BMJ public health最新文献

{"title":"Development and validation of a biological frailty score based on CRP, haemoglobin, albumin and vitamin D within an electronic health record database in France: a cross-sectional study.","authors":"Aurélie Mailliez, Maxime Leroy, Michael Génin, Elodie Drumez, François Puisieux, Jean-Baptiste Beuscart, Ivan Bautmans, Pierre Balayé, Eric Boulanger","doi":"10.1136/bmjph-2024-001941","DOIUrl":"10.1136/bmjph-2024-001941","url":null,"abstract":"<p><strong>Objectives: </strong>To easily detect frailty in a timely fashion, enabling targeted interventions and appropriate monitoring, will be a major worldwide public health and economic challenge as the proportion of older people increases in the population. Based on a review and meta-analysis showing that C-reactive protein (CRP), haemoglobin, albumin and vitamin D are associated with frailty, we aimed to develop and validate a biological score using these biomarkers for the detection of frailty.</p><p><strong>Design: </strong>We conducted a retrospective, cross-sectional, monocentric study using the electronic healthcare database of Lille University Hospital, France.</p><p><strong>Participants: </strong>Inclusion criteria were patients aged 50 and over, being hospitalised at Lille University Hospital between 1 January 2008 and 31 December 2021. We identified patients whose CRP, haemoglobin, albumin and vitamin D levels were measured. We selected patients whose assays fell within normal thresholds, outside acute clinical situations.</p><p><strong>Main outcome measures: </strong>To assess frailty, we used a scale adapted to electronic healthcare database, called the Hospital Frailty Risk Score. To develop and validate the predictive frailty score, the whole population was divided into a development and a validation cohort.</p><p><strong>Results: </strong>26 554 patients were included, of which 17 702 were in the development cohort and 8852 in the validation cohort. Based on the results of the multivariate analysis, we developed an equation combining CRP, haemoglobin, albumin and vitamin D with age and sex to obtain a score referred to as the bFRAil (biological FRAilty) score. Within the validation cohort, the area under the curve for this score is 0.78 (0.77-0.80) and the negative predictive value is 83.7%.</p><p><strong>Conclusions: </strong>This study has made it possible, for the first time, to develop and validate in a hospital setting a biological score called bFRAil score based on simple, easily measurable biomarkers for identifying frail patients in daily medical practice. Further studies are needed to validate its use.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001941"},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712684","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":"Integrating palliative care into primary care for older people with multimorbid serious illness: a multinational qualitative cross-sectional study in Sub-Saharan Africa.","authors":"Kennedy Bashan Nkhoma, Maya Jane Bates, Dorothee van Breevoort, Dickson Dick Chifamba, Catherine J Evans, Duncan Kwaitana, Adwoa Bemah Boamah Mensah, Modai Clement Mnenula, Lovemore Mupaza, Edwina Beryl Addo Opare-Lokko, Richard Harding","doi":"10.1136/bmjph-2024-001355","DOIUrl":"10.1136/bmjph-2024-001355","url":null,"abstract":"<p><strong>Background: </strong>The WHO primary palliative care strategy states that palliative care is 'an ethical responsibility of health systems' and calls for integration of palliative care into public healthcare systems to achieve universal health coverage. We aimed to determine stakeholders' perspectives on the necessary components of and considerations for a feasible and acceptable model of integrated palliative care and primary care for older people living with serious multimorbid illness in Sub-Saharan Africa.</p><p><strong>Methods: </strong>We conducted a multicountry cross-sectional qualitative study in Ghana, Malawi and Zimbabwe. In-depth qualitative interviews were conducted with multimorbid older people and family caregivers. Focus groups were conducted with healthcare staff. Verbatim transcripts were subjected to inductive framework analysis to identify stakeholders' needs and preferences for delivering and receiving palliative care in primary care facilities.</p><p><strong>Results: </strong>The coding framework identified five main themes: (i) communication; (ii) coordination of care; (iii) impact of living with chronic illness; (iv) seeking healthcare; and (v) living with chronic illness: coping strategies and resources. The impact of multimorbid illness on older people was multidimensional, including pain and symptom control, catastrophic spending, social exclusion and limitations on activities of daily living. Specific challenges were identified in care pathways and delivery. Communication was sub-optimal, with lack of appropriate information and patient involvement.</p><p><strong>Conclusion: </strong>Person-centred approaches are required to deliver palliative care to older multimorbid people in primary care settings. This study informs implementation of the WHO Healthy Ageing Policy intention to deliver person-centred primary palliative care and the WHO primary palliative care guidance.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001355"},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712291","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 China's primary healthcare reforms on utilisation, payments and self-reported health: a quasi-experimental analysis of a middle-aged and older cohort 2011-2018.","authors":"Chang Cai, Christopher Millett, Shangzhi Xiong, Maoyi Tian, Jin Xu, Thomas Hone","doi":"10.1136/bmjph-2024-001595","DOIUrl":"10.1136/bmjph-2024-001595","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive health reforms aimed at strengthening primary healthcare (PHC) are infrequently adopted and often poorly evaluated in low-income and middle-income countries. China launched a system-wide PHC reform with a staggered roll-out between 2014 and 2018 with multiple components: (1) gatekeeping via tiered reimbursement, (2) a family physician scheme and (3) a two-way referral system between PHC facilities and hospitals. This study examines the reform impacts on health service utilisation, out-of-pocket expenditures, health outcomes and health inequalities.</p><p><strong>Methods: </strong>The staggered roll-out of the reforms in 125 cities across China was identified using web-scraping. Using longitudinal data (2011-2018) from the China Health and Retirement Longitudinal Study (a cohort aged ≥45), this study adopted a difference-in-differences method to assess the reform's impacts on: (1) visits to PHC facilities, (2) hospitalisation, (3) out-of-pocket expenditures (OOPEs) and (4) self-reported health. Subgroup analyses were conducted by rural/urban populations and wealth quartiles.</p><p><strong>Results: </strong>The reform had small and short-lived impacts-a 7.8% increase in the probability of visiting PHC facilities (95% CI 0.3 to 15.2), a 10.2% increase in reporting good health (95% CI 0.6 to 19.8) and an 873.9 Chinese Yuan (US$129.1) increase in average annual OOPEs (95% CI 57.9 to 1689.9) in the first year of reform implementation. There was no impact on hospitalisation. Increases in PHC utilisation were only found in rural and lower-income populations.</p><p><strong>Conclusions: </strong>China's PHC reforms had some modest, temporary impacts on increasing primary care utilisation and self-reported health. However, further interventions are needed to transition away from the hospital-centric health system and to increase financial protection and health equity in China.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001595"},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712688","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":"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":"Social determinants of recovery from ongoing symptoms following COVID-19 in two UK longitudinal studies: a prospective cohort study.","authors":"Nathan J Cheetham, Vicky Bowyer, María Paz García, Ruth C E Bowyer, J D Carpentieri, Andy Guise, Ellen J Thompson, Carole H Sudre, Erika Molteni, Michela Antonelli, Rose S Penfold, Nicholas R Harvey, Liane S Canas, Khaled Rjoob, Benjamin Murray, Eric Kerfoot, Alexander Hammers, Sebastien Ourselin, Emma L Duncan, Claire J Steves","doi":"10.1136/bmjph-2024-001166","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001166","url":null,"abstract":"<p><strong>Introduction: </strong>Social gradients in COVID-19 exposure and severity have been observed internationally. Whether combinations of pre-existing social factors, particularly those that confer cumulative advantage and disadvantage, affect recovery from ongoing symptoms following COVID-19 and long COVID is less well understood.</p><p><strong>Methods: </strong>We analysed data on self-perceived recovery following self-reported COVID-19 illness in two UK community-based cohorts, COVID Symptom Study Biobank (CSSB) (N=2548) and TwinsUK (N=1334). Causal effects of sociodemographic variables reflecting status prior to the COVID-19 pandemic on recovery were estimated with multivariable Poisson regression models, weighted for inverse probability of questionnaire participation and COVID-19 infection and adjusted for potential confounders. Associations between recovery and social strata comprising combinations of sex, education level and local area deprivation were estimated using the intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach. Further analyses estimated associations with variables reflecting experiences during the pandemic.</p><p><strong>Results: </strong>Gradients in recovery from COVID-19 along the lines of social advantage were observed in intersectional MAIHDA models, with predicted probability of recovery lowest in female strata with lowest education and highest deprivation levels (CSSB: 55.1% (95% CI 44.0% to 65.1%); TwinsUK: 73.9% (95% CI 61.1% to 83.0%)) and highest in male strata with highest education and lowest deprivation levels (CSSB: 79.1% (95% CI 71.8% to 85.1%); TwinsUK: 89.7% (95% CI 82.5% to 94.1%)). Associations were not explained by differences in prepandemic health. Adverse employment, financial, healthcare access and personal experiences during the pandemic were also negatively associated with recovery.</p><p><strong>Conclusions: </strong>Inequalities in likelihood of recovery from COVID-19 were observed, with ongoing symptoms several months after coronavirus infection more likely for individuals with greater social disadvantage prior to the pandemic.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001166"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055540","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}