BMJ public health最新文献

{"title":"Association of patient, physician and visit characteristics with inappropriate antibiotic prescribing in Japanese primary care: a cross-sectional study.","authors":"Atsushi Miyawaki, Joseph B Ladines-Lim, Daichi Sato, Kei Kitajima, Jeffrey A Linder, Michael A Fischer, Kao-Ping Chua, Yusuke Tsugawa","doi":"10.1136/bmjph-2024-002364","DOIUrl":"10.1136/bmjph-2024-002364","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Objective: </strong>To assess the prevalence and associated factors of inappropriate antibiotic prescribing in Japanese primary care.</p><p><strong>Methods: </strong>This cross-sectional study analysed all antibiotic prescriptions written between 1 October 2022 and 30 September 2023, using an electronic health record database of primary care clinics across Japan. Using a previously developed classification algorithm, we determined whether diagnosis codes occurring on or during the 3 days before the antibiotic prescribing date 'always', 'sometimes' or 'never' justified antibiotic use. We classified antibiotic prescriptions into one of four mutually exclusive categories: 'appropriate' (associated with ≥1 'always' code), 'potentially appropriate' (associated with ≥1 'sometimes' code but no 'always' codes), 'inappropriate' (associated only with 'never' codes) and 'not associated with a recent diagnosis'. A linear probability model examined patient, physician and visit characteristics associated with inappropriate antibiotic prescribing among solo practice clinics.</p><p><strong>Results: </strong>Analyses included 2 058 021 outpatient antibiotic prescriptions to 1 267 708 patients at 2809 clinics. Among these prescriptions, 176 181 (8.6%) were appropriate, 1 238 549 (60.2%) were potentially appropriate, 348 949 (17.0%) were inappropriate and 294 342 (14.3%) were not associated with a recent diagnosis. Among solo practice clinics, inappropriate prescribing was more likely to patients aged <18 versus ≥65 years (+2.6%; 95% CI +0.3% to +4.9%) or with Charlson Comorbidity Index score ≥2 vs 0 (+2.0%; 95% CI +0.6% to +3.4%), for physicians aged ≥65 versus <45 years (+7.3%; 95% CI +3.6% to +11.0%), for physicians in the highest tertile of antibiotic prescribing volume (+4.9%; 95% CI +3.0% to +6.8%), during telehealth visits (+3.9% vs office visits; 95% CI +0.02% to +7.7%) and during regular hours care versus after hours care (+2.1%; 95% CI +0.7% to +3.5%). These findings were qualitatively unchanged when including both solo and group practice clinics.</p><p><strong>Conclusions: </strong>Targeting younger patients, patients with comorbidities, older physicians, physicians with high antibiotic prescribing, telehealth visits and regular hours care may further increase stewardship effectiveness.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002364"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984955","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":"Clustering of circumstances during the first 1000 days after conception and their association with school performance: a population-based cohort study from the Netherlands.","authors":"Malon Van den Hof, Ilona Veer, Ruben van Gaalen, Tessa Roseboom","doi":"10.1136/bmjph-2024-002176","DOIUrl":"10.1136/bmjph-2024-002176","url":null,"abstract":"<p><strong>Background: </strong>The first 1000 days of life are a crucial foundational period during which many different factors can impact development. It is unknown to what extent different factors cluster and how this affects later-life outcomes.</p><p><strong>Methods: </strong>In this population-based cohort study, we used registry data of all children born in the Netherlands in 2006. We used latent class analysis to investigate clustering of circumstances in the first 1000 days of life, including socioeconomic indicators (household income, parental education), prenatal and perinatal biomedical factors (maternal age, late-start antenatal care, preterm birth/born small for gestational age/poor start in life), and adverse childhood experiences in the first 1000 days (parental death, separation, mental health problems and detention) and associated clusters with school performance (ie, highest secondary school level advice at age 12).</p><p><strong>Results: </strong>In the study population of 181 575 children, we identified five clusters. We labelled cluster 1 (39%) and cluster 2 (27%) as 'resource-richest', clusters 3 (15%) and 4 (15%) as 'intermediate', and cluster 5 (5%) as 'resource-poorest', with the latter having the highest probabilities of low socioeconomic resources, adverse prenatal and perinatal biomedical factors and adverse childhood experiences in the first 1000 days. Compared with those in the resource-richest cluster (cluster 2), children in the resource-poorest cluster (cluster 5) had poorer school performance (OR 0.13, 95% CI 0.11 to 0.14), also after adjustment for parental education and household income (OR 0.20, 95% CI 0.18 to 0.24).</p><p><strong>Conclusions: </strong>Clustering of risk factors across different domains during the first 1000 days of life was associated with poorer school performance at age 12, suggesting that children growing up in resource-limited environments during this critical developmental window may face challenges in reaching their full developmental and educational potential. If we find similar associations with health-related outcomes, this would further underscore the importance of policies that strengthen resources across multiple domains early in life to support long-term human potential.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002176"},"PeriodicalIF":0.0,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884788","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":"Variation in coronary revascularisation and mortality after myocardial infarction across three public health insurance schemes in Thailand: an observational analysis from nationwide claims data.","authors":"Woranan Witthayapipopsakul, Orawan Anupraiwan, Gumpanart Veerakul, Anne Mills, Ipek Gurol-Urganci, Jan van der Meulen","doi":"10.1136/bmjph-2024-001264","DOIUrl":"10.1136/bmjph-2024-001264","url":null,"abstract":"<p><strong>Background: </strong>Evidence on the impact of diverse healthcare insurance arrangements on healthcare variation is limited in low-income and middle-income countries. In Thailand, the Civil Servant Medical Benefit Scheme (CSMBS), Social Health Insurance (SHI) and Universal Coverage Scheme (UCS) have different provider choice and reimbursement arrangements and cover different populations. We explored to what extent use of revascularisation in patients with ST elevation myocardial infarction (STEMI) varied by insurance scheme.</p><p><strong>Methods: </strong>We used claims data, including all admissions for patients with STEMI between 2015 and 2020. Outcomes were any type of revascularisation, primary percutaneous coronary intervention (PPCI) and mortality. Regression models were used to estimate absolute differences (ADs) by scheme, adjusted for age, sex, comorbidities and admission year.</p><p><strong>Results: </strong>Of 98 142 patients, 75.7% were covered by UCS, 13.3% by CSMBS and 11.0% by SHI. Overall, 76.3% underwent revascularisation and 53.8% received PPCI. Mortality rates were 13.2% in-hospital and 20.7% at 180 days. Compared with UCS, use of revascularisation was slightly higher with CSMBS and slightly lower with SHI (AD: CSMBS 1.3% (95% CI -0.2 to 2.8), SHI -0.8% (-2.6 to 1.0), p=0.0264) and use of PPCI was slightly higher with CSMBS and SHI (AD: CSMBS 2.4% (-0.3 to 5.2), SHI 5.2% (3.1 to 7.2), p<0.0001)). CSMBS and SHI-insured patients had lower mortality compared with UCS (AD for in-hospital: CSMBS -1.3% (-2.1 to -0.5), SHI -0.9% (-1.8 to -0.1), p<0.0001; AD for 180-day mortality: CSMBS -4.5% (-5.3 to -3.6), SHI -1.9% (-3.0 to -0.8), p<0.0001). Effects of insurance scheme varied by hospital type for all outcomes (p for interaction<0.0001).</p><p><strong>Conclusion: </strong>Three-quarters of patients with STEMI received coronary revascularisation, suggesting potential undertreatment. We identified relatively small differences in access to revascularisation by insurance scheme which are unlikely to explain the lower mortality with CSMBS and SHI. Claims data can be used to assess the impact of insurance on access to effective treatments.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e001264"},"PeriodicalIF":0.0,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884797","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":"Advancing dementia care: a review of Italy's public health response within the WHO Global Action Plan and European strategies.","authors":"Antonio Ancidoni, Simone Salemme, Domitilla Marconi, Guido Bellomo, Sara Maria Pani, Nicoletta Locuratolo, Eleonora Lacorte, Flavia Lucia Lombardo, Ilaria Bacigalupo, Elisa Fabrizi, Marco Canevelli, Francesco Sciancalepore, Patrizia Lorenzini, Ilaria Palazzesi, Alice Paggetti, Francesco Della Gatta, Paola Piscopo, Emanuela Salvi, Francesca Zambri, Annachiara Di Nolfi, Vittorio Palermo, Paolo Sciattella, Chiara Bini, Francesco Saverio Mennini, Caterina Bianca Neve Aurora Bianchi, Fiammetta Landoni, Maria Assunta Giannini, Teresa Di Fiandra, Nicola Vanacore","doi":"10.1136/bmjph-2024-002250","DOIUrl":"10.1136/bmjph-2024-002250","url":null,"abstract":"<p><strong>Introduction: </strong>Dementia is a growing global public health priority, with the WHO Global Action Plan (GAP) calling for coordinated efforts worldwide. Italy, one of the oldest nations globally, faces a significant challenge with approximately 2 million individuals living with dementia or mild cognitive impairment. In response, the Italian Fund for Alzheimer's and other Dementias (IFAD) was established in 2020 to align national efforts with the WHO GAP's objectives. This study analyses IFAD activities from 2021 to 2023, offering insights into Italy's public health response to dementia and its relevance to global strategies.</p><p><strong>Methods: </strong>We conducted a structured, iterative review of all activities coordinated by the Italian Dementia Observatory (OssDem-Istituto Superiore di Sanità (ISS)) within IFAD 2021-2023. Global, regional and national documents on dementia prevention, care and support were retrieved from official websites, institutional repositories and targeted web searches using the keywords 'dementia', 'brain health' and 'ageing'. Two reviewers independently screened and extracted data with a predefined matrix mapped to the seven WHO GAP Action Areas. Human-subject studies cited had independent ethics approval and informed consent; no new data were collected for this review.</p><p><strong>Results: </strong>IFAD activities led to substantial progress in dementia care services, with memory clinics, residential care facilities and daycare centres mapped, revealing regional disparities in service provision. Modifiable risk factors accounted for 39.5% of dementia cases in Italy, with an estimated 67 000 cases preventable through risk reduction. National guidelines were developed to standardise dementia care pathways, and training programmes addressed gaps in HP and caregiver preparedness, particularly highlighted by the COVID-19 pandemic.</p><p><strong>Discussion: </strong>Italy's experience provides valuable lessons for countries facing similar demographic challenges. The IFAD extension to 2024-2026 aims to address persistent regional disparities and further implement national guidelines and prevention strategies. By integrating Italy's progress with broader international frameworks, the Italian model can inform global efforts to enhance dementia care, highlighting the importance of scalable, regionally adapted strategies for addressing the growing global burden of dementia.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002250"},"PeriodicalIF":0.0,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884786","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":"Knowledge of sexual and reproductive health and rights among University of Rwanda students: a cross-sectional study.","authors":"Alice Muhayimana, Theoneste Ntalindwa, Aline Uwase, Kaberuka Gerard, Jean Damascene Niringiyumukiza, Allen Jean de la Croix Ingabire, Emmanuel Nzabonimana, Irene Josephine Kearns, Marie Laetitia Ishimwe Bazakare, Fulgence Maniriho, Jean de Dieu Habimana, Vedaste Bagweneza, Mathias Nduwingoma","doi":"10.1136/bmjph-2024-001607","DOIUrl":"10.1136/bmjph-2024-001607","url":null,"abstract":"<p><strong>Background: </strong>Poor knowledge of sexual and reproductive health and rights (SRHR) among university students has been constantly reported in low-income and middle-income countries. This study aimed to assess University of Rwanda (UR) students' knowledge on SRHR.</p><p><strong>Methods: </strong>This cross-sectional study involved an online survey of 441 students across UR. Data were collected using a validated 50-item SRHR knowledge questionnaire via Moodle. Data were cleaned and analysed using STATA. Descriptive and inferential statistics, such as a bivariate logistic regression model and multivariate logistic regression with backward elimination, were used for the final model. A P-value of 0.05 with 95% CI limits was considered. The association between explanatory variables and the outcome (SRHR knowledge) was evaluated. A mean cut-off was employed, categorising experiences into a binary outcome (poor and good SRHR knowledge scores). Stepwise backward elimination logistic regression analysis was conducted to identify predictors of good SRHR knowledge.</p><p><strong>Results: </strong>The majority of the participants (56%) had poor SRHR knowledge. In the bivariate analysis, statistically significant variables included prior exposure to the SRHR course by using YouTube (OR 2.36 (1.12 to 4.97) and radio (OR 3.08 (1.20 to 7.88)), prior learning SRHR courses online (OR 1.92 (1.10 to 3.38)) and participant age group 21-24 years (OR 0.50 (0.27 to 0.93). In the multivariate analysis, prior exposure to the SRHR course through YouTube (adjusted OR (aOR) 5.48 (1.29 to 23.22)) and SRHR prior exposure through radio (aOR 5.56 (1.37 to 23.04)) were associated with SRHR knowledge.</p><p><strong>Conclusion and recommendations: </strong>UR students do not have sufficient knowledge of SRHR. Every UR student can benefit from SRHR training from reliable sources so that they can make effective choices regarding their reproductive health.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e001607"},"PeriodicalIF":0.0,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884796","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":"Household ownership of latrines does not ensure use: a scoping review.","authors":"Nicolas Gaffan, Alphonse Kpozehouen, Cyriaque Degbey, Yolaine Glele Ahanhanzo, Moussiliou Noël Paraïso","doi":"10.1136/bmjph-2024-001527","DOIUrl":"10.1136/bmjph-2024-001527","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to conduct a scoping review of the factors associated with latrine utilisation by households.</p><p><strong>Design: </strong>We performed a scoping review to determine the factors associated with household latrine utilisation.</p><p><strong>Data sources: </strong>We conducted a bibliographic search using PubMed, Google Scholar, ScienceDirect, Epistemonikos and Semantic Scholar until April 2023.</p><p><strong>Eligibility criteria: </strong>The papers we included met the following criteria: the study population included members of households equipped with latrines, regardless of their status, excluding children under five; the study followed an observational design; the study design was quantitative; the manuscript was in either French or English; the study focused on factors associated with latrine utilisation; the study employed multivariate methods and the study manuscript was published in a peer-reviewed journal.</p><p><strong>Data extraction and synthesis: </strong>We conducted a narrative synthesis of key results.</p><p><strong>Results: </strong>This review selected 31 articles. The percentage of latrine utilisation spanned from 36.00% to 94.30%. Elderly individuals and those with lower educational attainment showed reduced latrine utilisation compared with younger and more educated people, respectively. Households without school-going children, those of larger size and those with lower economic status had less latrine utilisation than those with school-going children, smaller size and a higher wealth index. Some latrine attributes (age, level of household member involvement in construction, hand hygiene facilities, geographical accessibility, functionality, maintenance, cleanliness, type, superstructure, condition, etc) influenced latrine utilisation. Exposure to sanitation communication initiatives heightened the likelihood of latrine utilisation by individuals.</p><p><strong>Conclusion: </strong>The study stresses the importance of improving children's education and implementing poverty reduction initiatives to enable households to afford adequate sanitation facilities. It also suggests empowering communities to build suitable latrines, promoting community-based sanitation models and emphasising the need to raise awareness of the adverse effects of open defecation through educational campaigns.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e001527"},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877723","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":"Pregnant adolescents' dynamic engagement with participatory women's groups for maternal and newborn health in rural India: a qualitative study.","authors":"Farnaz Sabet, Smita Dattatraya Todkar, Nirmala Nair, Susan M Sawyer, George C Patton, Suchitra Rath, Audrey Prost","doi":"10.1136/bmjph-2024-001309","DOIUrl":"10.1136/bmjph-2024-001309","url":null,"abstract":"<p><strong>Introduction: </strong>Around 21 million girls globally become pregnant each year, many in the context of early marriage, yet we know very little about supporting them during the perinatal period. This study explores how pregnant adolescents engage with women's groups practising participatory learning and action (PLA) to improve maternal and newborn health in rural eastern India.</p><p><strong>Methods: </strong>The study was carried out with Ekjut, a non-governmental organisation responsible for training government-incentivised volunteers who facilitate groups in several Indian states. A team of three qualitative researchers carried out 29 semistructured interviews, nine focus group discussions and five video-recorded observations of groups in 12 villages of Jharkhand, eastern India, from December 2018 to December 2019. We interviewed girls and women with different levels of engagement with PLA groups, as well as health workers and analysed data using thematic analysis.</p><p><strong>Results: </strong>Pregnant adolescents wished to attend PLA groups and learn from them but faced many barriers to doing so. These included restrictive marital norms that were stronger with younger age and enforced by pervasive gossip. Marital family support and access to a skilled government health worker, however, could moderate these restrictive norms to enhance engagement with PLA groups. Pregnant adolescents expressed wanting elders present in PLA groups and valued marital family support to help them navigate the challenges of pregnancy and motherhood. Pregnant girls from more restrictive families were particularly vulnerable and socially isolated, requiring more intense engagement from health workers to connect them to PLA groups and health services.</p><p><strong>Conclusion: </strong>Research and programmes to support pregnant girls would benefit from acknowledging the restrictions of early marriage and pregnancy while also engaging constructively with these restrictions. This might involve recognising the potential of PLA groups to foster adolescents' developmental capacities but also constructively engaging with marital families and providing broader developmental support.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e001309"},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877784","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":"Factors influencing non-communicable disease policy process in Sub-Saharan Africa: a scoping review.","authors":"Enny Brouns, Chanelle Mulopo, Solange Mianda, Joy Mauti, Shannon McMahon, Connie Hoe, Bey-Marrie Schmidt","doi":"10.1136/bmjph-2024-001409","DOIUrl":"10.1136/bmjph-2024-001409","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Introduction: </strong>Non-communicable diseases (NCDs) have been the leading global cause of death for two decades, with a disproportionate impact on low- and middle-income countries. Despite the development of technical packages such as the WHO Best Buys, the adoption and implementation of NCD policies pose significant challenges. This scoping review explores the factors influencing the NCD policy process, including agenda setting, formulation, adoption, implementation and evaluation stages.</p><p><strong>Methods: </strong>This scoping review followed the methodological framework provided by Levac <i>et al</i>. To identify relevant studies for the scoping review, we searched the literature in the following databases: Web of Science and Scopus using PubMed. Reviewers independently screened titles, abstracts and full texts, and extracted data from the included studies. The results were collected using Excel and synthesised using descriptive numerical and thematic analysis.</p><p><strong>Results: </strong>The search yielded 7538 records, after screening for title, abstract and full text, 35 articles met the inclusion criteria for this review. Six different types of policy actors were identified, namely, (i) government, (ii) private sector, (iii) advocates, (iv) experts, (v) international partners, (vi) experts and (vii) general public. Policy actors used lobbying tactics to influence how the policy process was executed; however, it was unclear how the process of influence took place. We identified six barriers of the NCD policy process: (i) limited access to resources, (ii) limited reliable local data, (iii) role of the government, (iv) limited multisectoral collaboration, (v) limited infrastructure, (vi) knowledge and belief. Six facilitators of the NCD policy process were identified: (i) multisectoral approach, (ii) sufficient capacity and financial resources, (iii) access to reliable local evidence, (iv) strong advocacy, (v) existing infrastructures, and (vi) political will were reported.</p><p><strong>Conclusion: </strong>Findings from this review revealed a knowledge gap in understanding of the tactics used by actors to influence the policy process and the absence of evidence related to the evaluation of NCD policies in Sub-Saharan Africa.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e001409"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877722","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":"Using a neural network to derive early childhood neurodevelopmental profiles in the New Hampshire Birth Cohort Study.","authors":"Julia A Bauer, Susan A Korrick, John L Pearce, David C Bellinger, Megan E Romano, Margaret R Karagas","doi":"10.1136/bmjph-2024-001757","DOIUrl":"10.1136/bmjph-2024-001757","url":null,"abstract":"<p><strong>Background: </strong>Child-centred approaches represent a conceptual framework that emphasises the holistic characterisation of individual developmental patterns across cognitive, behavioural and social domains. As a complementary analytic tool, self-organising maps (SOMs), an artificial neural network, offer flexible, data-driven clustering capabilities that are well-suited to modeling complex, multidimensional and longitudinal developmental data. Despite their potential, few studies have applied such methods to profile early neurodevelopment, especially in rural populations.</p><p><strong>Methods: </strong>We applied SOM to longitudinal neurobehavioural data (n=235) from healthy participant children from 3 to 5 years of age in the New Hampshire Birth Cohort Study, a rural pregnancy cohort. Group profiles reflect measures of behaviour and social responsiveness, cognition and motor performance and were examined in relation to known predictors of maternal-child characteristics using multinomial logistic regression as a proof of concept.</p><p><strong>Results: </strong>In our cohort, most children had neurotypical neurobehavioural scores, and 51% were boys. Mothers predominantly had some college education (74%), were married (93%) and were 31 years of age on average with above-average IQs relative to US norms. We identified six distinct neurobehavioural profiles (18-57 children each). The six profiles included: highest overall scores (profile 5), worst overall scores (profile 4), greatest behavioural/social improvement (profile 1), slight improvement (profile 3), average scores (profile 2) and highest adaptability (profile 6) relative to the full sample. Regression models showed expected associations with child sex, maternal IQ and parent-child relationships (eg, higher maternal IQ correlated with better cognitive outcomes).</p><p><strong>Conclusions: </strong>Using a SOM, we identified distinct neurobehavioural profiles among rural children, reflecting variation across behaviour, social responsiveness, cognition and motor skills. These profiles varied by maternal and child characteristics and highlight the potential of neural network approaches to inform early risk or resilience identification in understudied populations.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e001757"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877787","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":"Can headwind, an online clinician-led mental health advisory platform, improve the engagement of distressed young people in community services? A multicohort analysis.","authors":"Yi Nam Suen, Kai Tai Chan, Yau Sum Wan, Melody Miriam So, Edwin Ho Ming Lee, Stephanie Ming Yin Wong, Sherry Kit Wa Chan, Christy Lai Ming Hui, Michael Tak Hing Wong, Eric Yu Hai Chen","doi":"10.1136/bmjph-2025-002692","DOIUrl":"10.1136/bmjph-2025-002692","url":null,"abstract":"<p><strong>Objective: </strong>The study evaluated the effectiveness of <i>headwind</i> service, an online, clinician-led mental health advisory platform, in engaging individuals with moderate to severe psychological distress. It also compared distress reduction achieved through <i>headwind</i> with natural recovery in a community cohort, providing a benchmark for evaluating active interventions.</p><p><strong>Design setting and participants: </strong>The study analysed data from 13 527 people across three cohorts: <i>headwind</i> users (n=3559), participants in a territory-wide youth mental health (YMH) programme (n=6734) and a community youth cohort (n=3234). Data were collected between April 2019 and December 2024 in Hong Kong.</p><p><strong>Intervention: </strong><i>headwind</i> offers single 30 min informal mental health advisory sessions through Zoom or telephone, led by psychiatrists and clinical psychologists. Designed for accessibility and anonymity, the service provides practical advice without establishing a formal doctor-patient relationship.</p><p><strong>Main outcomes and measures: </strong>Distress levels were measured using the Kessler Psychological Distress Scale (K6) at baseline and follow-up. Primary outcomes included engagement of individuals with moderate to severe levels of mental distress, reductions in K6 scores and shifts in distress severity categories. Secondary outcomes examined demographic subgroup differences and comparisons with natural recovery in the community cohort.</p><p><strong>Results: </strong>At baseline, <i>headwind</i> users reported higher baseline distress levels (mean K6 score: 13.11) than YMH (7.88) and community (7.27) cohorts (p<0.001). Following a single session, <i>headwind</i> participants experienced a substantial reduction in distress (large effect size: 0.74), with the largest improvements observed in individuals with severe distress. Reductions were consistent across age and gender subgroups. <i>headwind</i> users showed significantly greater distress reductions than the naturalistic recovery observed in the propensity score-matched community cohort (p=0.008).</p><p><strong>Conclusions: </strong>The <i>headwind</i> service effectively engages young people experiencing moderate to severe mental distress, delivering immediate and significant reductions in distress levels. Its low-barrier design, characterised by anonymity, timely access to professionals and an informal, user-friendly structure, effectively addresses systemic challenges in traditional mental healthcare, making it a scalable, accessible and impactful complement to existing mental healthcare systems.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002692"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884787","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}