BMJ public health最新文献

{"title":"Maternal immunisation towards prevention of neonatal tetanus: insights from a cross-sectional study in Pru East Municipality, Ghana.","authors":"Dennis Bardoe, Daniel Hayford, Isaac Owusu-Mensah, Robert Bagngmen Bio","doi":"10.1136/bmjph-2025-003200","DOIUrl":"10.1136/bmjph-2025-003200","url":null,"abstract":"<p><strong>Background: </strong>Although neonatal tetanus (NNT) has been eliminated in most countries, it remains prevalent in settings where poor hygiene during delivery and low maternal tetanus immunisation coverage persist. Protection against NNT requires at least two doses of tetanus-diphtheria vaccine (Td2+) during pregnancy. In Ghana, despite ongoing elimination efforts, 82 cases of NNT were reported in 2023, highlighting the need to address emerging gaps in surveillance and coverage. This study aimed to determine the prevalence and factors associated with Td2+ uptake among pregnant women in Pru East Municipality.</p><p><strong>Methods: </strong>A hospital-based cross-sectional study was conducted among 456 pregnant women from 22nd January to 15th April 2024. Data were collected using structured questionnaires, with Td2+ uptake verified from ANC cards. Descriptive statistics, chi-square tests, and logistic regression were performed in STATA 14. Variables with p ≤ 0.25 were adjusted in the multivariate model with 95% confidence intervals (CIs). Adjusted odds ratios (AORs) were calculated to estimate the strength of association between explanatory variables and Td2+ uptake after controlling for potential confounders.</p><p><strong>Results: </strong>Overall, uptake of Td2+ was 70.2% (95% CI: 66.01-74.4). Uptake was linked to early ANC visits [1st (AOR = 2.95) and 2nd (AOR = 2.54)], listening to the radio daily (AOR = 9.23) or weekly (AOR = 4.65), watching television daily (AOR = 1.71) or once a day (AOR = 17.13), frequent internet use (AOR = 1.47), long distance to health facility (AOR = 1.57), high (AOR = 2.47) or moderate (AOR = 3.44) knowledge, good (AOR = 2.26) or fair (AOR = 3.37) attitude, rural residence (AOR = 1.85), being married (AOR = 2.85), formal education (AOR = 2.23), and employment (AOR = 4.27).</p><p><strong>Conclusion: </strong>The 70.2% uptake of Td2+ was below the 80% target for every district. Achieving the recommended coverage target requires strengthening community outreach, improving health education and improving maternal service accessibility.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e003200"},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208696","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":"Health outcomes of women with gestational diabetes mellitus in North West London: a 10-year longitudinal study.","authors":"Gabrielle Goldet, Rakesh Dattani, Benjamin Pierce, Zia Ul-Haq, Tahereh Kamalati, Moulesh Shah, Andrew Frankel, Frederick Wai Keung Tam","doi":"10.1136/bmjph-2024-002279","DOIUrl":"10.1136/bmjph-2024-002279","url":null,"abstract":"<p><strong>Background: </strong>Gestational diabetes mellitus (GDM) is known to be associated with the development of type 2 diabetes mellitus (T2DM). However, the health outcomes of women with GDM are poorly understood. The aim of this study is to better understand long-term outcomes for women having suffered GDM.</p><p><strong>Methods: </strong>Among 2.3 million people in North West London in the Discover-NOW dataset, we identified a group of 400 subjects coded with GDM between 2010 and 2011 and followed them up through to the end of 2021. Affected individuals were assessed for a variety of complications (eg, hypertension, diabetic eye disease, cerebrovascular disease, ischaemic heart disease, fatty liver disease and diabetic foot disease) and time-to-event analyses were performed.</p><p><strong>Results: </strong>The median age of first pregnancy among the study cohort was 31.57 years, with a diverse ethnic mix observed. Increased rates of T2DM, diabetic eye complications and fatty liver disease were observed. HRs (adjusted for age category, ethnicity and Index of Multiple Deprivation) were 11.32 for T2DM, 5.27 for diabetic eye complications, 7.86 for fatty liver disease and 5.69 for any comorbidity.</p><p><strong>Conclusion: </strong>We have shown the burden of multimorbidity following GDM from real-world data over a 10-year period and demonstrated high rates of diabetic eye complications and fatty liver disease that have not been shown before.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002279"},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208678","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":"Changes in inpatient and outpatient stroke admissions during COVID-19: a difference-in-differences analysis based on claims data from 242 acute care hospitals in Japan.","authors":"Kazuhiro Abe, Shota Shibata, Atsushi Miyawaki, Ichiro Kawachi","doi":"10.1136/bmjph-2024-001958","DOIUrl":"10.1136/bmjph-2024-001958","url":null,"abstract":"<p><strong>Introduction: </strong>While COVID-19 has been associated with an elevated stroke risk due to its prothrombotic and inflammatory effects, previous studies have reported a decreased number of stroke hospitalisations during COVID-19. Patients with a stroke who could not be admitted might have been followed up in outpatient settings of these hospitals. Our study aimed to investigate the change in the number of patients who had a stroke admitted to inpatient and outpatient settings during COVID-19.</p><p><strong>Methods: </strong>A difference-in-differences design using claims data in 242 acute-care hospitals was adopted to examine stroke admissions in Japan, contrasting the pre-pandemic period (2015-2019) to the pandemic period (2020). The Japanese government's declaration of emergency in April 2020 was considered an exogenous shock. The outcomes were the numbers of ischaemic stroke (both embolic and non-embolic), intracerebral haemorrhage and subarachnoid haemorrhage admissions, with in-hospital mortality rates, modified Rankin Scale and procedure uses.</p><p><strong>Results: </strong>From a total of 27 631 stroke cases (44.3% women, median age 75 years (IQR 66-83)), no statistically significant changes were observed in the overall count of stroke admissions during the pandemic. A decrease in ischaemic stroke hospitalisations was detected (incidence-rate ratios (95% CI), 0.83 (0.73 to 0.95)), which was somewhat offset by an increasing trend for patients treated in the outpatient setting (1.06 (0.91 to 1.22)). No significant differences were found in in-hospital mortality rate, proportion of severe modified Rankin Scale at discharge and thrombolysis treatment rate. Rates of mechanical thrombectomy in ischaemic stroke were reduced (0.60 (0.36 to 0.99)), and length of stay was reduced for all types of stroke except intracerebral haemorrhage.</p><p><strong>Conclusion: </strong>When considering both inpatient and outpatient admissions for stroke, we found no statistically significant change in the number of stroke admissions in 2020 in Japan. In addition, our findings suggest that acute stroke inpatient care, at least during 2020, was appropriately managed despite limited resources.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e001958"},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208647","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":"Trends in myopia prevalence and projected visual impairment in Western Europe: a pooled analysis of Dutch population-based cohorts (1900-2000).","authors":"Sander Kneepkens, Clair A Enthoven, Jan Roelof Polling, Victor A de Vries, J Willem Lodewijk Tideman, Caroline Klaver","doi":"10.1136/bmjph-2024-002307","DOIUrl":"10.1136/bmjph-2024-002307","url":null,"abstract":"<p><strong>Importance: </strong>The global prevalence of myopia, a major cause of visual impairment and blindness, is on the rise. Understanding its trajectory and contributing factors in Europe is essential for implementing effective public health interventions.</p><p><strong>Objective: </strong>To assess the trend of myopia prevalence in Europe over the last century, examine the role of education across generations, and project future rates of myopia-related visual impairment and blindness.</p><p><strong>Design: </strong>This observational study used data from population-based cohorts in Rotterdam, Netherlands, including the Rotterdam Study I-IV, Generation R and Generation R Next.</p><p><strong>Setting: </strong>Population-based cohort studies conducted in Rotterdam, Netherlands.</p><p><strong>Participants: </strong>A total of 18 686 individuals born between 1900 and 2000, who underwent comprehensive ophthalmologic examinations.</p><p><strong>Exposures: </strong>Participants were stratified by birth year (1900-1920, 1920-1940, 1940-1960, 1960-1980 and 1980-2000) and analysed for associations between birth year and myopia prevalence, axial length (AL) and spherical equivalent (SE). The potential mediating and moderating role of education was examined using a four-way decomposition approach. Prevalence of severe visual impairment caused by myopia-related complications was estimated for the Netherlands and Europe.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were the prevalence of myopia (SE ≤-0.5 diopters (D)) and high myopia (SE ≤-6 D), and the projected prevalence of severe visual impairment due to myopia up to 2075.</p><p><strong>Results: </strong>Myopia prevalence increased 2.5 times (from 22% to 56%) and high myopia 3.5 times (from 2% to 7%) between 1900 and 2000. Compared with individuals born in 1900-1920, those born in 1980-2000 had significantly higher odds of being myopic (OR 4.79 (95% CI 3.72 to 6.18)) and highly myopic (OR 3.30 (95% CI 1.79 to 6.21)). Mean AL increased by 0.9 mm in men and 0.8 mm in women over the century. Education significantly mediated the association between birth year and myopia. By 2075, the prevalence of severe visual impairment or blindness due to myopia in Europe is projected to rise from 0.12% in 2015 to 0.84%, causing an estimated 3.6 million severely visually impaired.</p><p><strong>Conclusions and relevance: </strong>Myopia prevalence has risen dramatically in Europe, now affecting over 50% of young adults, with a corresponding increase in eye elongation over time. The burden of myopia-related visual impairment is expected to rise sharply as the population ages. By 2075, 0.84% of the European population is projected to be severely visually impaired or blind due to myopia-related complications. These findings underscore the urgent need for targeted public health interventions.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002307"},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208686","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":"Stakeholders' perspectives on funding malaria, HIV/AIDS and tuberculosis services in Tanzania through domestic resources mobilisation: a qualitative study.","authors":"Francis Donard Ngadaya, Kahabi Isangula, Happiness Kimambo, Grace Soka, Caritas Kitinya, Doreen Philbert, Lucy Mwenda, Gibson B Kagaruki, Godfather Kimaro, Esther Ngadaya, Amos Kahwa, Sayoki Mfinanga","doi":"10.1136/bmjph-2024-001861","DOIUrl":"10.1136/bmjph-2024-001861","url":null,"abstract":"<p><strong>Background: </strong>Low-income and middle-income countries continue to face challenges in financing health programmes due to budgetary constraints and decreased donor funding. Off-budget financing has become crucial for controlling diseases like malaria, HIV/AIDS and tuberculosis (TB). However, there is limited evidence on alternative domestic funding approaches to support implementation of healthcare programmes in Tanzania.</p><p><strong>Objective: </strong>The study explored stakeholder perspectives on alternative domestic funding approaches to support malaria, HIV/AIDS and TB services in Tanzania.</p><p><strong>Methods: </strong>A qualitative descriptive design was employed to gather insights from 76 purposely selected stakeholders, including policymakers, programme managers, regional health managers, district health managers and healthcare workers. Data were managed and analysed thematically.</p><p><strong>Results: </strong>Four major themes emerged: current sources of funds, financial resources needed, proposed alternative domestic funding mobilisation strategies to support implementation of malaria, HIV/AIDS and TB and challenges of implementing the proposed strategies. Current major sources of funds included multilateral donors, development partners, the central government and internal sources. There was a consensus on a decrease in donor funding due to the COVID-19 pandemic. The proposed alternative domestic funding strategies included establishing universal health insurance, reducing beneficiaries of service exemptions, establishment of disease-specific funds and taxation of certain products. Implementation challenges for the proposed strategies included poor awareness, conflicting political promises and accountability issues.</p><p><strong>Conclusions: </strong>The financing gap for malaria, HIV/AIDS and TB services is significant due to decreasing donor funding. Strategies such as strengthening insurance schemes, reducing exemption groups and taxation could help, but community sensitisation and improved fund accountability are crucial.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e001861"},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208708","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":"How many democratic countries have conducted COVID-19 public inquiries? An exploratory study of government-led postpandemic reviews (2020-2024).","authors":"Kevin Bardosh, Maximilien Lacour, Kira Pronin, Norma Correa Aste, Roger Koppl","doi":"10.1136/bmjph-2025-002567","DOIUrl":"10.1136/bmjph-2025-002567","url":null,"abstract":"<p><strong>Introduction: </strong>Many governments have initiated national inquiries into their responses to the COVID-19 pandemic. Lessons drawn from them will matter for public health policies. While these inquiries represent an opportunity for policy learning, there may also be obstacles. This study helps to explore these opportunities and obstacles by providing an initial survey of COVID-19 inquiries.</p><p><strong>Methods: </strong>We collected a novel data set of national COVID-19 inquiries in democratic countries, taking note of their type, membership, timing, mandate and whether their terms of reference asked the inquiry to consider the adequacy of the government pandemic response as well as the collateral harms arising from government interventions. We conducted a series of panel logit analyses to examine the extent to which country-level factors-such as the level of democracy and executive oversight, centralisation of executive power and economic development-were associated with the likelihood of appointing a COVID-19 inquiry.</p><p><strong>Results: </strong>We found 32 national COVID-19 inquiries, held in 25 (32%) of the countries in our data set, which included 78 countries with a score of at least 0.6 on the 2019 Varieties of Democracy (V-Dem) Electoral Democracy Index. Of the 32 national inquiries, 14 (44%) were public inquiries (proper), 15 (47%) were inquiries conducted by parliamentary committees and 3 (9%) were another type of inquiry. The earliest public inquiries (proper) were launched in the first half of 2020 in the Scandinavian countries. Generally, countries were slightly quicker to establish parliamentary committee inquiries than public inquiries proper. Many democracies, such as Canada, have yet to initiate one at all.A country's probability of initiating a COVID-19 inquiry was positively correlated with its level of democracy, gross domestic product per capita and executive oversight, but negatively correlated with higher values of the V-Dem index of presidentialism. These correlations were significant once we controlled for multicollinearity. The vast majority of inquiries (77%) were appointed in 2020 and 2021. Most inquiries' terms of reference were relatively open-ended, with few specifically demanding an examination of policy adequacy and most urging some sort of investigation into the COVID-19 measures' collateral harms.</p><p><strong>Conclusion: </strong>Although slightly less than a third of countries in our sample have initiated inquiries into their COVID-19 response, those that have tend to mention collateral harms in their terms of reference, but not policy inadequacy. Our exploratory study should be followed by fine-grained textual analyses of individual inquiries.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002567"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208725","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":"What works to reduce socioeconomic inequalities in hospitalisations and readmissions? Systematic review of the equity impacts of population-level, health service and integrative interventions.","authors":"Sarah Sowden, Behrouz Nezafat Maldonado, Fiona Beyer, William Bell, Mark Lambert, Richard Thomson, Richard Cookson, Clare Bambra","doi":"10.1136/bmjph-2025-002595","DOIUrl":"10.1136/bmjph-2025-002595","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Inequalities exist in hospitalisation rates, which are undesirable and costly for health systems; with higher rates in populations with lower levels of income, education or residing in socioeconomically marginalised neighbourhoods where ill-health is more prevalent and preventive care is more limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To understand which interventions reduce, maintain or increase socioeconomic inequalities in hospitalisations or readmissions to aid efforts of policymakers and practitioners working to improve health equity and reduce hospital pressures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Systematic review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;Intervention studies in any Organisation for Economic Co-operation and Development (OECD) country, involving individuals of any age, published in any language which reported the differential impact across socioeconomic group (any classification) for three categories of intervention (population-level, health service or integrative interventions) on hospitalisation or readmission outcomes (all cause or condition specific).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction and synthesis: &lt;/strong&gt;An electronic search of MEDLINE, Embase, CINAHL, Cochrane CENTRAL and Web of Knowledge was conducted covering 24 years (from 1 January 2000 to 1 April 2024), supplemented with full citation searches of included studies, website searches and expert consultation. Risk of bias was assessed using the EHPP tool, direction of effect classified and narrative synthesis conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From 25 618 records screened, 36 studies met the inclusion criteria, conducted in eight countries with 42% of these published in the past 5 years. Studies employed a range of study designs and 88% were rated as either moderate or strong quality. A range of equity impacts of interventions on hospitalisations and readmissions were observed; 6 interventions increased inequalities, 7 maintained, 10 had mixed or inconclusive impacts, and 13 studies reported effective interventions for reducing inequalities. Interventions successful at reducing inequalities were those implemented and enforced across entire populations and systems and supportive interventions tailored to the varied needs and contexts of people from different socioeconomic groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Socioeconomic disadvantage was variously measured making comparison of equity impacts across studies complex. Policymakers and practitioners cannot assume that interventions implemented to reduce hospitalisations or readmissions will necessarily reduce prevailing and costly healthcare inequalities; it is imperative that the equity impacts of interventions are consistently monitored. To improve equity of hospital outcomes, investment in population health and integrative activity addressing the social determinants of health, alongside health service interventions, is required.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Prospero registration number: &lt;/strong&gt;CRD42019153666.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002595"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152639","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":"Social and policy interventions to reduce hospital admissions among socioeconomically disadvantaged groups in OECD countries with universal health care: a systematic review.","authors":"Behrouz Nezafat Maldonado, William Bell, Jasmine Olivera, Fiona Beyer, Mark Lambert, Richard Thomson, Richard Cookson, Clare Bambra, Sarah Sowden","doi":"10.1136/bmjph-2025-002592","DOIUrl":"10.1136/bmjph-2025-002592","url":null,"abstract":"<p><strong>Objectives: </strong>Socioeconomic disadvantage increases the risk of acute illnesses and injuries requiring hospital admission, some of which are avoidable. This systematic review aimed to identify the impact of interventions on hospital admissions in socioeconomically disadvantaged populations and identify knowledge gaps.</p><p><strong>Design: </strong>Systematic review (PROSPERO, CRD42019153666).</p><p><strong>Data sources: </strong>We searched MEDLINE (OVID), Embase (OVID), CINAHL (EBSCO), Cochrane CENTRAL (Wiley) and the Web of Knowledge platforms.</p><p><strong>Eligibility criteria: </strong>Studies published between 1 January 2000 and 1 April 2024. We included quantitative studies that included a socioeconomically disadvantaged population, conducted studies in countries members of the Organisation for Economic Co-operation and Development (OECD) with universal healthcare and reported on hospital admission or readmissions.</p><p><strong>Data extraction and synthesis: </strong>We assessed study quality using the Effective Public Health Practice Project tool. We summarised studies using a narrative synthesis approach and present findings using vote counting as a measure of effect.</p><p><strong>Results: </strong>We included 20 studies of interventions targeted towards socioeconomically disadvantaged populations. Their impacts on hospitalisations of interventions, grouped under three domains-(1) population level health and social policy, (2) health and care service-based interventions and (3) integrative interventions-were mixed. Through vote counting, we found some evidence that social policy interventions targeting socioeconomically disadvantaged groups have an important impact on hospitalisations, especially those focused on improved housing and income.</p><p><strong>Conclusions: </strong>While ongoing efforts to ensure that healthcare interventions improve the equity of access, experience and outcome are warranted, social policy interventions that address the wider determinants of health, such as housing, income and education, hold promise for controlling rates of hospital admissions in socioeconomically disadvantaged groups. This underscores the value of multi-sectoral action to reduce inequalities. Future studies should explore the long-term outcomes of interventions, particularly integrative ones, which may bring benefits in the long term but not so much in the short term.</p><p><strong>Prospero registration number: </strong>CRD42019153666.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002592"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152685","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":"Trends in use of alcohol-free or low alcohol drinks in attempts to reduce alcohol consumption in Great Britain, 2020-2024: a population-based study.","authors":"Vera Buss, Dimitra Kale, Melissa Oldham, Lion Shahab, Abigail Stevely, Inge Kersbergen, Jamie Brown","doi":"10.1136/bmjph-2025-002775","DOIUrl":"10.1136/bmjph-2025-002775","url":null,"abstract":"<p><strong>Introduction: </strong>Sales and availability of alcohol-free and low alcohol drinks have increased in the UK since 2020. This study aimed to assess trends in the use of alcohol-free and low alcohol drinks to reduce alcohol consumption among people who drink at increasing and higher risk in Great Britain. The study compared trajectories across different subgroups from 2020 to 2024.</p><p><strong>Methods: </strong>Data were drawn from the Smoking and Alcohol Toolkit Study, which surveys adults monthly across Great Britain about their drinking behaviour. The study included 9397 adults with an AUDIT-C score of 5 or above who attempted to reduce their alcohol consumption in the past year. The analysis used regression analyses to assess time trends in using alcohol-free and low alcohol drinks to cut down overall and among subgroups (eg, gender and age), and in using evidence-based support compared with alcohol-free and low alcohol drinks in attempts to cut down alcohol consumption.</p><p><strong>Results: </strong>The proportion reporting the use of alcohol-free and low alcohol drinks to reduce alcohol consumption increased from 35.0% (95% confidence interval (CI): 31.8, 38.4) in October 2020 to 43.9% (95% CI: 40.9, 46.9) in August 2024 in serious attempts and from 25.5% (95% CI: 23.2, 28.0) to 38.8% (95% CI: 37.2, 40.4) in any attempt to cut down. Among subgroups, trajectories were mostly comparable. Noticeably, older adults first had lower prevalence of using alcohol-free and low alcohol drinks than young and middle-aged adults but had larger increases over time. While the proportion of participants using alcohol-free and low alcohol drinks in attempts to cut down consumption increased, the proportion using neither alcohol-free/low alcohol drinks nor evidence-based support decreased, and the proportion using evidence-based support, either alone or in combination with alcohol-free/low alcohol drinks, remained low.</p><p><strong>Conclusion: </strong>The growing use of alcohol-free/low alcohol drinks to reduce alcohol consumption among people at risk of increasing and higher risk drinking in Great Britain highlights the urgent need for more research to establish their effectiveness for alcohol reduction and to inform public health policy. While the use of alcohol-free/low alcohol drinks to cut down rose, the use of evidence-based support remained limited.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002775"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152678","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":"Health programme spillover effects on childhood vaccination in India: a difference-in-differences analysis of the Zinc and Oral Rehydration Salts Programme using retrospective demographic health surveys data.","authors":"Raf Van Gestel, Mujaheed Shaikh, Flore Vermijs, Carlos Riumallo-Herl","doi":"10.1136/bmjph-2024-001743","DOIUrl":"10.1136/bmjph-2024-001743","url":null,"abstract":"<p><strong>Background: </strong>Childhood immunisation coverage has stagnated globally and even declined in some countries during recent decades. We aimed to evaluate whether a public health programme targeted at diarrhoeal disease also impacted, as a spillover effect from the programme, immunisation coverage.</p><p><strong>Methods: </strong>Retrospective data from the 2015/2016 Indian Demographic Health Survey were obtained on 142 921 children, born to mothers in the 5 years leading up to the survey. A difference-in-differences study was performed to compare the completed child vaccination rates before and after the Clinton Health Access Initiative Zinc (CHAI)/Oral Rehydration Salts Programme in 2012, and between covered (Madhya Pradesh and Uttar Pradesh) and non-covered states.</p><p><strong>Results: </strong>The CHAI programme was associated with an increase in basic child vaccination coverage (one dose of BCG (Bacille Calmette-Guérin) and measles, and three doses of DTP (diphtheria, tetanus and pertussis) and polio vaccines) of 5.27 percentage points (95% CI 3.48 to 7.05). This increase was concentrated among male children, and no differences were found by wealth quintiles, maternal education or sanitation. Different intensities of the CHAI initiative across districts in Uttar Pradesh were not associated with different vaccination coverage rates.</p><p><strong>Conclusions: </strong>Existing studies rarely evaluate spillover effects or unintended consequences of public health campaigns. We find that a public health programme to reduce diarrhoeal diseases <i>was associated with increased</i> vaccination coverage in India. These findings highlight the potential horizontal health effects of disease-specific public campaigns and household behaviour responses to the programme. The evidence shows that actionable approaches to improve immunisation coverage exist that do not exclusively rely on vaccination campaigns.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e001743"},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152713","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}