BMJ public health最新文献

{"title":"Secondary care for people experiencing homelessness in Scotland: a retrospective cohort study.","authors":"Anna Ct Gordon, Haris Haseeb, Sarah Johnsen, Claire Mackintosh","doi":"10.1136/bmjph-2024-001766","DOIUrl":"10.1136/bmjph-2024-001766","url":null,"abstract":"<p><strong>Introduction: </strong>People experiencing homelessness (PEH) face multimorbidity and poor health outcomes alongside deep exclusion in accessing health and social care. A large proportion of PEH use unscheduled emergency care heavily due to a multitude of barriers to primary care. No existing research in Scotland has explored experiences of PEH in secondary care.</p><p><strong>Methods: </strong>In view of new national guidelines for the care of PEH, we conducted a retrospective study of 230 unscheduled presentations to secondary care, comparing 115 PEH with 115 patients matched by age and sex (July to December 2021). We aimed to profile morbidity, mortality and explore measures of quality of secondary care, particularly the involvement of multidisciplinary teams (MDTs), readmission rates, attendance at follow-up appointments and place of discharge.</p><p><strong>Findings: </strong>Our findings demonstrate that the PEH population were young (mean age 43.9), 79% of whom experience multimorbidity, with a mortality rate of 13% at 1 year (mean age of death 47.3). 86.09% of PEH experienced additional disadvantages including problematic alcohol use or illicit drug use, and over a third experience two. Despite this, few PEH were seen by relevant hospital MDT members during admission. 8% were discharged to permanent accommodation, 14% were discharged to rooflessness (without shelter) and 8.7% chose to terminate their admission. Significantly less PEHs were offered outpatient follow-up (52% compared with 80%) or attended follow-up (47% compared with 87%), and readmission rates within 1 month were double in the PEH cohort.</p><p><strong>Conclusions: </strong>Data clearly demonstrate the need for specialist support for PEH within secondary care during admission and integrated care beyond.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001766"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575058","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":"Uptake of and willingness to pay for health insurance in rural Senegal: a reinforcement effect.","authors":"Marwân-Al-Qays Bousmah, Cheikh Sokhna, Sylvie Boyer, Bruno Ventelou","doi":"10.1136/bmjph-2024-001636","DOIUrl":"10.1136/bmjph-2024-001636","url":null,"abstract":"<p><strong>Introduction: </strong>Expanding health insurance is viewed as a core strategy for achieving universal health coverage. In Senegal, as in many other developing countries, this strategy has been implemented by creating community-based health insurance (CBHI) schemes with voluntary enrolment and a fixed premium paid by enrollees. Yet little is known about how the individuals' experience of CBHI enrolment further influences their willingness to pay (WTP). In this paper, we test the existence of a reinforcement effect between effective enrolment in a CBHI and WTP for health insurance by analysing their mutual relationship.</p><p><strong>Methods: </strong>We rely on primary survey data collected in 2019-2020 in the rural area of Niakhar in Senegal. We use an econometric methodology involving: (1) Heckman-type selection models to estimate the determinants of CBHI membership conditioned on awareness of health insurance, addressing the issue of sample selection due to differential awareness and (2) a simultaneous equation model to jointly estimate the uptake and WTP for health insurance, addressing the issue of endogeneity due to reverse causality between both variables. We also focus on the roles that informational and geographical barriers, as well as individual risk preference and trust, play in both outcomes.</p><p><strong>Results: </strong>The final sample includes 1607 individuals. Results show that WTP further increases with the individuals' direct experience in a CBHI scheme, despite an environment characterised by low enrolment rates. We also provide evidence for a U-shaped relationship between risk tolerance and WTP for health insurance.</p><p><strong>Conclusion: </strong>We provide novel evidence on a reinforcement effect of enrolment in a CBHI on WTP for health insurance, with the presence of a substantial consumer surplus among enrolled individuals at the actual premium. Our findings suggest that policies aiming at improving health insurance awareness should foster the demand for health insurance in rural Senegal.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001636"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575063","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":"Prevalence and associated factors of psychological distress among patients with oral cancer in the selected tertiary care institutes in Sri Lanka: a combined cross-sectional and case-control study.","authors":"Nadisha Ratnasekera, Irosha Perera, Pushpakumara Kandapola Arachchige, Sumeth Perera, Prasanna Jayasekara","doi":"10.1136/bmjph-2024-001638","DOIUrl":"10.1136/bmjph-2024-001638","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Introduction: </strong>Oral cancer represents the most prevalent malignancy among Sri Lankan males. This aggressive disease is associated with significant psychological distress, driven by disfigurement and impairments of vital functions.While the detrimental impact of psychological distress on patients with oral cancer is well documented, its prevalence and associated determinants remain underexplored in the Sri Lankan context. This study aims to evaluate the prevalence and identify the factors associated with psychological distress in a selected cohort of patients with oral cancer in Sri Lanka.</p><p><strong>Methods: </strong>A hospital-based cross-sectional study was conducted among 355 patients with oral cancer to determine the prevalence of psychological distress. Additionally, a nested case-control study comprising 140 patients per group was carried out to evaluate the factors associated with psychological distress. Multivariate logistic regression analysis was performed to identify significant associated factors of psychological distress.</p><p><strong>Results: </strong>The prevalence of psychological distress among patients with oral cancer was 31.0% (95% CI=27.8-35.3%). Being <50 years of age (adjusted OR (AOR)=1.2, 95% CI=0.7-1.7, p=0.006), having pain (AOR=44.7, 95% CI=34-53.21, p=0.001), late stages of cancer at the diagnosis (AOR=10.7, 95% CI=1.07-28.78, p=0.04), being worried about basic functional disabilities (AOR=11.4, 95% CI=10.3-14.8, p=0.006) and the two psychological factors-<i>worry</i> (\"Other people <i>worry</i> about me more than I do\"; AOR=5, 95% CI=2.8-6.9) and <i>anger</i> (\"I feel very <i>angry</i> about what has happened to me\"; AOR=12.1, 95% CI=6.8-15.4)-emerged as significant independent factors that were associated with increased risk of psychological distress among patients with oral cancer.</p><p><strong>Conclusion: </strong>Approximately one-third of patients with oral cancer in the selected tertiary care hospitals were found to experience psychological distress, highlighting its high prevalence in this population. The identification of key factors associated with psychological distress provides valuable insights for the development of targeted intervention strategies aimed at mitigating psychological morbidity among patients with oral cancer.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001638"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575050","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":"Healthcare workers' perceptions of postoperative care and implementation challenges in conflict-affected northwest Syria: a mixed-methods analysis.","authors":"Stefany M Lazieh, Maia C Tarnas, Kelli Wagner, Ismail Alkhatib, Camila Polinori, Measser Netfagi, Ahmad Ghandour, Sameeh Qaddour, Bara Zuhaili, Gilbert Burnham","doi":"10.1136/bmjph-2024-001236","DOIUrl":"10.1136/bmjph-2024-001236","url":null,"abstract":"<p><strong>Introduction: </strong>Protracted violent conflict has severely reduced healthcare provision in northwest Syria (NWS), and this is especially concerning for postoperative care as conflict-related injuries have further compounded this strain. Without sufficient postoperative care, minor complications can evolve into life-threatening events. In this study, we aim to understand healthcare workers' attitudes, practices and perceptions regarding postoperative care in NWS and identify key barriers to postoperative care.</p><p><strong>Methods: </strong>Individuals with experience in health leadership positions in NWS were identified using purposive and snowball sampling and interviewed using a semistructured interview guide. Interview summaries were analysed using a standardised codebook to identify potential themes. In addition to these interviews, an online survey on hospital practices was sent to hospital administrators and non-governmental organisation leadership who disseminated the survey to all employees engaging in clinical work.</p><p><strong>Results: </strong>Eighteen key informants were interviewed, and 466 survey responses from doctors (39%), nurses (37%), medical technicians (13%) and administrators (11%) were recorded. Through key informant interviews, we demonstrate several barriers to postoperative care, including health system fragmentation, limited healthcare workforce, insufficient resources due to conflict, disinterest, and lack of clinical documentation and discharge standards. Survey respondents reported poor patient compliance (66%), lack of routine follow-up visits (42%) and non-sterile operating room instruments (42%) as primary reasons for postoperative complications. Identified pathways to improve postoperative care included increased staffing and training, improved operating room sterilisation, and enhanced patient follow-up and discharge processes.</p><p><strong>Conclusion: </strong>In conclusion, the health system in NWS is extremely overburdened from over a decade of violent conflict, increased demand for health services and insufficient resources. This has made implementing consistent and adequate postoperative care nearly impossible, contributing to unnecessary complications and mortality. Solutions to address postoperative complications in NWS must account for these complex realities and the broader context in which this system exists.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001236"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575027","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":"Assessing trends in non-coverage bias in mobile phone surveys for estimating insecticide-treated net coverage: a cross-sectional analysis in Tanzania, 2007-2017.","authors":"Matt Worges, Ruth A Ashton, Janna Wisniewski, Paul Hutchinson, Hannah Koenker, Tory Taylor, Hannah Metcalfe, Ester Elisaria, Mponeja P Gitanya, Charles Dismas Mwalimu, Frank Chacky, Joshua O Yukich","doi":"10.1136/bmjph-2024-001379","DOIUrl":"10.1136/bmjph-2024-001379","url":null,"abstract":"<p><strong>Introduction: </strong>Monitoring insecticide-treated net (ITN) coverage and use generally relies on household surveys which occur on a relatively infrequent basis. Because indicators of coverage are used to forecast the need for ITNs and aid in planning ITN distribution campaigns, higher frequency monitoring could be helpful to guide programme strategies. The use of mobile phone-based survey (MPS) strategies in low-income and middle-income countries has emerged as a rapid and comparatively inexpensive complement to large-scale population-based household surveys, considering the dramatic growth trend of mobile phone ownership.</p><p><strong>Methods: </strong>The potential for non-coverage bias in the calculation of ITN coverage estimates from MPSs was assessed through the use of five consecutive Tanzania-specific Demographic and Health Surveys (DHS). Primary comparisons were made between all households included in the data sets (the reference standard) and mobile phone-owning households (the comparator). Deviations in ITN coverage estimates between the reference standard and mobile phone-owning households were used as a proxy for assessing potential non-coverage bias, with estimates calculated using a bootstrap method.</p><p><strong>Results: </strong>By the 2017 DHS, regional measures of non-coverage bias for ITN coverage indicators rarely exceeded a ±3 percentage point difference when comparing mobile phone-owning households to the overall sample. However, larger differences were observed when comparing mobile phone-owning households to non-mobile phone-owning households, particularly in periods without recent mass ITN distributions.</p><p><strong>Conclusion: </strong>Results suggest that MPSs can reliably estimate ITN coverage at the population level when both ITN coverage and mobile phone ownership are high. However, as ITN coverage declines, the gap between phone-owning and non-phone-owning households widens, indicating potential non-coverage bias and underscoring the need for caution in interpreting MPS data under such conditions.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001379"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575009","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":"Community coalitions' navigation of policies to address the opioid epidemic: insights from qualitative interviews in four states.","authors":"Ramona G Olvera, Allyson G Cogan, Mary Bartkus, Shoshana N Benjamin, Jill Davis, Lisa A Frazier, Brandy F Henry, Timothy Hunt, Elizabeth N Kinnard, Hallie Mattingly, Ann Scheck McAlearney, Dean Rivera, Mari-Lynn Drainoni, Daniel M Walker","doi":"10.1136/bmjph-2024-001924","DOIUrl":"10.1136/bmjph-2024-001924","url":null,"abstract":"<p><strong>Introduction: </strong>The opioid epidemic in the USA presents a multifaceted challenge regulated by a patchwork of federal, state and local policies. In some communities, cross-sector coalitions navigate this complex policy environment to address the epidemic. However, limited research has explored these public health-oriented community coalitions and their interactions with the policy landscape. This study explores how cross-sector public health-oriented community coalition members perceive and navigate the multidimensional policy landscapes to address the opioid epidemic.</p><p><strong>Methods: </strong>Using data from 304 semistructured HEALing Communities Study coalition member interviews conducted April-June 2021 in 67 communities in Kentucky, New York, Massachusetts and Ohio, we inductively analysed participants' discussions of opioid-related policies to characterise themes and subthemes.</p><p><strong>Results: </strong>We describe two themes where coalitions and policy intersect: policy landscape barriers and navigation and mitigation strategies to address policy barriers. Participants revealed community misunderstandings and lack of knowledge of opioid-related policies. Furthermore, participants shared how these policies often hindered coalitions' initiatives to address substance use. Nevertheless, community coalitions functioned despite these policy challenges through knowledge sharing, innovation and policy advocacy.</p><p><strong>Conclusions: </strong>Cross-sector public health-oriented community coalitions serve a vital role in navigating the complexities of the multidimensional policy landscape regulating substance use services. Insights from these findings may encourage policy-makers to support community coalitions in pursuing solutions to the opioid crisis and other public health crises.</p><p><strong>Trial registration number: </strong>NCT04111939.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001924"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575012","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":"Does domestic violence legislation reduce permissive attitudes about intimate partner violence? Longitudinal evidence from men and women from 61 countries.","authors":"Robin A Richardson, Nuria Rodriguez-Planas, Alexandria Ree Hadd, Katjana Wiederkehr, Farheen Jamshed, Cari Jo Clark, Tarik Benmarhnia","doi":"10.1136/bmjph-2024-001837","DOIUrl":"10.1136/bmjph-2024-001837","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Introduction: </strong>Intimate partner violence (IPV) is highly prevalent and has substantial implication for women's health. Changing IPV attitudes is one pathway to reduce IPV. While evidence suggests that interventions targeting individuals may change IPV attitudes, the effect of wider-scale interventions, such as legislation, remains unknown.</p><p><strong>Methods: </strong>We used individual-level IPV attitudes information collected between 1997 and 2020 by the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys, which we linked with national-level domestic violence (DV) legislation information. We evaluated the effect of adoption of DV legislation on changes in IPV attitudes using a difference-in-differences study design that controlled for time-varying country-level confounding and accounted for staggered timing of legislation adoption.</p><p><strong>Results: </strong>Our sample included harmonised information across 61 countries, composed of 2 184 047 women from 60 countries and 390 877 men from 40 countries. After controlling for country-level time-varying confounders, adoption of DV legislation reduced IPV acceptability among women (average treatment effect among treated=-0.07, 95% CI: -0.16, 0.06) and men (average treatment effect among treated=-0.11, 95% CI: -0.22, 0.03) although estimates were imprecise and included the null.</p><p><strong>Conclusions: </strong>DV legislation may reduce permissive IPV attitudes, especially among men, although conclusions should be interpreted cautiously due to imprecise estimates.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001837"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598716","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":"Cross-sectional analysis of e-cigarettes, combustible tobacco and their dual use with binge drinking among college students in the USA.","authors":"Rose Thornquist, Fares Qeadan","doi":"10.1136/bmjph-2024-001480","DOIUrl":"10.1136/bmjph-2024-001480","url":null,"abstract":"<p><strong>Background: </strong>Tobacco use is a long-standing epidemic that has caused millions of premature deaths. Electronic cigarette use is rising among young adults, yet few studies have included combustible tobacco, e-cigarettes and their dual use in an analysis of binge drinking among college students. This study aims to calculate the associations between these three forms of tobacco use and binge drinking among college students.</p><p><strong>Methods: </strong>This cross-sectional study used data from 332 721 college students from the American College Health Association-National College Health Assessment survey. Tobacco use was organised into four groups: no tobacco use, e-cigarette use only, combustible tobacco use only and dual use of e-cigarettes and combustible tobacco. Binge drinking was a binary indication of whether students had engaged in binge drinking in the last 2 weeks. Multiple logistic regression was employed to examine the relationship between tobacco use and binge drinking, adjusting for demographic factors and constructs of the integrated behavioural model.</p><p><strong>Results: </strong>Each tobacco use group had significantly higher odds of binge drinking compared with students who did not use tobacco. Students who engaged in dual tobacco use had significantly higher odds of binge drinking compared with exclusive combustible tobacco use (adjusted OR, aOR=2.41, 95% CI: 2.29, 2.53) and exclusive e-cigarette use (aOR=1.79, 95% CI: 1.71, 1.86).</p><p><strong>Conclusion: </strong>The strong relationship between dual tobacco use and binge drinking among college students warrants further investigation into the aetiology and clinical manifestations of this emerging coupled substance use behaviour among the next generation of adults.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001480"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525927","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":"Unemployment and associations with diagnosed health problems in the Norwegian GP-DEP study: a repeated cross-sectional register study (2010-2016).","authors":"Inger Haukenes, Sabine Ruths, Tone Smith-Sivertsen, Øystein Hetlevik, Gunnel Hensing, Ann Kristin Knudsen, Valborg Baste","doi":"10.1136/bmjph-2024-001758","DOIUrl":"10.1136/bmjph-2024-001758","url":null,"abstract":"<p><strong>Introduction: </strong>While differences in mental health between recipients and non-recipients of unemployment benefits are well known, it is not known whether such differences exist for musculoskeletal and cardiovascular health problems. This study examined the difference in registry-based diagnoses between short term, long term and non-recipients of unemployment benefits in the Norwegian working-age population and further examined if these associations differed by educational level.</p><p><strong>Methods: </strong>A cross-sectional repeated register study comprising all working-age individuals (age 21-67 years) with pensionable income in Norway in the period 2010 (N=2 610 956) to 2016 (N=2 791 103). Data were retrieved from the Norwegian population registry, the Education Database, the Database of Social Insurance and the Control and Reimbursement of Health Care Claims Database and linked on individual level. Associations between recipients and non-recipients of unemployment benefits and physician-certified diagnoses were examined with Poisson regression with robust variance estimates (relative risk (RR) with 95% CI) and stratified by education.</p><p><strong>Results: </strong>Both short-term and long-term recipients of unemployment benefits were associated with an increased likelihood of having one or more musculoskeletal, psychological or cardiovascular diagnoses compared with non-recipients. The strength of the associations increased with cumulative days of unemployment, with adjusted RRs (95% CIs) for musculoskeletal disorder 1.7 (1.7 to 1.7); psychological diagnoses 2,.2 (2.2 to 2.3); subgroup depression 3.3 (3.2 to 3.3) and for cardiovascular disease 1.3 (1.3 to 1.3) compared with non-recipients. Among highly educated people, the association between unemployment and having a diagnosis was stronger than among unemployed with medium and low education.</p><p><strong>Conclusions: </strong>Unemployment benefits recipiency were associated with musculoskeletal, psychological and cardiovascular diagnoses, and the strength of the association increased with higher education. The direction of the relationship could not be determined in this study.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001758"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525932","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":"Risk factors associated with urogenital schistosomiasis: a multilevel assessment approach using an Oversampling Schistosomiasis Survey (SOS) community-based, Plateaux region, Togo 2022.","authors":"Smaila Alidou, Hélène E Kamassa, Fiali Lack, Essoham Ataba, Fiona M Fleming, Efoe Sossou, Manani Hemou, Kossi Yakpa, Mawèké Tchalim, Piham Gnossike, Penelope Vounatsou, Rachel Pullan, Katherine Gass, Ameyo M Dorkenoo","doi":"10.1136/bmjph-2024-001304","DOIUrl":"10.1136/bmjph-2024-001304","url":null,"abstract":"<p><strong>Background: </strong>Urogenital schistosomiasis is endemic in Togo. Since 2010, Togo has used preventive chemotherapy to control the disease and periodically assess its impact. This study aimed to estimate the prevalence of urogenital schistosomiasis and identify associated risk factors among school-age children in three districts of the Plateaux Region of Togo.</p><p><strong>Methods: </strong>A cross-sectional study surveyed school-age children in three Togo districts, using an oversampling strategy of door-to-door visits to collect urine samples, metadata and lifestyle data. Statistical analyses, including descriptive and multilevel regression, were used to determine prevalence and investigate individual/community risk factors associated with urogenital schistosomiasis and infection intensity.</p><p><strong>Results: </strong>This study surveyed 6400 children, uncovering a 15.0% prevalence of urogenital schistosomiasis (95% CI: 14.1% to 15.8%). Notably, 48.3% (95% CI: 45.1% to 51.5%) showed heavy-intensity infections, averaging 38 eggs per 10 mL (range: 0-9688). Key risk factors included age (adjusted OR (aOR)=1.9), swimming in surface water (aOR=2.6) and residing in the Ogou district (aOR=11.2), while the Est-Mono district posed a lower risk (aOR=0.2). Factors such as gender, with boys at higher risk (aOR=1.7), age (aOR=2.9), school attendance (aOR=2.4) and swimming in surface water (aOR=4.7) were linked to infection intensity. Consumption of public tap water (aOR=2.4; 95% CI: 1.0 to 5.2) and residing in Ogou (aOR=28.6) increased intensity, whereas living in Est-Mono (aOR=0.0; 95% CI: 0.0 to 0.08) or using rainwater (aOR=0.0; 95% CI: 0.0 to 0.4) decreased it.</p><p><strong>Conclusions: </strong>The prevalence and intensity of urogenital schistosomiasis were found to be correlated with household and behavioural risk factors. Integrating these factors into national control programmes and improving access to safe water and sanitation facilities will be crucial in eliminating this disease as a public health concern in Togo.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001304"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525967","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}