BMJ public health最新文献

{"title":"Has underweight increased among children and adolescents during 2012-2019, and does the prevalence depend on socioeconomic circumstances? A nationwide register-based study from Denmark.","authors":"Anne Vedelsdal Aurup, Lau C Thygesen, Marie Borring Klitgaard, Anne Thorsted, Katrine Strandberg-Larsen, Camilla Trab Damsgaard","doi":"10.1136/bmjph-2024-002328","DOIUrl":"10.1136/bmjph-2024-002328","url":null,"abstract":"<p><strong>Background: </strong>Childhood underweight, indicated by low body mass index (BMI) for age and sex, is associated with morbidity, mortality and poverty in low-income settings, but is often overlooked in high-income countries, due to unequivocal focus on overweight. This study examined the prevalence and socioeconomic characteristics of underweight among children and adolescents in Denmark during 2012-2019.</p><p><strong>Methods: </strong>We used nationwide Danish register data on height and weight measured objectively in 4 61 041 6-7 year-olds and 3 65 312 14-15 year-olds during 2012-2019, covering 89.4% and 67.2% of all schoolchildren in these age groups. We calculated BMI z-scores and classified underweight using the International Obesity Task Force age- and sex-specific BMI cut-offs and linked with data on parental education and household income as indicators of socioeconomic circumstances.</p><p><strong>Results: </strong>The prevalence of underweight remained relatively stable at~8.5% among 6-7-year-old girls during 2012-2019. Among 14-15-year-old girls, it was initially higher but decreased slightly (<1%-point) to 8.6% in 2019. Among boys, the prevalence increased from ~7% to just above 8% in both age groups during the period. Across all years, underweight was more common among 14-15 year-olds whose parents had long higher education (girls: 10.4%-12.1%; boys: 8.7%-10.2%) compared with primary school (girls: 5.6%-7.5%; boys: 6.1%-7.8%), with the most pronounced differences among girls. Similar differences across parental education were observed among 6-7 year-olds, although they were smaller. Less distinct but comparable differences in underweight prevalence were found across household income.</p><p><strong>Conclusions: </strong>Underweight is prevalent but has remained relatively stable during the 2010s among Danish children and adolescents. Unlike the pattern reported in low-income settings, and that seen for overweight, underweight is associated with socioeconomic advantage in this high-income setting.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e002328"},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social determinants of recovery from ongoing symptoms following COVID-19 in two UK longitudinal studies: a prospective cohort study.","authors":"Nathan J Cheetham, Vicky Bowyer, María Paz García, Ruth C E Bowyer, J D Carpentieri, Andy Guise, Ellen J Thompson, Carole H Sudre, Erika Molteni, Michela Antonelli, Rose S Penfold, Nicholas R Harvey, Liane S Canas, Khaled Rjoob, Benjamin Murray, Eric Kerfoot, Alexander Hammers, Sebastien Ourselin, Emma L Duncan, Claire J Steves","doi":"10.1136/bmjph-2024-001166","DOIUrl":"10.1136/bmjph-2024-001166","url":null,"abstract":"<p><strong>Introduction: </strong>Social gradients in COVID-19 exposure and severity have been observed internationally. Whether combinations of pre-existing social factors, particularly those that confer cumulative advantage and disadvantage, affect recovery from ongoing symptoms following COVID-19 and long COVID is less well understood.</p><p><strong>Methods: </strong>We analysed data on self-perceived recovery following self-reported COVID-19 illness in two UK community-based cohorts, COVID Symptom Study Biobank (CSSB) (N=2548) and TwinsUK (N=1334). Causal effects of sociodemographic variables reflecting status prior to the COVID-19 pandemic on recovery were estimated with multivariable Poisson regression models, weighted for inverse probability of questionnaire participation and COVID-19 infection and adjusted for potential confounders. Associations between recovery and social strata comprising combinations of sex, education level and local area deprivation were estimated using the intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach. Further analyses estimated associations with variables reflecting experiences during the pandemic.</p><p><strong>Results: </strong>Gradients in recovery from COVID-19 along the lines of social advantage were observed in intersectional MAIHDA models, with predicted probability of recovery lowest in female strata with lowest education and highest deprivation levels (CSSB: 55.1% (95% CI 44.0% to 65.1%); TwinsUK: 73.9% (95% CI 61.1% to 83.0%)) and highest in male strata with highest education and lowest deprivation levels (CSSB: 79.1% (95% CI 71.8% to 85.1%); TwinsUK: 89.7% (95% CI 82.5% to 94.1%)). Associations were not explained by differences in prepandemic health. Adverse employment, financial, healthcare access and personal experiences during the pandemic were also negatively associated with recovery.</p><p><strong>Conclusions: </strong>Inequalities in likelihood of recovery from COVID-19 were observed, with ongoing symptoms several months after coronavirus infection more likely for individuals with greater social disadvantage prior to the pandemic.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001166"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting communities with high tuberculosis case-finding efficiency to optimise resource allocation in Pakistan: comparing the performance of a negative binomial spatial lag model with a Bayesian machine-learning model.","authors":"Christina Mergenthaler, Jake D Mathewson, Stephanie Lako, Andreas Werle van der Merwe, Matthys Potgieter, Vincent Meurrens, Abdullah Latif, Hasan Tahir, Tanveer Ahmed, Zia Samad, Frank Cobelens, Daniella Brals, Mirjam I Bakker, Ente Rood","doi":"10.1136/bmjph-2024-001424","DOIUrl":"10.1136/bmjph-2024-001424","url":null,"abstract":"<p><strong>Introduction: </strong>Despite progress in tuberculosis (TB) treatment coverage in past years, an estimated 183 000 people with TB may not have been diagnosed in Pakistan in 2022. Therefore, there is a need to develop models which help to steer active case finding (ACF) towards populations with a high probability of having undetected TB. The aim of this study was to cross-validate TB positivity rate predictions in ACF settings of an existing Bayesian machine learning (BML) with a simpler frequentist model.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of cross-sectional data to identify predictors for detection of bacteriologically confirmed TB cases during ACF events in Pakistan. A predictive negative binomial regression (NBR) model was created, and the presence of spatial autocorrelation was examined to account for spatial dependencies in the outcome variable. The NBR and BML models were compared on their respective predictive precisions for the identification of TB hotspots, based on Root Mean Square Error values, k-fold cross-validation and tehsil-level (sub-district) prediction rankings.</p><p><strong>Results: </strong>407 (1.9%) bacteriologically confirmed cases among 21 227 visitors were detected in 414 ACF events between September 2020 and January 2022. In the final NBR, the spatial lag variable explained most variation in TB positivity rates across ACF events. NBR and BML predictions were similar at tehsil level. While the BML had a slightly lower root mean squared error (1.02 vs 1.03) the NBR had a slightly better fit based on the Akaike information criterion.</p><p><strong>Conclusions: </strong>Statistical models can be effective in predicting TB hotspots for ACF planning, and the relatively simpler NBR model was nearly as effective as a more complex BML model. The predictions of different modelling approaches were similar, suggesting that predictions are more driven by covariates rather than modelling framework. The agreement between model results increases confidence in the potential utility of models to spatially target ACF activities in high need, low access areas.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001424"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164523","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":"Socioeconomic pattern of breastfeeding in sub-Saharan Africa: an individual participant data meta-analysis of six longitudinal cohorts.","authors":"Shamsudeen Mohammed, Clara Calvert, Emily L Webb, Judith R Glynn, Suzanne Filteau, Alison Price, Albert Dube, Joseph O Mugisha, Ronald Makanga, Milly Marston, Laura Oakley","doi":"10.1136/bmjph-2024-001298","DOIUrl":"10.1136/bmjph-2024-001298","url":null,"abstract":"<p><strong>Background: </strong>Breastfeeding rates in sub-Saharan Africa (SSA) are declining, and at the current rate, only four African countries will meet the WHO's 2030 exclusive breastfeeding target. We examined the association between maternal socioeconomic status (SES) and breastfeeding practices in SSA.</p><p><strong>Methods: </strong>Six cohorts in Ethiopia, Malawi, Uganda and Zambia, with 11 863 participants, were analysed. Data for the cohorts were collected between 2000 and 2021, covering births from 2000 to 2019. SES exposures were maternal education and household income. Breastfeeding outcomes included ever breastfed, early initiation of breastfeeding (Ethiopia only), exclusive breastfeeding for ≥4 months or ≥6 months, and continued breastfeeding for ≥1 year. Risk ratios from multivariable Poisson regression models for individual cohorts were pooled in a random-effects meta-analysis to assess the effects of SES on breastfeeding, adjusting for confounders.</p><p><strong>Results: </strong>Meta-analysis found no evidence of a difference in ever breastfeeding between mothers with secondary or tertiary education and those with primary/no education. Mothers with secondary education (adjusted risk ratio (aRR)=1.11, 95% CI=1.01 to 1.21) and those from middle-wealth households (aRR=1.12, 95% CI=1.01 to 1.24) were more likely to initiate breastfeeding early than those with primary/no education or low household wealth, but there was no evidence of association in the tertiary education and higher-wealth groups. The association between maternal education and exclusive breastfeeding for ≥4 months and ≥6 months varied across cohorts, with no evidence of association in most cohorts. Overall, household wealth was not associated with exclusive breastfeeding for ≥4 months or ≥6 months. The meta-analysis showed no evidence of association between household wealth and breastfeeding for ≥1 year, but mothers with tertiary education were less likely (aRR=0.93, 95% CI=0.88 to 0.99) to breastfeed for ≥1 year than those with primary or no education.</p><p><strong>Conclusion: </strong>We observed no clear socioeconomic pattern in breastfeeding, contrasting with patterns observed in high-income countries.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001298"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the case fatality rate in 2 031 309 hospitalised Brazilian patients due to COVID-19: An observational study of the first 3 years of the pandemic in Brazil.","authors":"Camila Vantini Capasso Palamim, Tais Mendes Camargo, Felipe Eduardo Valencise, Fernando Augusto Lima Marson","doi":"10.1136/bmjph-2023-000724","DOIUrl":"10.1136/bmjph-2023-000724","url":null,"abstract":"<p><strong>Introduction: </strong>Since the beginning of the COVID-19 pandemic, in Brazil, there has been a high rate of deaths, mainly among those who were hospitalised due to the disease and those who needed intensive care units (ICUs) and mechanical ventilation support.</p><p><strong>Methods: </strong>The study evaluated the hospitalised patients with COVID-19 as well as subgroups considering those hospitalised patients who needed ICU treatment and those who received invasive mechanical ventilation in an ICU. The risk of death was compared in these three groups with adjustments for gender, age, race and comorbidities. A multivariable analysis was performed to identify the main predictors of death. A hospitalised patient was considered COVID-19 positive if they had a positive real-time polymerase chain reaction (RT-PCR) or serological test, followed by a notification form completed by a health professional, usually a medical doctor. The study was approved by the ethics committee of the institution (Certificate of Presentation of Ethical Appreciation n° 67241323.0.0000.5514; Study Approval Technical Opinion n° 5.908.611).</p><p><strong>Results: </strong>The study evaluated 2 031 309 hospitalised individuals with COVID-19. The case fatality rate was 33.2% (673 527/2 031 309). The case fatality rate was even higher among those patients who required ICU (372 031/665 621; 55.9%) treatment with the need for invasive ventilation support (240 704/303 505; 79.3%). In the multivariable analysis, the male sex (OR=1.14; 95% CI=1.13-1.15), older age [61 to 72 years old (OR=2.43; 95% CI=2.41-2.46), 83 to 85 years old (OR=4.10; 95% CI=4.06-4.14) and+85 years (OR=6.98; 95% CI=6.88-7.07)], race [mixed individuals (<i>Pardos</i>) (OR=1.33; 95% CI=1.32-1.34), Black people (OR=1.57; 95% CI=1.55-1.60) and Indigenous peoples (OR=1.82, 95% CI=1.69-1.97)] and the presence of comorbidities [mainly, hepatic disorder (OR=1.80; 95% CI=1.73-1.87), immunosuppressive disorder (OR=1.80; 95% CI=1.76-1.84) and kidney disorder (OR=1.67; 95% CI=1.64-1.70)] were associated with an increased chance of death, except asthma (OR=0.77; 95% CI=0.75-0.79). In addition, among all admitted patients with COVID-19, the need for an ICU (OR=2.08; 95% CI=2.06-2.13) and invasive ventilatory support (OR=14.86; 95% CI=14.66-15.05) had an impact on death as an outcome.</p><p><strong>Conclusion: </strong>Although the number of daily deaths from the coronavirus dropped during the COVID-19 pandemic in Brazil, our retrospective analysis showed a higher case fatality rate in patients requiring ICU, mainly when using invasive ventilation, compared with the rest of the world.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e000724"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal retrospective study of real-world adherence to colorectal cancer screening before and after the COVID-19 pandemic in the USA.","authors":"Harsh Gupta, Robyn Ann Husa, Staci J Wendt, Ann Vita, Claire Boone, Jessica B Weiss, Anton J Bilchik","doi":"10.1136/bmjph-2024-001734","DOIUrl":"10.1136/bmjph-2024-001734","url":null,"abstract":"<p><strong>Introduction: </strong>At-home stool tests are an increasingly popular practice for colorectal cancer screening, especially when access to healthcare facilities is challenging. However, there is limited information about whether stool tests provide sufficient coverage when patients must undergo repeat testing. This study evaluates repeat preventative stool tests over 2 year periods in a healthcare system with 51 hospitals and over 1000 clinics across seven western US states, before and after the onset of the COVID-19 pandemic.</p><p><strong>Methods: </strong>We conduct a real-world, observational, retrospective and longitudinal study based on electronic medical records. We measure the rate of repeat screening and mean delay in repeat screening among patients who receive an initial stool test. We estimate the changes in the likelihood of colorectal cancer screening using a Cox proportional hazard model.</p><p><strong>Results: </strong>Our sample included 4 03 085 patients. The share of patients with an initial negative stool test who received a repeat screening ranged from 38% to 49% across different years. Among patients who received a repeat screening, there is a delay of 3 months on average. The volume of stool tests increased during the pandemic: the HR of screening after the onset of the pandemic to that before the pandemic was 1.18 (95% CI (1.15, 1.20), p<0.001).</p><p><strong>Conclusions: </strong>Our findings show that less than 50% of patients received a repeat stool test, creating gaps in their screening coverage. The increase in stool tests during the pandemic is partly due to a substitution away from colonoscopies, underscoring the increasing importance of stool tests in CRC screening. Programmes that aim to increase CRC screening uptake should focus on repeated testing after an initial screening.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001734"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Why would I go somewhere where I'm not welcome?' Dehumanisation of people experiencing homelessness in medical settings and the healing potential of a structurally competent model: a qualitative study.","authors":"Ren Bruguera, Alicia Agnoli, Pamela Suzanne Portnoy, Liliana Melgoza, Na'amah Razon","doi":"10.1136/bmjph-2024-001881","DOIUrl":"10.1136/bmjph-2024-001881","url":null,"abstract":"<p><strong>Introduction: </strong>People experiencing homelessness (PEH) face myriad barriers to healthcare, including preventative sexual health services. A street medicine team in one Northern California county observed low uptake of sexually transmitted infection (STI) screening among PEH. We conducted this study to understand the factors contributing to PEH's decision to seek or accept STI screening.</p><p><strong>Methods: </strong>This is a qualitative study using semistructured interviews and demographics surveys among PEH. The interviews focused on understanding facilitators and barriers to STI screening and experiences in healthcare settings more broadly. Interviews were audio-recorded, transcribed and analysed using a thorough memoing process and matrix-based analysis.</p><p><strong>Results: </strong>We enrolled a total of 50 adult, English-speaking PEH: 24 men, 26 women; 52% white, 28% Black/African American, 22% Native American, 4% Asian, 22% Hispanic/Latino. Qualitative analysis revealed a theme of 'dehumanising' prior experiences in healthcare environments including judgement, dismissal of medical concerns, and denial of treatment. Participants reported similar experiences outside of medical settings, which together shaped their self-worth and factored into their decision to delay seeking routine and urgent forms of care, including STI screening. Approximately half of the participants had received medical services from the street medicine team. PEH perceived the street medicine team to foster trust by physically, emotionally and structurally 'meeting patients where they are'.</p><p><strong>Conclusion: </strong>Prior experiences of exclusion within and outside of healthcare settings informed PEH's decision to avoid seeking healthcare until extremely urgent, and to deprioritise services like STI screening. In order to develop interventions to increase STI screening and other preventative health services, it is critical to understand the structural elements underlying relationships between PEH and healthcare systems, and the relevance of social exclusion beyond medicine. This street medicine team exemplifies features of structural competency, a model that may be integrated in other settings and in medical education to promote more equitable and inclusive healthcare.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001881"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring misaligned contraceptive use among reproductive-aged women in Kisumu, Kenya: a cross-sectional, population-based study.","authors":"Brooke W Bullington, Stephanie Chung, Claire W Rothschild, Dickens Onyango, Leigh Senderowicz, Emilia Goland, Abigael Mwanyiro, Ben Wekesa, Brian Frizzelle, Ginger Golub, Katherine Tumlinson","doi":"10.1136/bmjph-2024-001671","DOIUrl":"10.1136/bmjph-2024-001671","url":null,"abstract":"<p><strong>Introduction: </strong>Global family planning scholars have critiqued traditional measures of programmatic success and called for new, person-centred measures that consider people's preferences. We propose a new measure that assesses the alignment between an individual's contraceptive desires and use.</p><p><strong>Methods: </strong>We use data from a population-based survey implemented among adult reproductive-aged women in Kisumu, Kenya. We define misaligned contraceptive use as discordance between contraceptive desires and use (ie, desire for contraception paired with non-use or no desire for contraception paired with use). We expand misaligned use to incorporate non-preferred contraceptive method use, defined as the use of a method with a preference for a different method among contraceptive users. We also compare unmet need for family planning with misaligned use.</p><p><strong>Results: </strong>In our total sample, including contraceptive users and non-users, 86% of participants had aligned contraceptive use and 14% had misaligned use. Among contraceptive users, we found that 74% of participants had aligned and preferred method use, 21% had aligned and non-preferred method use, 2% had misaligned and preferred use, and 3% had misaligned and non-preferred use. Our comparison of misaligned use and unmet need showed little agreement.</p><p><strong>Conclusions: </strong>Measuring misaligned and non-preferred contraceptive method use has implications for family planning measurement and programming. Our results demonstrate the importance of capturing contraceptive desires rather than assuming an implicit desire for contraception among those who do not desire pregnancy. Further, incorporating method preferences into misaligned use provides additional detail on who does and does not have their contraceptive desires met. Finally, measuring misaligned and non-preferred method use highlights subsets of populations who may benefit from additional contraceptive programming to improve contraceptive access or enable method discontinuation or switching, and therefore can be imperative to ensuring that individuals have their reproductive desires realised.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001671"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the composite dietary antioxidant index and sarcopenia risk in American adults: a cross-sectional NHANES study.","authors":"Yun She, Lingling Zhu, Xiangyun Guo, Jinran Qin, Xiqiao Zhou, Jiangyi Yu, Qianhua Yan","doi":"10.1136/bmjph-2024-001447","DOIUrl":"10.1136/bmjph-2024-001447","url":null,"abstract":"<p><strong>Background: </strong>Given the absence of specific pharmacological treatments for sarcopenia, identifying effective lifestyle and dietary interventions is imperative. This study aims to explore the association between the composite dietary antioxidant index (CDAI) and sarcopenia, offering new insights into nutritional strategies for sarcopenia-prone populations.</p><p><strong>Methods: </strong>This cross-sectional study analysed secondary data from the National Health and Nutrition Examination Survey cycles spanning 2001-2006 and 2011-2018. Weighted multivariate logistic regression and restricted cubic spline (RCS) analyses were employed to evaluate the non-linear association between CDAI and sarcopenia and to perform stratified analyses.</p><p><strong>Results: </strong>In this study, encompassing 19 683 American adults, representative of the national population of 132 140 502 residents, 7.97% were diagnosed with sarcopenia. Across all adjusted models, a higher CDAI was inversely associated with the risk of sarcopenia (OR 0.94, 95% CI 0.92, 0.96; <i>P</i><0.0001). The highest quartile of CDAI scores to those in the lowest revealed significantly reduced odds of sarcopenia (OR 0.46, 95% CI 0.38, 0.56; <i>P</i><0.0001). RCS analysis demonstrated a non-linear relationship between CDAI and sarcopenia. Additionally, stratified analyses indicated that the inverse association between CDAI and sarcopenia was more pronounced among participants with higher educational levels and those diagnosed with tumours.</p><p><strong>Conclusions: </strong>There was a negative relationship between CDAI scores and the prevalence of sarcopenia, suggesting that higher CDAI scores may help in managing and preventing the occurrence of sarcopenia.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001447"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health care cascade performance and associated factors: longitudinal analyses of routine Ministry of Health services in Mozambique.","authors":"Morgan Turner, Alberto Muanido, Vasco Cumbe, João Nhalimue Jala, Ernesto Eusébio Armando, Eduarte Mambuque, Flávia Faduque, Ernesto Rodrigo Xerinda, Kenneth Sherr, Bryan J Weiner, Brian P Flaherty, Monisha Sharma, Bradley H Wagenaar","doi":"10.1136/bmjph-2024-001024","DOIUrl":"10.1136/bmjph-2024-001024","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Introduction: </strong>Mental, neurological and substance use (MNS) disorders are leading causes of disability worldwide. Nevertheless, limited research exists regarding MNS health system performance across the care cascade and associated patient characteristics in low-income and middle-income countries (LMICs) such as Mozambique.</p><p><strong>Methods: </strong>We used baseline data from an ongoing randomised controlled trial, collected across 16 outpatient clinics on variables of sex, age, marital status, tuberculosis and HIV status, alcohol and drug use, suicidal ideation, pregnancy and MNS diagnosis. Mixed-effects multivariable regression was used to examine factors associated with patient functional improvement or low functional impairment measured by a standardised disability questionnaire.</p><p><strong>Results: </strong>From February to September 2022, there were 4323 patient visits, of which 65.9% (n=2851) were attended on time (±5 days), 41.4% (n=1793) had medication adherence and 30.5% (n=1321) achieved a functional impairment score <10 or 50% improvement from baseline. Patients 15-18 years old had 60% lower odds of demonstrating functional improvement or low functional impairment during a follow-up visit compared with those 26-35 years old (95% CI: 0.19, 0.85). Compared with single persons, those in a domestic union had 3.3 times higher odds of demonstrating functional improvement or low functional impairment (95% CI: 1.8, 6.1). Individuals expressing suicidal ideation had 85% lower odds of demonstrating functional improvement than those without suicidal ideation (95% CI: 0.02, 0.91). For patients new to treatment, each additional visit was associated with a mean reduction in functional impairment of 0.62 points (95% CI: -0.76, -0.47).</p><p><strong>Conclusions: </strong>This analysis revealed gaps in patients reaching functional improvement or low functional impairment in outpatient MNS care in Mozambique. Gaps were more pronounced for patients who are ≤18 years of age, single or expressing suicidal ideation. Implementation strategies to optimise patient outcomes are needed as nascent mental health systems are scaled-up in Mozambique and other similar LMICs.</p><p><strong>Trial registration number: </strong>NCT05103033.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001024"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}