BMJ Public Health最新文献

{"title":"Association of physical and sexual assault with mortality in two British birth cohorts","authors":"Vishal Bhavsar, J. Das-Munshi, J. H. MacCabe, Ioannis Bakolis, William Lee","doi":"10.1136/bmjph-2023-000285","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000285","url":null,"abstract":"The association of assault in adulthood with all-cause mortality, and the relevance of intermediate psychological distress, alcohol use and cigarette smoking, is poorly understood. We used data from British birth cohorts (the 1958 National Child Development Study referred to as the 1958 birth cohort and the 1970 British Birth Cohort Study) to investigate association between assault and mortality, employing a formal approach for the identification of psychological distress, alcohol use and cigarette smoking as mediators.Associations (HRs), between assault and mortality were estimated with Cox regressions, adjusting for potential confounders. Mediation via intermediate psychological distress, alcohol use and cigarette smoking was explored using the gformula approach. The birth cohorts were analysed separately, and together estimating interaction between exposure and cohort year.Results were based on 353 deaths in 19 725 individuals. Based on multiply imputed data, the fully adjusted estimate for assault on mortality was 1.72 (95% CI 1.22 to 2.42) in the combined cohorts, 1.53 (95% CI 0.97 to 2.40) in the 1958 birth cohort and 2.05 (95% CI 1.20 to 1.50) in the 1970 birth cohort. The fully adjusted estimate for the association of sexual assault with mortality was 3.17 (95% CI 1.17 to 8.60) in the combined cohorts, 1.36 (95% CI 0.19 to 9.81) in the 1958 birth cohort and 6.02 (95% CI 1.84 to 19.69) in the 1970 birth cohort. The fully adjusted mortality HR for one additional assault was 1.46 (95% CI 1.23 to 1.73) in the combined cohorts, 1.34 (95% CI 0.99 to 1.82) in the 1958 birth cohort and 1.53 (95% CI 1.25 to 1.87) in the 1970 birth cohort. Greater need for medical treatment for assault was associated with a fully adjusted mortality HR of 1.56 (95% CI 1.19 to 2.05) in the combined cohorts, 1.43 (95% CI 1.00 to 2.05) in the 1958 birth cohort and 1.79 (95% CI 1.18 to 2.74) in the 1970 birth cohort.There was statistical evidence on combining the two birth cohorts, and on analysing the 1970 birth cohort, that assault in adulthood is associated with mortality. Understanding mechanisms underlying this relationship could benefit violence reduction strategies for public health.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subjective social status and trajectories of frailty: findings from the English Longitudinal Study of Ageing","authors":"Asri Maharani, Lindsay Richards, P. Präg","doi":"10.1136/bmjph-2023-000629","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000629","url":null,"abstract":"Subjective social status is a known antecedent for many health outcomes, but little research has examined the association between subjective status and frailty among older people. Using longitudinal data, the goal of this study was, first, to identify latent trajectories of frailty over time, and second, to investigate the relationship between subjective social status and frailty trajectory.Data were drawn from the 2002–2019 surveys of the English Longitudinal Study of Ageing, involving 9484 individuals aged 50+ years at baseline. Group-based trajectory models were used to identify frailty trajectories over the 18-year period, and multinomial regression models were used to investigate the relationship between subjective social status and frailty trajectory membership. Controls were included for confounding factors, including a range of socioeconomic indicators and health behaviours.Four trajectories of the frailty index were retained: low frailty (53% of participants), progressive mild frailty (25%), progressive moderate frailty (15%) and high frailty (6%). Higher subjective social status is associated with higher probabilities of being in the low-frailty group and lower probabilities of being in one of the progressive or high-frailty groups.Subjective social status is significantly associated with being in a milder frailty trajectory after controlling for age, health behaviours and a wide range of objective socioeconomic status markers.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140401356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep patterns and long-term mortality among older Israeli adults: a population-based study","authors":"Saar Ashri, Gali Cohen, T. Hasin, Lital Keinan-Boker, Yariv Gerber","doi":"10.1136/bmjph-2023-000651","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000651","url":null,"abstract":"The joint association of night-time sleep duration and daytime napping (siesta) with mortality remains elusive. We explored sleep patterns and long-term mortality in older adults and tested whether the relationship is modified by cognitive function.We analysed data from 1519 participants in the National Health and Nutrition Survey of older adults aged 65+ years (‘Mabat Zahav’), conducted by the Israel Center for Disease Control during 2005–2006. A detailed questionnaire was administered at study entry to gather information on sleeping habits, including night-time sleep duration and siesta. A Mini-Mental State Examination was administered to assess cognitive status (score <27 considered impaired). Mortality data were obtained from the Ministry of Health (last follow-up: June 2019; 782 deaths). Cox models were constructed to estimate the HRs for mortality associated with sleep patterns, defined according to night sleep duration (>8 vs ≤8 hours) and siesta (Y/N). Spline regression models were constructed to examine the linearity of the association across cognitive statuses.Sleep categories among participants (mean age 75; 53% women) included 291 (19.2%) with long night sleep and siesta, 139 (9.1%) with long night sleep and no siesta, 806 (53.1%) with short night sleep and siesta, and 283 (18.6%) with short night sleep and no siesta. HRs for mortality were 2.07 (95% CI: 1.63 to 2.62), 1.63 (95% CI: 1.22 to 2.18) and 1.43 (95% CI: 1.16 to 1.76) in the former three versus latter sleep patterns, respectively. Multivariable adjustment for sociodemographic, behavioural and clinical covariates attenuated the HRs to 1.27–1.41 (all p<0.05). The relationship between night sleep duration and mortality was linear (plinearity=0.047) among cognitively preserved individuals and U-shaped (pnon-linearity<0.001) among cognitively impaired ones.Prolonged night sleep and siesta were associated with increased mortality, a relationship that varied by cognitive performance.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modelling the potential clinical and economic impact of universal antenatal hepatitis C (HCV) screening and providing treatment for pregnant women with HCV and their infants in Egypt: a cost-effectiveness study","authors":"N. Hachicha-Maalej, Clotilde Lepers, I. Collins, Aya Mostafa, Anthony E Ades, Ali Judd, Karen Scott, Diana Gibb, Sarah Pett, Giuseppe Indolfi, Y. Yazdanpanah, Manal H El Sayed, S. Deuffic-Burban","doi":"10.1136/bmjph-2023-000517","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000517","url":null,"abstract":"Pregnant women and children are not included in Egypt’s hepatitis C virus (HCV) elimination programmes. This study assesses the cost-effectiveness of several screening and treatment strategies for pregnant women and infants in Egypt.A Markov model was developed to simulate the cascade of care and HCV disease progression among pregnant women and their infants according to different screening and treatment strategies, which included: targeted versus universal antenatal screening; treatment of women in pregnancy or deferred till after breast feeding; treatment of infected children at 3 years vs 12 years. Current practice is targeted antenatal screening with deferred treatment for the mother and child. We also explored prophylactic treatment after birth for children of diagnosed HCV-infected women. Discounted lifetime cost, life expectancy (LE) and disability-adjusted life-years (DALYs) were calculated separately for women and their infants, and then combined.Current practice led to the highest cost (US$314.0), the lowest LE (46.3348 years) and the highest DALYs (0.0512 years) per mother–child pair. Universal screening and treatment during pregnancy followed by treatment of children at 3 years would be less expensive and more effective (cost saving) compared with current practice (US$219.3, 46.3525 and 0.0359 years). Prophylactic treatment at birth for infants born to HCV RNA-positive mothers would also be similarly cost saving, even with treatment uptake as low as 15% (US$218.6, 46.3525 and 0.0359 years). Findings were robust to reasonable changes in parameters.Universal screening and treatment of HCV in pregnancy, with treatment of infected infants at age 3 years is cost saving compared with current practice in the Egyptian setting.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140401349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exposure to famine during early life and the risk of MAFLD during adulthood: evidence from the China Multi-Ethnic Cohort (CMEC) study","authors":"J. Yin, Nichang Zhang, Yuemei Feng, Qiong Meng, Teng Zhang, Rudan Hong, Xuehui Zhang","doi":"10.1136/bmjph-2023-000114","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000114","url":null,"abstract":"Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common chronic liver disease, affecting nearly one-third of the global population. The relationship between early-life famine exposure and MAFLD remains unclear in the multiethnic region of less-developed southwest China.A total of 18 558 participants who came from the baseline survey of the China Multi-Ethnic Cohort Study in Yunnan were included. Participants were divided into four groups according to birth year, including non-exposed (1962–1978 and 1939–1943), fetal exposed (1959–1961), childhood exposed (1949–1958) and adolescence exposed (1943–1949). Logistic regression analysis was used to explore the relationship between famine exposure in early life and the risk of MAFLD in adulthood.Experiencing the shock of early-life exposure to famine would affect adulthood MAFLD. Exposure to famine during fetal life and childhood increased the risk of MAFLD in adulthood, with this association being particularly pronounced in Bai populations. Moreover, famine exposure in males during fetal life raised the risk of MAFLD in adulthood.We suggest that adequate nutrition in early life may be beneficial in preventing MAFLD in adulthood. The prevention of chronic liver disease should adopt a whole-life strategy by extending the prevention window beginning from fetal life.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vision impairment and differential access to eye health services in Aotearoa New Zealand: a scoping review","authors":"J. T. Rogers, Joanna Black, M. Harwood, Ben Wilkinson, Himal Kandel, Jacqueline Ramke","doi":"10.1136/bmjph-2023-000313","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000313","url":null,"abstract":"In Aotearoa New Zealand, Māori and Pacific People experience worse health outcomes compared with other New Zealanders. No population-based eye health survey has been conducted, and eye health services do not generate routine monitoring reports, so the extent of eye health inequality is unknown. This information is required to plan equitable eye health services. In this scoping review, we aimed to summarise the nature and extent of the evidence reporting vision impairment, its main causes and access to eye health services by ethnicity in New Zealand.This scoping review was reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. An information specialist conducted a search on MEDLINE and Embase databases in October 2022. Included studies reported outcomes among any population group resident in New Zealand or attendees at New Zealand health facilities. Data screening, full-text review and data extraction were performed independently by two authors. We summarised the characteristics of studies and outcomes, and the results were synthesised narratively.Our search identified 2711 reports, of which 53 (from 47 studies) were included. We mapped 72 outcomes, many of which were access-related (n=32), published since 2000 (n=28) and largely focused on diabetic retinopathy (n=21) or cataract (n=13) in facility-based settings (n=18). Over two-thirds of reported outcomes were disaggregated by at least two ethnicities. When outcomes were disaggregated by ethnicity, Māori and Pacific People were consistently included, and experienced worse access and outcomes compared with other New Zealanders.The findings of this review highlight the presence of ethnic disparity in access to diabetic retinopathy and cataract services. Closing the evidence gap identified for refractive error, glaucoma and macular degeneration service coverage could be a priority for future research. Furthermore, future research can be strengthened to enable consistent monitoring of eye health service coverage over time.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten-year (2009–2019) epidemiological study of head and neck, salivary glands and upper aerodigestive tract cancers, and overall survival outcomes in the Northern Territory of Australia","authors":"Nayellin Reyes-Chicuellar, Kate Thimbleby, Bhavya Balasubramanya, Hemi Patel, Suresh Mahendran","doi":"10.1136/bmjph-2023-000551","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000551","url":null,"abstract":"Head and neck, salivary glands and aerodigestive tract cancers (HNACs) rank sixth in cancer incidence in Australia, posing significant public health and economic challenges. However, data on HNACs in the Northern Territory (NT) are lacking, crucial for healthcare planning.This study aims to analyse HNACs epidemiology, risk factors and survival outcomes in the NT, focusing on Indigenous and non-Indigenous Australians.We conducted a retrospective analysis (2009–2019) of HNACs cases from the NT Cancer Registry. Ethically approved, the study assessed incidence, mortality, risk factors and survival across ethnic populations.Of 612 potential cases, 524 were analysed, with 35.5% identifying as Aboriginal or Torres Strait Islanders. Predominantly affecting males (median age: 62 years), HNACs showed an age-standardised incidence of 21.9 per 100 000, with stable trends. The 5-year survival rate was 39.6%, notably lower in Indigenous Australians (25%) and remote areas (18%) vs the national average (68%). Oropharyngeal malignancies were common (36% survival). High-risk behaviours such as alcohol use (73%) and smoking (91%) prevailed. Most patients (73%) presented with advanced disease (stages III–IV), with one-third offered palliative care at diagnosis. P16-negative tumours predominated, with increasing P16-positive cases in non-Indigenous patients.HNACs survival rates in the NT are significantly lower than the national average, especially among Indigenous Australians and remote residents. Targeted interventions are needed to improve service planning and delivery, considering identified risk factors and cultural sensitivities, and promoting Indigenous participation.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing food preferences and eating behaviour among the Forcibly Displaced Myanmar Nationals (FDMN) adolescents in Cox’s Bazar, Bangladesh: a cross-sectional survey","authors":"Rashedul Islam, Nahid Hasan, Nusrat Jahan Ferdous, A. B. Sharif, Mahamudul Hasan, Dr Azaz Bin","doi":"10.1136/bmjph-2023-000237","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000237","url":null,"abstract":"Adolescence is a pivotal period for physical, mental, social and behavioural development, so it is crucial to understand the factors influencing adolescent food preferences and eating behaviour. This study aimed to investigate the factors that influence adolescents’ food preferences and eating behaviours in the Forcibly Displaced Myanmar Nationals (FDMN) camp in Cox’s Bazar, Bangladesh.A cross-sectional study was conducted in the FDMN camp, recruiting 545 adolescents. The purposive sampling technique was applied. First, 12 camps in the Ukhiya region were randomly selected. Adolescents of both sexes, aged between 10 and 19, were included in the study. Respondents’ sociodemographic characteristics and dietary patterns, as well as the participant’s nutritional status, were recorded. Descriptive statistics were used to present the baseline characteristics, while Pearson’s χ2test was used to assess the relationship between food preference and baseline characteristics.A significant number of participants failed to meet their daily requirements for essential nutrients, including protein (89.9%), vegetables (82.8%) and dairy products (90.8%). Additionally, 58.9% of the respondents did not consume adequate water daily. Food preferences and eating behaviours among FDMN adolescents in Cox’s Bazar were found to be influenced by a range of factors, including peer influence, access to nutritional education, food sources, cultural beliefs, ration sufficiency, food prices as well as age, gender, education level and household income.In conclusion, understanding and addressing the multifaceted factors that influence the food preferences of FDMN adolescents is crucial for developing targeted interventions and comprehensive nutritional programmes.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140469628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative focus group discussions exploring PrEP method and service delivery preferences among female sex workers and their managers in four Zambian provinces","authors":"E. Evens, Tendai Munthali, Featherstone G. Mangunje, Mercy L Kotaka, Holly M. Burke, Bupe Musonda, Musonda Musonda, Catherine S. Todd","doi":"10.1136/bmjph-2023-000483","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000483","url":null,"abstract":"To describe the experiences of oral HIV pre-exposure prophylaxis (PrEP) use, preferences comparing oral PrEP to future long-acting PrEP products (the dapivirine vaginal ring (PrEP ring) and injectable cabotegravir (CAB PrEP)), and service provision preferences among female sex workers (FSWs) and their managers.Qualitative formative focus group discussions were conducted in two urban (Copperbelt, Lusaka) and two rural (Central, Luapula) provinces in Zambia. Consenting participants included 43 FSWs and 36 sex work managers. Eligible participants self-identified as FSWs or sex work managers, were 18 years or older and spoke English, Nyanja or Bemba.FSWs had a median age of 28 years and 60% reported ever using oral PrEP. Among potential future HIV prevention options, most FSWs preferred longer acting PrEP methods, mainly CAB PrEP over the PrEP ring. This preference was consistent across provinces. Many FSWs had personal oral PrEP experience and appreciated the high effectiveness but conveyed that the realities of daily use, including pill visibility, and attributed side effects did not meet their needs. FSWs and managers also identified frequent stigma and misinformation-related barriers to PrEP access and use at community and facility levels. Most FSWs and managers agreed that informing non-paying or long-term partners of PrEP use was acceptable. Participants offered recommendations for greater sensitisation and peer-led services or service extension through trusted figures in the community.Zambian FSWs and their managers preferred longer acting PrEP methods, particularly CAB PrEP, as part of comprehensive HIV prevention method choice, with little difference between provinces. PrEP programming led by FSW peers, managers or other trusted figures was recommended to address misinformation, sensitise partners and potentially deliver services to circumvent perceived stigma at health facilities.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140465580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting the effects of introducing an emergency transport system in low-income and middle-income countries: a spatial-epidemiological modelling study","authors":"Katie Scandrett, R. Lilford, Dmitri Nepogodiev, S. Katikireddi, Justine Davies, Stephen Tabiri, Samuel I Watson","doi":"10.1136/bmjph-2023-000321","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000321","url":null,"abstract":"Many low-income and middle-income countries lack an organised emergency transportation system, leaving people to arrange informal transport to hospital in the case of a medical emergency. Estimating the effect of implementing an emergency transport system is impractical and expensive, so there is a lack of evidence to support policy and investment decisions. Alternative modelling strategies may be able to fill this gap.We have developed a spatial-epidemiological model of emergency transport for life-threatening conditions. The model incorporates components to both predict travel times across an area of interest under different scenarios and predict survival for emergency conditions as a function of time to receive care. We review potentially relevant data sources for different model parameters. We apply the model to the illustrative case study of providing emergency transport for postpartum haemorrhage in Northern Ghana.The model predicts that the effects of an ambulance service are likely to be ephemeral, varying according to local circumstances such as population density and road networks. In our applied example, the introduction of the ambulance service may save 40 lives (95% credible interval 5 to 111), or up to 107 lives (95% credible interval −293 to –13) may be lost across the region in a year, dependent on various model assumptions and parameter specifications. Maps showing the probability of reduced transfer time with the ambulance service may be particularly useful and allow for resource allocation planning.Although there is scope for improvement in our model and in the data available to populate the model and inform parameter choices, we believe this work provides a foundation for pioneering methodology to predict the effect of introducing an ambulance system. Our spatial-epidemiological model includes much oppurtunity for flexibility and can be updated as required to best represent a chosen case study.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140469963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}