BMJ public health最新文献

{"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}

{"title":"Role of risk perceptions and vaccine hesitancy on decision-making among low-income mothers in Kenya: a qualitative study.","authors":"Stephen Gichuhi Kimotho","doi":"10.1136/bmjph-2024-001601","DOIUrl":"10.1136/bmjph-2024-001601","url":null,"abstract":"<p><strong>Abstracts: </strong></p><p><strong>Introduction: </strong>Vaccine hesitancy among mothers in low-income communities in Kenya presents a serious obstacle to achieving successful childhood immunisation. The aim of this study was to explore the determinants of vaccine hesitancy among mothers from low-income rural communities, risk perceptions associated with vaccines and how these factors influence decision-making regarding their children's immunisation.</p><p><strong>Methods: </strong>A qualitative descriptive study was conducted in three counties in Kenya (Murang'a, Kiambu and Machakos) using in-depth interviews and focus group discussions with mothers of children under 5 years. Participants were purposively sampled from low-income rural communities and were mothers attending postnatal clinics at various health facilities. Thematic analysis was used to identify key themes and subthemes, coding of transcripts, identification of patterns and organisation of themes into categories.</p><p><strong>Results: </strong>Several critical factors that contribute to vaccine hesitancy among mothers regarding their children's immunisation were identified through thematic analysis. Safety concerns emerged as a primary issue, with mothers expressing fears of adverse reactions such as fever, pain, swelling or other unexpected complications. Misinformation significantly influenced perceptions, including beliefs that vaccines might cause infertility or long-term health problems. Distrust in the health system further exacerbated hesitancy, with mothers questioning the quality, administration and motives of vaccinators. Limited vaccine knowledge also played a role, which led to misconceptions about the severity and risks of vaccine-preventable diseases. Moreover, sociocultural and religious beliefs influenced decision-making, with some mothers viewing vaccines as unsafe or ineffective, driven by cultural norms, reliance on traditional remedies or religious objections.</p><p><strong>Conclusions: </strong>This study provides valuable insights into the complexities of vaccine hesitancy among mothers in low-income communities in Kenya. Furthermore, the results emphasise the complex nature of hesitancy, driven by an interplay of safety concerns, misinformation, distrust, limited knowledge, and sociocultural and religious influences. Addressing these determinants requires interventions that would prioritise clear and accurate communication about vaccine safety, engagement with community and religious leaders, and strengthening trust in healthcare providers and systems. Additionally, enhancing vaccine knowledge through targeted health education programmes would be crucial for empowering mothers to make informed decisions about their children's health.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001601"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652991","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":"Disparities in the access to immune checkpoint inhibitors approved in the United States, the European Union and mainland China: a serial cross-sectional study.","authors":"Jia-Xin Cai, Shi-Yu Wang, Hao Hu, Carolina Oi Lam Ung, Fu-Xiao Li, Teng-Fei Lin, Shi-Fu Luo, Hai-Bo Song, Zhi-Rong Yang, Jin-Ling Tang, Wei-Hua Meng","doi":"10.1136/bmjph-2024-001995","DOIUrl":"10.1136/bmjph-2024-001995","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) have revolutionised antitumour therapy. However, regional differences in ICI labels, including the impact of the review process and supporting trial evidence, remain unclear.</p><p><strong>Methods: </strong>We conducted a serial cross-sectional study to examine trends and differences in indication approvals and associated clinical trials for ICIs across different regulatory agencies. We searched ICI labels approved by the Food and Drug Administration (FDA), European Medicines Agency (EMA) and National Medical Products Administration (NMPA) in Mainland China before 31 December 2022 and assessed the indications and clinical trials in labels. Relative lags of indication approvals were compared using the Mann-Whitney U test. The review time and interval between trial completion and indication submission were compared using the Kruskal-Wallis test.</p><p><strong>Results: </strong>We collected 10 ICIs with 90 indications from the FDA, 10 ICIs with 70 indications from EMA and 16 ICIs with 65 indications from NMPA. Relative lags of ICI indication approval in China (median 344.0 (IQR 220.0, 688.0) days) were longer than in the European Union (118.5 (55.0, 189.0) days) (p<0.0001). Both the European Union (243.0 (191.0, 298.0) days) and China (283.0 (248.0, 339.5) days) demonstrated significantly longer review durations for ICI indications than the United States (181.0 (148.8, 191.8) days) (p<0.0001). While indication submissions to NMPA were significantly more delayed than those to the FDA (p<0.001), the former relied more on trial evidence of OS (84.0%) than the latter (58.0%).</p><p><strong>Conclusion: </strong>ICIs approved in the United States, the European Union and mainland China differed in indications, approval time, review duration and evidence base, which may impact access to life-saving treatments. Future studies should investigate the impact of these differences and the underlying reasons beyond the evidence supporting the label approvals.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001995"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652925","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":"Key factors determining the development of SARS-CoV-2 testing strategies in EU countries: a mixed-methods study.","authors":"L S Kengne Kamga, A C G Voordouw, M C De Vries, A Timen, M P G Koopmans","doi":"10.1136/bmjph-2024-001269","DOIUrl":"10.1136/bmjph-2024-001269","url":null,"abstract":"<p><strong>Background: </strong>The WHO and the European Center for Disease Prevention and Control (ECDC) advocated for extensive testing as a crucial pillar in managing the COVID-19 pandemic. Yet, public health emergency responses varied across European countries. In particular, there were differences in the national laboratory capacities and diagnostic testing strategies. This study was conducted during the pandemic to identify the key factors in developing national, SARS-CoV-2 testing strategies across a selection of European countries.</p><p><strong>Methods: </strong>A mixed-methods study, comprising an interview phase and a survey phase, was performed. First, laboratory, policy-making and/or public health experts from different European countries were interviewed between 8 January 2021 and 19 March 2021, to review the development and implementation of national testing strategies.Second, a cross-sectional survey was conducted among ECDC National Focal Points (NFP) for Preparedness and Response and/or Microbiology between July and October 2022 to validate the interview findings.</p><p><strong>Results: </strong>12 European experts were interviewed and identified the following key factors determining the development of the national SARS-COV-2 testing strategies in their countries: (1) changing testing goals over time, (2) the prevailing epidemiological situation, (3) testing capacities, (4) availability of reference laboratories, (5) supply and stockpiling of testing material, (6) availability of human resources and (7) quality management standards across laboratories. The experts interviewed stressed the important role of stockpile management, the existence of expert networks, as well as the centralisation of decision-making. Lastly, determining the actors responsible for the testing strategy and putting in place 'coordination, accountability and governance' proved to be pivotal.The survey outcome with 15 European NFPs demonstrated that the testing strategies generally changed over time to include a broader group of individuals. Furthermore, the actors 'Ministry of Health', 'Public health officials', 'National public health institutes' and 'National Expert and/or advisory groups' were selected as key players by survey respondents.</p><p><strong>Conclusions: </strong>In general, the scope of the testing strategy in European countries included in this study expanded as the pandemic progressed. This study identified key factors discussed by European experts interviewed that contributed to the development of SARS-CoV-2 testing strategies across European countries.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001269"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652975","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":"Epidemiology of active tuberculosis among adult household contacts of patients with smear-positive pulmonary tuberculosis in Kembata-Tembaro zone, southern Ethiopia: a cross-sectional study.","authors":"Wondimu Daniel, Sebsibe Tadesse, Temesgen Tamirat, Markos Selamu","doi":"10.1136/bmjph-2024-001531","DOIUrl":"10.1136/bmjph-2024-001531","url":null,"abstract":"<p><strong>Background: </strong>The risk of tuberculosis transmission is higher among household contacts than the general population. However, there is a paucity of information that explains the risk of experiencing active tuberculosis among household contacts in countries with a high burden of tuberculosis.</p><p><strong>Objective: </strong>This study aimed to assess the prevalence of tuberculosis infection and associated factors among adult household contacts of smear-positive pulmonary tuberculosis patients in the Kembata-Tembaro zone, southern Ethiopia.</p><p><strong>Methods: </strong>A cross-sectional study design was conducted in the Kembata-Tembaro zone, southern Ethiopia, from August to September 2022. Data were collected from 336 adult household contacts using a pretested questionnaire, and sputum examinations were done using fluorescence microscopy. Binary logistic regression models were used to identify factors associated with tuberculosis infection among adult household contacts.</p><p><strong>Results: </strong>The prevalence of active tuberculosis among adult household contacts of smear-positive pulmonary tuberculosis patients was 6.9% (95% CI 4% to 10%). Nearly half, 47.8%, of them belonged to economically productive adults aged 30-44 years. Smoking cigarettes (adjusted OR (AOR) 6.5, 95% CI (1.04 to 40.17)), sharing a bed with the index tuberculosis case (AOR 6.0, 95% CI (1.97 to 18.28)), poor housing ventilation (AOR 4.2, 95% CI (2.85 to 17.16)) and overcrowded housing (AOR 4.6, 95% CI (1.42 to 14.58)) were associated with tuberculosis infection among household contacts of patients with smear-positive pulmonary tuberculosis.</p><p><strong>Conclusions: </strong>This study has revealed that the prevalence of active tuberculosis among adult household contacts of smear-positive pulmonary tuberculosis patients was detected to be similar to other reports from Ethiopia. Additionally, interventions to prevent tuberculosis transmission among household contacts should focus on providing behaviour change education, improving housing conditions, early detection and isolation of index cases, contact tracing, isoniazid chemoprophylaxis of household contacts with weakened immunity and covering the mouth and nose when coughing or sneezing.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001531"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575021","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}