult Population ◽

Education Status ◽

Inflammation Score

Objective: We aimed to evaluate the association between the dietary and lifestyle inflammation score (DLIS) and metabolic syndrome (MetS) and its components in a sample of Iranian adults.Design: Population-based cross-sectional study.Setting: General adult population living in Tehran, Iran.Subjects: We included 827 adult men and women with an age range of 18–59 years who were referred to health centers in different districts of Tehran, Iran. Dietary intake was assessed by a semiquantitative food frequency questionnaire with 168 items. The DLIS was calculated based on four components, including dietary inflammation score, physical activity, cigarette smoking, and general obesity. Higher DLIS represents a more proinflammatory diet and lifestyle. The odds ratio (OR) and 95% confidence interval (CI) of the MetS across quartiles of the DLIS was calculated by using logistic regression analysis, controlling for age, sex, energy intake, marital status, education status, and occupation.Results: A total of 827 participants (31% men) were included, with a mean age of 44.7 ± 10.7 years. The prevalence of the MetS was 30.5%. The DLIS ranged between −2.35 and +3.19 (mean ± SD: 0.54 ± 1.09). There was a significant positive association between the DLIS and odds of MetS (OR fourthvs.thefirstquartile: 1.57, 95% CI: 1.01–2.45) in the fully adjusted model.Conclusion: Our results showed a significant positive association between the DLIS and odds of MetS. The results of the present crosssectional study suggested that having a more proinflammatory lifestyle can be associated with MetS. More prospective studies are needed to confirm the findings.

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