Prevalence of dental caries among children in Indonesia: A systematic review and meta-analysis of observational studies.

Objective: The prevalence of dental caries among children in Indonesia remains unclear. Therefore, we aimed to provide an updated assessment of this prevalence while also investigating the influence of patient characteristics and methodological factors. Design: We performed a systematic review and meta-analysis, including searches of PubMed, Cochrane Library, and Embase from inception to August 24, 2023. We included 8840 participants in 27 studies reporting the prevalence of dental caries among Indonesian children. Results: The overall prevalence of dental caries was 76 % (95 % confidence interval: 71%-81 %). Studies in which decay-missing-filled teeth (DMFT) criteria were used to diagnose dental caries were significantly more prevalent than studies using non-DMFT criteria (78 % vs. 64 %, P < 0.05). No significant moderators were identified for the study subgroup based on study origin (Jakarta vs. non-Jakarta) or comorbidity status (comorbidity vs. no comorbidity). Owing to incomplete reporting of variables, metaregression analysis could not be conducted for continuous variables, such as age and male percentage. Conclusions: The prevalence of dental caries among Indonesian children remains notably high, showing consistency across Jakarta-based studies and non-Jakarta studies. Initiating dental caries prevention and health promotion campaigns is imperative, focusing on the critical importance of early detection.

Association between the quantity of stroke care units and the complement of neurosurgical and neurology specialists in Japan: A retrospective study.

BACKGROUND: Stroke care units provide advanced intensive care for unstable patients with acute stroke. We conducted a survey to clarify the differences in stroke care units between urban and regional cities and the relationship between the number of stroke care unit beds and neurologists. METHODS: This retrospective observational study was conducted in 2,857 and 4,184 hospitals in urban and regional cities in 47 provinces of Japan, respectively, between January 2020 and August 2023. Tokyo and ordinance-designated cities in provinces were defined as urban cities, and those without such cities were defined as regional cities. The primary endpoint was the presence or absence of a stroke care unit. RESULTS: Multiple linear regression analysis revealed that the presence of stroke care units was significantly associated with the number of neurosurgical specialists. Receiver operating characteristic curve analysis was performed to predict the number of personnel required for stroke care unit installation based on the number of neurosurgical specialists. The area under the receiver operating characteristic curve, Youden index, sensitivity, and specificity were 0.721, 0.483, 0.783, and 0.700, respectively. CONCLUSIONS: Our study underscores the indispensability of SCUs in stroke treatment, advocating for a strategic allocation of medical resources, heightened accessibility to neurosurgical specialists, and a concerted effort to address geographic and resource imbalances. The identified cutoff value of 8.99 neurosurgical specialists per 100,000 population serves as a practical benchmark for optimizing SCU establishment, thereby potentially mitigating stroke-related mortality.

The Impact of an Undergraduate Community-Based Medical Education Program in a Japanese Urban City.

INTRODUCTION:  With an aging global population posing healthcare challenges, especially in community healthcare, training professionals for community healthcare remains a global educational challenge, including in Japan. While previous research shows increased student interest in community healthcare through practical experiences, the focus has primarily been on rural areas, leaving a gap in understanding urban-based community medical education. This study aimed to evaluate the impact of urban community-based medical education on students' understanding and attitudes toward community healthcare. METHODS:  This study was conducted at Kyushu University in Fukuoka City, the sixth-largest city in Japan. For fifth-grade medical students, a community-based medical education program is mandatory, with a one-week schedule that includes orientation, one day in a clinic, and three days in a community hospital. The program aimed to expose students to various healthcare settings, emphasizing outpatient care, inpatient management, home health care, home nursing, and rehabilitation. A self-administered questionnaire referencing the Model Core Curriculum for medical education was administered immediately before and after the program, and the differences in students' perceptions were assessed using the Student's t-test. RESULTS:  Findings from 188 students completing both pre- and post-program questionnaires revealed significant improvements in perceptions of students' knowledge and skills related to community healthcare. After the training, there was a noteworthy positive shift in attitudes toward community healthcare and increased interest in primary care physicians as a career choice. Although students maintained a preference for urban areas, there was a notable inclination towards rural settings. The study highlights the program's success in enhancing students' understanding and positive attitudes toward community healthcare within an urban context. It challenges prior notions regarding work-life balance and urban-rural preferences in career choices. CONCLUSIONS:  Urban community-based medical education significantly improved students' perceptions and attitudes toward community healthcare. It offers valuable insights for curriculum planners, emphasizing the need for continued research into sustained effects and broader applicability.

The influence of PM2.5 exposure duration and concentration on outpatient visits of urban hospital in a typical heavy industrial city.

To explain the duration and dose effects of pollutant exposure on public health and provide scientific data for air pollution prevention and control and disease prevention by examining the influence of PM2.5 concentration and exposure duration on daily outpatient visits among patients with cardiovascular, cerebrovascular, and respiratory diseases in a typical heavy industrial city in China. Daily outpatient data on cardiovascular, cerebrovascular, and respiratory diseases and regional PM2.5 exposure duration and concentration were collected from a provincial hospital in Taiyuan, China, from 2016 to 2021. The correlations of numeric variables were analyzed using the Pearson correlation method. A generalized additive model (GAMs) was also established to investigate the effects of PM2.5 concentration and exposure duration on outpatient visits. Correlation analysis showed that the outpatient visits in Taiyuan was significantly correlated with the PM2.5 concentration and exposure duration. The longer the exposure time of PM2.5 pollution, the stronger the correlation of PM2.5 with outpatient visits showed. Cardiovascular outpatient visits were extremely significant related with medium to long-term exposure of PM2.5 (exposure with more than 30 days) (p < 0.001). In addition, outpatient visits of cerebrovascular and respiratory disease were extremely significant correlated with PM2.5 (exposures within 0-360 days) (p < 0.001). The results of GAMs showed the linear or the nonlinear relationships between outpatient visits and exposure of PM2.5. Among the linear relationships, when average concentration of PM2.5 (exposure within less than 15 days) increased by 1 mg/m3, the cardiovascular outpatient visits increased most dramatically (by about 440 people). For nonlinear relationships, when the average PM2.5 concentration (exposure with over 30 days or more) increased by 1 mg/m3, the most dramatic increase occurred in cardiovascular outpatient visits (with a maximum increase of 7000), followed by cerebrovascular outpatient visits (with a maximum increase of 1200), and respiratory outpatient visits (with a maximum increase of 250). The GAMs also revealed a dose effect in the relationship between outpatient visits and PM2.5 exposure. In moderately polluted air (based on air quality standards of China, GB3095-2012), when the average concentration of PM2.5 increased by 1 mg/m3, the cardiovascular outpatient visits increased the most (by 1200 people), followed by cerebrovascular outpatient visits (by 200 people) and respiratory outpatient visits (by 20 people). We concluded that outpatient visits in cardiovascular, cerebrovascular, and respiratory disease are closely correlated with the concentration and exposure duration of air pollution. There is a linear relationship between short-term air pollution exposure (exposure within less than 15 days) and outpatient visits. As PM2.5 concentration increases, cardiovascular outpatient visits increase gradually, with its growth trend exceeding that of cerebrovascular and respiratory disease. There is a nonlinear relationship between medium and long-term air pollution exposure (exposure with more than 30 days) and outpatient visits, with cardiovascular and cerebrovascular outpatient visits showed a nonlinear but overall upward trend when the atmosphere is moderately polluted.

Enrichment, sources, and distributions of toxic elements in the farming land's topsoil near a heavily industrialized area of central Bangladesh, and associated risks assessment.

Toxic element accumulation in the surrounding soils of the advanced industry- and agriculture-oriented areas may lead to severe environmental degradation and harmful impact on inhabitants. This work examined the concentration of some concerned toxic elements (Cr, Pb, Cd, Cu, As, and Ni) in the representative topsoil from 10 industrially contaminated sites in central Bangladesh (Narayanganj district) using an Inductively Coupled Plasma Mass Spectrometer concerning the probable ecological and human health risks. The mean concentrations (mg/kg) of the elements were found in the order of Ni (58.1 ± 11.8) > Pb (34.1 ± 14.3) > Cr (32.1 ± 6.77) > Cu (14.5 ± 3.30) > Cd (2.74 ± 1.08) > As (1.49 ± 0.43). The findings pointed out that diversified manmade events enhanced the intensities of elemental contamination through the studied sites. Source analysis showed that Cr, Pb, As, and Cd may originate from industrial wastewater and agricultural activities, whereas Cu and Ni came from natural sources. The geo-accumulation index level for Cd (1.70-3.39) was determined as grade 3 (moderately to strongly polluted), the enrichment factor score for Cd (13.9) fell in the very severe enhanced category (cluster 5), and the highest contamination factor value was found for Cd (15.7). The contamination degree values for all the tested elements signify a moderate to severe contamination grade; conversely, pollution load index levels depicted the nonexistence of elemental pollution. The assessment revealed serious Cd pollution in agricultural soils and moderate to significant potential ecological risk for the rest of the examined toxic elements. Furthermore, hazard index values exceeded the safe exposure levels, indicating that there was potential non-carcinogenic risk in the soils for children and adults. Ingestion exposure had much higher carcinogenic risk values than inhalation and cutaneous exposure, and children are exposed to considerable carcinogenic hazards. Therefore, it is suggested that the harmful practices that expose this farming soil to contaminants should be stopped immediately and effective environment-friendly techniques of waste management and effluent treatment should be employed in the study area.

Microplastics in the Atmosphere and Water Bodies of Coastal Agglomerations: A Mini-Review.

Microplastics are ubiquitously in various environments from the equator to the poles. Coastal agglomerations act as both a source and sink connecting the global microplastic cycles of oceans and continents. While the problem of microplastics is particularly severe and complex in the coastal zones, where both inland and marine pollution are concentrated, the present study aimed to provide hot topics and trends of coastal urban microplastic studies and to review the researches on microplastic pollution in the atmosphere and water bodies in coastal agglomerations in terms of characteristics, behavior, and health threat of microplastics. The results of the bibliometric analysis showed an increase in the annual output of microplastic research. Research hot topics and clusters were analyzed using the VOSviewer. Characteristics of microplastics varied in abundance, size, and polymer type in different environments and countries. Furthermore, coastal cities are taken as a system to sort out the input, output, and internal transmission pathways of microplastics. The health threat of microplastics to urban residents was briefly reviewed and the exposure and health risks of microplastics to infants and young children were of particular concern. Detailed and comprehensive studies on intervention and reduction in the transmission of microplastics between the atmosphere and water bodies, whether microplastics are harmful to infants and young children, and measures to reduce the risk of microplastic exposure are needed.

Urban to rural COVID-19 progression in India: The role of massive migration and the challenge to India's traditional labour force policies.

The coronavirus disease-2019 (COVID-19) has emerged as a deadliest disease in the 21st century. Initially in India, this disease was concentrated in major urban cities like Mumbai, Delhi, Gujarat, and Chennai, which were the national hotspots for the COVID-19 pandemic. However, in subsequent months, returning migrants (mainly day labour) brought the disease back to their home; this vector triggered significant spread to semi-urban and rural areas. This highlighted serious concerns in rural India, where access to sophisticated healthcare and mitigation strategies were lacking. There is little data on this new pattern of disease spread. This article provides a short review for tracking the spread of COVID-19 into major rural states in India based on understanding urban-rural workforce migration relative to the growing proportion of the nation's COVID-19 caseload between May-September 2020.

Socio-demographic factors of cesarean births in Nha Trang city, Vietnam: a community-based survey.

BACKGROUND: The cesarean section rate in Vietnam has been increasing especially in urban area. However, limited evidence identified regarding socio-demographic factors of the cesarean section birth. The objective of this study was to determine the current cesarean birth rate and the associated socio-demographic factors among mothers in Nha Trang city, south-central Vietnam. METHODS: A community-based cross-sectional study was conducted between October and November in 2016 as part of a Streptococcus pneumoniae carriage survey conducted in 27 communes of Nha Trang city. From each commune, 120 mothers and their children less than 2 years old were randomly selected. Mothers were asked to answer standardized questions regarding socio-demographic information and mode of birth. Multivariate logistic regression was adopted to examine associations between socio-demographic variables and mode of birth. RESULTS: Of 3148 participants, the number of cesarean births was 1396 (44.3 %). Older maternal age (≥ 30 years old), having another child going to school or kindergarten, monthly income more than 644 USD, gestational weeks at birth over 42 weeks, and low (< 2500 g) or high (≥ 3500 g) birth weight were associated with higher likelihood of cesarean births. CONCLUSION: The CS rate obtained in this study was more than twice of what is recommended by the World Health Organization, which is consistent with the previous nation-wide study in Viet Nam. Further monitoring is suggested to examine the non-medical reason for the increased CS rate.

Bio-reserves inventory-improving substrate management for anaerobic waste treatment in a fast-growing Indian urban city, Chennai.

India is one among the Asia's newly industrialized countries, in which urban centres generate large amount of municipal solid wastes due to the rapid urbanization. To demonstrate urban waste potentials for biogas production by anaerobic digestion, a comprehensive analysis on the availability of organic waste hotspots and its biogas potential for the exemplary case of Chennai, India, was undertaken. The identified hotspots and their biogas potential were plotted with Geographical Information System as thematic maps. The results of biogas potential tests revealed strong variations in the biogas potentials of individual waste streams from 240.2 to 514.2 mLN/g oDM (organic dry matter) with oDM reduction in the range of 36.4-61.5 wt.-%. Major waste generation hotspots were identified from the surveyed urban bio-reserves and the biogas potentials within an effective area of 5 km radius surrounding the hotspot were estimated. It was found that the biogas potential of individual hotspots ranged between 38.0-5938.7 m3/day. Further results revealed that the biogas potential during anaerobic co-digestion, by considering nearby bio-reserves in the effective areas of major hotspots, with and without residential organic waste, ranged between 4110.4-18-106.1 m3/day and 253.2-5969.5 m3/day, originating from 144.0-620.0 tons and 3.1-170.5 tons, respectively. Despite variations in the composition of the wastes, the Carbon/Nitrogen ratio, oDM reduction, biogas production and substrate availability were improved during co-digestion of nearby bio-reserves within the major hotspots, thereby improving the prevailing barriers in substrate management during anaerobic digestion of wastes.

Epidemiological transition in morbidity: 10-year data from emergency consultations in Dakar, Senegal.

BACKGROUND: It is thought that low-income countries are undergoing an epidemiological transition from infectious to non-communicable diseases; however, this phenomenon is yet to be examined with long-term data on morbidity. METHODS: We performed a prospective evaluation of all emergency medical consultations at a major emergency service provider in Dakar, Senegal from 2005 to 2014. Using standardised definitions, the primary diagnosis for each consultation was classified using the International Classification of Diseases-10 and then broadly categorised as 'infectious', 'non-communicable' and 'other' diseases. Morbidity rates for each year in the 10-year observation period were plotted to depict the epidemiological transition over time. To quantify the yearly rate ratios of non-communicable over infectious diagnosis, we used a generalised Poisson mixed model. RESULTS: Complete data were obtained from 49 702 visits by African patients. The mean age was 36.5±23.2 and 34.8±24.3 years for women and men, respectively. Overall, infections accounted for 46.3% and 42.9% and non-communicable conditions 32.2% and 40.1% of consultations in women and men, respectively. Consultation for non-communicable compared with infectious conditions increased by 7% every year (95% CI: 5% to 9%; p<0.0001) over the 10 years. Consultations for non-communicable condition were more likely in women compared with men (RR=1.29, 95% CI: 1.18, 1.40) and at older ages (RR=1.27; 95% CI 1.25, 1.29 for 10-year increase in age). CONCLUSION: Using high-quality disease morbidity data over a decade, we provide novel data showing the epidemiological transition of diseases as manifested in emergency service consultations in a large Sub-Saharan African city. These results can help reorientation of healthcare policy in Sub-Saharan Africa.

Impact of Behavioural Factors and Living Conditions on Dental Caries Among Pupils from Shanghai and Jiangxi Province in China: A School-based Cross-sectional Study.

PURPOSE: Dental health is associated with the growth and development, physical or psychological, of children. Although numerous preventive measures are available, dental caries among primary schoolchildren remains a public health concern in China. Understanding the disparity of children's dental health between rural and urban areas in China could provide further insight into the prevention of caries. METHODS: A cross-sectional study was conducted to examine the oral health of pupils aged 6-12 years in Pudong District (Shanghai) and Lichuan (Jiangxi Province) in China. A questionnaire survey was performed among children's guardians to identify the potential risk factors for childhood dental caries. RESULTS: A total of 1922 primary schoolchildren were included in this study, with 815 from Pudong and 1107 from Lichuan. The mean age of children from Pudong was 8.57 (SD = 1.61), which was statistically significantly lower than their counterpart from Lichuan (9.36 ± 1.75). The prevalence of caries in Pudong and Lichuan was 63.4% and 75.0%, respectively. Statistically significant differences of demographical and behavioural features were observed between schoolchildren in Pudong and Lichuan. In general, Lichuan children had a higher caries risk compared with their Pudong counterparts (OR = 3.43, 95%CI 2.65-4.28). Moreover, the non-parental caregivers, low family income, low parental educational level, as well as bad dietary habits, were identified as risk factors for caries. CONCLUSIONS: Childhood caries in the rural area was far more severe than that in the urban area. This disparity was determined by several factors such as the high proportion of left-behind children in the rural area (e.g. children who remain in rural regions of China while their parents leave to work in urban areas). Our government should put the prevention of caries among rural children at a higher priority in the near future to narrow the gap between rural and urban areas.

Do sedentary behavior and physical activity spatially cluster? Analysis of a population-based sample of Boston adolescents.

Sedentary behavior and lack of physical activity are key modifiable behavioral risk factors for chronic health problems, such as obesity and diabetes. Little is known about how sedentary behavior and physical activity among adolescents spatially cluster. The objective was to detect spatial clustering of sedentary behavior and physical activity among Boston adolescents. Data were used from the 2008 Boston Youth Survey Geospatial Dataset, a sample of public high school students who responded to a sedentary behavior and physical activity questionnaire. Four binary variables were created: 1) TV watching (>2 hours/day), 2) video games (>2 hours/day), 3) total screen time (>2 hours/day); and 4) 20 minutes/day of physical activity (≥5 days/week). A spatial scan statistic was utilized to detect clustering of sedentary behavior and physical activity. One statistically significant cluster of TV watching emerged among Boston adolescents in the unadjusted model. Students inside the cluster were more than twice as likely to report > 2 hours/day of TV watching compared to respondents outside the cluster. No significant clusters of sedentary behavior and physical activity emerged. Findings suggest that TV watching is spatially clustered among Boston adolescents. Such findings may serve to inform public health policymakers by identifying specific locations in Boston that could provide opportunities for policy intervention. Future research should examine what is linked to the clusters, such as neighborhood environments and network effects.

Factors associated with risk for assisted living among community-dwelling older Japanese.

OBJECTIVES: To clarify the factors associated with risk for assisted living among community-dwelling older people, we conducted a large-scale survey in an urban city in Japan. DESIGN: Population-based cross-sectional study. SETTING: A mid-sized urban city in western Japan with a population of approximately 410,000. PARTICIPANTS: Nondisabled and nondemented community-dwelling older people (≥65 years). MEASUREMENTS: A self-administered postal questionnaire, including a health checklist for the screening of older people at high risk for assisted living, as well as demographic/sociodemographic questions on sex, age, present illness, living alone, duration of residence within the current city, community participation, and employment status, was distributed. RESULTS: There were 41,796 returned questionnaires (response rate: 73.8%, average age: 72.0). Participants who were at high risk for assisted living accounted for 25.2%. The independent factors associated with risk for men and women were higher age, present illness, lack of community participation, unemployment, and<20years of residence. Living alone was a significant factor for men, whereas it was insignificant among women. The types of illnesses among people at risk were different between men and women. CONCLUSION: Higher age, present illness, and several social factors were independently associated with high-risk status for assisted living in the large-scale whole community survey, and there was a sex difference. Our results may provide basic information for the further application of effective preventive intervention in the community.