Relative and absolute inequalities in cerebrovascular disease mortality rates: exploring the influence of socioeconomic status and urbanization levels in Taiwan.

BACKGROUND/OBJECTIVE: Limited evidence exists regarding the socioeconomic inequalities in cerebrovascular disease (CBD) mortality at different urbanization levels. Therefore, this study was conducted to assess the socioeconomic inequalities and urbanization levels in township-based CBD mortality in Taiwan. METHODS: Socioeconomic variables, including the percentages of low-income households, individuals with a university education and above, and tax payments, were measured at the township level from 2011 to 2020. Urbanization was also determined by the national survey and divided into seven levels. Age-standardized mortality rate (ASMR) of CBD was calculated using a Geographic Information System (GIS) in 358 townships. The effects of socioeconomic variables and urbanization levels on relative and absolute inequalities in township-based CBD mortality rates were examined. RESULTS: Significant differences in ASMR of CBD were observed across all socioeconomic status indicators over the years. Higher proportions of low-income households were associated with higher ASMR of CBD. Conversely, there were negative correlations between higher proportions of individuals with a university education and above and tax payments with ASMR of CBD. The regression analysis indicated significant impacts of relative and absolute socioeconomic inequalities on ASMR of CBD. Additionally, a moderation effect of socioeconomic variables and urbanization on CBD mortality rates was observed, with rural areas showing sensitivity to these factors. CONCLUSION: Although ASMR of CBD showed significant decreases over time, socioeconomic inequalities in CBD mortality rates persist. Interventions targeting socioeconomic inequalities in health outcomes, especially in rural areas, are needed to address this issue.

Job-related stress associated with work-related upper extremity musculoskeletal disorders (UEMDs) in municipal waste collectors: the moderation and mediation effect of job support.

BACKGROUND: Since the policy of "keeping trash off of the ground" in Taiwan, long-term exposure to repetitive motion in waste collection process results in high risk of upper extremity musculoskeletal disorders (UEMDs). Thus, we assessed the moderation and mediation effects of job-related stress and job support on work-related UEMDs among municipal waste collectors. METHODS: A cross-sectional study was conducted in two cities located at northern Taiwan during 2018-2019. 626 municipal waste collectors voluntarily participated and anonymously filled out a structured questionnaire. The moderation and mediation effects of effort-reward imbalance (ERI) and social support on UEMDs were analyzed by Haye's Process Macro Model. RESULTS: Prevalence of UEMDs in municipal waste collectors were 43.4% for neck, 56.0% for shoulder, 24.1% for upper back, and 33.1% for hand/wrist. There was high prevalence of shoulder (72.2%), neck (48%), and upper back (30%) in female workers compared to male, most significantly in shoulders. In univariate and multivariate analysis, high ERI and low job support were significantly associated with ORs of 3.11 (95% CI:1.58-6.13) for elbow, 2.79 (95% CI:1.39-5.56) for shoulder, 3.39 (95% CI:1.64-7.00) for upper back and 3.83 (95% CI:1.98-7.41) for hand/wrist. Prevalent UEMDs were positively associated with high ERI in municipal waste collectors but negatively with job support. The moderation effects of ERI and job support on UEMDs, of which the measured synergy index exceeded one, were 18.24 for shoulder, 3.32 for elbow, and 2.45 for hand/wrist, but mediation effects were not significant. CONCLUSIONS: This study found municipal waste collectors with work-related upper extremity disorders were significantly associated with work-related psychological risk factors. Therefore, waste collection cannot only to be improved by semi-automatic and automatic processes but immediate intervention programs for the reduction of psychological risk factors is needed promptly.

Association of health checkups with health-related quality of life among public servants: a nationwide survey in Taiwan.

BACKGROUND: Preventive health checkups have gained in importance over the last decade. The association of health checkups and the number of diseases with health-related quality of life (HRQoL), including physical and mental health, remains unclear. We sought to investigate the aforementioned association among Taiwanese public servants. METHODS: A cross-sectional survey was conducted using randomized and multistage stratified cluster sampling based on proportional probabilistic sampling. The questionnaires addressed demographics, job characteristics, health behaviors, health status, 3 types of health checkups during the preceding 3 years (government-paid health checkup [GPHC], self-paid health checkup [SPHC], and no health checkup [NOHC]), and physical component summary (PCS) and mental component summary (MCS) scores of the Short-Form Health Survey. In total 11,454 middle-aged public servants were analyzed. A multivariate general linear model (GLM) was used to estimate PCS and MCS scores by using least square means. RESULTS: Health checkup types were associated with a significant difference in PCS scores among the public servants. Scores of PCS and MCS were both significantly higher in the GPHC group than in the NOHC group for those with no chronic diseases (51.20 vs. 50.66 [P = 0.008] and 46.23 vs. 45.58 [P = 0.02], respectively). Compared with the NOHC group, both scores of GPHC and SPHC groups were significantly associated with higher PCS scores for public servants with ≥ 2 chronic diseases (46.93 vs. 45.13 [P = 0.002] and 46.52 vs. 45.13 [P = 0.009], respectively). CONCLUSION: In Taiwan, public servants undergoing GPHCs are more likely to report higher PCS scores than are those undergoing SPHCs. It is crucial that encourage periodically using the health checkup to improve health status and HRQoL.

Effects of physical and social environments on the risk of dementia among Taiwanese older adults: a population-based case-control study.

BACKGROUND: Physical and social environments may influence cognition health in older adults. However, evidence regarding physical and social environments linked to dementia is lacking, especially in Asia. This study aims to explore the influence of physical and social environments on the incidence of dementia through a population-based case-control design in Taiwan. METHODS: We identified 26,206 incident cases with dementia aged≧65 years in 2010, with the same no. of controls from National Health Insurance claims. Environmental measures were collected from government statistics including three physical environments and three social environments. Multilevel logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CI) of the association between dementia incidence and the environmental measures at the township level. RESULTS: We observed a significant reduction of 12% in the odds ratios of dementia in areas with higher availability of playgrounds and sport venues (OR 0.88, 95% CI 0.81-0.95), after controlling for individual and other environmental characteristics. Community center availability was also significantly associated with an 8% decreased odds for dementia (OR 0.92, 95% CI 0.87-0.99), but the association was not significant after further consideration of individual-level characteristics. Although higher odds of dementia were found in areas with high median annual family income (OR 1.14, 95% CI 1.04-1.25), such a significant relationship did not appear in the full model. CONCLUSIONS: Our study suggests that specific physical and social environmental features have different influences on the risk of dementia. Public health interventions may consider these environmental aspects for preventing dementia incidence.

Environmental health risks perception, attitude, and avoidance behaviour toward municipal solid waste incinerator.

This study aims to assess the relationship between risk perception, attitude, and avoidance among residents toward an urban incinerator in Taichung, Taiwan. A cross-sectional study was conducted and three schools were enrolled. The case group was composed of 514 residents who live near an incinerator. The control group was composed of 264 people nearly the same age and who have lived in that area basically the same period of time. All participants were interviewed using a structured questionnaire. Results of this study showed that there was no significant difference between the exposure group and the control group in risk perception and attitude regarding the incinerator. However, the exposure group showed a significantly higher desire to move within one year or move sometime in the future than the control group. Therefore, these people should encourage the Environmental Protection Administration (EPA) to do everything it can to make sure that the incinerator operates safely.

[Health Without Borders: Creating Healthy Cities].

Urbanization, a rapidly rising trend worldwide, is being felt particularly strongly in East Asia. The World Health Organization (WHO) launched a healthy-cities plan in 1986 as a platform to encourage cities around the world to eliminate the problems resulting from increasingly dense urban population densities. The health and quality of life of city residents are seriously affected by the problems associated with urbanization, including environmental pollution, traffic congestion, public insecurity, and inadequate infrastructure, which may exceed the scope of local government plans and expectations. Rather than dealing with these problems individually, urban planners must take a global approach to issue of urbanization. Public and private-sector inputs are critical to facilitating good urban planning and community development by local governments in order to help cities achieve a well-managed urban environment that gives citizens a good environment in which to live, work, and play. The promotion healthy-city plans in Taiwan will foster the creation of cities of health through the integration or cooperation of government health, urban-planning, environmental-protection, industrial-development, transportation, cultural-education, and other departments and agencies. Based on the vision of a healthy city, Taiwan's cities should gradually attain a sustainable, healthy society and healthy environment that promotes the holistic health of their residents. Therefore, we look forward to fulfilling the vision of "health without borders, creating healthy cities" through the implementation of the healthy city plan.

Cooking fuel and risk of under-five mortality in 23 Sub-Saharan African countries: a population-based study.

Relationship between cooking fuel and under-five mortality has not been adequately established in Sub-Saharan Africa (SSA). We therefore investigated the association between cooking fuel and risk of under-five mortality in SSA, and further investigated its interaction with smoking. Using the most recent Demographic Health Survey data of 23 SSA countries (n = 783,691), Cox proportional hazard was employed to determine the association between cooking fuel and risk of under-five deaths. The adjusted hazard ratios were 1.21 (95 % CI, 1.10-1.34) and 1.20 (95 % CI, 1.08-1.32) for charcoal and biomass cooking fuel, respectively, compared to clean fuels. There was no positive interaction between biomass cooking fuel and smoking. Use of charcoal and biomass were associated with the risk of under-five mortality in SSA. Disseminating public health information on health risks of cooking fuel and development of relevant public health policies are likely to have a positive impact on a child's survival.

Effort-reward imbalance and self-rated health among Gambian healthcare professionals.

BACKGROUND: The effort-reward imbalance (ERI) model of work stress has been widely applied in investigating association between psychosocial factors at work and health. This study examined associations between perceived psychosocial work stress as measured by the ERI model and self-rated health (SRH) among nurses and environmental health officers (EHOs) working in secondary public healthcare facilities in the Gambia. METHOD: A cross-sectional study on a random sample of 287 health care professionals (201 nurses and 86 EHOs). A 22-item ERI questionnaire was used to collect data on the psychosocial factors defined by the ERI model. SRH was assessed using a single item measure. RESULTS: The distribution of subjective health was not statistically different between nurses and EHOs. However, our study uncovered significant associations between perceived psychosocial work stress and subjective health. Specifically, we found that a perceived high effort-reward imbalance (ER-ratio > 1) is a significant risk factor for poor SRH, in both occupational groups. However, over-commitment was not significantly associated with poor SRH in the two groups. When efforts and rewards were considered as separate variables in the analysis, rewards were inversely associated with poor SRH in both groups. CONCLUSION: Because of the high perceived Effort-Reward Imbalance among healthcare professionals at secondary public healthcare facilities, it is necessary to modify working conditions through improvement of psychosocial work environment, such as reasonable allocation of resources to increase pay, incentives or other forms of rewards from government. Interventions that could mitigate and prevent stress at work are worth considering in future healthcare policies.

Parental weight changes as key predictors of child weight changes.

BACKGROUND: Parents are the key agents of behavioural changes in their children. This fact is as an important aspect of obesity treatment and prevention. The present study aims to evaluate the influence of parents who have gained or lost weight on their children's weights and to examine parental and child patterns of weight changes from a baseline over a 14-year duration. METHODS: We performed a secondary analysis on the Indonesia Family Life Survey (IFLS), an ongoing national prospective longitudinal cohort study in Indonesia. Height and weight measurements, information regarding parental education, maternal employment, household income, and residence were collected from children under five years old (n = 3,147) and their parents in 1993. Data were taken from the same individuals at different points in time, in 1997, 2000, and 2007. RESULTS: During each transition, the children of parents who gained weight had a significantly weights than did children of parents who lost weight. A mother's positive weight change increased the chance of her pre-schooler's or school-aged child's positive weight change. However we found no such association between a father's positive weight change and his child's positive weight change. CONCLUSIONS: Parental weight change is an independent predictor of child weight change. Positive weight change in the mother had a more dominant influence than did the father's positive weight change. Future family-based obesity prevention and treatment programs should consider how best to include and engage mothers as a catalyst for the reduction of obesity-related risk factors in the long term.

Adverse effects of parental smoking during pregnancy in urban and rural areas.

BACKGROUND: Parental smoking during pregnancy is associated with lower birthweight and gestational age, as well as with the risks of low birthweight (LBW) and preterm birth. The present study aims to assess the association of parental smoking during pregnancy with birth outcomes in urban and rural areas. METHODS: This was a secondary analysis of data collected in the Indonesia Family Life Survey, between 1993 and 2007, the first national prospective longitudinal cohort study in Indonesia. Retrospective data of parental smoking habits, socioeconomic status, pregnancy history and birth outcomes were collected from parents with children aged 0 to 5 years (n = 3789). We assessed the relationships between the amount of parental smoking during pregnancy with birthweight (LBW) and with gestational age (preterm birth). RESULTS: We found a significant reduction in birthweight to be associated with maternal smoking. Smoking (except for paternal smoking) was associated with a decrease in the gestational age and an increased risk of preterm birth. Different associations were found in urban area, infants born to smoking fathers and both smoking parents (>20 cigarettes/day for both cases) had a significant reduction in birthweight and gestational age as well as an increased risk of LBW and preterm birth. CONCLUSIONS: Residence was found to be an effect modifier of the relation between parental smoking during pregnancy, amount of parental smoking, and birth outcomes on their children. Smoking cessation/reduction and smoking intervention program should be advised and prioritized to the area that is more prone to the adverse birth outcomes.

The mediating effect of health behaviors on the association between job strain and mental health outcome: a national survey of police officers.

Police officers often face emotionally challenging interpersonal situations and numerous studies have demonstrated that policing is a stressful occupation. A study revealed a significant positive correlation between emotional demands among police officers and emotional dissonance, as well as burnout. Health-promoting behaviors can contribute to better overall health outcomes and reduce the risk of developing health problems, but there is limited research evaluating the association of job strain and health behaviors with mental health outcomes in police officers. The objective of this study was to assess the job strain associated with mental health mediated by health behaviors in Taiwanese police officers. This was a cross-sectional quantitative study conducted in Oct 2016. A total of 41,871 police officers (response rate was 79.7%) participated questionnaire that consisted of demographic information, job characteristics, health behaviors, and mental component summary (MCS) scores of the Short-Form Health Survey. Independent t-tests and one-way analysis of variance (One-way ANOVA) were conducted to assess the differences in mean MCS scores across various demographics, health behavior, and job characteristics. Multivariate regression analyses were used to assess the relationship between job strain and health behaviors with mental health outcomes. MCS scores were associated with job characteristics and health behaviors among police officers except for gender. After adjusting for covariates, multivariate analysis indicated that police officers with high job demands and high job strain index exhibited poor MCS scores. Job strain was significantly associated with MCS mediated by health behaviors (consumption of fruits and vegetables, and physical activity) in Taiwanese police officers. Since regular physical activity and increased vegetable and fruit consumption might alleviate the effects of job strain on mental health status, it is recommended that institutional policies be established to promote health-enhancing behaviors among police officers.

Risk factors for and prevalence of clonorchiasis in Miaoli County, Taiwan.

The objective of this study was to investigate the risk factors for and prevalence of clonorchiasis in Miaoli County, Taiwan. In 2009, 6,929 subjects were randomly selected in Miaoli County and given a questionnaire to fill out regarding risk factors for clonorchiasis; the response rate was 69%. Stool sample was obtained from each participant who filled out the questionnaire and examined using the merthiolate-iodine-formaldehyde concentration (MIFC) technique to determine the presence and concentration of Clonorchis sinensis eggs. Fifty-one subjects gave a history of clonorchiasis (prevalence rate 0.7%). Seven stool samples were positive for C. sinensis (prevalence rate 0.1%). Shihtan Township (5.0%) in Miaoli County had the highest prevalence of clonorchiasis. Using logistic regression, we found people who often fished (OR: 3.65, p=0.013) or who had a family member with a history of clonorchiasis (OR: 18.7, p<0.001) were more likely to have it. We also found tourists who traveled to China and ate fish there (OR: 2.46, p=0.105) or who owned a fish pond (OR: 1.93, p=0.128) were more likely to get clonorchiasis. The prevalence of clonorchiasis in Miaoli County was relatively low, which can be explained by good sanitation and personal hygiene. The Public Health Department of Taiwan should warn Taiwanese travelers about high risk areas for contracting clonorchis infection and encourage these travelers to avoid going fishing or eating raw fish in high risk areas.

The effects of respiratory training for chronic obstructive pulmonary disease patients: a randomised clinical trial.

AIMS AND OBJECTIVES: To assess the effects of respiratory training on lung function, activity tolerance and quality of life in patients with chronic obstructive pulmonary disease. BACKGROUND: For patients with chronic obstructive pulmonary disease, pulmonary rehabilitation can increase activity tolerance and improve their psychological state by relieving dyspnoea and promoting their quality of life. DESIGN: A randomised clinical trial was conducted in a local hospital. METHODS: Patients with chronic obstructive pulmonary disease were randomly assigned to intervention (n=20) and control groups (n=20). Spirometry, six-minute walking distance and quality of life were used to assess the efficacy of respiratory training programme. RESULTS: Significant improvement in lung function, including forced vital capacity (p=0.037), forced expiratory volume in one-second (p=0.006) and per cent predicted forced expiratory volume in one-second (p=0.008) in the intervention group. Regarding efficacy of the training programme for patients with chronic obstructive pulmonary disease, in forced expiratory volume in one-second (p=0.024) and per cent predicted forced expiratory volume in one-second (p=0.035), six-minute walking distance significantly increased. In addition, there were significant improvements for symptoms (p=0.018), impact (p<0.001) and total quality of life scores (p<0.001), as well as significantly decreased body mass, airflow obstruction, dyspnoea and exercise capacity index (p=0.004) in the intervention group. CONCLUSIONS: A respiratory training programme for patients with chronic obstructive pulmonary disease was found to relieve dyspnoea, maintain lung function, increase activity tolerance and improve quality of life. RELEVANCE TO CLINICAL PRACTICE: Respiratory training programme can be used as a routine rehabilitation protocol for patients with chronic obstructive pulmonary disease and can be used by nurses as a reference to monitor chronic obstructive pulmonary disease patients' health status.

Implementation Determinants of Zimbabwe National Occupational Safety and Health Policy in Willowvale Industrial Area, Zimbabwe.

Zimbabwe introduced the National Occupational Safety and Health Policy (ZNOSHP) in August 2014 with the vision and mission to eliminate occupational accidents, injuries, diseases, and fatalities and to promote Occupational Safety and Health (OSH). This study was therefore aimed at exploring the individual- and organizational-level determinants of ZNOSHP's implementation. Data were collected from 309 workers in the Willowvale industrial area in Harare, Zimbabwe. Negative binomial regression models were used to explore the determinants of ZNOSHP's implementation. After adjustment, participant's knowledge of ZNOSHP (Incidence Rate Ratio, IRR = 1.32; 95% Confidence Interval, CI: 1.19-1.46; p ≤ 0.001), production department (IRR = 1.13; 95% CI: 1.03-1.26; p ≤ 0.05), company years of operation (IRR = 1.33; 95% CI: 1.21-1.46; p ≤ 0.001), participants who identified several implementation barriers (IRR = 1.12; 95% CI: 1.01-1.25; p ≤ 0.001), and agricultural industry were associated with higher rates of ZNOSHP's implementation. In conclusion, individual- and organizational-level determinants of implementation of OSH standards were explored, and positive associations were found. Policy implementation, enforcement, and follow up strategies need to be developed in order to ensure adherence to safety measures. This study should be extended to other parts of Zimbabwe in order to develop evidence-based policy.

Effort-reward imbalance and job strain index associated with health-related quality of life for civil servants in a national survey: the mediation effect of job support and over-commitment.

OBJECTIVES: Work-related stress (WRS) is significantly associated with health-related quality of life (HRQoL), but the amounts of evidence on differences of effort-reward imbalance (ERI) and job strain index (JSI) remain sparse and have limited generalizability. Therefore, we aimed to assess the association between ERI and JSI with HRQoL and assess the mediation effect of social support (JS) and over-commitment (OC) on this association in Taiwan's civil servants. MATERIAL AND METHODS: A cross-sectional national survey was given to registered civil servants in Taiwan - 20 046 civil servants from 647 institutions were enrolled using multistage stratified random cluster sampling. A web-questionnaire collected demographic information, job characteristics, and different indexes of ERI and job-control-demand-support (JCDS) models. Structural equation model (SEM) was used to examine the association between ERI and JSI with HRQoL, and the mediation effect of JS and OC on the associations. RESULTS: In the ERI model, ERI and OC were consistently negatively associated with the mental component score (MCS) (r = -0.46 and r = -0.37) and physical component score (PCS) (r = -0.45 and r = -0.34), which were higher than job demand (r = -0.28 and r = -0.22) and JSI (r = -0.38 and r = -0.29). Using hierarchical multiple regression analyses, ERI was significantly correlated with MCS and PCS, which was consistently higher than JSI. The ERI and JSI were significantly correlated with MCS (ß = -0.170 and ß = -0.140) and PCS (ß = -0.150 and ß = -0.082) using SEM analysis, whereas ERI was considerably higher than in JSI. In addition, OC and JS mediated the association between The ERI and JSI with HRQoL. CONCLUSIONS: We found the ERI index is significantly correlated with HRQoL superior to JSI, in particular among Taiwan civil servants. Further longitudinal studies are needed to determine the causality and spatiotemporal relation of these differences. Int J Occup Med Environ Health. 2022;35(4):425-36.

Urinary Malondialdehyde (MDA) and N-Acetyl-ß-D-Glucosaminidase (NAG) Associated with Exposure to Trichloroethylene (TCE) in Underground Water.

Trichloroethylene (TCE) is commonly used in various industries. If wastewater in factories is not effectively treated, the inflow into and subsequent contamination of underground water is likely. Our study assessed the association of exposure to TCE in underground water with oxidative stress and renal tubule damage. We selected 579 residents from areas with underground water contaminated with TCE. Each participant was interviewed via a questionnaire. We also assessed their urinary trichloroacetic acid (TCA) levels by gas chromatography (GC)-FID. Urinary malondialdehyde (MDA) and N-acetyl-ß-D-glucosaminidase (NAG) were taken as indicators of oxidative stress and renal tubule damage. We found about 73% of the residents to have consumed underground water. The average duration of consumption was 26 years, with an average of 1.6 L per day. Currently, only 1.5% of the residents still continuously consume underground water. The consumption of underground water positively correlated with heightened urinary TCA levels (r = 0.554). Heightened urinary TCA levels, in turn, were positively associated with NAG levels (r = 0.180) but negatively associated with MDA levels (r = -0.193). The results held even after we had segmented urinary TCA levels into three groups of different levels. The elimination of the source of heightened TCE levels from various industrial effluents is essential. Residents exposed to TCE-laden underground water should periodically undergo health inspections.

Moderating and Mediating Effects of Over-Commitment on the Association Between Effort-Reward Imbalance (ERI) with Upper Back and Hand/Wrist Disorders in Municipal Solid Waste Collectors.

PURPOSE: Despite repetitive activities and the frequency of high workload for municipal solid waste (MSW) collectors, the risks of work-related stress on upper extremity pain are inconclusive. The objective of this study is to assess the moderation and mediation effect of effort-reward imbalance (ERI) and over-commitment (OC) on upper back and hand/wrist disorders in MSW collectors. METHODS: A cross-sectional study was conducted with MSW collectors from two cities in Taiwan. Each participant was asked to anonymously fill out a structured questionnaire. Work-related stress, including ERI and OC, was assessed by a Chinese version of the Job Content Questionnaire (C-JCL). Upper back and hand/wrist disorders were assessed using the Nordic musculoskeletal questionnaire. Multivariate analysis was used to assess moderation and mediation effect of OC and ERI on upper extremity pain. RESULTS: The moderation effect of ERI and OC on upper back and hand/wrist disorders in MSW collectors was found. Disorders were higher in the group with both ERI ≥1 and high OC (OR (odds ratio) = 3.25 and OR = 3.00) than in the group with ERI ≥1 and low OC (OR = 2.66 and OR = 1.87) and in the ERI <1 and high OC group (OR = 2.27 and OR = 1.26). Synergy indexes were 0.77 and 1.77, respectively. Using multivariate analysis after adjusting for covariates, the mediation effect of OC was significant for the association between ERI and upper back and hand/wrist pains. The indirect effects of OC for upper back and hand/wrist pains accounted for 35% and 42%, respectively, and OC appears to mediate the relationship between ERI and upper back and hand/wrist disorders in MSW collectors. CONCLUSION: Work-related stress measured ERI and OC may play a role in moderating and mediating effects on upper extremity pain. Encouraging provisions of work modification and stress management is needed to mitigate the occurrence of upper extremities pain in MSW collectors.