BMJ public health最新文献

{"title":"Antimicrobial resistance among children in Southeast Asia: a systematic review.","authors":"Robert C Duguid, Elizabeth A Ashley, Paul Turner, Anousone Douangnouvong, Pathana Panyaviseth, Priyali Wijeratne, Jessica Saunders, Phoebe Cm Williams","doi":"10.1136/bmjph-2024-001312","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001312","url":null,"abstract":"<p><strong>Introduction: </strong>There is increasing evidence that antimicrobial resistance (AMR) is responsible for a large burden of morbidity and mortality in children, potentially compounded by reduced efficacy of many commonly recommended empirical antibiotic regimens to treat infections in children.</p><p><strong>Methods: </strong>We used the PRISMA framework to systematically review studies describing AMR in children (0 to 18 years) in Southeast Asia. We analysed bacterial pathogens with a focus on the Global Antimicrobial Resistance Surveillance System (GLASS) reported in studies published between 2010 and 2023. For each pathogen, non-susceptibility to currently recommended WHO empirical antibiotics was analysed with descriptive statistics.</p><p><strong>Results: </strong>We evaluated AMR profiles for 21 191 bacterial isolates collated across 111 studies incorporating 484 540 children. Most published data (71 studies) arose from India. High levels of non-susceptibility were evident in gram-negative pathogens, with <i>Klebsiella</i> spp. exhibiting particularly high levels of resistance to gentamicin (median: 64%; IQR 38 to 81, n=2097) and third-generation cephalosporins (median 76%; IQR 40 to 92, n=2415). Furthermore, a median of 73% (IQR 50 to 86, n=4405) of <i>Escherichia coli</i> isolates were non-susceptible to third-generation cephalosporins, and 48% (IQR 32 to 64, n=3659) were non-susceptible to gentamicin. Among gram-positive pathogens, the median methicillin resistance to <i>Staphylococcus aureus</i> was 43% (IQR 33 to 60, n=1139).</p><p><strong>Conclusions: </strong>There are very high rates of AMR in pathogens isolated from children with common infectious illnesses in Southeast Asia. However, published data available are of variable quality and are heavily weighted towards South Asian countries (India, Nepal and Bangladesh), limiting the generalisability of these findings and highlighting the need for enhanced clinical surveillance networks to improve the surveillance within this populous and high-burden region.</p><p><strong>Prospero registration number: </strong>CRD42021259320.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001312"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047801","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":"Estimation of unconfirmed COVID-19 cases from a cross-sectional survey of >10 000 households and a symptom-based machine learning model in Gilgit-Baltistan, Pakistan.","authors":"Daniel S Farrar, Lisa G Pell, Yasin Muhammad, Sher Hafiz Khan, Lauren Erdman, Diego G Bassani, Zachary Tanner, Imran Ahmed Chauhadry, Muhammad Karim, Falak Madhani, Shariq Paracha, Masood Ali Khan, Sajid Soofi, Monica Taljaard, Rachel F Spitzer, Sarah M Abu Fadaleh, Zulfiqar A Bhutta, Shaun K Morris","doi":"10.1136/bmjph-2024-001255","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001255","url":null,"abstract":"<p><strong>Introduction: </strong>Robust estimates of COVID-19 prevalence in settings with limited capacity for SARS-CoV-2 molecular and serologic testing are scarce. We aimed to describe the epidemiology of confirmed and probable COVID-19 in Gilgit-Baltistan, and to develop a symptom-based predictive model to identify infected but undiagnosed individuals with COVID-19.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey in 10 257 randomly selected households in Gilgit-Baltistan from June to August 2021. Data regarding SARS-CoV-2 testing, healthcare worker (HCW) diagnoses, symptoms and outcomes since March 2020 were self-reported by households. 'Confirmed/probable' infection was defined as a positive test, HCW COVID-19 diagnosis or HCW pneumonia diagnosis with COVID-19-positive contact. Robust Poisson regression was conducted to assess differences in symptoms, outcomes and SARS-CoV-2 testing rates. We developed a symptom-based machine learning model to differentiate confirmed/probable infections from those with negative tests. We applied this model to untested respondents to estimate the total prevalence of SARS-CoV-2 infection.</p><p><strong>Results: </strong>Data were collected for 77 924 people. Overall, 314 (0.5%) had confirmed/probable infections, 3263 (4.4%) had negative tests and 74 347 (95.1%) were untested. Children were tested less often than adults (adjusted prevalence ratio (aPR) 0.08, 95% CI 0.06 to 0.12 for ages 1-4 years vs 30-39 years), while males were tested more often than females (aPR 1.51, 95% CI 1.40 to 1.63). In the predictive model, area under the receiver operating characteristic curve was 0.92 (95% CI 0.90 to 0.93). We estimate there were 8-17 total SARS-CoV-2 infections for each positive test (8-17:1). The ratio of estimated to confirmed cases was higher for ages 1-4 years (211-480:1), 5-9 years (80-185:1) and for females (13-25:1).</p><p><strong>Conclusions: </strong>From March 2020 to August 2021, the majority of SARS-CoV-2 infections in Gilgit-Baltistan went unconfirmed, particularly among women and children. Predictive models which incorporate self-reported symptoms may improve understanding of the burden of disease in settings lacking diagnostic capacity.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001255"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030726","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":"Use of benefits during pregnancy: a cohort study in four organisations in Spain.","authors":"Martina Lupia, Consol Serra, Rosa Serrano, Joan Inglés, Júlia Pratdesava, Pilar Peña, Xavier Duran, Pere Plana, Fernando G Benavides","doi":"10.1136/bmjph-2024-001730","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001730","url":null,"abstract":"<p><strong>Objectives: </strong>To analyse the use of either sick leave (SL) benefit and/or pregnancy-related occupational risk (POR) benefit by workers taking work absence during pregnancy.</p><p><strong>Methods: </strong>Retrospective cohorts of working women from the beginning to the end of pregnancy in three public hospitals and one pharmaceutical company, between 2015 and 2019. We measured the frequency and duration of absences, by age and occupational variables, and cumulative absence days, classifying work status as at work, on SL and on POR absence. Differences between groups for each variable were analysed through the Kruskal-Wallis rank test followed by Dunn's Pairwise Comparisons. Sequence analysis was used to identify pregnancy trajectories.</p><p><strong>Results: </strong>Among 1116 pregnant workers, absence days due to SL ranged from 9.9% to 28.6% of total possible working days, from 9.2% to 38.4% due to POR, while only 3.9% did not take any absence. Nurse aides and nurses used benefits most often and for the longest duration with respect to other occupational categories (p value<0.001). Age had no statistically significant difference (p value=0.245). Three pregnancy trajectories were identified, characterised by mostly active work, active work combined with POR and active work with SL, with differences by workplace, occupation and work area (p value<0.001). The total time in days during which pregnant women were actively working ranged between 56% and 64% depending on the organisation.</p><p><strong>Conclusions: </strong>This study in four organisations shows a very similar pattern regarding total time absent from work during pregnancy. Women were actively working for two-thirds of their pregnancy. Of the remaining time, while in two organisations, absences were mainly due to SL, in other two were due to POR. Organisational variations in the management of pregnant women could be an explanation. We need further investigation on this topic.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001730"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065557","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":"Towards development of guidelines for harnessing implementation science for suicide prevention: an international Delphi expert consensus study.","authors":"Sadhvi Krishnamoorthy, Gregory Armstrong, Victoria Ross, Lennart Reifels, Hayley Purdon, Jillian Francis, Jacinta Hawgood, Sharna Mathieu, Alexandr Kasal, Allison Crawford, Allison M Gustavson, András Székely, Anna Baran, Annette Erlangsen, Ashley Nemiro, Chez Curnow, Daniel Reidenberg, Daria Biechowska, Ella Arensman, Emmanuel Nii-Boye Quarshie, Fiona Shand, Caroline Mae Ramirez, Isabel Zbukvic, Jorgen Gullestrup, Katherine McGill, Kylie King, Lakshmi Vijayakumar, Lauren White, Loraine Barnaby, Mark Sinyor, Marlena Sokół-Szawłowska, Maryke Van Zyl, Merike Sisask, Michael Phillips, Mohsen Rezaeian, Naohiro Yonemoto, Nathaniel Pollock, Nikhil Jain, Paul Siu Fai Yip, Ping Qin, Piotr Toczyski, Rakhi Dandona, Ricardo Gusmão, Samah Jabr, Sarah Spafford, Tae-Yeon Hwang, Thomas Niederkrotenthaler, Ulrich Hegerl, Vita Poštuvan, Yutaka Motohashi, Kairi Kõlves","doi":"10.1136/bmjph-2024-001206","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001206","url":null,"abstract":"<p><strong>Objectives: </strong>Suicide research and prevention are complex. Many practical, methodological and ethical challenges must be overcome to implement effective suicide prevention interventions. Implementation science can offer insights into what works, why and in what context. Yet, there are limited real-world examples of the application of implementation science in suicide prevention. This study aimed to identify approaches to employ principles of implementation science to tackle important challenges in suicide prevention.</p><p><strong>Methods: </strong>A questionnaire about promoting implementation science for suicide prevention was developed through thematic analysis of stakeholder narratives. Statements were categorised into six domains: research priorities, practical considerations, approach to intervention design and delivery, lived experience engagement, dissemination and the way forward. The questionnaire (n=52 statements-round 1; n=44 statements-round 2; n=9 statements-round 3) was administered electronically to a panel (n=62-round 1, n=48-round 2; n=45-round 3) of international experts (suicide researchers, leaders, project team members, lived experience advocates). Statements were rated on a Likert scale based on an understanding of importance and priority of each item. Statements endorsed by at least 85% of the panel would be included in the final guidelines.</p><p><strong>Results: </strong>Eighty-two of the 90 statements were endorsed. Recommendations included broadening research inquiries to understand overall programme impact; accounting for resources in the translation of evidence into practice; embedding implementation science in intervention delivery and design; meaningfully engaging lived experience; considering channels for dissemination of implementation-related findings and focusing on next steps needed to routinely harness the strengths of implementation science in suicide prevention research, practice and training.</p><p><strong>Conclusion: </strong>An interdisciplinary panel of suicide prevention experts reached a consensus on optimal strategies for using implementation science to enhance the effectiveness of policies and programmes aimed at reducing suicide.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001206"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034834","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":"Understanding alcohol use among males in Colombo district: a cross-sectional survey.","authors":"Mahesh Kumbukage, Neil Thalagala, Vindya Kumarapeli","doi":"10.1136/bmjph-2024-001722","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001722","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Background: </strong>Alcohol consumption is a significant public health concern in Sri Lanka, which is linked to a variety of diseases and socioeconomic consequences. There is a rising trend in the overall per capita consumption and associated economic and disease burden in Southeast Asian countries, including Sri Lanka. This study aimed to assess the prevalence and patterns of alcohol consumption among adult males in the Colombo district.</p><p><strong>Methods: </strong>A community-based analytical cross-sectional study was carried out between June 2019 and June 2020 among 1160 participants selected through multi-stage cluster sampling with a cluster size of 20. 58 clusters represented all administrative divisions of the district.</p><p><strong>Results: </strong>A total of 1106 adult males with a mean age of 45.7 (SD=17.4) years participated, of which the majority (n=859, 77.7%) were urban residents, while 228 (20.6%) were from rural areas. The study revealed that 53.4% of adult males in the Colombo district have ever consumed alcohol, with 29.3% having done so in the past 30 days. Findings indicate that alcohol use remains prevalent among adult males, with consumption patterns varying across socio-demographic groups. While a notable proportion of individuals reported alcohol consumption in the past year, there was a marked reduction in binge drinking and daily alcohol use compared with global and national figures. The study also highlights higher alcohol consumption among temporarily employed individuals and older age groups.</p><p><strong>Conclusions: </strong>These insights contribute to a more comprehensive understanding of alcohol consumption trends in Sri Lanka and emphasise the need for continued research and policy efforts to address the health and social impacts of alcohol use.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001722"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040549","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 the reduction in obstetric hospitals result in an unintended decreased in-hospital delivery utilisation? A causal multilevel analysis in China.","authors":"Nan Chen, Peter C Coyte, Jay Pan","doi":"10.1136/bmjph-2024-001683","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001683","url":null,"abstract":"<p><strong>Introduction: </strong>China's progress towards achieving Sustainable Development Goals for maternal health is largely attributed to a reduction in maternal mortality rates, driven by increased in-hospital delivery services utilisation. However, recent reductions in the number of obstetric hospitals have raised concerns about compromised access to these services. This study investigates the impact of reduced obstetric hospitals on spatial accessibility and the utilisation of in-hospital delivery services.</p><p><strong>Methods: </strong>Data from 2016 to 2020 were collected from a densely populated province with approximately 83 million residents. Directed Acyclic Graph was applied to identify a minimally sufficient set of confounders, including residential characteristics and transportation-related factors. Multilevel regression models were employed to analyse the causal effects, with sensitivity analysis using fixed effect and quantile regression models.</p><p><strong>Results: </strong>Between 2017 and 2020, the number of obstetric hospitals decreased by 21.3% (from 1209 to 951), leading to a decline in the proportion of pregnant women covered within a 2-hour driving radius (from 97.4% to 97.1%) and an increase in the maximum of shortest driving time within county (from 117.2 to 121.0 min). Multilevel regression models, adjusted for confounders, showed that a 1 percentage point increase in the proportion of pregnant women covered within a 2-hour driving radius was associated with a 13 percentage point (95% CI: 11.4 to 14.7) increase in in-hospital delivery rates, especially in areas with lower coverage and in-hospital delivery rates.</p><p><strong>Conclusions: </strong>The reduction in obstetric hospitals increased travel distances, negatively impacting in-hospital delivery utilisation. Expanding the proportion of pregnant women covered within a 2-hour driving radius may be more effective than reducing the maximum of shortest travel distance within a county when optimising obstetric hospital locations. These findings provide insights for optimising obstetric facility locations in similar low- and middle-income countries. While improving spatial accessibility is important, the potential quality gains from centralising obstetric resources should also be considered.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001683"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051946","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":"Evaluating UV exposure and skin cancer prevention behaviours in Canada: a national population-based cross-sectional study.","authors":"Amina Moustaqim-Barrette, Hibo Rijal, Santina Conte, Mahan Maazi, Johnny Hanna, Alexandra Sarah Victoria Kelly, Alicia Belaiche, Alyson McKenna, Sandra Pelaez, François Lagacé, Ivan V Litvinov","doi":"10.1136/bmjph-2024-001983","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001983","url":null,"abstract":"<p><strong>Introduction: </strong>Cutaneous melanoma is a common cancer with increasing incidence and significant economic burden. Sun-protective behaviours are crucial in addressing UV-related skin cancer risk and are responsive to public health intervention. This study provides a comprehensive overview of recent prevalence and trends in sun protection and UV exposure in Canada.</p><p><strong>Methods: </strong>Using data from the Canadian Community Health Survey (CCHS), we examined sun-protective behaviours and UV exposure in a sample of over 77 000 individuals aged ≥18 years during 2011-2018. The analysis employed multivariable logistic regression, considering factors including age, sex, income and immigration status, with results weighted to reflect the Canadian population. We further evaluated temporal trends in UV exposure and sun-protective practices from 2007 to 2018.</p><p><strong>Results: </strong>Age, sex, income and immigration status significantly influenced sun-protective behaviours. One-third (33.3%) of respondents reported having had a sunburn in the past 12 months, and most reported irregular or 'never use' of sunscreen on their body (64.3%) and face (58.1%). Women had significantly higher odds of using sunscreen on their body and face compared with men (OR 2.85, 95% CI 2.68 to 3.03 and OR 4.22, 95% CI 3.96 to 4.49, respectively). Individuals in the highest income quintile were similarly more likely to use sunscreen on their body and face than those in the lowest income quintile (OR 1.78, 95% CI 1.55 to 2.04 and OR 2.45, 95% CI 2.10 to 2.86, respectively). Temporal trends demonstrated an increasing prevalence of spending 2 hours or more in the sun and a decreasing trend in the use of any sunscreen on the body and face.</p><p><strong>Conclusions: </strong>The findings highlight disparities in sun protection linked to demographic factors. Public health strategies should target high-risk groups to enhance sun-protective behaviours and reduce melanoma incidence. Future interventions must address these disparities to improve skin cancer prevention.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001983"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035025","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":"Quality of life and its determinants in women with delayed conception in low-mid socioeconomic neighbourhoods of Northern India: a cross-sectional study.","authors":"Barsha Gadapani Pathak, Gitau Mburu, Ndema Habib, Rita Kabra, James Kiarie, Ranadip Chowdhury, Neeta Dhabhai, Sarmila Mazumder","doi":"10.1136/bmjph-2024-001740","DOIUrl":"10.1136/bmjph-2024-001740","url":null,"abstract":"<p><strong>Background: </strong>The inability to conceive or delay in conception has negative and multidimensional effects on health and well-being, daily functioning and societal interactions. This study assesses the impact of delayed conception on quality of life (QoL) among Indian women with delayed conception and evaluates the Fertility Quality of Life (FertiQoL) questionnaire's reliability and construct validity in this population.</p><p><strong>Methodology: </strong>A cross-sectional study of 1530 women aged 18-30, who had not conceived over a period of 18 months, was conducted in low-to-mid-socioeconomic neighbourhoods in Delhi, India. The 24-item core module of the FertiQoL questionnaire was used to assess participants' QoL. Researchers analysed data to identify factors associated with QoL scores and evaluated FertiQoL's internal consistency and validity. Data were collected between July 2020 and August 2021.</p><p><strong>Result: </strong>The average FertiQoL score was 31.71 out of 100, indicating a moderately low QoL. Among the subscales, emotional (mean: 29.0) and mind-body domains (mean: 25.4) scored the lowest, while the relational domain scored the highest (mean: 50.7). Factors negatively associated with QoL included a longer duration of delayed conception (β=-0.3, 95% CI: -0.5 to -0.1), husbands fathering children with other partners (β=-1.1, 95% CI: -1.7 to -0.38), domestic violence-emotional (β=-3.5, 95% CI: -4.5 to -2.4), verbal (β=-3.2, 95% CI: -4.7 to -1.7), physical abuse by family (β=-3.6, 95% CI: -5.5 to -1.6), lack of financial support (β=-3.2, 95% CI: -5.2 to -1.2), social pressures (β=-1.6, 95% CI: -2.3 to -0.9) and physical health issues (β=-0.9, 95% CI: -1.7 to -0.2). The FertiQoL tool demonstrated acceptable reliability (Cronbach's alpha=0.64) and good construct validity (confirmatory factor analysis), confirming its utility in this population.</p><p><strong>Conclusion: </strong>Indian women experiencing delayed conception have reduced QoL, particularly in emotional and mind-body domains, due to various psychosocial and socioeconomic challenges. The FertiQoL questionnaire proved to be a reliable and valid tool for assessing QoL in this context. Psychosocial interventions addressing emotional, social and economic stressors are urgently needed to improve their well-being. Future research should include men to better understand the holistic challenges faced by couples struggling to conceive.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001740"},"PeriodicalIF":0.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039686","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 abortion access after implementation of Medicaid coverage in Illinois: a retrospective analysis.","authors":"Carmela Zuniga, Valeria Hernandez, Debra Stulberg, Lee Hasselbacher, Ashley McHugh, Danielle Young, Hanz Dismer, Terri-Ann Thompson","doi":"10.1136/bmjph-2024-001966","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001966","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Introduction: </strong>In 2018, Illinois implemented House Bill 40 (HB-40), allowing state funds to provide Medicaid coverage for abortion. This study aimed to quantitatively measure changes in access among Illinois residents after the law's implementation, with a focus on changes experienced by Medicaid versus non-Medicaid patients.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using 67 462 abortion visits across 18 health centres comparing service delivery patterns 1 year before and 3 years after HB-40 implementation. We used a t-test and difference-in-differences regression to assess the policy's effect on mean gestational age at the time of abortion among Medicaid patients and non-Medicaid patients. We used χ² tests to capture differences in insurance type used for payment, as well as differences between Medicaid and non-Medicaid patients in presenting at ≤11 weeks gestation, abortion method provided and time between scheduling and getting an abortion.</p><p><strong>Results: </strong>From 2017 to 2020, the overall volume of abortions increased by 27% and the share of abortions paid for with Medicaid increased from 15% to 49%. Compared with non-Medicaid patients, Medicaid patients experienced a significant decrease in average gestational age at the time of abortion post-HB-40 (incidence rate ratio (IRR)=0.93, 95% CI 0.91 to 0.95, p<0.001). The proportion of Medicaid patients ≤11 weeks gestation increased post-HB-40 (76% to 83%; p<0.001) but did not change among non-Medicaid patients (89% to 90%; p=0.62). By 2020, the 13%-point gap that existed between the two groups in 2017 (76% and 89%) was reduced to 4 (86% and 90%). The proportion of medication abortions increased substantially for Medicaid patients post-HB-40 (27% to 46%; p<0.001) and increased slightly for non-Medicaid patients (51% to 53%; p=0.001), resulting in decreased gaps in medication abortions received between the two groups.</p><p><strong>Conclusion: </strong>Medicaid coverage of abortion reduced insurance-related disparities for Medicaid patients, as shown by decreased gaps in average gestational age among Medicaid and non-Medicaid patients. It was also associated with increased medication abortions among Medicaid patients.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001966"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016539","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":"Indian women's settlement experiences and the impact on their health: a narrative study in Brampton, Ontario.","authors":"Sarah Ruth Kipp, David Shiyokha Busolo","doi":"10.1136/bmjph-2024-001700","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001700","url":null,"abstract":"<p><strong>Introduction: </strong>Women who have immigrated from India experience health decline during settlement in Canada. However, little is known about how their settlement experiences impact their health. Accordingly, our study examined the impact of Indian women's settlement experiences on their health.</p><p><strong>Method: </strong>Eight Indian women aged 25-45 years were recruited for our study through purposive and snowball sampling. Guided by narrative inquiry, data collection included individual interviews and a demographic survey. Subsequently, data analysis was completed using Clandinin and Connelly's thematic and holistic method.</p><p><strong>Results: </strong>Narratives described three phases of settlement: 'discovering and seeking', 'compromising and surviving' and 'transitioning and accepting'. Narratives of 'discovering and seeking' described the women's process of exploring and learning about their surroundings and their efforts to obtain information and essential resources. Narratives of 'compromising and surviving' described how the women accepted circumstances below their expectations and applied extraordinary efforts to settle. Narratives of 'transitioning and accepting' depicted women becoming familiar, skilled and supported. This process led to them accepting their new lives and developing hope for a better future. Throughout these phases, women faced social determinants of health (SDOH) challenges and a lack of support which contributed to a decline in their health.</p><p><strong>Conclusion: </strong>Challenges faced during settlement negatively impacted health. When SDOH challenges and distress persist, functional impairment, increased healthcare costs, chronic disease and mortality risk are likely. Alternatively, improved navigation support, culturally appropriate healthcare and equitable employment opportunities could promote Indian women's health during settlement.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001700"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049825","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}