BMJ public health最新文献

{"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":null,"pages":null},"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":"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":null,"pages":null},"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":"‘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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":"Correction: Improving influenza vaccine uptake in clinical risk groups: patient, provider and commissioner perspectives on the acceptability and feasibility of expanding delivery pathways in England","authors":"","doi":"10.1136/bmjph-2024-000929corr1","DOIUrl":"https://doi.org/10.1136/bmjph-2024-000929corr1","url":null,"abstract":"","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840920","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":"Oral health-related knowledge, attitude and practices among nurses: a hospital-based questionnaire survey from a tertiary healthcare setting in Faridabad, India","authors":"Shilpa Khullar Sood, Megha Jain, Manu Raj, Sakshi Sharma","doi":"10.1136/bmjph-2023-000791","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000791","url":null,"abstract":"Nurses play an integral part in the comprehensive delivery of healthcare services and contribute significantly to the success of public health initiatives. The knowledge, attitude and practices of nurses in the domain of oral health influence their own oral hygiene as well as that of the community. Their impact on overall oral health of the community is due to the fact that they provide health education as the primary contact of patients and their family members. The objective of this study was to evaluate the oral health knowledge, attitude and practice among nurses of a tertiary healthcare facility.We conducted a cross-sectional questionnaire-based study among nurses working at a tertiary healthcare setting in Faridabad, India, to assess their oral health-related knowledge, attitude and practice.We recruited a total of 300 nurses from the study institution. Among participants, 235 (78.4 %) were females. In the study population, 220 (73.4%) were nursing diploma holders, 55 (18.6%) had a bachelor’s degree, 20 (6.6%) had a post-graduate nursing diploma and 5 (1.5%) completed their master’s degree. Overall oral health-related knowledge was found to be good in 270 (90%) of participants. Overall oral health-related attitude was satisfactory in 270 (90%) participants. Among participants, 225 (75%) brushed their teeth using fluoridated toothpaste. In addition, 247 (82.6%) participants reported brushing in circular direction, 256 (85.6%) reported spending 2 min to clean their teeth and 285 (95%) reported cleaning their tongue daily.Nurses demonstrated good knowledge, good attitude and a positive outlook related to oral health. They contributed significantly towards maintenance of healthy practices regarding oral health and hygiene in the community. This was primarily by taking up an active role in motivating family and friends to have regular dental check-ups.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853170","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":"Impacts of the COVID-19 pandemic on HIV care and treatment services among adolescents attending a tertiary hospital in Dar es Salaam, Tanzania: a qualitative study","authors":"Eva Kidabulo, Lilian Nkinda, D. Mwakawanga, Agricola Joachim","doi":"10.1136/bmjph-2024-000935","DOIUrl":"https://doi.org/10.1136/bmjph-2024-000935","url":null,"abstract":"The COVID-19 pandemic has caused substantial disruption on HIV care and treatment programmes, especially for adolescents living with HIV (ALHIV) who are known to have poorer health outcomes compared with adults. Efforts made to overcome the pre-existing challenges were hampered by the emergence of the pandemic which interrupted adolescent-friendly healthcare services. Therefore, the aim of this study was to assess the impacts of the pandemic on HIV care and treatment services from healthcare providers and adolescents’ experiences at a tertiary hospital in Dar es Salaam, Tanzania.A descriptive qualitative study using in-depth interviews was conducted with 17 study participants. Purposive and convenient sampling techniques were used to recruit healthcare providers and adolescents, respectively. Swahili semistructured interview guide was used to conduct interviews. Thematic analysis was conducted to generate themes and subthemes describing the experiences on effects brought by COVID-19 on HIV care and treatment among adolescents.The study revealed that alteration of approach in delivery of healthcare and limited human and non-human resources in healthcare facilities during the COVID-19 pandemic decreased effectiveness and quality of care which resulted in adolescent’s poor adherence to medication and loss to follow-up. Loss of family income, food insecurity and limited socialisation posed threat to adolescent’s mental health and overall quality of life.Our findings underscore the impacts of COVID-19 and its immediate responses that significantly affected adolescent HIV care and treatment services. Reinforcement of sustainable ALHIV programmes and funding supports to these programmes are essential to promote retention and engagement to care during pandemics.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853711","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":"Client perspectives on creating supportive sexual health environments for people with persistent anxiety: a qualitative study","authors":"Stéphanie Black, Sarah Watt, Mark Gilbert, Heather Nicole Pedersen, Aidan Ablona, Hsiu-Ju Chang, T. Salway","doi":"10.1136/bmjph-2023-000625","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000625","url":null,"abstract":"We sought to explore sexual health service clients’ perspectives, preferences and suggestions for how to better address or alleviate anxiety among clients of sexual health services (eg, sexually transmitted infection testing) regarding both online and in-person sexual health services among those who experience persistent anxiety.We conducted qualitative interviews with 27 sexual health service clients with persistent experiences of anxiety in British Columbia, Canada. Participants were recruited from respondents to a COVID-19-related sexual health survey who consented to follow up. Interviews were conducted via Zoom, recorded and transcribed. Transcripts were coded and analysed using thematic analysis by searching for themes in order to summarise the experiences and needs of participants.The median participant age was 34. 16 participants identified as women, 10 as men and 1 each as non-binary and gender fluid. Participants described anxiety related to sexual health service access and experiences due to sexual health-related stigma and privacy concerns; provider judgement and lack of communication or information regarding test results. They suggested that routinely integrating discussions with providers about mental health in sexually transmitted and bloodborne infection (STBBI) testing appointments may help clients feel safer and could connect them to support. They highlighted the need for personal and genuine interactions with providers (eg, making appointments feel less perfunctory, asking clients how they are feeling about why they are there) and sufficient time with providers (eg, not feeling rushed through the appointment, time to discuss resources, testing and advice).Disease-specialised health services may not adequately address the multifaceted and inter-related mental health needs of people accessing services. In STBBI testing service settings, more personalised appointments, additional communication with providers and easier access to results can help improve both the service experiences of people experiencing persistent anxiety and their connections to appropriate mental health support.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843421","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":"Do current maternal health staffing and bed occupancy benchmarks work in practice? Results from a simulation model","authors":"R. Baggaley, G. Gon, Said Mohammed Ali, Salma Abdi Mahmoud, Farhat Jowhar, Carolin Vegvari","doi":"10.1136/bmjph-2023-000212","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000212","url":null,"abstract":"The WHO has issued the global target of reducing maternal mortality rates by two-thirds of 2010 baseline levels by 2030. In low-income settings, high birth rates and a relative lack of medical resources mean that an efficient use of resources and skilled staff is important in ensuring quality of intrapartum and postpartum care.We use a stochastic, individual-based model to explore whether WHO resourcing benchmarks are sufficient to ensure consistent quality of care. We simulate all deliveries occurring in a region over a year, with date and time of presentation of each woman delivering at a facility assigned at random. Each woman stays in the delivery room for an assigned duration before her delivery, then moves to the maternity ward, followed by discharge. We explore the potential impact of seasonality of births on our findings and then apply the model to a real-world setting using 2014 data from Emergency Obstetric Care (EmOC) facilities in Zanzibar, United Republic of Tanzania.We find that small EmOCs are frequently empty, while larger EmOCs are at risk of temporarily falling below minimum recommended staff-to-patient ratios. Similarly for Zanzibar, capacity of EmOCs in terms of beds is rarely exceeded. Where over-capacity occurs, it is generally smaller, basic EmOCs (BEmOCs) that are affected. In contrast, capacity in terms of staffing (skilled birth attendants:women in labour ratio) is exceeded almost 50% of the time in larger Comprehensive EmOCs (CEmOCs).Our findings suggest that increasing staffing levels of CEmOCs while maintaining fewer small BEmOCs may improve quality of care (by increasing the staff-to-patient ratio for the most frequently used facilities), provided that timely access to EmOCs for all women can still be guaranteed. Alternatively, BEmOCs may need to be upgraded to ensure that women trust and choose these facilities for giving birth, thus relieving pressure on CEmOCs.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139537382","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}