BMJ public health最新文献

{"title":"Modelling the economic impact of substandard uterotonics on postpartum haemorrhage in Nigeria: safeguarding medicine quality can reduce costs and contribute towards universal health coverage.","authors":"Yi-Fang Ashley Lee, Colleen R Higgins, Petra Procter, Sara Rushwan, Chimezie Anyakora, Ahmet Metin Gülmezoglu, Lester Chinery, Sachiko Ozawa","doi":"10.1136/bmjph-2023-000624","DOIUrl":"10.1136/bmjph-2023-000624","url":null,"abstract":"<p><strong>Introduction: </strong>Little evidence exists on the economic threat that substandard uterotonics pose to postpartum haemorrhage (PPH), maternal mortality, and national health systems. For clinical emergencies such as PPH, the quality of the uterotonic drugs required for prevention and treatment plays a central role in whether a severe outcome or fatality occurs and has a direct knock-on effect on the cost of further treatment and care. We modelled the health and economic burden of substandard uterotonics on PPH in Nigeria.</p><p><strong>Methods: </strong>A decision-tree model was built to simulate women giving birth in various healthcare settings, using uterotonics of varying quality, and facing PPH risks. We used the Demographic and Health Survey for care-seeking data and the Cochrane review for uterotonic effectiveness. Trial data from the Early detection of postpartum haemorrhage and treatment using the WHO MOTIVE bundle (E-MOTIVE) was applied for health outcomes by oxytocin quality. Scenarios were compared with and without substandard uterotonics.</p><p><strong>Results: </strong>We estimated that using substandard uterotonics led to avertable out-of-pocket and productivity losses totaling US$89 million (~₦ 68.4 billion) annually in Nigeria. These avertable losses were the result of using substandard uterotonics in 1.6 million mothers. Without substandard uterotonics, healthcare providers can avert nearly 75 000 preventable PPH cases, reduce uterotonic use, save blood transfusions and avert around 1500 maternal deaths due to PPH annually in Nigeria.</p><p><strong>Conclusion: </strong>This study demonstrates that use of quality-assured uterotonics would result in substantial reductions in the economic and health burden of PPH and contribute to decreasing maternal mortality and morbidity. Use of substandard uterotonics leads to increased out-of-pocket expenses and costs to health systems, which should be prevented to promote universal health coverage (UHC). Medicines quality assurance improves health outcomes and results in cost savings for governments to scale their implementation of UHC.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e000624"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805255","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":"Excess mortality during and after the COVID-19 emergency in Japan: a two-stage interrupted time-series design.","authors":"Ganan Devanathan, Paul L C Chua, Shuhei Nomura, Chris Fook Sheng Ng, Nasif Hossain, Akifumi Eguchi, Masahiro Hashizume","doi":"10.1136/bmjph-2024-002357","DOIUrl":"10.1136/bmjph-2024-002357","url":null,"abstract":"<p><strong>Summary: </strong></p><p><strong>Background: </strong>The COVID-19 pandemic has had unprecedented impacts on mortality worldwide. This study aimed to estimate excess all-cause mortality in Japan from 2020 to 2023, stratified by age, sex and prefecture, to assess the evolving impact of the pandemic, particularly in the latter years. The study period extends beyond Japan ending the public health emergency.</p><p><strong>Methods: </strong>Using national vital statistics data from 2015 to 2023, we employed a two-stage interrupted time series analysis to estimate excess mortality during the COVID-19 pandemic (2020-2023) compared with the prepandemic period (2015-2019). Models were adjusted for seasonality, long-term trends, temperature and influenza activity. We calculated excess deaths during (14 January 2020 to 7 May 2023) and after (8 May 2023 to 31 December 2023) the COVID-19 emergency.</p><p><strong>Results: </strong>Japan experienced 219 516 excess deaths (95% empirical CI (eCI) 138 142 to 301 590) during the study period, corresponding to 3.7% (95% eCI 2.33 to 5.09) excess mortality. Excess mortality was negative in 2020 (-1.67%, 95% eCI -2.76 to -0.55), becoming positive in 2021 (2.19%, 95% eCI 0.9 to 3.49) and peaking in 2022 (7.55%, 95% eCI 5.96 to 9.13) before declining in 2023 (5.76%, 95% eCI 4.29 to 7.24). The <60 age group consistently showed the highest percentage excess mortality. Males had slightly higher excess mortality than females. By 2022, all prefectures exhibited positive excess mortality. The relative risk peaked in late 2022, with a smaller peak in summer 2023, coinciding with the post-emergency period. Comparing this post-emergency period with prior years shows the highest percentage excess mortality in 2022. Rural prefectures, and those with lower influenza cases, showed reduced excess mortality during the latter and post-emergency period.</p><p><strong>Conclusion: </strong>Despite initial success in mitigating excess deaths, Japan saw increasing excess mortality as the pandemic progressed, with continued elevation post-emergency. The varying impact across age groups and time highlights the complex factors affecting mortality. This study's findings underline the importance of continuous monitoring of excess mortality as a key indicator for public health dynamics.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e002357"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805249","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":"High-level political commitment to action against AMR: what is next?","authors":"Li Yang Hsu, Helena Legido-Quigley, Alvin Qijia Chua","doi":"10.1136/bmjph-2024-002351","DOIUrl":"10.1136/bmjph-2024-002351","url":null,"abstract":"","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e002351"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805254","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":"Gender equality in caregiver attendance for children with chronic diseases: a Swedish longitudinal observational study.","authors":"Linda Mark, Viktoria Mellqvist, Jens Michelsen, Henrik Imberg, Kristel Björkman, Niklas Johansson, Marcus Svedberg","doi":"10.1136/bmjph-2024-001584","DOIUrl":"10.1136/bmjph-2024-001584","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Objectives: </strong>In countries at the forefront of gender equality policy, mothers still play a more pronounced role than fathers in the provision of parental care for their children. This study aimed to explore gender equality in attendance at doctor's appointments among caregivers of children with chronic diseases before and after the introduction of video conference visits.</p><p><strong>Methods: </strong>Children aged 0-17 years diagnosed with cystic fibrosis, inflammatory bowel disease, diabetes or a chronic neurological disease at Gothenburg's and Lund's paediatric hospitals were included. Data on caregiver attendance from 2019 to 2022 were retrospectively collected from medical records. Doctors' appointments were categorised as in-person, telephone or video conference visits. Using mixed-effects models, we evaluated trends in parental attendance and assessed the associations between different types of appointments and gender equality in healthcare.</p><p><strong>Results: </strong>A total of 347 participants were included between 2019 and 2022, resulting in 6134 appointments. Overall attendance rates were 74% for mothers and 44% for fathers, corresponding to a difference of 30%-points (95% CI 27% to 32%-points, p<0.001). Mothers had consistently higher attendance rates across all types of appointments (all p<0.05). The attendance gap between mothers and fathers remained similar over time, except for video conference visits where an increase in maternal attendance was observed (p<0.001) while paternal attendance remained constant (p=0.90). Video conference visits had higher joint attendance rates than in-person and telephone appointments (both p<0.001).</p><p><strong>Conclusion: </strong>Mothers attended paediatric outpatient visits more frequently than fathers across all appointment types. The gender gap in attendance remained unchanged after the introduction of video conference visits, while the joint attendance increased. Future interventions should explore structural strategies to enhance gender equality in caregiver attendance.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001584"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805250","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 the impact of cigarette smoking on mortality been underestimated by overlooking second-hand smoke? Tohoku medical megabank community-based cohort study.","authors":"Masato Takase, Naoki Nakaya, Kozo Tanno, Mana Kogure, Rieko Hatanaka, Kumi Nakaya, Ippei Chiba, Sayuri Tokioka, Kotaro Nochioka, Takahiro Tabuchi, Taku Obara, Mami Ishikuro, Yuka Kotozaki, Akira Uruno, Tomoko Kobayashi, Eiichi N Kodama, Yohei Hamanaka, Masatsugu Orui, Soichi Ogishima, Satoshi Nagaie, Takahito Nasu, Hideki Ohmomo, Nobuo Fuse, Junichi Sugawara, Shinichi Kuriyama, Yoko Izumi, Atsushi Hozawa","doi":"10.1136/bmjph-2024-001746","DOIUrl":"10.1136/bmjph-2024-001746","url":null,"abstract":"<p><strong>Objectives: </strong>Previous studies have assessed the impact of active smoking on mortality using the population-attributable fraction (PAF). However, these studies have not included second-hand smoking (SHS), potentially underestimating smoking's impact. We compared the PAF from active smoking alone with the PAF, including SHS exposure.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>A community-based cohort study in Japan.</p><p><strong>Participants: </strong>40 796 participants aged ≥20 years.</p><p><strong>Main outcome measures: </strong>SHS was defined as inhaling someone else's cigarette smoke at the workplace or home in the past year. We classified smoking status and SHS into ten categories: never-smoker without SHS, never-smoker with SHS, past smoker without SHS, past smoker with SHS, current smoker 1-9 cigarettes/day without SHS, current smoker 1-9 cigarettes/day with SHS, 10-19 cigarettes/day without SHS, 10-19 cigarettes/day with SHS, ≥20 cigarettes/day without SHS and ≥20 cigarettes/day with SHS. The main outcome was all-cause mortality.</p><p><strong>Results: </strong>During the median follow-up period of 6.5 (5.7-7.5) years, 788 men and 328 women died. For men, compared with never-smokers without SHS, past smokers without SHS (HR, 1.39 [95% CI, 1.11 to 1.73]) and past smokers with SHS (HR, 1.48 (95% CI, 1.10 to 2.00)) were associated with all-cause mortality. For women, never-smokers with SHS had a significantly higher risk of all-cause mortality (HR, 1.36 (95% CI, 1.00 to 1.84)). Without considering SHS, 28.0% and 2.3% of all-cause mortality in men and women, respectively, were attributable to past and current smoking. Including SHS, PAF increased to 31.3% in men and 8.4% in women.</p><p><strong>Conclusions: </strong>We clarified that smoking's impact was underestimated by not accounting for SHS, especially in women. Information on SHS is crucial for understanding smoking's health impact. This study supports the importance of avoiding smoking and preventing SHS.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001746"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805253","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":"Modifiable social and structural factors influence COVID-19 vaccine intention among frontline workers in the Midwestern USA: a community-engaged survey study.","authors":"Precious-Junia de-Winton Cummings, Carolina Gonzalez Bravo, Kimberly C Dukes, Aloha D Wilks, Christopher D Ahlers, Fernando E Casado Castillo, Andrea Courtney, Alaina N Elliott-Wherry, Jessica E Knobbe, Natalie M Pineiro-Falcon, Sienna E Schaeffer, Sarai Tillinghast, Emilio F Tovar, Aneli T Villa, Martha L Carvour","doi":"10.1136/bmjph-2023-000859","DOIUrl":"10.1136/bmjph-2023-000859","url":null,"abstract":"<p><strong>Introduction: </strong>COVID-19 vaccines have been a crucial measure in the pandemic response, yet vaccine uptake has been variable across the population. We sought to identify social and structural factors associated with COVID-19 vaccine intention among adults in the Midwestern USA who worked in one or more frontline industries during the COVID-19 pandemic.</p><p><strong>Methods: </strong>A community-engaged, cross-sectional online survey study was conducted between May and July 2022 among 889 workers. Guided by Thomas and Penchasky's 5As theory of access and Thomson <i>et al</i>'s 5As taxonomy of vaccine uptake, we assessed modifiable social and structural factors related to access (transportation and convenient locations), affordability (time and incentives), activation (reminders), acceptability (experiences in a healthcare setting, political confidence and vaccine confidence) and accommodation (language inclusion and flexible appointments). Multinomial logistic regression was used to identify potentially modifiable factors that may influence vaccine intention among more than 200 surveyed workers who had not yet been vaccinated.</p><p><strong>Results: </strong>Workers who intended not to receive the vaccine were at least three times more likely to report transportation challenges, limited time off work and inflexible vaccine appointments compared with those who intended to vaccinate. Interest in financial incentives was strongly endorsed among workers who did not intend to vaccinate and among those who were undecided. Concerns about vaccine safety or side effects did not influence intention, whereas concerns about vaccine effectiveness were more common among workers who did not intend to vaccinate. Mistrust in government leaders was associated with positive vaccine intention.</p><p><strong>Conclusions: </strong>Vaccine intention among frontline workers is strongly influenced by social and structural factors and not solely by hesitancy about the vaccine itself.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e000859"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757150","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":"Mass testing for discovery and control of COVID-19 outbreaks in adult social care: an observational study and cost-effectiveness analysis of 14 805 care homes in England.","authors":"Siyu Chen, Richard Creswell, Rachel Hounsell, Liberty Cantrell, Sumali Bajaj, Prabin Dahal, Joseph Tsui Lok Hei, Olumide Kolade, Ma'ayan Amswych, Reshania Naidoo, Tom Fowler, Susan Hopkins, Kasia Stepniewska, Merryn Voysey, Lisa White, Rima Shretta, Ben Lambert","doi":"10.1136/bmjph-2024-001376","DOIUrl":"10.1136/bmjph-2024-001376","url":null,"abstract":"<p><strong>Introduction: </strong>We retrospectively evaluated the impact of COVID-19 testing among residents and staff in social care homes in England.</p><p><strong>Methods: </strong>We obtained 80 million reported PCR and lateral flow device (LFD) test results, from 14 805 care homes (residents and staff) in England, conducted between October 2020 and March 2022. These testing data were then linked to care home characteristics, test costs and 24 500 COVID-19-related deaths of residents. We decomposed the mechanism of outbreak mitigation into outbreak discovery and outbreak control and used Poisson regressions to investigate how reported testing intensity was associated with the size of outbreak discovered and to uncover its association with outbreak control. We used negative binomial regressions to determine the factors influencing COVID-19-related deaths subsequent to outbreaks. We performed a cost-effectiveness analysis of the impact of testing on preventing COVID-19-related deaths of residents.</p><p><strong>Results: </strong>Reported testing intensity generally reflected changes in testing policy over time, although there was considerable heterogeneity among care homes. Client type was the strongest determinant of whether COVID-19-related deaths in residents occurred subsequent to testing positive. Higher staff-to-resident ratios were associated with larger outbreak sizes but rapid outbreak control and a decreased risk of COVID-19-related deaths. Assuming our regression estimates represent causal effects, care home testing in England was cost-effective at preventing COVID-19-related deaths among residents during the pandemic and approximately 3.5 times more cost-effective prior to the vaccine rollout.</p><p><strong>Conclusions: </strong>PCR and LFD testing was likely an impactful intervention for detecting and controlling COVID-19 outbreaks in care homes in England and cost-effective for preventing COVID-19-related deaths among residents. In future pandemics, testing must be prioritised for care homes, especially if severe illness and death particularly affect older people or individuals with characteristics similar to care home residents, and an efficacious vaccine is unavailable.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001376"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775224","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 of feeding practices with growth in infants: a longitudinal observational study in a rural district of Pakistan.","authors":"Waliyah Mughis, Sheraz Ahmed, Fayaz Umrani, Sadaf Jakhro, Khaliq Qureshi, Amnat Mangrio, Arjumand Rizvi, Asad Ali","doi":"10.1136/bmjph-2024-001204","DOIUrl":"10.1136/bmjph-2024-001204","url":null,"abstract":"<p><strong>Background: </strong>Exclusive breastfeeding (EBF) is recommended for the first 6 months of an infant's life, but barriers to EBF persist due to sociocultural, economic and health-related factors in resource-poor settings. This study examines the association between feeding practices and malnutrition in a birth cohort from a rural district of Pakistan.</p><p><strong>Methods: </strong>Data were collected from a cohort of n=2697 infants, up to 6 months of age, through routine household visits by community health workers. The study analysed demographic characteristics, feeding practices, anthropometric and health information of infants and their mothers.</p><p><strong>Results: </strong>Breastfeeding practices varied, with EBF being more common in the first month, while predominant breastfeeding (breastmilk with non-milk liquids) was most prevalent from 1 to 6 months. Almost all (98.3%) infants had been breastfed at some point between birth and 6 months but <10% were being exclusively breastfed by 6 months of age, with a significant proportion already identified as wasting (14.7%), stunted (36.7%) and underweight (38.5%) at baseline (birth). Early initiation of complementary feeding or breastmilk alternatives before 4 months was significantly associated with increased odds of wasting by 6 months of age (adjusted OR (AOR)=4.14; 95% CI: 1.95 to 8.77; p<0.001). Infants not born in medical facilities had higher risks of wasting (AOR=2.43; 95% CI: 1.13 to 5.21) and underweight status (AOR=1.74; 95% CI: 1.13 to 2.71).</p><p><strong>Conclusion: </strong>Our study indicates that infants were over four times more likely to be malnourished by 6 months if complementary feeding was initiated before 4 months of age. While causal relations/directionality cannot be established from these findings, we believe that parents may resort to suboptimal complementary feeding practices shortly after birth, due to perceived inadequate infant growth. A tailored approach addressing systemic barriers to optimal feeding practices is recommended for resource-constrained, nutrition-poor settings, such as rural Pakistan.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001204"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756993","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":"Optimal risk assessment intervals for primary prevention of cardiovascular disease: a population-based two-stage landmarking study.","authors":"Zander Gu, Francesca Gasperoni, Ellie Paige, Michael Sweeting, Juliet Usher-Smith, Katrina Poppe, David Stevens, Matthew Arnold, Emanuele Di Angelantonio, Angela M Wood, Jessica K Barrett","doi":"10.1136/bmjph-2024-001241","DOIUrl":"10.1136/bmjph-2024-001241","url":null,"abstract":"<p><strong>Introduction: </strong>The recommended assessment intervals for primary prevention of cardiovascular disease (CVD) differ in major international guidelines. We aimed to provide empirical evidence on the optimal frequency of CVD risk assessment to inform future guidelines.</p><p><strong>Methods: </strong>We estimated the expected time to cross the 10-year CVD risk treatment threshold of 10% using extended two-stage landmarking for more than 2 million people using UK primary care electronic health records between April 2004 and May 2019 from the Clinical Practice Research Datalink GOLD Database (CPRD GOLD), which was linked to hospital admissions data from the Hospital Episodes Statistics (HES) dataset and national mortality records from the Office for National Statistics (ONS). We grouped people based on their sex, initial risk level and age, and computed various percentiles of the expected crossing times per group. Based on the percentiles, optimal assessment intervals were identified and their performance was evaluated comparing to the current recommended intervals in the UK.</p><p><strong>Results: </strong>Our results showed that the expected crossing times for people with lower initial risk were much longer than those with higher initial risk. Within each initial risk group, expected time to crossing the risk treatment thresholds was shorter in people aged ≥65 years. Based on the median expected crossing times, our recommended intervals for women with initial 10-year risk of 7.5%-10%, 5%-7.5%, 2.5%-5% or<2.5% are 3 (1 if ≥65 years old), 7 (4), 10 (6) and 10 (10) years, respectively; intervals for men are 2 (1), 5 (5), 9 (9) and 10 (10) years. These intervals outperformed the 5-yearly risk reassessment for all individuals currently recommended in the UK.</p><p><strong>Conclusions: </strong>Our evidence suggests that CVD risk assessment intervals for primary prevention should be stratified by sex, initial risk level and age. For the UK population, our method found risk assessment intervals that reduce the number of assessments required while shortening the waiting time to the next assessment for those most in need.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001241"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757157","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":"Inclusive sexual and reproductive health services for teenage mothers: a qualitative study in a Rwandan district.","authors":"Vedaste Bagweneza, Joselyne Rugema, Innocent Twagirayezu, Bellancille Nikuze, Alice Nyirazigama, Marie Laetitia Ishimwe Bazakare, Gerard Kaberuka, Alice Muhayimana, Jacqueline Mukakamanzi, Madeleine Mukeshimana","doi":"10.1136/bmjph-2024-001852","DOIUrl":"10.1136/bmjph-2024-001852","url":null,"abstract":"<p><strong>Background: </strong>Sexual and reproductive health (SRH) plays a crucial role in overall well-being, and there is a concerning rise in teenage pregnancies globally, particularly evident in Rwanda according to the Demographic and Health Survey. These pregnancies result in serious consequences, impacting the health of teenage mothers and various aspects of their lives. Lack of accessibility to inclusive SRH services among adolescents was documented in different studies and deters them from using SRH services. To date, no studies have explored how teenage mothers access inclusive SRH services in Rwanda.</p><p><strong>Purpose: </strong>This study aimed at exploring the accessibility to inclusive SRH services among teenage mothers. The focus was on exploring the understanding of teenage mothers about SRH services; exploring their inclusiveness to SRH services and identifying their suggestions to improve their inclusiveness in SRH services.</p><p><strong>Methods: </strong>A qualitative descriptive design was used. 50 teenage mothers from 5 health centres of a Rwandan district participated. They were recruited using purposive sampling and interviewed in five focus group discussions. Before participation, the participants provided their consent. For participants who were minors, consent was obtained from their legal guardians in addition to the participants' assent. The discussions were audio-recorded, transcribed and thematically analysed.</p><p><strong>Results: </strong>Some participants had limited knowledge of certain aspects of SRH and reported difficulties accessing inclusive SRH services, while others mentioned receiving unfriendly SRH services. Participants suggested flexibility in policies related to providing SRH services to teenage mothers, as well as the assignment of specific healthcare providers to address their SRH needs.</p><p><strong>Conclusions: </strong>This study revealed knowledge gaps among participants in SRH and limited accessibility to inclusive SRH services among teenage mothers, due to policy and negative attitudes of some healthcare providers. This highlights the need to educate these professionals in offering inclusive and quality SRH services to teenage mothers.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001852"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775195","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}