BMJ public health最新文献

{"title":"COVID-19 in migrating people at the US-Mexico border during Title 42 immigration restrictions.","authors":"Amir M Mohareb, Sarah Draugelis, Samuel Bishop, Andrea Leiner, Mackenzie G Cater, Ramya Kumar, Carlos Franco-Paredes, George A Yendewa","doi":"10.1136/bmjph-2025-003358","DOIUrl":"https://doi.org/10.1136/bmjph-2025-003358","url":null,"abstract":"<p><strong>Introduction: </strong>In March 2020, the US government implemented the policy of 'Title 42,' which restricted entry of asylum seekers on the stated basis of COVID-19 prevention. In the subsequent years, informal settlements for displaced persons developed and increased in size near the US-Mexico border. We sought to determine the risk of COVID-19 in this setting and compare this to nearby communities at the border.</p><p><strong>Methods: </strong>We conducted an observational study of COVID-19 using data from a humanitarian relief operation at informal settlements at the US-Mexico border from March 2020 to March 2021. People who used this clinic had travelled through irregular routes of migration in Latin America. We reviewed patient characteristics, symptoms and point-of-care SARS-CoV-2 test results during the study period. We compared COVID-19 percent positivity in the camp with the surrounding communities in Mexico and Texas, USA, over 4-week periods.</p><p><strong>Results: </strong>In 6764 clinical encounters, there were 3737 SARS-CoV-2 tests completed with 482 positive results (12.9%, 95% CI 11.8% to 14.1%). Percent positivity was higher in people aged 30-39 years (16.5%) and 40-49 years (16.2%) compared with other age groups (p<0.001) and was 61.5% in pregnant women. Percent positivity was higher in asymptomatic people with suspected close contact exposures than in people with symptoms (15.2% vs 6.9%, p<0.001). Percent positivity was never higher in the camp than in the surrounding community in Matamoros, Tamaulipas, Mexico, and for 8 of the 13 4-week periods, not higher than in Cameron County, Texas.</p><p><strong>Conclusion: </strong>COVID-19 percent positivity was typically lower or the same in this population of migrating people as in the surrounding communities, which provides further evidence against the use of pandemic-era immigration restrictions through Title 42.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e003358"},"PeriodicalIF":1.7,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279624","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":"Awareness of sexually transmitted infections among women of reproductive age in Indonesia: a nationally representative cross-sectional study.","authors":"McKenzie Maviso, Solomon Samson","doi":"10.1136/bmjph-2026-005545","DOIUrl":"https://doi.org/10.1136/bmjph-2026-005545","url":null,"abstract":"<p><strong>Introduction: </strong>Awareness of sexually transmitted infections (STIs) is essential for prevention and timely care. In Indonesia, the burden of STIs among women remains substantial, yet evidence on their awareness is limited. This study assessed STI awareness and its associated factors among Indonesian women aged 15-49 years.</p><p><strong>Methods: </strong>Data from the 2017 Indonesia Demographic and Health Survey, a nationally representative cross-sectional survey, were analysed. Survey weights were applied to account for the complex sampling design. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with STI awareness. Results are presented as adjusted ORs (AORs) with 95% CIs. Statistical significance was set at p≤0.05.</p><p><strong>Results: </strong>Among 13 889 Indonesian women included in the analysis, 88.7% reported STI awareness, with the largest proportion residing in Java (58%). In the multivariable analysis, women residing in Java (AOR=1.81, 95% CI 1.48 to 2.22), Nusa Tenggara (AOR=1.45, 95% CI 1.12 to 1.86) and Papua (AOR=2.21, 95% CI 1.02 to 4.82) had higher odds of STI awareness than those in Sumatra. Higher odds were also observed among women aged 25-34 years (AOR=1.06, 95% CI 1.01 to 1.51), those whose sexual debut occurred at age 20 years or older (AOR=1.19, 95% CI 1.09 to 1.72) and those who reported no sexual activity in the past 4 weeks (AOR=1.24, 95% CI 1.07 to 2.05). Conversely, women residing in Sulawesi, those with lower levels of education, those from the poorest households and those with limited access to mass media and information technology had lower odds of STI awareness.</p><p><strong>Conclusions: </strong>Despite high STI awareness among Indonesian women, substantial geographic, socioeconomic and demographic disparities persist. Targeted, context-specific interventions are needed to promote equitable access to sexual health information and STI awareness among underserved populations.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e005545"},"PeriodicalIF":1.7,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279562","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":"Sexual and reproductive health rights service utilisation and barriers in humanitarian and fragile settings in East Africa: a systematic review.","authors":"Dessie Abebaw Angaw, Nimrod Muhumuza, Nana Koomson, Maria Birungi, Frank Ssekamwa, Stuart Ssebibubbu, Moses Mulumba","doi":"10.1136/bmjph-2025-003351","DOIUrl":"https://doi.org/10.1136/bmjph-2025-003351","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the status of sexual and reproductive health and rights (SRHR) services in humanitarian and fragile settings and identify the specific barriers hindering their implementation in East Africa.</p><p><strong>Design: </strong>This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.</p><p><strong>Data source: </strong>SCOPUS, PubMed, ScienceDirect, Epistimonikos and Hinari, as well as two search engines (Google and Google Scholar), were searched up to 28 January 2025.</p><p><strong>Eligibility: </strong>We included qualitative and quantitative studies on SRHR conducted in East African humanitarian or fragile settings and published after 2000. We excluded editorials; narrative, literature and scoping reviews; and individual or expert opinions from the analysis.</p><p><strong>Data extraction and synthesis: </strong>Reviewers developed a data extraction template before starting extraction, piloting it on six included articles. Thematic content analysis, guided by the Socio-Ecological Model, was performed using MAXQDA software.</p><p><strong>Results: </strong>After screening 1721 articles retrieved from electronic databases and search platforms, we included 59 studies that met all eligibility criteria. Several barriers impede access to sexual and reproductive health services. These barriers are categorised as intrapersonal (perceptions, age, menstrual shame, marital status and knowledge), interpersonal (family size, patriarchal practices and household income), community (social stigma, socioeconomic factors, cultural attitudes and norms) and systemic (lack of friendly services, safety/security issues, food/water insecurity, legal abortion restrictions and insufficiently trained personnel, especially in humanitarian contexts).</p><p><strong>Conclusion: </strong>In humanitarian settings, significant gaps in SRHR service access and utilisation, compounded by displacement and trauma, negatively impact women's health and community well-being. Addressing these gaps requires a multifaceted approach that strengthens healthcare infrastructure, trains healthcare workers, empowers women through education and fosters trust between refugees and providers. Integrated strategies focusing on immediate needs and long-term empowerment are essential to safeguard the SRHR of women in humanitarian settings.</p><p><strong>Prospero registration number: </strong>CRD420251000754.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e003351"},"PeriodicalIF":1.7,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279361","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 facility readiness to provide quality emergency obstetric and newborn care in rural Uganda: a cross-sectional study.","authors":"Brian Turigye, Peter M Macharia, Edgar M Mulogo, Joseph Ngonzi, Michael Kanyesigye, Lenka Benova","doi":"10.1136/bmjph-2026-005103","DOIUrl":"https://doi.org/10.1136/bmjph-2026-005103","url":null,"abstract":"<p><strong>Introduction: </strong>Despite efforts to improve maternal and newborn care services, maternal and newborn mortality in Uganda remains high. Over half of births occur in lower-level health facilities, where limited readiness and suboptimal quality of care may hinder the provision of emergency obstetric and newborn care (EmONC). This study aimed to assess health facility readiness to provide quality EmONC in Kasese and Bundibugyo districts, midwestern Uganda.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted in all 42 district-level public health facilities (health centre (HC) IIIs, HC IVs and general hospitals) offering childbirth services in Kasese and Bundibugyo districts. We used a facility assessment questionnaire based on the WHO's Service Availability and Readiness Assessment and the Averting Maternal Death and Disability tool. Composite readiness scores were calculated across five domains (human resources, physical resources, referral, equipment and drugs and supplies) and signal functions by health facility level. HCIII facilities were considered Basic EmONC (BEmONC), while HC IVs and general hospitals were considered comprehensive EmONC (CEmONC) facilities.</p><p><strong>Results: </strong>The overall mean availability of expected signal functions was 42.3%, and overall readiness was 53.3%. These were lowest in HCIIIs. The least provided CEmONC signal function was blood transfusion, available in 83.3% (n=5) of the CEmONC-designated facilities, and assisted vaginal delivery was the most frequently missing BEmONC signal function, with no facilities reporting its provision. Staffing and training were most available at 70.6%, while physical resources (44%) and functional referral system (44.7%) were least available.</p><p><strong>Conclusions: </strong>EmONC signal function availability and overall readiness were suboptimal, particularly at HC IIIs. Strengthening the capacity and readiness of HC IIIs, improving essential resources and enhancing referral systems should be prioritised to improve access to quality EmONC.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e005103"},"PeriodicalIF":1.7,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279342","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":"Mexican Social Security Institute (IMSS) Pandemic Workforce Administrative Cohort (IMPACT): design and descriptive estimates of surveillance-detected COVID-19 outcomes and primary-series vaccination coverage.","authors":"Edgar Ortiz-Brizuela, Mireille E Schnitzer, Denis Talbot, Gabriel Alejandro Real Ornelas, Rebeca Velasco Reyna, Mauricio Hernandez-Avila, Mabel Carabali","doi":"10.1136/bmjph-2025-004581","DOIUrl":"https://doi.org/10.1136/bmjph-2025-004581","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic placed unprecedented strain on health systems and their workers. In Mexico, the health-system workforce faced this crisis amid major population health, socioeconomic and institutional constraints. Despite these challenges, no population-level research platform existed to support pandemic-related research on this occupational group. In this study, we describe the design of the Mexican Social Security Institute (IMSS) Pandemic Workforce Administrative Cohort (IMPACT) and, as its first application, characterise primary-series vaccination coverage and surveillance-detected COVID-19 outcomes.</p><p><strong>Methods: </strong>Using IMSS payroll records, we identified workers employed during the pandemic and linked this roster to additional real-world data sources. Guided by relevant literature, we operationalised variables for baseline characteristics, vaccination status and surveillance-detected COVID-19 outcomes. We defined two analytical cohorts from these linked data (follow-up end: 9 May 2023): a closed cohort comprising workers already employed at pandemic onset and an open cohort that additionally included subsequent hires. Vaccination was assessed in the closed cohort whereas COVID-19 outcomes were assessed in both. Analyses were conducted overall and stratified by work-unit type, job category, department and geography.</p><p><strong>Results: </strong>In the closed cohort (n=434 655), first-dose and full-series coverage exceeded 70% by days 123 and 169 of the rollout, reaching 93.4% (95% CI 93.3% to 93.5%) and 84.0% (95% CI 83.8% to 84.1%) by follow-up end. Over this period, cumulative incidence was 55.4% (95% CI 55.2% to 55.5%) for infection, 0.99% (95% CI 0.96% to 1.02%) for hospitalisation and 0.22% (95% CI 0.21% to 0.24%) for death. In the open cohort (n=506 995), incidence rates per 100 000 person-days were 60.7 (95% CI 60.6 to 60.9) for infection, 0.80 (95% CI 0.77 to 0.83) for hospitalisation and 0.18 (95% CI 0.15 to 0.20) for death. Unstandardised estimates varied substantially across strata.</p><p><strong>Conclusions: </strong>Among workers employed at pandemic onset, vaccination coverage was high, particularly for first doses. Although surveillance-detected infection was common, severe outcomes were infrequently recorded. Stratified analyses identified vaccination gaps and high-burden strata warranting further investigation. IMPACT provides a valuable platform for policy-relevant research into this workforce.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e004581"},"PeriodicalIF":1.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13711531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149291634","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":"Service availability and readiness of primary healthcare facilities in Cambodia (2020-2025): a systematic review.","authors":"Sokha Yem, Sreypeov Tun, Sokunthea Kem","doi":"10.1136/bmjph-2026-004922","DOIUrl":"https://doi.org/10.1136/bmjph-2026-004922","url":null,"abstract":"<p><strong>Objectives: </strong>To synthesise evidence published between 2020 and 2025 on the availability and readiness of primary healthcare (PHC) services in Cambodia and identify key gaps for health system strengthening.</p><p><strong>Design: </strong>Systematic review conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.</p><p><strong>Data sources: </strong>Seven electronic databases (Web of Science, PubMed/MEDLINE, Scopus, Google Scholar, PubMed Central, CINAHL and Western Pacific Regional Health Indexes) were searched, supplemented by grey literature from the WHO, World Bank and Cambodia's Ministry of Health.</p><p><strong>Eligibility criteria: </strong>Studies published in English between January 2020 and December 2025 reporting quantitative measures of PHC service availability or readiness in Cambodia were included. Eligible facilities comprised health centres, health posts and community-based primary care facilities assessed using Service Availability and Readiness Assessment (SARA), WHO Package of Essential NCD Interventions (PEN) or comparable frameworks. Hospital-based studies, qualitative studies, editorials and conference abstracts were excluded.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently screened studies and extracted data using a standardised form. Risk of bias was assessed using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Due to methodological heterogeneity, findings were synthesised narratively.</p><p><strong>Results: </strong>Eight studies met the inclusion criteria, with facility sample sizes ranging from 45 to 1288. Maternal and child health services had the highest availability, with approximately 62%-85% of facilities providing them. Overall readiness scores ranged from 42% to 74%, with an average of about 58%, below commonly reported low- and middle-income country benchmarks. The lowest readiness levels were observed for essential medicines (~49%), infection prevention and control (~37%), non-communicable disease (NCD) services (~32%) and emergency care (~24%). Significant rural-urban disparities were consistently reported. Risk of bias was low in one study, moderate in four and serious in three.</p><p><strong>Conclusions: </strong>Cambodia's PHC system demonstrates moderate service availability but inadequate readiness, particularly for NCD and emergency care services. Strengthening rural workforce distribution, medicine supply chains, infrastructure, NCD capacity and national monitoring systems is essential to achieve universal health coverage.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e004922"},"PeriodicalIF":1.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279422","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":"Ethnic differences in albuminuria and advanced chronic kidney disease among individuals with type 2 diabetes: a retrospective cohort study in South London.","authors":"Thamer Alobaid, Janaka Karalliedde, Matthew Dl O'Connell, Salma Ayis","doi":"10.1136/bmjph-2025-004564","DOIUrl":"https://doi.org/10.1136/bmjph-2025-004564","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a major complication of type 2 diabetes (T2D) and contributes to morbidity and mortality. Ethnic disparities in CKD progression are well recognised, but the role of albuminuria and other clinical risk factors in driving these differences remains unclear.</p><p><strong>Methods: </strong>We examined 26 298 adults with T2D identified from primary care records in Lambeth DataNet between 2005 and 2021. The mean (SD) age was 61.2 (12.3) years, ranging from 18 to 90 years; 52.1% were males. Self-reported ethnic distribution showed 40.5% Black (n=10 651), 36.7% White (n=9656), 15.5% Asian (n=4074), 4.0% Mixed (n=1043) and 3.3% Other (n=874). Baseline demographic, clinical, biochemical and medication data were analysed. Albuminuria was classified using the urine albumin-to-creatinine ratio (ACR) as A1 (<3 mg/mmol), A2 (3-30 mg/mmol) or A3 (>30 mg/mmol). Advanced CKD was defined as stage 4-5 (estimated glomerular filtration rate (eGFR)<30 mL/min/1.73 m²). Traditional risk factors included age, sex, body mass index (BMI), glycated haemoglobin (HbA1c), blood pressure (BP), lipid profile, baseline eGFR, albuminuria and medication use. Logistic regression was used to identify predictors of advanced CKD, adjusting for these traditional risk factors, as well as ethnicity and the interaction of age and ACR.</p><p><strong>Results: </strong>Albuminuria distribution varied significantly by ethnicity, with macroalbuminuria (A3) most prevalent in Mixed (25.6%; n=213) and Other ethnicities (24.6%; n=177), compared with Whites (23.2%; n=1758) and Blacks (22.4%; n=1960). In multivariable models, Asian ethnicity was independently associated with advanced CKD (adjusted OR 1.30 (95% CI 1.01 to 1.69), p=0.04) compared with White. Additional predictors included older age (OR 1.02 (95% CI 1.01 to 1.03), p<0.001), higher HbA1c (OR 1.02 (95% CI 1.01 to 1.02), p<0.001), BMI (OR 1.02 (95% CI 0.99 to 1.02), p=0.01), systolic BP (OR 1.02 (95% CI 1.01 to 1.02), p=0.003), microalbuminuria (A2) (OR 1.33 (95% CI 1.02 to 1.73)) and macroalbuminuria (A3) (OR 1.22 (95% CI 1.02 to 1.45)). Conversely, higher LDL cholesterol (OR 0.72 (95% CI 0.63 to 0.83)) and baseline eGFR (OR 0.95 (95% CI: 0.95 to 0.96)) were associated with lower risk of advanced CKD.</p><p><strong>Conclusions: </strong>Asian ethnicity and modifiable risk factors, including poor glycaemic control, obesity and systolic hypertension, are key determinants of advanced CKD in people with T2D. Albuminuria A3 was most prevalent in Asian people, emphasising the need for early, proactive management and culturally tailored interventions.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e004564"},"PeriodicalIF":1.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279357","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":"Impact of COVID-19 on gastrointestinal disease in vaccinated and unvaccinated individuals: a population-based cohort study in England.","authors":"Marwa Al Arab, Genevieve Cezard, Colin Crooks, Yinghui Wei, Elsie Horne, Tom M Palmer, Jose I Cuitun Coronado, Alex J Walker, Millie Green, Louis Fisher, Jon Massey, Simon Davy, Amir Mehrkar, Sebastian Bacon, Ben Goldacre, Nishi Chaturvedi, Angela Wood, Jonathan A C Sterne, Venexia Walker, Rachel Denholm","doi":"10.1136/bmjph-2025-004709","DOIUrl":"https://doi.org/10.1136/bmjph-2025-004709","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 is associated with higher rates of gastrointestinal diseases, although the duration of this effect and the roles of vaccination and COVID-19 severity remain uncertain.</p><p><strong>Objective: </strong>To investigate the relationship between COVID-19 and gastrointestinal diseases by vaccination status in hospitalised and non-hospitalised patients.</p><p><strong>Design: </strong>With NHS England approval, OpenSAFELY-TPP was used to access linked data from 24 million English adults. We defined three cohorts: 'prevaccination' (January 2020-June 2021), 'vaccinated' and 'unvaccinated' (June-December 2021). We estimated adjusted HRs (aHRs) comparing the incidence of 10 gastrointestinal diseases, including upper and lower gastrointestinal bleeding, after vs before or without a COVID-19 diagnosis overall and by COVID-19 severity.</p><p><strong>Results: </strong>COVID-19 diagnosis was associated with elevated incidence of gastrointestinal diseases, particularly after hospitalised disease. In the prevaccination cohort (n=18 422 781), the aHRs for upper gastrointestinal bleeding after hospitalised COVID-19 were 20.1 (95% CI 18.4 to 22.1) in weeks 1-4 and 1.90 (1.63 to 2.22) in weeks 53-102. The corresponding aHRs after non-hospitalised COVID-19 were 1.92 (1.74 to 2.11) and 1.34 (1.23 to 1.45), respectively. Across time periods, aHRs for gastrointestinal diseases were lower in vaccinated (n=14 948 727) than in unvaccinated (n=3 479 043) individuals. These patterns were similar across gastrointestinal diseases.</p><p><strong>Conclusion: </strong>The incidence of gastrointestinal disease is elevated for up to 2 years among individuals hospitalised following a COVID-19 diagnosis, especially in the first few weeks after diagnosis. Increases in incidence are attenuated among vaccinated individuals. Monitoring for gastrointestinal diseases after severe COVID-19 and promotion of vaccination in vulnerable groups are key to reducing long-term burden.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e004709"},"PeriodicalIF":1.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279426","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":"Associations of intimate partner violence with menstrual symptoms and healthcare-seeking among women in China: a nationwide cross-sectional survey.","authors":"Chenyu Yan, Wenxin Yan, Liangyu Kang, Wenwen Liu, Yichunzi Zhang, Siyu Liu, Heshuqi Wang, Hong He, Jialei Fu, Liyuan Tao, Jue Liu, Wannian Liang","doi":"10.1136/bmjph-2026-005194","DOIUrl":"https://doi.org/10.1136/bmjph-2026-005194","url":null,"abstract":"<p><strong>Introduction: </strong>Intimate partner violence (IPV) is a major global public health issue linked to adverse reproductive health outcomes, while menstrual symptoms (primary dysmenorrhoea (PD) and premenstrual syndrome (PMS)) are highly prevalent among reproductive-aged women. Evidence on the associations between IPV (overall and by type) and menstrual symptoms, as well as IPV's modifying role in healthcare-seeking behaviour for these symptoms, remains limited in China.</p><p><strong>Methods: </strong>This nationwide cross-sectional study used a two-stage sampling design, recruiting 4175 women aged 18-54 years (June-August 2025). IPV was assessed with a revised Extended-Hurt, Insult, Threaten, Scream scale (categorised as overall, physical, sexual and psychological violence). PD severity was rated via a 0-10 numerical scale, and PMS symptoms were broadly defined by self-reported presence of typical peri-menstrual symptoms. Healthcare-seeking behaviour for menstrual problems was a binary outcome. Bivariate analyses and multivariable regression models with cluster-robust SEs were used for analysis.</p><p><strong>Results: </strong>The prevalence of IPV exposure was 59.59%, with psychological violence being the most common (80.10%). PD and broadly defined PMS symptoms were reported by 84.55% and 95.93% of participants, respectively while only 23.04% had sought formal healthcare for menstrual symptoms. After adjusting for confounders, IPV exposure was independently associated with increased odds of PD (OR=1.288, 95% CI 1.133 to 1.464) and PMS (OR=1.979, 95% CI 1.442 to 2.715), with psychological violence being the only significant subtype (PD: OR=1.180, 95% CI 1.005 to 1.386; PMS: OR=1.785, 95% CI 1.258 to 2.533). IPV modified the association between PMS and healthcare-seeking: PMS predicted care-seeking in non-exposed women (OR=2.357, 95% CI 1.166 to 4.765) but not in exposed women (OR=1.672, 95% CI 0.905 to 3.088). PD severity consistently drove healthcare-seeking across both groups.</p><p><strong>Conclusion: </strong>IPV was associated with more severe menstrual symptoms and with a weaker association between PMS and formal healthcare-seeking among Chinese women. Integrating IPV-informed screening, menstrual health education and referral pathways into reproductive health services may help identify women with unmet needs and inform future longitudinal and intervention studies. It also could address unmet health needs and advance Sustainable Development Goal 3 and Sustainable Development Goal 5.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e005194"},"PeriodicalIF":1.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279636","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":"A probabilistic framework reveals life course heterogeneity in global diet and healthy longevity associations.","authors":"Yuzhe Pan, Nan Zhang, Xiqin Tong, Guopeng Chen, Xinqi Li, Jinxian Wu, Jiamin Fang, Duantengchuan Li, Liutao Wu, Shuang Peng, Qian Liu, Fuling Zhou","doi":"10.1136/bmjph-2026-005263","DOIUrl":"https://doi.org/10.1136/bmjph-2026-005263","url":null,"abstract":"<p><strong>Introduction: </strong>Conventional dietary adherence scores may limit cross-population comparability and allow strong components to offset marked shortfalls. We developed a probabilistic framework to place established dietary patterns on a common scale while retaining information on limiting components.</p><p><strong>Methods: </strong>We constructed the Dietary Matching Index (DMI) for eight dietary patterns using age-specific and sex-specific dietary estimates from 185 countries from 1990 to 2018. Parameters were selected using outcome-blind sensitivity analyses. Construct validity was assessed using global dietary data and six harmonised individual-level dietary datasets. Spatial clustering was evaluated using global and local Moran's I. Associations with health-adjusted life expectancy (HALE) were estimated using geographically and temporally weighted regression models adjusted for sex and socioeconomic and ecological covariates.</p><p><strong>Results: </strong>DMI rankings were robust to calibration choices and Monte Carlo resampling. Across joint parameter settings, minimum Spearman correlations with baseline rankings ranged from 0.971 to 0.993, and Spearman correlations between the 250-draw and 500-draw estimates were 1.00 for all eight patterns. Component-level analyses reproduced the intended structure of the original dietary patterns, and individual-level gradients were consistent across six validation datasets. Dietary alignment varied substantially across countries and showed persistent geographic clustering. DMI-based models showed comparable or modestly better fit than conventional-score models. Associations with HALE were modest and varied by age and region. The largest positive pooled association was 0.17 additional HALE years for a one-standard-deviation higher Mediterranean-style DMI in ages 2<b>-</b>19 years (95% uncertainty interval 0.08 to 0.22). Between-country heterogeneity was greatest in midlife, with I² exceeding 50% for most patterns.</p><p><strong>Conclusions: </strong>DMI provides a common probabilistic scale for comparing dietary patterns and identifying limiting components. Dietary alignment showed persistent geographic structure, while associations with HALE varied by age and region. These ecological findings may support dietary surveillance and prioritisation, but causal interpretation requires evidence from longitudinal or intervention studies.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"4 4","pages":"e005263"},"PeriodicalIF":1.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13711543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149291555","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}