BMJ public health最新文献

{"title":"Navigating healthcare barriers: a cross-sectional study using respondent-driven sampling to assess migrant women sex workers' access to primary care in France.","authors":"Maeva Jego, Roxane Shahbazkia, Maxime Hoyer, Marine Mosnier, Jean Gaudart, Perrine Roux, Bruno Spire, Grâce Inegbeze, David Michels, Manuela Salcedo Robledo, Stéphanie Vandentorren, Carole Eldin, Emilie Mosnier","doi":"10.1136/bmjph-2024-002234","DOIUrl":"10.1136/bmjph-2024-002234","url":null,"abstract":"<p><strong>Introduction: </strong>Migrant women sex workers (MWSWs) are affected by higher morbidity rates, reflecting the complex health risks associated with sex work and migration which they face. This study aimed to assess MWSWs' use of primary care services in France, as well as the factors associated with having a family doctor.</p><p><strong>Methods: </strong>This cross-sectional observational study of 135 cisgender and transgender MWSWs is part of the larger Favoriser l'Accès à la Santé Sexuelle des Travailleuses du Sexe project, which aims to improve global knowledge of and access to sexual healthcare among this population. MWSWs aged 18 years and older were enrolled over 1 year between 2022 and 2023. The primary outcome was the percentage of MWSWs who reported having a family doctor. A best model analysis and a regression model were used to examine associations between having a family doctor and MWSWs' health and social characteristics.</p><p><strong>Results: </strong>Only 33% of participants reported having a family doctor. Among these, 24% had disclosed they were sex workers to the latter. In general, MWSWs had poor access to preventive healthcare (33% had been HIV tested in the previous year, 33% had used contraception and 19% reported lifetime cervical cancer screening). In contrast, most participants (63.5%) perceived they were in good health. In the multivariate analysis, having a family doctor was not significantly associated with better health outcomes or with the quality of healthcare.</p><p><strong>Conclusions: </strong>The majority of MWSWs did not have a family doctor; this fact compounds existing health vulnerabilities faced by this marginalised population. Improved targeted interventions are needed to increase healthcare access and quality for MWSWs. These interventions should include strategies to enhance communication with healthcare providers about this population's specific needs.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e002234"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of risk perceptions and vaccine hesitancy on decision-making among low-income mothers in Kenya: a qualitative study.","authors":"Stephen Gichuhi Kimotho","doi":"10.1136/bmjph-2024-001601","DOIUrl":"10.1136/bmjph-2024-001601","url":null,"abstract":"<p><strong>Abstracts: </strong></p><p><strong>Introduction: </strong>Vaccine hesitancy among mothers in low-income communities in Kenya presents a serious obstacle to achieving successful childhood immunisation. The aim of this study was to explore the determinants of vaccine hesitancy among mothers from low-income rural communities, risk perceptions associated with vaccines and how these factors influence decision-making regarding their children's immunisation.</p><p><strong>Methods: </strong>A qualitative descriptive study was conducted in three counties in Kenya (Murang'a, Kiambu and Machakos) using in-depth interviews and focus group discussions with mothers of children under 5 years. Participants were purposively sampled from low-income rural communities and were mothers attending postnatal clinics at various health facilities. Thematic analysis was used to identify key themes and subthemes, coding of transcripts, identification of patterns and organisation of themes into categories.</p><p><strong>Results: </strong>Several critical factors that contribute to vaccine hesitancy among mothers regarding their children's immunisation were identified through thematic analysis. Safety concerns emerged as a primary issue, with mothers expressing fears of adverse reactions such as fever, pain, swelling or other unexpected complications. Misinformation significantly influenced perceptions, including beliefs that vaccines might cause infertility or long-term health problems. Distrust in the health system further exacerbated hesitancy, with mothers questioning the quality, administration and motives of vaccinators. Limited vaccine knowledge also played a role, which led to misconceptions about the severity and risks of vaccine-preventable diseases. Moreover, sociocultural and religious beliefs influenced decision-making, with some mothers viewing vaccines as unsafe or ineffective, driven by cultural norms, reliance on traditional remedies or religious objections.</p><p><strong>Conclusions: </strong>This study provides valuable insights into the complexities of vaccine hesitancy among mothers in low-income communities in Kenya. Furthermore, the results emphasise the complex nature of hesitancy, driven by an interplay of safety concerns, misinformation, distrust, limited knowledge, and sociocultural and religious influences. Addressing these determinants requires interventions that would prioritise clear and accurate communication about vaccine safety, engagement with community and religious leaders, and strengthening trust in healthcare providers and systems. Additionally, enhancing vaccine knowledge through targeted health education programmes would be crucial for empowering mothers to make informed decisions about their children's health.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001601"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in the access to immune checkpoint inhibitors approved in the United States, the European Union and mainland China: a serial cross-sectional study.","authors":"Jia-Xin Cai, Shi-Yu Wang, Hao Hu, Carolina Oi Lam Ung, Fu-Xiao Li, Teng-Fei Lin, Shi-Fu Luo, Hai-Bo Song, Zhi-Rong Yang, Jin-Ling Tang, Wei-Hua Meng","doi":"10.1136/bmjph-2024-001995","DOIUrl":"10.1136/bmjph-2024-001995","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) have revolutionised antitumour therapy. However, regional differences in ICI labels, including the impact of the review process and supporting trial evidence, remain unclear.</p><p><strong>Methods: </strong>We conducted a serial cross-sectional study to examine trends and differences in indication approvals and associated clinical trials for ICIs across different regulatory agencies. We searched ICI labels approved by the Food and Drug Administration (FDA), European Medicines Agency (EMA) and National Medical Products Administration (NMPA) in Mainland China before 31 December 2022 and assessed the indications and clinical trials in labels. Relative lags of indication approvals were compared using the Mann-Whitney U test. The review time and interval between trial completion and indication submission were compared using the Kruskal-Wallis test.</p><p><strong>Results: </strong>We collected 10 ICIs with 90 indications from the FDA, 10 ICIs with 70 indications from EMA and 16 ICIs with 65 indications from NMPA. Relative lags of ICI indication approval in China (median 344.0 (IQR 220.0, 688.0) days) were longer than in the European Union (118.5 (55.0, 189.0) days) (p<0.0001). Both the European Union (243.0 (191.0, 298.0) days) and China (283.0 (248.0, 339.5) days) demonstrated significantly longer review durations for ICI indications than the United States (181.0 (148.8, 191.8) days) (p<0.0001). While indication submissions to NMPA were significantly more delayed than those to the FDA (p<0.001), the former relied more on trial evidence of OS (84.0%) than the latter (58.0%).</p><p><strong>Conclusion: </strong>ICIs approved in the United States, the European Union and mainland China differed in indications, approval time, review duration and evidence base, which may impact access to life-saving treatments. Future studies should investigate the impact of these differences and the underlying reasons beyond the evidence supporting the label approvals.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001995"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key factors determining the development of SARS-CoV-2 testing strategies in EU countries: a mixed-methods study.","authors":"L S Kengne Kamga, A C G Voordouw, M C De Vries, A Timen, M P G Koopmans","doi":"10.1136/bmjph-2024-001269","DOIUrl":"10.1136/bmjph-2024-001269","url":null,"abstract":"<p><strong>Background: </strong>The WHO and the European Center for Disease Prevention and Control (ECDC) advocated for extensive testing as a crucial pillar in managing the COVID-19 pandemic. Yet, public health emergency responses varied across European countries. In particular, there were differences in the national laboratory capacities and diagnostic testing strategies. This study was conducted during the pandemic to identify the key factors in developing national, SARS-CoV-2 testing strategies across a selection of European countries.</p><p><strong>Methods: </strong>A mixed-methods study, comprising an interview phase and a survey phase, was performed. First, laboratory, policy-making and/or public health experts from different European countries were interviewed between 8 January 2021 and 19 March 2021, to review the development and implementation of national testing strategies.Second, a cross-sectional survey was conducted among ECDC National Focal Points (NFP) for Preparedness and Response and/or Microbiology between July and October 2022 to validate the interview findings.</p><p><strong>Results: </strong>12 European experts were interviewed and identified the following key factors determining the development of the national SARS-COV-2 testing strategies in their countries: (1) changing testing goals over time, (2) the prevailing epidemiological situation, (3) testing capacities, (4) availability of reference laboratories, (5) supply and stockpiling of testing material, (6) availability of human resources and (7) quality management standards across laboratories. The experts interviewed stressed the important role of stockpile management, the existence of expert networks, as well as the centralisation of decision-making. Lastly, determining the actors responsible for the testing strategy and putting in place 'coordination, accountability and governance' proved to be pivotal.The survey outcome with 15 European NFPs demonstrated that the testing strategies generally changed over time to include a broader group of individuals. Furthermore, the actors 'Ministry of Health', 'Public health officials', 'National public health institutes' and 'National Expert and/or advisory groups' were selected as key players by survey respondents.</p><p><strong>Conclusions: </strong>In general, the scope of the testing strategy in European countries included in this study expanded as the pandemic progressed. This study identified key factors discussed by European experts interviewed that contributed to the development of SARS-CoV-2 testing strategies across European countries.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001269"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of active tuberculosis among adult household contacts of patients with smear-positive pulmonary tuberculosis in Kembata-Tembaro zone, southern Ethiopia: a cross-sectional study.","authors":"Wondimu Daniel, Sebsibe Tadesse, Temesgen Tamirat, Markos Selamu","doi":"10.1136/bmjph-2024-001531","DOIUrl":"10.1136/bmjph-2024-001531","url":null,"abstract":"<p><strong>Background: </strong>The risk of tuberculosis transmission is higher among household contacts than the general population. However, there is a paucity of information that explains the risk of experiencing active tuberculosis among household contacts in countries with a high burden of tuberculosis.</p><p><strong>Objective: </strong>This study aimed to assess the prevalence of tuberculosis infection and associated factors among adult household contacts of smear-positive pulmonary tuberculosis patients in the Kembata-Tembaro zone, southern Ethiopia.</p><p><strong>Methods: </strong>A cross-sectional study design was conducted in the Kembata-Tembaro zone, southern Ethiopia, from August to September 2022. Data were collected from 336 adult household contacts using a pretested questionnaire, and sputum examinations were done using fluorescence microscopy. Binary logistic regression models were used to identify factors associated with tuberculosis infection among adult household contacts.</p><p><strong>Results: </strong>The prevalence of active tuberculosis among adult household contacts of smear-positive pulmonary tuberculosis patients was 6.9% (95% CI 4% to 10%). Nearly half, 47.8%, of them belonged to economically productive adults aged 30-44 years. Smoking cigarettes (adjusted OR (AOR) 6.5, 95% CI (1.04 to 40.17)), sharing a bed with the index tuberculosis case (AOR 6.0, 95% CI (1.97 to 18.28)), poor housing ventilation (AOR 4.2, 95% CI (2.85 to 17.16)) and overcrowded housing (AOR 4.6, 95% CI (1.42 to 14.58)) were associated with tuberculosis infection among household contacts of patients with smear-positive pulmonary tuberculosis.</p><p><strong>Conclusions: </strong>This study has revealed that the prevalence of active tuberculosis among adult household contacts of smear-positive pulmonary tuberculosis patients was detected to be similar to other reports from Ethiopia. Additionally, interventions to prevent tuberculosis transmission among household contacts should focus on providing behaviour change education, improving housing conditions, early detection and isolation of index cases, contact tracing, isoniazid chemoprophylaxis of household contacts with weakened immunity and covering the mouth and nose when coughing or sneezing.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001531"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of factors associated with acute malnutrition in children under 5 years and forecasting future prevalence: assessing the potential of statistical and machine learning methods.","authors":"Meike Reusken, Christopher Coffey, Frans Cruijssen, Bertrand Melenberg, Cascha van Wanrooij","doi":"10.1136/bmjph-2024-001460","DOIUrl":"10.1136/bmjph-2024-001460","url":null,"abstract":"<p><strong>Introduction: </strong>Eliminating acute malnutrition in children under 5 years of age stands as a critical health priority outlined in the United Nations Sustainable Development Goal 2, 'Zero Hunger'. This requires targeted provision of treatment and preventative services. However, accurately forecasting future prevalence of cases remains challenging, with the application of predictive models being notably scarce. Addressing this gap, this paper aims to identify factors associated with Global Acute Malnutrition (GAM) and explores the potential of machine learning in predicting its prevalence using data from Somalia.</p><p><strong>Methods: </strong>Survey data on GAM prevalence systematically collected in Somalia every 6 months at a district level from 2017 to 2021 were collated alongside a range of potential climatic, demographic, disease, environmental, conflict and food security-related factors over a matching time period. We conducted both simple and multiple, parametric and non-parametric statistical analyses to identify factors associated with GAM to be used as input in forecasting future GAM prevalence. We then applied tree-based machine learning algorithms to a dataset comprising the GAM prevalence estimates and associated factors to try to forecast the trajectory and fluctuations in GAM prevalence 6 months into the future.</p><p><strong>Results: </strong>We found factors statistically associated with GAM prevalence relating to rainfall, land vegetation quality, food security status, crop production and demographics. The majority of these associations were nonlinear, motivating the use of tree-based machine learning-based forecasts. Among the forecasting methods tested, random forest machine learning proves to be the most effective and was found to accurately forecast the direction of GAM prevalence in test data for many of the districts in Somalia.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001460"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575030","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 and years of life lost from 2020 to 2023 in France: a cohort study of the overall impact of the COVID-19 pandemic on mortality.","authors":"Paul Moulaire, Gilles Hejblum, Nathanaël Lapidus","doi":"10.1136/bmjph-2024-001836","DOIUrl":"10.1136/bmjph-2024-001836","url":null,"abstract":"<p><strong>Introduction: </strong>Excess mortality has been frequently used worldwide for summarising the COVID-19 pandemic-related burden. Estimates for France for the years 2020-2022 vary substantially from one report to another, and the year 2023 is poorly documented. The present study assessed the level of excess mortality that occurred in France between 2020 and 2023 together with the corresponding years of life lost (YLL), in order to provide a reliable, detailed and comprehensive description of the overall impact of the pandemic.</p><p><strong>Method: </strong>This open cohort study of the whole French population analysed the 8 451 372 death occurrences reported for the years 2010-2023. A Poisson regression model was trained with years 2010-2019 for determining the age-specific and sex-specific evolution trends of mortality before the pandemic period. These trends were then used for estimating the excess mortality during the pandemic period (years 2020-2023). The life expectancies of the persons in excess mortality were used for estimating the corresponding YLL.</p><p><strong>Results: </strong>From 2020 to 2023, the number of excess deaths (mean (95% CI) (percentage of change versus expected mortality)) was, respectively, 49 541 (48 467; 50 616) (+8.0%), 42 667 (41 410; 43 909) (+6.9%), 53 129 (51 696; 54 551) (+8.5%), and 17 355 (15 760; 18 917) (+2.8%). Corresponding YLL were 512 753 (496 029; 529 633), 583 580 (564 137; 602 747), 663 588 (641 863; 685 723), and 312 133 (288 051; 335 929). Individuals younger than 60 years old accounted for 17% of the YLL in 2020, 26% in 2021, 32% in 2022 and 50% in 2023. Men were more affected than women by both excess mortality and YLL.</p><p><strong>Conclusion: </strong>This study highlights the long-lasting impact of the pandemic on mortality in France, with four consecutive years of excess mortality and a growing impact on people under 60, particularly men, suggesting lasting and profound disruption to the healthcare system.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001836"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575007","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 associated with school dropout and sexual and reproductive health: a cross-sectional analysis among out-of-school girls in western Kenya.","authors":"Susan Nungo, Anna Maria van Eijk, Linda Mason, Elizabeth Nyothach, Benard Asuke, Philip Spinhoven, David Obor, Christine Khaggayi, Daniel Kwaro, Penelope A Phillips-Howard, Garazi Zulaika","doi":"10.1136/bmjph-2024-001528","DOIUrl":"10.1136/bmjph-2024-001528","url":null,"abstract":"<p><strong>Introduction: </strong>Out-of-school girls are at higher risk of sexual and reproductive health (SRH) harms. Schools provide a protective environment for adolescents and lessen their exposure to such risks. This paper explores factors associated with school dropout, sexual activity, marriage and pregnancy among out-of-school girls in western Kenya.</p><p><strong>Methods: </strong>Eligible adolescents were systematically recruited from area households in Siaya County. Generalised linear models were fit to obtain adjusted ORs (aOR) and 95% CIs of key covariates against individual outcomes. Factors with p values <0.1 in the univariate analysis were added to a multivariable model using backward stepwise regression techniques, and factors significant at p<0.05 were retained in the final adjusted models. Models were bootstrapped at 1000 replications to validate factor selection.</p><p><strong>Results: </strong>Of the 915 girls enrolled (mean 18.3 years, SD: 1.3), 2.1% had never attended school. Of those who started school, 34.6% dropped out during primary education. Reasons for dropout included marriage, pregnancy and needing childcare (42.5%), financial reasons (eg, lack of school fees, needing to work, 42.5%), lack of interest (5.6%), illness (3.0%), failing school (2.2%) and other factors (4.1%). Reaching menarche prior to age 13 (aOR 1.50, 95% CI 1.00 to 2.23, p=0.048), experiencing physical violence (aOR 1.48, 95% CI 1.01 to 2.17, p=0.042) or sexual partner violence (aOR 2.16, 95% CI 1.08 to 4.34, p=0.030) were associated with not completing primary school. Experiencing sexual harassment (aOR 2.20, 95% CI 1.35 to 3.58, p=0.002) or needing to engage in transactional sex (aOR 1.74, 95% CI 1.20 to 2.51, p=0.003) were associated with being sexually active. Low socioeconomic status (aOR 1.98, 95% CI 1.36 to 2.90, p<0.001), having an older partner (aOR 1.65, 95% CI 1.10 to 2.47, p=0.016) and higher parity (aOR 2.56, 95% CI 1.42 to 4.62, p=0.002) were associated with being married or cohabiting with a partner. Girls identified provision of school fees and schooling items (67.9%) as the primary solution to resuming school; obtaining counselling, mentorship and support services (22.2%) for their general health; and provision of menstrual products (24.2%) for daily challenges.</p><p><strong>Conclusions: </strong>Out-of-school girls in western Kenya face numerous SRH challenges related to menstruation, sexual and physical violence, and poverty. Social and financial support and interventions for school re-entry are warranted for this neglected population. National policies and multisectoral strategies to support adolescent girls' education and health should be prioritised, enforced and monitored for impact.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001528"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575013","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":"Scaling up structured lifestyle interventions to improve the management of cardiometabolic diseases in low-income and middle-income countries: a systematic review of strategies, methods and outcomes.","authors":"Abha Shrestha, Lu Yang, Getu Debalkie Demissie, Rolina Dhital, Jeemon Panniyammakal, Ganeshkumar Parasuraman, Sabrina Gupta, Biraj Karmacharya, Kavumpurathu R Thankappan, Brian Oldenburg, Tilahun Haregu","doi":"10.1136/bmjph-2024-001371","DOIUrl":"10.1136/bmjph-2024-001371","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiometabolic diseases (CMDs), the leading causes of death in low-income and middle-income countries (LMICs), are proven to be mitigated through structured lifestyle interventions (SLIs-dietary changes, physical activity, tobacco cessation and alcohol intake), but the challenge lies in scaling them up in LMICs. Therefore, we undertook a systematic review to identify the strategies, methods and outcomes used in scaling up SLI programmes to improve cardiometabolic outcomes in LMICs.</p><p><strong>Methods: </strong>We searched studies implementing scale-up strategies (delivery approaches enhancing an intervention's adoption, implementation and sustainability), methods (theories, models and frameworks) and present outcomes (feasibility, fidelity, etc) following the Proctor E framework. We searched six databases to identify studies published in English with no time restriction, guided by the Setting, Perspective, Intervention, Comparison and Evaluation framework. Quality assessment was performed using the Cochrane risk-of-bias, National Institutes of Health and Joanna Briggs Institute tools. Given the heterogeneity of the outcome measures, we conducted a narrative synthesis of the extracted information.</p><p><strong>Results: </strong>Out of the 26 studies included, 18 (69%) adapted SLI interventions to suit local contexts. Strategies such as system integration, strengthening facility services and training led to up to 100% attendance of participants. Notably, only four studies (15%) used theories, models and frameworks for the full scale-up process, which is crucial for large-scale implementation in resource-limited settings. 15 (58%) studies reported the feasibility of scale-up, whereas 7 (27%) reported no significant differences in lifestyle behaviours or CMD biomarkers.</p><p><strong>Conclusions: </strong>Early community and local stakeholders' engagement is crucial for codeveloping strategies for the scale-up of SLIs. Conducting readiness assessments and system integration are all essential considerations for improving scale-up outcomes. Additionally, we strongly recommend using suitable frameworks to guide the scale-up of SLIs to maximise the benefit for the population.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001371"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575054","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":"Global patterns in access and benefit-sharing: a comprehensive review of national policies.","authors":"Gunnar V Ljungqvist, Ciara M Weets, Tess Stevens, Hailey Robertson, Ryan Zimmerman, Ellie Graeden, Rebecca Katz","doi":"10.1136/bmjph-2024-001800","DOIUrl":"10.1136/bmjph-2024-001800","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Introduction: </strong>The goal of access and benefit-sharing (ABS) in global health governance is to ensure that countries that provide access to genetic resources, including pathogens, receive equitable access to the benefits derived from their use. The increasing digitalisation of health data has brought this issue to the forefront of discussions on global health security and health equity. While originally conceptualised in supranational agreements, implementation of these treaties requires national-level legislation in each country. This descriptive analysis represents to our knowledge the first open-access comprehensive effort to map ABS policies in all 193 United Nations member states.</p><p><strong>Methods: </strong>We conducted a standardised review of the legislation for 193 United Nations Member States across three global legal databases (ABS Clearing House, WIPOLEX and FAOLEX), national legal databases and a systematic Google search. Legally enforceable policies were identified, and data were extracted across the following eight aspects of ABS legislation: Scope of Legislation, Digital Sequence Information (DSI), Access to Resources, Prior Informed Consent, Contractual Terms, Benefit-Sharing, Compliance and Legal Sanctions.</p><p><strong>Results: </strong>We found that 104 countries have legally enforceable policies on ABS, with 92 countries having ABS policies relevant to microorganisms. Of these, 74 countries have chosen to restrict access to their domestic pathogens, and 53 have chosen to link access to pathogenic resources with an obligation to share benefits. Altogether 22 countries have a codified position on DSI with regard to ABS in legally enforceable policy: 16 have explicitly included it, 2 have explicitly excluded it and 4 have ambiguous wording. WHO regional coverage of ABS policy on genetic resources ranged from 28% (3/11) of countries in the Eastern Mediterranean Region to 57% (21/35) in the Region of the Americas. Likewise, regional coverage of legally enforceable ABS policy related to DSI ranged from 0% in the Eastern Mediterranean and European Regions to 36% (4/11) of countries in the Southeast Asian Region.</p><p><strong>Conclusion: </strong>These findings highlight the heterogeneity found in the global policy landscape as it pertains to ABS, and provide data to inform future agreements and research efforts related to ABS.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001800"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575025","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}