BMJ public health最新文献

{"title":"Occupational injuries among healthcare workers and objective workload at a tertiary hospital in Lebanon: a retrospective study.","authors":"Ghassan M Khairallah, Samar Al-Hajj, Hani Mowafi, Khalil El-Asmar, Diana Rahme, Carine J Sakr","doi":"10.1136/bmjph-2024-001586","DOIUrl":"10.1136/bmjph-2024-001586","url":null,"abstract":"<p><strong>Background: </strong>Healthcare workers (HCWs) are at an increased risk of occupational injuries due to exposure to many hazards at work. The COVID-19 pandemic exacerbated these occupational risks, particularly with hospital employees working in increasingly demanding environments. HCW shortages further increase the risk of injury to remaining HCWs who shoulder the patient load with fewer human resources. This study aims to explore trends of occupational injuries in Lebanon-a country that faced a multi-faceted healthcare crisis with a severe economic collapse, a resulting massive HCW exodus, coupled with increased workload due to the COVID-19 pandemic. This study further investigates the association between HCW injuries and objective workload measures.</p><p><strong>Methods: </strong>This is a retrospective study examining incident reports completed by HCWs over 5 years (January 2018 to December 2022). The data were complemented by monthly workload measures (admissions, occupied beds, procedures, ED visits, clinic visits) and absenteeism data. Analysis was performed using linear regression models to assess the relationship between workload predictors and injury rate.</p><p><strong>Results: </strong>2291 injuries were recorded, and 22.61% were sustained by registered nurses. The mean monthly injury rate was 1.68 per 100 EFTE, with an increased yearly trend. 40.39% of injuries were due to needle-pricks. Higher injury rates were found to be positively associated with workload: with each 1000 additional procedures each month (8.8% increase), the mean injury rate increased by 0.11 (95% CI 0.04 to 0.18, p value=0.002) (6.34% increase).</p><p><strong>Conclusion: </strong>HCWs sustain a high burden of occupational injuries. Understanding the socio-economic factors and the changes in workload in relation to injury trends is crucial. The study offers valuable insights into suitable staffing and workload levels and can inform policies.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001586"},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712418","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":"Cohort study examining social determinants of health and their association with mortality among hospitalised adults in New York and California.","authors":"Andrew Wang, Dustin French, Bernard Black, Abel N Kho","doi":"10.1136/bmjph-2024-001266","DOIUrl":"10.1136/bmjph-2024-001266","url":null,"abstract":"<p><strong>Background: </strong>Adults in the US face significant disparities in health as a result of the social determinants of health (SDOH). While the link between SDOH and mortality is well-established, their impact on outcomes after hospitalisation is less understood.</p><p><strong>Methods: </strong>Among adults aged 18-84 years hospitalised in New York (NY) during the period of 2000-2009 and in California (CA) from during the period of 2000-2006, we examined the association between 1-year post-hospitalisation mortality and a community-level SDOH combined index (comprising six component domains) using Kaplan-Meier survival analysis and multivariable Cox proportional-hazard models to estimate the mortality HR (adjusted HR (aHR)) adjusted for age, gender, race, ethnicity and Charlson Comorbidity Index. We also studied subcohorts in NY and CA grouped by hospitalisation conditions (subgroups with chronic or acute disease).</p><p><strong>Results: </strong>In NY, the overall 1-year mortality rate was 8.9% (9.7% for chronic diseases and 13.2% for acute diseases). In CA, the overall 1-year mortality rate was 8.3% (12.6% for chronic diseases and 15.8% for acute diseases). In both states, the 1-year risk of death was significantly lower for those in the best (Q4) SDOH (combined index) compared with the worst (Q1 is the reference category). In NY, the aHR was 0.964 (p<0.001 and 95% CI 0.950 to 0.978), while in CA, the aHR: 0.83 (p<0.001 and 95% CI 0.825 to 0.842). Similar patterns were observed for the disease cohorts in both states. The Economic and Education domains of SDOH showed stronger and more consistent associations with mortality risk compared with the domains of Neighbourhood, Food Access, Community and Social Context, and Healthcare.</p><p><strong>Conclusions: </strong>This study demonstrates a significant association between worse SDOH and higher post-hospitalisation mortality. The findings emphasise the importance of community-level SDOH in patient care planning and discharge strategies to reduce health disparities.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001266"},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712682","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":"Has underweight increased among children and adolescents during 2012-2019, and does the prevalence depend on socioeconomic circumstances? A nationwide register-based study from Denmark.","authors":"Anne Vedelsdal Aurup, Lau C Thygesen, Marie Borring Klitgaard, Anne Thorsted, Katrine Strandberg-Larsen, Camilla Trab Damsgaard","doi":"10.1136/bmjph-2024-002328","DOIUrl":"10.1136/bmjph-2024-002328","url":null,"abstract":"<p><strong>Background: </strong>Childhood underweight, indicated by low body mass index (BMI) for age and sex, is associated with morbidity, mortality and poverty in low-income settings, but is often overlooked in high-income countries, due to unequivocal focus on overweight. This study examined the prevalence and socioeconomic characteristics of underweight among children and adolescents in Denmark during 2012-2019.</p><p><strong>Methods: </strong>We used nationwide Danish register data on height and weight measured objectively in 4 61 041 6-7 year-olds and 3 65 312 14-15 year-olds during 2012-2019, covering 89.4% and 67.2% of all schoolchildren in these age groups. We calculated BMI z-scores and classified underweight using the International Obesity Task Force age- and sex-specific BMI cut-offs and linked with data on parental education and household income as indicators of socioeconomic circumstances.</p><p><strong>Results: </strong>The prevalence of underweight remained relatively stable at~8.5% among 6-7-year-old girls during 2012-2019. Among 14-15-year-old girls, it was initially higher but decreased slightly (<1%-point) to 8.6% in 2019. Among boys, the prevalence increased from ~7% to just above 8% in both age groups during the period. Across all years, underweight was more common among 14-15 year-olds whose parents had long higher education (girls: 10.4%-12.1%; boys: 8.7%-10.2%) compared with primary school (girls: 5.6%-7.5%; boys: 6.1%-7.8%), with the most pronounced differences among girls. Similar differences across parental education were observed among 6-7 year-olds, although they were smaller. Less distinct but comparable differences in underweight prevalence were found across household income.</p><p><strong>Conclusions: </strong>Underweight is prevalent but has remained relatively stable during the 2010s among Danish children and adolescents. Unlike the pattern reported in low-income settings, and that seen for overweight, underweight is associated with socioeconomic advantage in this high-income setting.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e002328"},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712686","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":"Evaluation of the case fatality rate in 2 031 309 hospitalised Brazilian patients due to COVID-19: An observational study of the first 3 years of the pandemic in Brazil.","authors":"Camila Vantini Capasso Palamim, Tais Mendes Camargo, Felipe Eduardo Valencise, Fernando Augusto Lima Marson","doi":"10.1136/bmjph-2023-000724","DOIUrl":"10.1136/bmjph-2023-000724","url":null,"abstract":"<p><strong>Introduction: </strong>Since the beginning of the COVID-19 pandemic, in Brazil, there has been a high rate of deaths, mainly among those who were hospitalised due to the disease and those who needed intensive care units (ICUs) and mechanical ventilation support.</p><p><strong>Methods: </strong>The study evaluated the hospitalised patients with COVID-19 as well as subgroups considering those hospitalised patients who needed ICU treatment and those who received invasive mechanical ventilation in an ICU. The risk of death was compared in these three groups with adjustments for gender, age, race and comorbidities. A multivariable analysis was performed to identify the main predictors of death. A hospitalised patient was considered COVID-19 positive if they had a positive real-time polymerase chain reaction (RT-PCR) or serological test, followed by a notification form completed by a health professional, usually a medical doctor. The study was approved by the ethics committee of the institution (Certificate of Presentation of Ethical Appreciation n° 67241323.0.0000.5514; Study Approval Technical Opinion n° 5.908.611).</p><p><strong>Results: </strong>The study evaluated 2 031 309 hospitalised individuals with COVID-19. The case fatality rate was 33.2% (673 527/2 031 309). The case fatality rate was even higher among those patients who required ICU (372 031/665 621; 55.9%) treatment with the need for invasive ventilation support (240 704/303 505; 79.3%). In the multivariable analysis, the male sex (OR=1.14; 95% CI=1.13-1.15), older age [61 to 72 years old (OR=2.43; 95% CI=2.41-2.46), 83 to 85 years old (OR=4.10; 95% CI=4.06-4.14) and+85 years (OR=6.98; 95% CI=6.88-7.07)], race [mixed individuals (<i>Pardos</i>) (OR=1.33; 95% CI=1.32-1.34), Black people (OR=1.57; 95% CI=1.55-1.60) and Indigenous peoples (OR=1.82, 95% CI=1.69-1.97)] and the presence of comorbidities [mainly, hepatic disorder (OR=1.80; 95% CI=1.73-1.87), immunosuppressive disorder (OR=1.80; 95% CI=1.76-1.84) and kidney disorder (OR=1.67; 95% CI=1.64-1.70)] were associated with an increased chance of death, except asthma (OR=0.77; 95% CI=0.75-0.79). In addition, among all admitted patients with COVID-19, the need for an ICU (OR=2.08; 95% CI=2.06-2.13) and invasive ventilatory support (OR=14.86; 95% CI=14.66-15.05) had an impact on death as an outcome.</p><p><strong>Conclusion: </strong>Although the number of daily deaths from the coronavirus dropped during the COVID-19 pandemic in Brazil, our retrospective analysis showed a higher case fatality rate in patients requiring ICU, mainly when using invasive ventilation, compared with the rest of the world.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e000724"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652970","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":"Longitudinal retrospective study of real-world adherence to colorectal cancer screening before and after the COVID-19 pandemic in the USA.","authors":"Harsh Gupta, Robyn Ann Husa, Staci J Wendt, Ann Vita, Claire Boone, Jessica B Weiss, Anton J Bilchik","doi":"10.1136/bmjph-2024-001734","DOIUrl":"10.1136/bmjph-2024-001734","url":null,"abstract":"<p><strong>Introduction: </strong>At-home stool tests are an increasingly popular practice for colorectal cancer screening, especially when access to healthcare facilities is challenging. However, there is limited information about whether stool tests provide sufficient coverage when patients must undergo repeat testing. This study evaluates repeat preventative stool tests over 2 year periods in a healthcare system with 51 hospitals and over 1000 clinics across seven western US states, before and after the onset of the COVID-19 pandemic.</p><p><strong>Methods: </strong>We conduct a real-world, observational, retrospective and longitudinal study based on electronic medical records. We measure the rate of repeat screening and mean delay in repeat screening among patients who receive an initial stool test. We estimate the changes in the likelihood of colorectal cancer screening using a Cox proportional hazard model.</p><p><strong>Results: </strong>Our sample included 4 03 085 patients. The share of patients with an initial negative stool test who received a repeat screening ranged from 38% to 49% across different years. Among patients who received a repeat screening, there is a delay of 3 months on average. The volume of stool tests increased during the pandemic: the HR of screening after the onset of the pandemic to that before the pandemic was 1.18 (95% CI (1.15, 1.20), p<0.001).</p><p><strong>Conclusions: </strong>Our findings show that less than 50% of patients received a repeat stool test, creating gaps in their screening coverage. The increase in stool tests during the pandemic is partly due to a substitution away from colonoscopies, underscoring the increasing importance of stool tests in CRC screening. Programmes that aim to increase CRC screening uptake should focus on repeated testing after an initial screening.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001734"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652980","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":"'Why would I go somewhere where I'm not welcome?' Dehumanisation of people experiencing homelessness in medical settings and the healing potential of a structurally competent model: a qualitative study.","authors":"Ren Bruguera, Alicia Agnoli, Pamela Suzanne Portnoy, Liliana Melgoza, Na'amah Razon","doi":"10.1136/bmjph-2024-001881","DOIUrl":"10.1136/bmjph-2024-001881","url":null,"abstract":"<p><strong>Introduction: </strong>People experiencing homelessness (PEH) face myriad barriers to healthcare, including preventative sexual health services. A street medicine team in one Northern California county observed low uptake of sexually transmitted infection (STI) screening among PEH. We conducted this study to understand the factors contributing to PEH's decision to seek or accept STI screening.</p><p><strong>Methods: </strong>This is a qualitative study using semistructured interviews and demographics surveys among PEH. The interviews focused on understanding facilitators and barriers to STI screening and experiences in healthcare settings more broadly. Interviews were audio-recorded, transcribed and analysed using a thorough memoing process and matrix-based analysis.</p><p><strong>Results: </strong>We enrolled a total of 50 adult, English-speaking PEH: 24 men, 26 women; 52% white, 28% Black/African American, 22% Native American, 4% Asian, 22% Hispanic/Latino. Qualitative analysis revealed a theme of 'dehumanising' prior experiences in healthcare environments including judgement, dismissal of medical concerns, and denial of treatment. Participants reported similar experiences outside of medical settings, which together shaped their self-worth and factored into their decision to delay seeking routine and urgent forms of care, including STI screening. Approximately half of the participants had received medical services from the street medicine team. PEH perceived the street medicine team to foster trust by physically, emotionally and structurally 'meeting patients where they are'.</p><p><strong>Conclusion: </strong>Prior experiences of exclusion within and outside of healthcare settings informed PEH's decision to avoid seeking healthcare until extremely urgent, and to deprioritise services like STI screening. In order to develop interventions to increase STI screening and other preventative health services, it is critical to understand the structural elements underlying relationships between PEH and healthcare systems, and the relevance of social exclusion beyond medicine. This street medicine team exemplifies features of structural competency, a model that may be integrated in other settings and in medical education to promote more equitable and inclusive healthcare.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001881"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652999","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":"Measuring misaligned contraceptive use among reproductive-aged women in Kisumu, Kenya: a cross-sectional, population-based study.","authors":"Brooke W Bullington, Stephanie Chung, Claire W Rothschild, Dickens Onyango, Leigh Senderowicz, Emilia Goland, Abigael Mwanyiro, Ben Wekesa, Brian Frizzelle, Ginger Golub, Katherine Tumlinson","doi":"10.1136/bmjph-2024-001671","DOIUrl":"10.1136/bmjph-2024-001671","url":null,"abstract":"<p><strong>Introduction: </strong>Global family planning scholars have critiqued traditional measures of programmatic success and called for new, person-centred measures that consider people's preferences. We propose a new measure that assesses the alignment between an individual's contraceptive desires and use.</p><p><strong>Methods: </strong>We use data from a population-based survey implemented among adult reproductive-aged women in Kisumu, Kenya. We define misaligned contraceptive use as discordance between contraceptive desires and use (ie, desire for contraception paired with non-use or no desire for contraception paired with use). We expand misaligned use to incorporate non-preferred contraceptive method use, defined as the use of a method with a preference for a different method among contraceptive users. We also compare unmet need for family planning with misaligned use.</p><p><strong>Results: </strong>In our total sample, including contraceptive users and non-users, 86% of participants had aligned contraceptive use and 14% had misaligned use. Among contraceptive users, we found that 74% of participants had aligned and preferred method use, 21% had aligned and non-preferred method use, 2% had misaligned and preferred use, and 3% had misaligned and non-preferred use. Our comparison of misaligned use and unmet need showed little agreement.</p><p><strong>Conclusions: </strong>Measuring misaligned and non-preferred contraceptive method use has implications for family planning measurement and programming. Our results demonstrate the importance of capturing contraceptive desires rather than assuming an implicit desire for contraception among those who do not desire pregnancy. Further, incorporating method preferences into misaligned use provides additional detail on who does and does not have their contraceptive desires met. Finally, measuring misaligned and non-preferred method use highlights subsets of populations who may benefit from additional contraceptive programming to improve contraceptive access or enable method discontinuation or switching, and therefore can be imperative to ensuring that individuals have their reproductive desires realised.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001671"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652983","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":"Association between the composite dietary antioxidant index and sarcopenia risk in American adults: a cross-sectional NHANES study.","authors":"Yun She, Lingling Zhu, Xiangyun Guo, Jinran Qin, Xiqiao Zhou, Jiangyi Yu, Qianhua Yan","doi":"10.1136/bmjph-2024-001447","DOIUrl":"10.1136/bmjph-2024-001447","url":null,"abstract":"<p><strong>Background: </strong>Given the absence of specific pharmacological treatments for sarcopenia, identifying effective lifestyle and dietary interventions is imperative. This study aims to explore the association between the composite dietary antioxidant index (CDAI) and sarcopenia, offering new insights into nutritional strategies for sarcopenia-prone populations.</p><p><strong>Methods: </strong>This cross-sectional study analysed secondary data from the National Health and Nutrition Examination Survey cycles spanning 2001-2006 and 2011-2018. Weighted multivariate logistic regression and restricted cubic spline (RCS) analyses were employed to evaluate the non-linear association between CDAI and sarcopenia and to perform stratified analyses.</p><p><strong>Results: </strong>In this study, encompassing 19 683 American adults, representative of the national population of 132 140 502 residents, 7.97% were diagnosed with sarcopenia. Across all adjusted models, a higher CDAI was inversely associated with the risk of sarcopenia (OR 0.94, 95% CI 0.92, 0.96; <i>P</i><0.0001). The highest quartile of CDAI scores to those in the lowest revealed significantly reduced odds of sarcopenia (OR 0.46, 95% CI 0.38, 0.56; <i>P</i><0.0001). RCS analysis demonstrated a non-linear relationship between CDAI and sarcopenia. Additionally, stratified analyses indicated that the inverse association between CDAI and sarcopenia was more pronounced among participants with higher educational levels and those diagnosed with tumours.</p><p><strong>Conclusions: </strong>There was a negative relationship between CDAI scores and the prevalence of sarcopenia, suggesting that higher CDAI scores may help in managing and preventing the occurrence of sarcopenia.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001447"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652920","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":"Mental health care cascade performance and associated factors: longitudinal analyses of routine Ministry of Health services in Mozambique.","authors":"Morgan Turner, Alberto Muanido, Vasco Cumbe, João Nhalimue Jala, Ernesto Eusébio Armando, Eduarte Mambuque, Flávia Faduque, Ernesto Rodrigo Xerinda, Kenneth Sherr, Bryan J Weiner, Brian P Flaherty, Monisha Sharma, Bradley H Wagenaar","doi":"10.1136/bmjph-2024-001024","DOIUrl":"10.1136/bmjph-2024-001024","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Introduction: </strong>Mental, neurological and substance use (MNS) disorders are leading causes of disability worldwide. Nevertheless, limited research exists regarding MNS health system performance across the care cascade and associated patient characteristics in low-income and middle-income countries (LMICs) such as Mozambique.</p><p><strong>Methods: </strong>We used baseline data from an ongoing randomised controlled trial, collected across 16 outpatient clinics on variables of sex, age, marital status, tuberculosis and HIV status, alcohol and drug use, suicidal ideation, pregnancy and MNS diagnosis. Mixed-effects multivariable regression was used to examine factors associated with patient functional improvement or low functional impairment measured by a standardised disability questionnaire.</p><p><strong>Results: </strong>From February to September 2022, there were 4323 patient visits, of which 65.9% (n=2851) were attended on time (±5 days), 41.4% (n=1793) had medication adherence and 30.5% (n=1321) achieved a functional impairment score <10 or 50% improvement from baseline. Patients 15-18 years old had 60% lower odds of demonstrating functional improvement or low functional impairment during a follow-up visit compared with those 26-35 years old (95% CI: 0.19, 0.85). Compared with single persons, those in a domestic union had 3.3 times higher odds of demonstrating functional improvement or low functional impairment (95% CI: 1.8, 6.1). Individuals expressing suicidal ideation had 85% lower odds of demonstrating functional improvement than those without suicidal ideation (95% CI: 0.02, 0.91). For patients new to treatment, each additional visit was associated with a mean reduction in functional impairment of 0.62 points (95% CI: -0.76, -0.47).</p><p><strong>Conclusions: </strong>This analysis revealed gaps in patients reaching functional improvement or low functional impairment in outpatient MNS care in Mozambique. Gaps were more pronounced for patients who are ≤18 years of age, single or expressing suicidal ideation. Implementation strategies to optimise patient outcomes are needed as nascent mental health systems are scaled-up in Mozambique and other similar LMICs.</p><p><strong>Trial registration number: </strong>NCT05103033.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001024"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652985","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":"Navigating healthcare barriers: a cross-sectional study using respondent-driven sampling to assess migrant women sex workers' access to primary care in France.","authors":"Maeva Jego, Roxane Shahbazkia, Maxime Hoyer, Marine Mosnier, Jean Gaudart, Perrine Roux, Bruno Spire, Grâce Inegbeze, David Michels, Manuela Salcedo Robledo, Stéphanie Vandentorren, Carole Eldin, Emilie Mosnier","doi":"10.1136/bmjph-2024-002234","DOIUrl":"10.1136/bmjph-2024-002234","url":null,"abstract":"<p><strong>Introduction: </strong>Migrant women sex workers (MWSWs) are affected by higher morbidity rates, reflecting the complex health risks associated with sex work and migration which they face. This study aimed to assess MWSWs' use of primary care services in France, as well as the factors associated with having a family doctor.</p><p><strong>Methods: </strong>This cross-sectional observational study of 135 cisgender and transgender MWSWs is part of the larger Favoriser l'Accès à la Santé Sexuelle des Travailleuses du Sexe project, which aims to improve global knowledge of and access to sexual healthcare among this population. MWSWs aged 18 years and older were enrolled over 1 year between 2022 and 2023. The primary outcome was the percentage of MWSWs who reported having a family doctor. A best model analysis and a regression model were used to examine associations between having a family doctor and MWSWs' health and social characteristics.</p><p><strong>Results: </strong>Only 33% of participants reported having a family doctor. Among these, 24% had disclosed they were sex workers to the latter. In general, MWSWs had poor access to preventive healthcare (33% had been HIV tested in the previous year, 33% had used contraception and 19% reported lifetime cervical cancer screening). In contrast, most participants (63.5%) perceived they were in good health. In the multivariate analysis, having a family doctor was not significantly associated with better health outcomes or with the quality of healthcare.</p><p><strong>Conclusions: </strong>The majority of MWSWs did not have a family doctor; this fact compounds existing health vulnerabilities faced by this marginalised population. Improved targeted interventions are needed to increase healthcare access and quality for MWSWs. These interventions should include strategies to enhance communication with healthcare providers about this population's specific needs.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e002234"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652990","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}