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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 24172

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Dr. Evridiki Patelarou

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Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
Interests: epidemiology; public health; health promotion; disease prevention; evidence-based practice
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Dr. Athina E. Patelarou

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Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71500 Crete, Greece
Interests: evidence-based practice; nursing; genetics; genomics; precision care; education; simulation; healthcare
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Dr. Enkeleint A. Mechili

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Department of Healthcare, Faculty of Health, University of Vlora, 9401 Vlora, Albania
Interests: public health; health policy; epidemiology; primary care
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Special Issue Information

Dear Colleagues,

It is a great pleasure to introduce this Special Edition on “Epidemiology and Global Health”. A disease that appears in a special geographic area can be presented everywhere. Currently, more than ever, discussing global health issues is of high importance. In order to improve global health, the United Nations have included a third sustainable goal that focuses on “Good Health and Well-Being”. The global health community is dealing with many health challenges such as non-communicable diseases (e.g., cancer, diabetes, cardiovascular and respiratory diseases), drug resistance, health inequalities, immunisation, communicable diseases, suicide, air pollution and climate change, healthy ageing, etc. The COVID-19 pandemic has made it clearer than ever that collaboration between countries and coordinated work is needed to address health challenges. This Special Edition aims to present aspects of contemporary health issues both on its epidemiology aspect as well as on their general impact on global health. This edition is not focused on a specific geographic area, while use of both qualitative and quantitative methods are very welcome. Additionally, articles that focus on social and cultural determinants of health, on measurement of health status and healthcare systems are of high priority. To some extent, articles that use interdisciplinary approach and aim to change the health behaviour through education are welcome.

Dr. Evridiki Patelarou
Dr. Athina E. Patelarou
Dr. Enkeleint A. Mechili
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

global health
epidemiology
health status
healthcare systems
qualitative approach
quantitative approach
mix methods
health education
health determinants
air pollution
climate change
reproductive- child health
healthy ageing
pandemic
COVID19

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Related Special Issue

COVID-19 Vaccination, Role of Vaccines and Global Health in Vaccines (30 articles)

Published Papers (10 papers)

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Research

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18 pages, 2118 KiB

Open AccessArticle

Suit the Remedy to the Case—The Effectiveness of COVID-19 Nonpharmaceutical Prevention and Control Policies Based on Individual Going-Out Behavior

by Siqing Shan, Feng Zhao, Menghan Sun, Yinong Li and Yangzi Yang

Int. J. Environ. Res. Public Health 2022, 19(23), 16222; https://doi.org/10.3390/ijerph192316222 - 4 Dec 2022

Viewed by 1416

Abstract

Nonpharmaceutical policies for epidemic prevention and control have been extensively used since the outbreak of COVID-19. Policies ultimately work by limiting individual behavior. The aim of this paper is to evaluate the effectiveness of policies by combining macro nonpharmaceutical policies with micro-individual going-out behavior. For different going out scenarios triggered by individual physiological safety needs, friendship needs, and family needs, this paper categorizes policies with significant differences in intensity, parameterizes the key contents of the policies, and simulates and analyzes the effectiveness of the policies in different going-out scenarios with simulation methods. The empirical results show that enhancing policy intensity can effectively improve policy effectiveness. Among different types of policies, restricting the times of going out is more effective. Further, the effect of controlling going out based on physiological safety needs is better than other needs. We also evaluate the policy effectiveness of 26 global countries or regions. The results show that the policy effectiveness varies among 26 countries or regions. The quantifiable reference provided by this study facilitates decision makers to establish policy and practices for epidemic prevention and control. Full article

(This article belongs to the Special Issue Epidemiology and Global Health)

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13 pages, 415 KiB

Open AccessArticle

Using Random Effect Models to Produce Robust Estimates of Death Rates in COVID-19 Data

by Amani Almohaimeed, Jochen Einbeck, Najla Qarmalah and Hanan Alkhidhr

Int. J. Environ. Res. Public Health 2022, 19(22), 14960; https://doi.org/10.3390/ijerph192214960 - 14 Nov 2022

Cited by 3 | Viewed by 1625

Abstract

Tracking the progress of an infectious disease is critical during a pandemic. However, the incubation period, diagnosis, and treatment most often cause uncertainties in the reporting of both cases and deaths, leading in turn to unreliable death rates. Moreover, even if the reported counts were accurate, the “crude” estimates of death rates which simply divide country-wise reported deaths by case numbers may still be poor or even non-computable in the presence of small (or zero) counts. We present a novel methodological contribution which describes the problem of analyzing COVID-19 data by two nested Poisson models: (i) an “upper model” for the cases infected by COVID-19 with an offset of population size, and (ii) a “lower” model for deaths of COVID-19 with the cases infected by COVID-19 as an offset, each equipped with their own random effect. This approach generates robustness in both the numerator as well as the denominator of the estimated death rates to the presence of small or zero counts, by “borrowing” information from other countries in the overall dataset, and guarantees positivity of both the numerator and denominator. The estimation will be carried out through non-parametric maximum likelihood which approximates the random effect distribution through a discrete mixture. An added advantage of this approach is that it allows for the detection of latent subpopulations or subgroups of countries sharing similar behavior in terms of their death rates. Full article

(This article belongs to the Special Issue Epidemiology and Global Health)

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13 pages, 1999 KiB

Open AccessArticle

Impact of Respiratory Syncytial Virus and Influenza Virus Infection in the Adult Population in Spain between 2012 and 2020

by Marco Heppe-Montero, Ruth Gil-Prieto, Jorge del Diego Salas, Valentín Hernández-Barrera and Ángel Gil-de-Miguel

Int. J. Environ. Res. Public Health 2022, 19(22), 14680; https://doi.org/10.3390/ijerph192214680 - 9 Nov 2022

Cited by 16 | Viewed by 3768

Abstract

Respiratory syncytial virus (RSV) infection is increasingly recognized as a cause of significant morbidity and mortality in adults. We aimed to estimate the rates of age-specific hospitalization and in-hospital mortality caused by acute lower respiratory tract infections (ALRTIs) in Spain between 2012 and 2020 and to compare the relative impact of RSV and influenza virus infection in adults. We used the discharge reports from the Minimum Basic Data Set to retrospectively analyze hospital discharge data on the basis of the ICD-9-CM and ICD-10-CM diagnosis codes. A total of 1,518,244 patients were hospitalized for ALRTIs, of whom 137,794 (9.1%) were admitted for RSV-related infections and 46,288 (3.0%) for influenza-related infections. In patients aged 60 years or older, the hospitalization rates (per 100,000 population) were estimated at 1.69 (95% CI 1.68–1.70) and 2.72 (95% CI 2.71–2.73) for RSV and influenza patients, respectively. However, in-hospital mortality rates were significantly higher among RSV patients than among influenza patients, 7.91% (95% CI 7.89–7.93) (83.0% of all RSV-related deaths) versus 6.91% (95% CI 6.89–6.93) (85.6% of all influenza-related deaths), respectively (p = 0.007). RSV-associated in-hospital mortality increases exponentially with age, posing a greater risk for older adults, particularly frail and high-risk patients. Full article

(This article belongs to the Special Issue Epidemiology and Global Health)

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10 pages, 1626 KiB

Open AccessArticle

Pharmaceutical Incompatibility of Lubricating Gel Formulation Reduces Antibacterial Activity of Chlorhexidine Gluconate: In Vitro Study in Northern Thailand

by Thanawat Pattananandecha, Sasithorn Sirilun, Sutasinee Apichai, Teerapat Ouirungroj, Phisit Uirungroj, Fumihiko Ogata, Naohito Kawasaki and Chalermpong Saenjum

Int. J. Environ. Res. Public Health 2022, 19(19), 12285; https://doi.org/10.3390/ijerph191912285 - 27 Sep 2022

Cited by 2 | Viewed by 2658

Abstract

Chlorhexidine gluconate (CHG) is a cationic disinfectant. The positive charge of CHG molecules binds to phospholipid’s negative charge in bacterial cell walls, causing membrane disruption. The in vitro kinetic physical, chemical and biological incompatibilities of nine lubricating gels with 1% w/v CHG were investigated. Five containing anionic thickener, two containing nonionic thickener, and two containing cationic thickener were collected from hospitals in northern Thailand. All the anionic and nonionic lubricating gels significantly reduced (p < 0.05) the CHG amount after 5 min of exposure time from 12.54% to 54.99%, respectively. In contrast, the amount of CHG exposed with cationic lubricating gels was maintained. Antibacterial activity was significantly reduced to a 1.17–4.33 log10 reduction for Staphylococcus aureus ATCC25923 and a 1.07–3.52 log10 reduction for Escherichia coli ATCC25922 after 5 min exposure to all anionic and nonionic lubricating gels. In contrast, the two cationic lubricating gels maintained the antibacterial activity of the CHG solution (5.69 ± 0.14 and 5.45 ± 0.17 log10 reduction). The results suggest that anionic and nonionic thickeners in lubricating gel formulations may neutralize the positive charge and reduce the antibacterial activity of CHG, reducing its effectiveness as a disinfectant. Full article

(This article belongs to the Special Issue Epidemiology and Global Health)

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17 pages, 11073 KiB

Open AccessArticle

Multi-Impacts of Spatial Self-Policing during COVID-19: Evidence from a Chinese University

by Yuan Sun, Zhu Wang, Zhi Qiu and Congyue Zhou

Int. J. Environ. Res. Public Health 2022, 19(19), 12172; https://doi.org/10.3390/ijerph191912172 - 26 Sep 2022

Cited by 3 | Viewed by 1872

Abstract

Current research has focused on the impacts of the COVID-19 pandemic on university students’ physical and mental health conditions but has rarely examined the secondary effects caused by school management and prevention policies. Chinese universities generally took a self-policing strategy to address the COVID-19 pandemic. This study aimed to examine how the self-policing effect fluctuated during the pandemic, assessed from the perspective of university students. We collected monthly data from January 2020 to August 2022 from Zhejiang University’s online forum CC98 and analyzed the monthly frequency of keywords in the online posts’ titles. The dataset covered five topics: pandemic situations, epidemic prevention policies, campus access control, campus space use, and emotional conditions. The results showed that university students have expressed concern about the pandemic over the past thirty-two months, which still has an unignorable influence on their lives and studies. They paid more attention to the epidemic prevention policies, which directly affected their social connections, spatial use, and psychological well-being. University students gradually questioned their duty to obey and showed impatience and resistance toward school self-policing management, especially during the second Omicron wave. Additionally, the findings investigated an introverted trend for university students living in a gated campus environment. In conclusion, we call for reflections on the current Chinese campus self-policing strategy to cope with future long-term and normalized pandemic situations. The concerns of university students should be taken into account as we move toward a post-COVID-19 world. Full article

(This article belongs to the Special Issue Epidemiology and Global Health)

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10 pages, 1485 KiB

Open AccessArticle

Spatio-Temporal Variation of Lung Cancer in Crete, 1992–2013. Economic or Health Crisis?

by Dimitra Sifaki-Pistolla, Vasiliki Eirini Chatzea, Enkeleint A. Mechili, Filippos Koinis, Vassilis Georgoulias, Christos Lionis and Nikos Tzanakis

Int. J. Environ. Res. Public Health 2022, 19(19), 12161; https://doi.org/10.3390/ijerph191912161 - 26 Sep 2022

Cited by 1 | Viewed by 1598

Abstract

(1) Background: This is the first population-based study in Greece, with the aim to measure the changing trends of lung cancer (LC) and the associated risk factors before and after the economic crisis. Among the main objectives were the identification of LC hot spots and high-risk areas; (2) Methods: The study was conducted in Crete, the biggest island in Greece. Data (5057 LC cases) were collected from the Cancer Registry of Crete (CRC). The age-standardized incidence and mortality rates (ASIR, ASMR/100,000/year) were estimated, while additional indexes were used, including the adjusted Charlson’s comorbidity index (CCI%), the deprivation index (HPI-2), and the exposure to outdoor air pollution (OAP). The analysis was performed for two time periods (Period A: 1992–2008; Period B: 2009–2013); (3) Results: ASIR presented a significant increase during the economic crisis, while an even higher increase was observed in ASMR (Period A: ASMR = 30.5/100,000/year; Period B: ASMR = 43.8/100,000/year; p < 0.001). After 2009, a significant increase in the observed LC hot spots was identified in several sub-regions in Crete (p = 0.04). The risk of LC mortality increased even more for smokers (RR = 5.7; 95%CI = 5.2–6.3) and those living in highly deprived geographical regions (RR = 5.4; 95%CI = 5.1–5.8) during the austerity period. The multiple effect of LC predictors resulted in adjusted RRs ranging from 0.7 to 5.7 within the island (p < 0.05); (4) Conclusions: The increased LC burden after the onset of the economic crisis, along with a changing pattern of LC predictors stressed the urgent need of geographically oriented interventions and cancer control programs focusing on the most deprived or vulnerable population groups. Full article

(This article belongs to the Special Issue Epidemiology and Global Health)

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16 pages, 3816 KiB

Open AccessArticle

A Study on a Neural Network Risk Simulation Model Construction for Avian Influenza A (H7N9) Outbreaks in Humans in China during 2013–2017

by Wen Dong, Peng Zhang, Quan-Li Xu, Zhong-Da Ren and Jie Wang

Int. J. Environ. Res. Public Health 2022, 19(17), 10877; https://doi.org/10.3390/ijerph191710877 - 31 Aug 2022

Cited by 1 | Viewed by 1919

Abstract

The main purposes of this study were to explore the spatial distribution characteristics of H7N9 human infections during 2013–2017, and to construct a neural network risk simulation model of H7N9 outbreaks in China and evaluate their effects. First, ArcGIS 10.6 was used for spatial autocorrelation analysis, and cluster patterns ofH7N9 outbreaks were analyzed in China during 2013–2017 to detect outbreaks’ hotspots. During the study period, the incidence of H7N9 outbreaks in China was high in the eastern and southeastern coastal areas of China, with a tendency to spread to the central region. Moran’s I values of global spatial autocorrelation of H7N9 outbreaks in China from 2013 to 2017 were 0.080128, 0.073792, 0.138015, 0.139221 and 0.050739, respectively (p < 0.05) indicating a statistically significant positive correlation of the epidemic. Then, SPSS 20.0 was used to analyze the correlation between H7N9 outbreaks in China and population, livestock production, the distance between the case and rivers, poultry farming, poultry market, vegetation index, etc. Statistically significant influencing factors screened out by correlation analysis were population of the city, average vegetation of the city, and the distance between the case and rivers (p < 0.05), which were included in the neural network risk simulation model of H7N9 outbreaks in China. The simulation accuracy of the neural network risk simulation model of H7N9 outbreaks in China from 2013 to 2017 were 85.71%, 91.25%, 91.54%, 90.49% and 92.74%, and the AUC were 0.903, 0.976, 0.967, 0.963 and 0.970, respectively, showing a good simulation effect of H7N9 epidemics in China. The innovation of this study lies in the epidemiological study of H7N9 outbreaks by using a variety of technical means, and the construction of a neural network risk simulation model of H7N9 outbreaks in China. This study could provide valuable references for the prevention and control of H7N9 outbreaks in China. Full article

(This article belongs to the Special Issue Epidemiology and Global Health)

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11 pages, 982 KiB

Open AccessArticle

Gram-Negative Rods on Inanimate Surfaces of Selected Hospital Facilities and Their Nosocomial Significance

by Ondrej Zahornacký, Štefan Porubčin, Alena Rovňáková and Pavol Jarčuška

Int. J. Environ. Res. Public Health 2022, 19(10), 6039; https://doi.org/10.3390/ijerph19106039 - 16 May 2022

Cited by 7 | Viewed by 2160

Abstract

Inanimate surfaces are often referred to as nosocomial bacterial reservoirs and represent an important vector in the process of spreading pathogens to patients. Most gram-negative rods can survive on inanimate surfaces for several months. The aim of this study is to determine the prevalence and resistance of gram-negative bacteria isolated from the inanimate surfaces of two selected hospital departments. MALDI-TOF identified gram-negative rods isolated from inanimate surfaces. Antibiotic resistance was determined using a disk diffusion method, and the phenotype of resistance was determined using an inhibitory analyzer. From the inanimate surfaces, 98 strains of gram-negative nosocomial bacteria were identified by the MALDI-TOF MS. The most frequently isolated bacterium occurring in both departments was Pseudomonas aeruginosa (n = 33), followed by Acinetobacter baumannii (n = 20) and Enterobacter cloacae (n = 14). The most common phenotypic type of resistance in both departments was ampicillin resistance—AmpC (n = 38), then production of extended-spectrum β-lactamase (ESBL) (n = 33), followed by SHV-1 (n = 11), TEM-1 (n = 11), and fluoroquinolone resistance—Qnr (n = 22). The nosocomial important enzymes capable of hydrolyzing carbapenems, OXA-48 and metallo-β-lactamases, were confirmed in 12 and 2 cases, respectively. The results of our study prove that inanimate surfaces in hospitals are a reservoir of resistant gram-negative bacteria, which directly threaten hospitalized patients. Full article

(This article belongs to the Special Issue Epidemiology and Global Health)

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11 pages, 621 KiB

Open AccessArticle

Breakdown of Diabetic Foot Ulcer Care during the First Year of the Pandemic in Poland: A Retrospective National Cohort Study

by Marcin Kleibert, Beata Mrozikiewicz-Rakowska, Patrycja Małgorzata Bąk, Daniel Bałut, Jakub Zieliński and Leszek Czupryniak

Int. J. Environ. Res. Public Health 2022, 19(7), 3827; https://doi.org/10.3390/ijerph19073827 - 23 Mar 2022

Cited by 9 | Viewed by 2589

Abstract

The COVID-19 pandemic revealed a breakdown of the system of DFU patient care. This retrospective national cohort study analyses the epidemiological status of DFU patients in relation to urgent and elective hospitalizations, amputation rates, and deaths in Poland from 2017 to 2019, and during 2020 when the COVID-19 pandemic began. The data were obtained from national medical records gathered by the National Health Fund (NHF). Discharge diagnoses were categorized according to ICD-10 and ICD-9 codes. Analysis of the data showed a statistically significant decrease in elective hospital admissions (from 29.6% to 26.3%, p = 0.001). There was a decrease in the percentage of hospitalizations related to limb-salvage procedures (from 79.4% to 71.3%, p = 0.001). The opposite tendency was observed among urgent hospital admissions (from 67.0% to 73.2%, p = 0.01), which was related to a significant increase in the number of minor amputations (from 3146 to 4269, p = 0.017). This rise was in parallel with the increase in the percentage of patients who died during hospitalization due to DFU (from 3.9% to 4.8%, p = 0.03). The number of deaths has not changed significantly (from 590.7 to 668.0, p = 0.26). The results of the conducted analyses confirm the negative tendencies in the medical care of patients with DFU during the first year of the pandemic in Poland. Changes in therapy schemes and stronger patient support following this period are necessary to avoid further complications in patients with DFU. Full article

(This article belongs to the Special Issue Epidemiology and Global Health)

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Review

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11 pages, 3357 KiB

Open AccessReview

Evidence-Based Conceptual Collection of Methods for Spatial Epidemiology and Analysis to Enhance Cancer Surveillance and Public Health

by Dimitra Sifaki-Pistolla, Vasiliki Eirini Chatzea, Elpiniki Frouzi, Enkeleint A. Mechili, Georgia Pistolla, George Nikiforidis, Vassilis Georgoulias, Christos Lionis and Nikos Tzanakis

Int. J. Environ. Res. Public Health 2022, 19(19), 12765; https://doi.org/10.3390/ijerph191912765 - 6 Oct 2022

Cited by 6 | Viewed by 2265

Abstract

(1) Background: Although spatial statistics are often used by cancer epidemiologists, there is not yet an established collection of methods to serve their needs. We aimed to develop an evidence-based cancer-oriented conceptual collection of methods for spatial analysis; (2) Methods: A triangulation of approaches was used; literature review, consensus meetings (expert panel), and testing the selected methods on “training” databases. The literature review was conducted in three databases. This approach guided the development of a collection of methods that was subsequently commented on by the expert panel and tested on “training data” of cancer cases obtained from the Cancer Registry of Crete based on three epidemiological scenarios: (a) low prevalence cancers, (b) high prevalence cancers, (c) cancer and risk factors; (3) Results: The final spatial epidemiology conceptual collection of methods covered: data preparation/testing randomness, data protection, mapping/visualizing, geographic correlation studies, clustering/surveillance, integration of cancer data with socio-economic, clinical and environmental factors. Some of the tests/techniques included in the conceptual collection of methods were: buffer and proximity analysis, exploratory spatial analysis and others. All suggested that statistical models were found to fit well (R2 = 0.72–0.96) in “training data”; Conclusions: The proposed conceptual collection of methods provides public health professionals with a useful methodological framework along with recommendations for assessing diverse research questions of global health. Full article

(This article belongs to the Special Issue Epidemiology and Global Health)

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