BMJ public health最新文献

{"title":"Problem of pain in the USA: evaluating the generalisability of high-impact chronic pain models over time using National Health Interview Survey (NHIS) data.","authors":"Titilola Falasinnu, Md Belal Hossain, Mohammad Ehsanul Karim, Kenneth Arnold Weber, Sean Mackey","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>High-impact chronic pain (HICP) significantly affects the quality of life for millions of U.S. adults, imposing substantial economic/healthcare burdens. Disproportionate effects are observed among racial/ethnic minorities and older adults.</p><p><strong>Methods: </strong>We leveraged the National Health Interview Survey (NHIS) from 2016 (n=32,980), 2017 (n=26,700), and 2021 (n=28,740) to validate and develop analytical models for HICP. Initial models (2016 NHIS data) identified correlates associated with HICP, including hospital stays, diagnosis of specific diseases, psychological symptoms, and employment status. We assessed the models' generalizability and drew comparisons across time. We constructed five validation scenarios to account for variations in the availability of predictor variables across datasets and different time frames for pain assessment questions. We used logistic regression with LASSO and random forest techniques. We assessed model discrimination, calibration, and overall performance using metrics such as area under the curve (AUC), calibration slope, and Brier score.</p><p><strong>Results: </strong>Scenario 1, validating the NHIS 2016 model against 2017 data, demonstrated excellent discrimination with an AUC of 0.89 (95% CI: 0.88-0.90) for both LASSO and random forest models. Subgroup-specific performance varied, with the lowest AUC among adults aged ≥65 years (0.81, 95% CI: 0.78-0.82) and the highest among Hispanic respondents (0.91, 95% CI: 0.88-0.94). Model calibration was generally robust, although underfitting was observed for Hispanic respondents (calibration slope: 1.31). Scenario 3, testing the NHIS 2016 model on 2021 data, showed reduced discrimination (AUC: 0.82, 95% CI: 0.81-0.83) and overfitting (calibration slopes < 1). De novo models based on 2021 data showed comparable discrimination (AUC: 0.86, 95% CI: 0.85-0.87) but poorer calibration when validated against older datasets.</p><p><strong>Conclusion: </strong>These findings underscore the potential of these models to guide personalized medicine strategies for HICP, aiming for more preventive rather than reactive healthcare. However, the model's broader applicability requires further validation in varied settings and global populations.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterising the killing of girls and women in urban settings in Latin America, 2000–2019: an analysis of variability and time trends using mortality data from vital registration systems","authors":"B. Trejo, Yvonne L. Michael, Ana V. Diez Roux, Brisa N. Sánchez, Nina Sun, Heidi Stöckl, Dèsirée Vidaña-Pérez, Catalina Correa-Salazar, A. Ortigoza, A. A. de Lima Friche, Vanessa DiCecco, Mónica Mazariegos, U. Bilal","doi":"10.1136/bmjph-2024-000985","DOIUrl":"https://doi.org/10.1136/bmjph-2024-000985","url":null,"abstract":"Latin America is burdened by high levels of violence. Although boys and men often experience more violence and fatalities, girls and women face a greater risk of being killed by family members or intimate partners due to their gender, a phenomenon known as femicide. Our study estimates femicide rates in Latin America across age groups, examining city-level variations and temporal trends.Utilising data from theSalud Urbana en America Latinaproject, we analysed mortality data from 343 cities in nine countries between 2000 and 2019. We calculate the variability between and within countries using data from 2015 to 2019. We then describe time trends using femicide counts by year and city and fitting a three-level negative binomial model with a random intercept for country, fixed effects for age categories, and city-level and country-level random slopes for time (scaled to decades). Finally, we assess longitudinal time trends by age by including an interaction term for age and time (scaled to decades).Our results highlight substantial heterogeneity in femicide rates within and between countries. Additionally, we find that women 15–29 and 30–44 years of age experience the highest femicide rates across all countries. While our findings suggest a slight decline in femicide rates per additional decade (RR 0.95, 95% CI: 0.74 to 1.24) between 2000 and 2019, the trends diverge in different countries, suggesting increasing rates in some countries like Mexico. Age-specific trends suggest the persistence of higher rates among women 15–29 and 30–44 years of age over time.We underscore the need to consider gender dynamics in understanding and preventing femicides, focusing on city-level interventions to address the multifaceted causes of violence against girls and women in the region.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"8 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Industry of employment and occupational class in relation to cardiovascular health by race/ethnicity, sex/gender, age and income among adults in the USA: a cross-sectional study.","authors":"Jamie A Murkey, Symielle A Gaston, Dana M Alhasan, W Braxton Jackson, Chandra L Jackson","doi":"10.1136/bmjph-2023-000726","DOIUrl":"10.1136/bmjph-2023-000726","url":null,"abstract":"<p><strong>Background: </strong>Racially minoritised groups tend to have poorer cardiovascular health (CVH) than non-Hispanic (NH)-White adults and are generally more likely to work in labourer or support service positions where job strain-associated with cardiovascular disease-is often high. Yet, few studies have included racially/ethnically diverse samples.</p><p><strong>Methods: </strong>Using 2004-2018 National Health Interview Survey cross-sectional data, we investigated standardised occupational classifications in relation to 'ideal' CVH using a modified 'ideal' CVH (mICVH) metric among US adults (n=230 196) by race/ethnicity, sex/gender, age, and income. mICVH was defined as a report of 'yes' to the following: never smoked/former smoker; body mass index (≥18.5-25 kg/m²); physical activity (≥150-300 min/week moderate or ≥75-150 min/week vigorous); sleep duration (7-9 hours/night); and no prior diagnosis of dyslipidaemia, hypertension, or diabetes/pre-diabetes. Adjusting for sociodemographic, clinical factors, and health behaviour confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% CIs of mICVH overall and by race/ethnicity and performed Wald tests for interaction.</p><p><strong>Results: </strong>Latinx (53%) and NH-Black (37%) adults were more likely than NH-White adults (29%) to report labourer positions and had the lowest prevalence of mICVH (5.2% (Latinx) and 3.9% (NH-Black)). Labourer versus professional/management occupational class positions were associated with a lower mICVH prevalence among NH-Asian (PR=0.60 (0.46-0.79)), NH-White (PR=0.80 (0.74-0.87)) and NH-Black (PR=0.77 (0.58-1.01)), but with no evidence of an association among Latinx (PR=0.94 (0.78-1.14) adults; p interaction <0.001).</p><p><strong>Conclusions: </strong>In conclusion, working in labourer versus professional/management positions was associated with lower mICVH, except among Latinx adults. Given the higher likelihood of labourer occupations and lower prevalence of mICVH among minoritised racial/ethnic groups, social determinants related to occupational class should be considered in future studies of racial and ethnic disparities in CVH.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suicide in Hong Kong during the COVID-19 pandemic: an observational study","authors":"A. Bai, Jinjian Li, Yuhang Pan, Yu Jiang","doi":"10.1136/bmjph-2024-001125","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001125","url":null,"abstract":"The COVID-19 pandemic has exacerbated suicide risk factors in Hong Kong, which faces economic shocks and strict travel restrictions due to its unique economic structure and geographical location. However, there is a scarcity of reliable empirical evidence regarding the relationship between the pandemic and suicide mortality. This study examines whether changes in the suicide rate align with COVID-19 situations and anti-COVID-19 policy events in Hong Kong, focusing on vulnerable population groups based on demographic and socioeconomic characteristics.Suicide data spanning 1 January 2019 to 31 December 2022 were sourced from the Hong Kong Suicide Press Database. Case-level data were aggregated monthly by district. Population-weighted Poisson regression with district-level fixed effects was employed to analyse suicide patterns and their association with COVID-19 developments. Robustness checks and demographic-based heterogeneity analysis were conducted, distinguishing suicide risk among different population groups.A total of 4061 suicide cases were analysed, encompassing deaths and attempts. The first wave of the pandemic saw a 30% decline in suicide cases compared with the 2019 average, while the second and fifth waves witnessed increases of 33% and 51% in suicide rates, respectively. Older adults and individuals with lower socioeconomic status were particularly susceptible to the adverse effects, as evidenced by a significant rise in suicides during the fifth wave.The findings underscore the importance of targeted interventions to address the mental health needs of vulnerable populations during pandemics, highlighting the impact of COVID-19 situations and antipandemic policies on the suicide rate.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between coexisting hypertension, dyslipidaemia and elevated C reactive protein with cardiovascular disease and mortality: a cross-sectional and longitudinal analysis in a representative cohort of older US adults.","authors":"Thomas Karadimas, Helen C S Meier","doi":"10.1136/bmjph-2023-000455","DOIUrl":"10.1136/bmjph-2023-000455","url":null,"abstract":"<p><strong>Objective: </strong>Hypertension and dyslipidemia are established risk factors for cardiovascular disease (CVD), but are often insufficient alone in predicting CVD. Inflammation also contributes to CVD, but research on the co-occurrence of inflammation, hypertension, and dyslipidemia and CVD risk is limited. Knowledge of inflammatory status in addition to other risk factors is vital for clinicians to correctly evaluate patients for CVD risk.</p><p><strong>Methods: </strong>Prospective data from the Health and Retirement Study, a representative cohort of US adults over 50 years of age (n = 7895) were used. The average participant age was 68.8 years, and 54.9% were female. 80.7% were Non-Hispanic White, 10.1% were Non-Hispanic Black, and 9.2% were Hispanic. Hypertension, dyslipidemia, and elevated C-reactive protein (CRP) were used to create a CVD risk score: low (0-1 factors), medium (2 factors), or high (all 3 factors). Measurement and definition guidelines for these variables are thoroughly explained in the methods section. Weighted logistic regression models estimated the odds ratio (OR) of 1) prevalent and incident CVD for medium and high-risk groups versus the low-risk group and 2) 4-year mortality adjusting for covariates.</p><p><strong>Results: </strong>Cross-sectionally, high-risk participants (n=1706) had significantly higher odds of CVD prevalence compared to participants with low-risk (n=3107) (adjusted OR = 1.54, 95% CI: [1.29 - 1.84]). Medium-risk (n=3082) participants had higher odds of CVD prevalence, though this did not reach significance. Prospectively, medium and high-risk participants had significantly higher odds of 4-year CVD incidence (medium-risk adjusted OR = 1.57, 95% CI: [1.18 - 2.09]; high-risk adjusted OR = 1.67, 95% CI: [1.19 - 2.36]) compared to those with low-risk. Risk of 4-year mortality was higher in high-risk (OR = 2.12, 95% CI: [1.60 - 2.8]) participants vs. low-risk, and non-significantly elevated in medium-risk participants.</p><p><strong>Conclusions: </strong>Co-occurrence of hypertension, dyslipidemia, and elevated CRP was strongly associated with increased CVD prevalence, higher incident CVD, and elevated 4-year mortality in older US adults, emphasizing the importance of multifactor screening for CVD risk.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"2 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current and potential contributions of large-scale food fortification to meeting micronutrient requirements in Senegal: a modelling study using household food consumption data.","authors":"Katherine P Adams, Reina Engle-Stone, Brent Wibberley, Becky L Tsang, Ann Tarini, Maguette Beye, Laura A Rowe","doi":"10.1136/bmjph-2024-001221","DOIUrl":"10.1136/bmjph-2024-001221","url":null,"abstract":"<p><strong>Introduction: </strong>Micronutrient deficiencies are common among women of reproductive age (WRA) and children in Senegal. Large-scale food fortification (LSFF) can help fill gaps in dietary intakes.</p><p><strong>Methods: </strong>We used household food consumption data to model the contributions of existing LSFF programs (vitamin A-fortified refined oil and iron and folic acid-fortified wheat flour) and the potential contributions of expanding these programs to meeting the micronutrient requirements of WRA (15-49 years) and children (6-59 months).</p><p><strong>Results: </strong>Without fortification, apparent inadequacy of household diets for meeting micronutrient requirements exceeded 70% for vitamin A, thiamin, riboflavin, folate, and zinc, was 61% for iron among WRA (43% among children), and was ~25% for vitamin B12. At estimated current compliance, fortified refined oil was predicted to reduce vitamin A inadequacy to ~35%, and could further reduce inadequacy to ~25% if compliance with the standard improved. Fortified wheat flour at estimated current compliance reduced iron and, especially, folate inadequacy, but improvements in compliance would be necessary to achieve the full potential. Beyond existing programs, expanding wheat flour fortification to include additional micronutrients was predicted to have a modest impact on thiamin and riboflavin inadequacies and larger impacts on vitamin B12 and, especially, zinc inadequacies. Adding a program to import fortified rice could further reduce inadequacies of multiple micronutrients (generally by > 10 percentage points), although potential risk of high intake of vitamin A, folic acid, and zinc among children should be carefully considered. With both wheat flour and rice fortification, predicted prevalence of vitamin A, iron, and zinc inadequacy remained above 25% in some regions, pointing to the potential need for coordinated, targeted micronutrient interventions to fully close gaps.</p><p><strong>Conclusions: </strong>When considered alongside evidence on the cost and affordability of these programs, this evidence can help inform the development of a comprehensive micronutrient intervention strategy in Senegal.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"2 2","pages":"e001221"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Two sides of the same coin’? A longitudinal analysis evaluating whether financial austerity accelerated NHS privatisation in England 2013-2020","authors":"B. Goodair, A. Bach-Mortensen, Aaron Reeves","doi":"10.1136/bmjph-2024-000964","DOIUrl":"https://doi.org/10.1136/bmjph-2024-000964","url":null,"abstract":"To understand the relationship between increasing privatisation of the NHS and austerity cuts to public funding.Longitudinal analysis.170 Clinical Commissioning Groups (CCGs) in England between 2013 and 2020.The UK austerity programme, spearheaded by the conservative-led governments of the 2010s, leveraged the 2008 financial crisis to roll-back spending to local government and social security spending. They also restricted the rate of growth in NHS spending—but cuts varied for different areas, often impacting deprived areas hardest.For-profit outsourcing by NHS commissioners. After the implementation of the 2012 Health and Social Care act commissioners were encouraged and obliged to open contracts to the private sector. The uptake of for-profit outsourcing varied massively. Some CCGs contracted out almost half of their activity, and others almost none.We calculate the size of austerity across all CCGs. The financial restrictions meant that commissioners had, on average, £21.2 m more debt by 2021 than in 2014 in real terms. We find that there is a null and very small effect of changes to local NHS funding on for-profit outsourcing. A decrease in £100 per capita of NHS funding corresponds in a decrease in 0.441 percentage points (95% CI −0.240 to 1.121) of for-profit expenditure. We also find that local changes to public expenditure on the NHS, local government and social security do not confound the relationship between for-profit outsourcing and treatable mortality rates.NHS privatisation at the local level does not appear to be a direct response to or result of austerity. That does not mean that it is unproblematic. Rather than being confounded by funding levels, the deteriorating health outcomes associated with privatisation should be considered as a distinct concern to the disastrous health effects of austerity policies.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic evaluation of Maternal Depression Treatment in HIV (M-DEPTH) for perinatal depression among women living with HIV in Uganda: a cost-effectiveness analysis","authors":"Ryan McBain, Adeyemi Okunogbe, Violet Gwokyalya, R. Wanyenze, Glenn Wagner","doi":"10.1136/bmjph-2023-000754","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000754","url":null,"abstract":"We conducted a cost-effectiveness analysis of an evidence-based collaborative care model for treatment of perinatal depression among women living with HIV in Uganda.Maternal Depression Treatment in HIV (M-DEPTH) is a cluster randomised controlled trial implemented from July 2019 to August 2023, during which 391 pregnant women with mild-to-severe depressive symptoms were randomised to receive stepped care for depression (M-DEPTH: behavioural and pharmacological treatments) or care as usual (CAU: hospital referral for severe cases), at one of eight public health facilities in Uganda.We implemented time-driven, activity-based costing to determine the economic cost of M-DEPTH from a societal perspective, compared with CAU. Change in the prevalence of depressive disorder—from enrolment to 18 months postpartum—was quantified using the Patient Health Questionnaire, with depressive disorder assigned a disability weight according to the Global Burden of Disease project. Incremental cost-effectiveness ratios (ICERs) were expressed as cost per disability-adjusted life years (DALY) averted.The estimated economic cost of M-DEPTH was US$128.82 per participant, compared with $1.53 per participant for CAU. At baseline, prevalence of depressive disorder did not differ according to treatment assignment. Remission of depressive disorder was more prevalent among those assigned to M-DEPTH—across all time periods, including 18-month follow-up (aOR: 0.09; 95% CI 0.05 to 0.16; p<0.001). This yielded an ICER of $397 per DALY averted, when limiting benefits to those accrued over the study period. Sensitivity analyses generated estimates ranging from $162 to $418 per DALY averted.M-DEPTH represents a financially feasible task-shifted model of evidence-based perinatal depression screening and treatment. The intervention is cost-effective at a willingness-to-pay threshold of less than half of median gross domestic product per capita in Uganda.NCT03892915.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"22 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of vitamin D-related knowledge, attitudes and practices among Sultan Qaboos University students in Oman: a cross-sectional study","authors":"Rahma Said Al Hadhrami, Rehab Al Kaabi, Hajer Juma Al Shuaibi, Rawan Salim Al Abdulsalam","doi":"10.1136/bmjph-2023-000539","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000539","url":null,"abstract":"Vitamin D deficiency, a circulating level of 25-hydroxyvitamin D <30 nmol/L, has become an emerging public health issue in recent years. Despite being a sun-rich country, vitamin D deficiency is widespread in Oman (87.5%).This study aimed to evaluate knowledge, attitudes and practices regarding vitamin D among university students in Oman to assess the need for additional awareness campaigns.This descriptive, cross-sectional study was conducted from September to December 2022 and involved 399 students enrolled in various degree programmes at the Sultan Qaboos University (SQU) in Muscat, Oman, using self-administered, 38-item vitamin D-related KAP (D-KAP-38) questionnaire to collect information regarding the participants’ vitamin D-related general knowledge, nutritional knowledge, attitudes and practices.Of the 399 college students, 384 (96.2%) were Omani nationals, 283 (70.9%) were women and 255 (64.1%) were between the ages of 20 and 26 years. Overall, the participants demonstrated moderate general knowledge (mean D-KAP-38 score: 77.3), poor nutritional knowledge (mean D-KAP-38 score: 45.1), moderate attitudes (mean D-KAP-38 score: 64.4) and average practices (mean D-KAP-38 score: 60.0). In general, female students demonstrated greater general knowledge (p=0.004) and more positive attitudes (p=0.007) compared with males; however, males more frequently reported better practices (p<0.001). In addition, participants who lived off-campus reported better practices compared with those living on-campus (p<0.001).University students in Oman demonstrated moderate vitamin D-related general knowledge, attitudes and practices, while nutritional knowledge was poor.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"11 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and progression of chronic kidney disease among adults undergoing creatinine testing in South African public healthcare facilities: a study leveraging data from South Africa's National Health Laboratory Service (NHLS).","authors":"Alana T Brennan, Emma M Kileel, Siyabonga Khoza, Nigel J Crowther, Jacob Bor, Matthew P Fox, Sydney Rosen, Patricia Hibberd, Frederick Raal, Kamy Chetty, Koleka Mlisana, Jaya A George","doi":"10.1136/bmjph-2023-000799","DOIUrl":"10.1136/bmjph-2023-000799","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) has emerged as a substantial global health challenge, with a marked rise in associated mortality. However, it often goes undetected until advanced stages, particularly in low-income and middle-income countries such as South Africa. We investigated the prevalence and progression of CKD in South Africa, utilising a subset of data from the National Health Laboratory Services Multi-morbidity Cohort.</p><p><strong>Methods: </strong>This study was a retrospective analysis of adults aged 18-85 years who underwent initial creatinine laboratory testing at government hospitals and clinics from January 2012 to January 2016. CKD was assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, excluding the race factor, with a cut-off of CKD-EPI<60 mL/min/1.73 m². Lab-diagnosed CKD was defined as two estimated glomerular filtration rate measurements <60 mL/min/1.73 m² at least 90 days apart. Cox regression and survival curves were used to estimate HRs and rates of progression.</p><p><strong>Results: </strong>Among 6 106 521 adults tested between 2012 and 2016, 1.5% (95% CI 1.4% to 1.5%) were diagnosed with CKD, with the majority in stage 3. Over follow-up (median: 2 years, IQR: 0.8-3.6 years), 28.2% (95% CI 27.7% to 28.6%) of patients diagnosed as stage 3a progressed to a more severe disease state. Among patients who were in stage 3b at diagnosis, 29.6% (95% CI 29.0% to 30.1%) progressed and 33.3% (95% CI 32.5% to 34.1%) of stage 4 patients progressed. We estimated a 48% higher adjusted hazard of CKD progression for individuals with diabetes (adjusted HR 1.48, 95% CI 1.41 to 1.57) compared with those without. Advancing age also increased the risk, particularly for those aged >50 years.</p><p><strong>Conclusions: </strong>This study underscores the urgency for early detection and management of CKD in South Africa, particularly for high-risk individuals. Strengthening primary healthcare systems and raising CKD awareness are vital for improved patient outcomes and to alleviate the burden on healthcare resources. Early intervention can delay CKD progression, thus reducing the need for costly treatments like dialysis and transplantation.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}