Journal of Global Health最新文献

{"title":"Effective coverage of newborn postnatal care: assessing the service contact-content gap in 32 low- and middle-income countries using household survey data.","authors":"Safia S Jiwani, Assanatou Bamogo, Elizabeth A Hazel, Abdoulaye Maiga, Emily B Wilson, Gouda Roland Mesmer Mady, Agbessi Amouzou","doi":"10.7189/jogh.15.04219","DOIUrl":"10.7189/jogh.15.04219","url":null,"abstract":"<p><strong>Background: </strong>High-quality postnatal care (PNC) is essential for newborn survival. However, newborn PNC coverage indicators do not reflect the quality of care received. We estimated effective coverage of newborn PNC by incorporating content of care and calculated the contact-content gap in 32 low-and middle-income countries (LMICs).</p><p><strong>Methods: </strong>Using household survey data from 32 LMICs, we defined effective coverage of newborn PNC as the proportion of mothers or babies who received five essential signal functions as part of their newborn's PNC check by a medically trained provider within the first two days of birth. We calculated the contact-content gap as the absolute difference between service coverage of newborn PNC and effective coverage of newborn PNC, in percentage points (pp). We described inequalities in effective coverage of newborn PNC by mother's age, parity, wealth, education, residence, antenatal care seeking, delivery facility type, and managing authority.</p><p><strong>Results: </strong>The median effective coverage of newborn PNC was 27.5% across countries, ranging from 2.1% (95% confidence interval (CI) = 1.6, 2.7) in Burundi to 78.3% (95% CI = 74.3, 81.8) in Armenia. We identified large PNC contact-content gaps, up to 52.6 pp in The Gambia. Content of care was generally poor, with only 37.1% of mothers across countries receiving counselling on newborn danger signs. We found important demographic, socioeconomic, and health systems inequalities in newborn PNC effective coverage, disproportionately favouring newborns whose mother was older (35-49 years), primiparous, lived in urban areas, belonged to the wealthiest households, had at least secondary education, and delivered in a hospital or the private sector in most countries.</p><p><strong>Conclusions: </strong>In most countries, a substantial number of newborns who are checked during PNC do not receive all basic services. Effective coverage measures offer a more comprehensive estimate for assessing service gaps, driving action, and ensuring health gains. Addressing the missed opportunities of inadequate care content and focussing on equity will be critical to improve survival of all mothers and newborns.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04219"},"PeriodicalIF":4.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food insecurity and sleep deficiency among older Filipinos: the mediating roles of depressive symptoms and frailty phenotypes.","authors":"Divine Grace C Domingo, Tuo-Yu Chen, Grace Cruz, Philile S Mgabhi, Kian Lee Lim, Chrispin Mandiwa, Yasuhiko Saito","doi":"10.7189/jogh.15.04235","DOIUrl":"https://doi.org/10.7189/jogh.15.04235","url":null,"abstract":"<p><strong>Background: </strong>Although research has shown that food insecurity may lead to sleep problems due to poor mental health, it remains unclear whether physical health mediates this relationship. We investigated whether depressive symptoms and frailty phenotypes mediated the association of food insecurity with sleep deficiency among community-dwelling older adults in the Philippines.</p><p><strong>Methods: </strong>We analysed data from the baseline survey of a longitudinal study of ageing and health in the Philippines involving a nationally representative sample of older adults aged ≥60 years (n = 3599). Sleep deficiency was conceptualised as self-reported sleeping of <6 hours, complaining about falling and staying asleep, and/or having non-restorative sleep. Food insecurity was defined as household hunger and lack of food over the past three months. Frailty phenotypes were operationalised using modified Fried's criteria, and depressive symptoms using the Centre for Epidemiological Studies-Depression Scale. Covariates included sociodemographics (age, sex, education, wealth, living arrangements, and urbanity), health (pain, chronic diseases, and body mass index), and lifestyles (naps, smoking, and drinking). Mediation analysis using the PROCESS macro was conducted to estimate the direct and indirect effects in the moderated mediation models.</p><p><strong>Results: </strong>Bootstrapping results showed significant indirect effects of food insecurity on sleep deficiency through depressive symptoms (bootstrap estimate (b) = 0.09, standard error (SE) = 0.02; 95% confidence interval (CI) = 0.05, 0.14) and frailty phenotypes (b = 0.03, SE = 0.01; 95% CI = 0.01, 0.06). However, the direct effect of food insecurity on sleep deficiency was insignificant (b = 0.31, SE = 0.16; 95% CI = -0.003, 0.64).</p><p><strong>Conclusions: </strong>The results indicated that food insecurity is associated with sleep deficiency, with frailty phenotype and depressive symptoms playing a potential mediating role. However, further research is needed to establish causal pathways. Preventing frailty and depression may help improve sleep health among individuals who are food insecure.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04235"},"PeriodicalIF":4.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of circadian rhythm-related genes in type 2 diabetes from a multi-omics perspective.","authors":"Liangxiao Xie, Duobin Huang, Xiaoyun Zha, Changshun Wei, Jiajia Dong, Huaqiang Zheng, Zehong Xu, Jinzhi Wu, Pengbin Lai","doi":"10.7189/jogh.15.04227","DOIUrl":"https://doi.org/10.7189/jogh.15.04227","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have established a connection between circadian rhythm disruption and the development of type 2 diabetes mellitus (T2DM), yet the underlying genetic mechanisms remain inadequately understood. This research aims to elucidate the causal relationships between circadian rhythm-related genes and T2DM by utilising a multi-omics approach.</p><p><strong>Methods: </strong>The study employed the GeneCards database to identify genes associated with circadian rhythms. Integration of quantitative trait loci (QTL) data for gene expression (eQTLs), DNA methylation (mQTLs), and protein expression (pQTLs) was conducted alongside genome-wide association study summary data for T2DM sourced from the Integrative Epidemiology Unit (IEU) and FinnGen databases.</p><p><strong>Results: </strong>The summary-databased Mendelian randomization (SMR) methodology was utilised to analyse potential causal relationships, supported by colocalisation analyses to confirm the origin of genetic signals. The analysis yielded 47 mQTLs, five eQTLs, and three pQTLs significantly correlated with T2DM outcomes, maintaining a significance threshold of P_SMR_multi <0.05, P_SMR<0.05, and P-HEIDI>0.01.</p><p><strong>Conclusions: </strong>The integration of mQTL and eQTL data identified 20 critical methylation sites and 13 associated genes relevant to T2DM, with Heat Shock Factor 1(HSF1) emerging as a pivotal gene. Notably, high methylation at the site cg18814314 was inversely correlated with T2DM risk, while increased expression of HSF1 showed a positive correlation. These findings suggest that HSF1 plays a vital role in the pathogenesis of T2DM through circadian rhythm regulation, highlighting its potential as a target for early intervention strategies. Further research is warranted to investigate the timing of circadian gene expression and methylation in T2DM development.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04227"},"PeriodicalIF":4.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and all-cause mortality in female patients with idiopathic pulmonary fibrosis in Chinese population.","authors":"Aiyuan Zhou, Qing Song, Rongli Lu, Dingding Deng, Yi Li, Xiyan Zhang, Pinhua Pan","doi":"10.7189/jogh.15.04246","DOIUrl":"https://doi.org/10.7189/jogh.15.04246","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic pulmonary fibrosis (IPF) exhibits notable sex-based disparities and male patients with IPF are significantly more numerous than female patients. Therefore, the female patients are often overlooked and under-investigated. This study aimed to evaluate the clinical characteristics and all-cause mortality in female patients with IPF in Chinese population.</p><p><strong>Methods: </strong>This retrospective cohort study included IPF patients registered at Xiangya Hospital of Central South University and the First Affiliated People's Hospital of Shaoyang University from January 2015 to May 2024. The data on age, sex, body mass index, smoking (pack-years), forced expiratory volume in one second to forced vital capacity, diffusing capacity of the lung for carbon monoxide percentage of predicted (DL_CO %pred), diffusing capacity divided by the alveolar volume (DL_CO/VA), laboratory analysis, comorbidities, and antifibrotic therapy were collected. The patients were followed-up to collect the data on all-cause mortality.</p><p><strong>Results: </strong>A total of 583 patients were enrolled and 116 (19.9%) of them were female. Female patients had higher levels of forced expiratory volume in one second to forced vital capacity, DL_CO %pred, DL_CO/VA, arterial oxygen partial pressure (Pao₂), and total cholesterol, while a lower smoking (pack-years), haemoglobin, blood urea, uric acid, myoglobin, and creatine kinase. The proportion of lung cancer and antifibrotic therapy were lower in female patients (P < 0.05). Logistic regression analysis showed that haemoglobin (odds ratio (OR) = 0.813; 95% confidence interval (CI) = 0.706-0.937) and blood urea (OR = 0.158; 95% CI = 0.030-0.849) as negatively associated with female, while total cholesterol (OR = 14.699; 95% CI = 1.892-114.190) and DL_CO %pred (OR = 1.112; 95% CI = 1.005-1.229) were positively associated (P < 0.05). Over a median follow-up period of 31.0 (12.0-64.0) months, a total of 489 patients with IPF were analysed the all-cause mortality and 101 (20.7%) of them were female. Cox regression analysis revealed that female patients had significantly lower all-cause mortality compared to males (hazard ratio = 0.168; 95% CI = 0.031-0.920, P < 0.05).</p><p><strong>Conclusions: </strong>Significant differences in clinical characteristics and prognosis were observed between male and female IPF patients in Chinese population. Specifically, female patients exhibited better pulmonary function, higher Pao₂, and lower all-cause mortality than male patients. Therefore, gender differences should be systematically evaluated in the diagnostic and therapeutic approach to IPF, and targeted strategies should be developed to optimise treatment outcomes in female patients.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04246"},"PeriodicalIF":4.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"E-Commerce and global dietary health: a longitudinal analysis of food availability and imports pathways across 64 countries (2008-2022).","authors":"Shiwen Quan, Huiyun Zhang","doi":"10.7189/jogh.15.04287","DOIUrl":"https://doi.org/10.7189/jogh.15.04287","url":null,"abstract":"<p><strong>Background: </strong>Improving dietary health has become a key objective in public health policies worldwide. Concurrently, rapid technological advancements have profoundly altered food acquisition methods, with the widespread adoption of the internet shifting food commerce from offline to online platforms. This study aims to empirically examine the impact of e-commerce on residents' dietary health.</p><p><strong>Methods: </strong>Utilising unbalanced panel data from 64 countries between 2008 and 2022, this study employs a two-way fixed-effects model to empirically analyse the effects of e-commerce on dietary health. Mediation analysis is conducted to examine the underlying mechanisms, specifically food availability and food imports. Heterogeneity analysis is conducted to investigate the heterogeneity of these effects with different economic development levels.</p><p><strong>Results: </strong>E-commerce positively promotes dietary health among residents. Regarding specific dimensions of dietary health, the promotion effects of e-commerce on the Healthy Food Diet Index (HFD) and the Balanced Index of Food Consumption Structure (f_coi) are stronger than on the Balanced Index of Nutritional Structure (n_coi). Mechanism tests indicate that food availability acts as a partial mediating factor in the relationship between e-commerce and dietary health, while food imports mediate the relationship between e-commerce and two dietary health dimensions (HFD and f_coi) with indirect effect of 5.0% and 7.3% respectively. Heterogeneity analysis reveals that the positive impact of e-commerce on HFD and f_coi weakens progressively with rising levels of economic development.</p><p><strong>Conclusions: </strong>It is recommended that efforts should be made to strengthen supporting infrastructure such as cold chain logistics to effectively promote the positive impact of e-commerce on dietary health, especially in low-income countries. Concurrently, vigilant monitoring is required to mitigate the exacerbating effects of food imports on dietary health. The higher marginal benefit of e-commerce development on dietary health in low-income countries effectively narrows the dietary health gap with developed nations, thereby advancing global health equity.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04287"},"PeriodicalIF":4.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based nursing interventions in cognitive dysfunction among adults with brain injury: a quasi-experiment.","authors":"Yitian Gao, Wanqiong Zhou, Ying Wang, Lanshu Zhou","doi":"10.7189/jogh.15.04253","DOIUrl":"https://doi.org/10.7189/jogh.15.04253","url":null,"abstract":"<p><strong>Background: </strong>While evidence-based interventions are increasingly used in cognitive care, their effectiveness for patients with brain injury remains not well established. Therefore, we aimed to compare the effects of an evidence-based nursing intervention programme vs. conventional nursing care in patients with cognitive dysfunction following brain injury.</p><p><strong>Methods: </strong>We enrolled brain injury patients from two neurosurgical wards (A and B) of a Shanghai rehabilitation hospital (July 2023-January 2024) in a non-randomised controlled trial. Ward A implemented the evidence-based cognitive intervention programme, while ward B maintained routine care. The segregated ward design prevented cross-contamination between groups. Outcomes were measured at baseline, immediately after a two-week intervention (T1), and at a four-week follow-up (T2). We analysed primary (i.e. the Mini-Mental State Examination (MMSE)) and secondary (i.e. activities of daily living (ADL) and cognitive knowledge scores) outcomes using generalised estimating equations (GEE) with terms for time, group, and their interaction. We set statistical significance at P < 0.05.</p><p><strong>Results: </strong>We enrolled 124 brain injury patients with cognitive dysfunction, with 117 completing the study (intervention n = 59; control n = 58; attrition = 5.6%). No significant differences were found between the groups at baseline. The GEE results showed significantly higher cognitive function improvements in the intervention group than the control group at both T1 (b = 1.71; 95% confidence interval (CI) = 0.76, 2.66; P < 0.001) and T2 (b = 2.71; 95% CI = 1.42, 4.00; P = 0.001). Results also showed a significantly greater increase in ADL (b = 4.93; 95% CI = 2.14, 7.72; P = 0.001) and caregivers' cognitive scores (b = 8.09; 95% CI = 2.78, 13.41; P = 0.003) at T1, with sustained increases at T2 in ADL (b = 5.46; 95% CI = 2.15, 8.77; P = 0.001) and caregivers' cognitive scores (b = 13.51; 95% CI = 6.76, 20.27; P < 0.001).</p><p><strong>Conclusions: </strong>The programme was effective in improving cognitive function and shows potential for clinical implementation and generalisation. A longer follow-up study is needed to evaluate its long-term effects on clinical outcomes.</p><p><strong>Registration: </strong>We prospectively registered this study with the Chinese Clinical Trial Registry (Registration ID: ChiCTR2300072283).</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04253"},"PeriodicalIF":4.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A laboratory-focussed desk review of health systems in Uganda, Kenya, and the UK to respond to current and future pandemics.","authors":"Winters Muttamba, Bernadette O'Hare, Andrew Ramsay, Vibhor Saxena, Bruce Kirenga, Wilber Sabiiti","doi":"10.7189/jogh.15.04194","DOIUrl":"https://doi.org/10.7189/jogh.15.04194","url":null,"abstract":"<p><strong>Background: </strong>Laboratory systems play a crucial role in managing diseases effectively, and the COVID-19 pandemic serves as a prime example. The pandemic underscored the need to make laboratory health systems more resilient and robust to respond to future pandemics.</p><p><strong>Methods: </strong>We conducted a desk review guided by the six World Health Organization health system building blocks (health service delivery, health financing, medical products, vaccines, and technologies, human resources for health, governance, and health information systems).</p><p><strong>Results: </strong>The three countries' strengths include health information systems, well-established reference laboratories, mobile and community-level testing, a vibrant private laboratory sector in Uganda and Kenya, and a growing private sector in the UK. In Uganda and Kenya, there are laboratory connectivity solutions for molecular diagnostics, multi-disease testing platforms and specimen referral systems, while in the UK, there are hub-and-spoke networks. Weaknesses in Uganda and Kenya include vertical laboratory systems strengthening, ill-equipped laboratories, constrained and inequitable distribution of laboratory human resources, and limited data use. In the UK, there is chronic underfunding and undervaluing of disciplines supporting infection testing, microbiology and virology.</p><p><strong>Conclusions: </strong>The growing contribution of the private sector in the three countries and the deployment of multi-disease testing platforms should be supported, given the advantage of shared financial costs in the face of chronic underfunding for laboratory systems.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04194"},"PeriodicalIF":4.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BNT162b2 COVID-19 vaccination uptake, safety, effectiveness, and waning in children and young people aged 5-11 years in Scotland.","authors":"Igor Rudan, Steven Kerr, Christopher Sullivan, Karen Jeffrey, Zoe Grange, Lynda Fenton, Amanj Kurdi, Ting Shi, Lucy Cullen, Colin R Simpson, Srinivasa Vittal Katikireddi, Lewis D Ritchie, Chris Robertson, Aziz Sheikh","doi":"10.7189/jogh.15.04250","DOIUrl":"https://doi.org/10.7189/jogh.15.04250","url":null,"abstract":"<p><strong>Background: </strong>Few large-scale population studies have examined both safety and vaccine effectiveness (VE) specifically for 5-11-year-olds during the Omicron-dominant period in a setting with low vaccine uptake. The BNT162b2 (Pfizer-BioNTech) vaccine, administered in two doses, has shown strong efficacy against symptomatic and severe COVID-19 in clinical trials involving children and young people (CYP). Accordingly, we examined the uptake, real-world safety, VE, and waning of BNT162b2 VE against symptomatic COVID-19 among children aged 5-11 years in Scotland.</p><p><strong>Methods: </strong>This national prospective cohort study used the Scotland-wide Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) platform. We evaluated vaccine uptake using national data from the Turas Vaccination Management Tool, up to 16 April 2024. We assessed vaccine safety through national records on hospital admissions, employing a self-controlled case series design to examine 17 predefined health outcomes. We estimated VE against symptomatic, COVID-19 infection confirmed by reverse transcription-polymerase chain reaction and caused by the Omicron variant using a test-negative design.</p><p><strong>Results: </strong>From 19 March 2022 to 1 January 2023, 25.3% of the 392 658 children aged 5-11 years received their first COVID-19 vaccine dose and 16.2% completed the second dose. We found no increased risk of safety related hospital admission for 17 health outcomes in the post-vaccination period. During the Omicron period, VE against symptomatic COVID-19 was 60.8% (95% confidence interval (CI) = 0.3-84.5%) at 2-26 weeks post-first dose and 41.6% (95% CI = -89.6, 82.0) at 2-26 weeks post-second dose. The protective effect against symptomatic disease was no longer detectable in the period ≥27 weeks following both the first and second doses.</p><p><strong>Conclusions: </strong>The BNT162b2 vaccine demonstrated a strong safety profile in this age group. Receiving both doses was linked to a reduction in the risk of symptomatic COVID-19 during the Omicron variant period, but this protection waned over the following six months.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04250"},"PeriodicalIF":4.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of pooled procurement of medicines on patient adherence and economic burden: evidence from China.","authors":"Boya Zhao, Jing Wu, Zhao Cheng, Xing Lin Feng","doi":"10.7189/jogh.15.04229","DOIUrl":"https://doi.org/10.7189/jogh.15.04229","url":null,"abstract":"<p><strong>Background: </strong>Pooled procurement is widely adopted to improve medicine affordability, yet its impact on patients' medicine adherence and economic burden remains underexplored. This study addresses these gaps under China's National Volume-Based Procurement (NVBP) policy.</p><p><strong>Methods: </strong>Using claims data from Tianjin, China (2017-2020), we conducted a retrospective cohort study of new-users of NVBP antihypertensive medicines before and after policy implementation. During one-year follow-up since medicine initiation, medicine adherence (measured by proportional days covered), medicine persistence (measured by discontinuation rate), and direct medical costs (broken down by components) were compared between cohorts. Linear regressions, Cox proportional hazard models and generalised linear models were used to analyse outcome differences, adjusting for patients' demographics, medical history, and prior health care utilisation.</p><p><strong>Results: </strong>We identified 14 560 and 18 858 patients in pre- and post-policy cohorts, respectively (mean age = 57.1; 52.8% men). Compared to the pre-policy cohort, the post-policy cohort presented a slight increase in adherence to NVBP medicines (proportional days cover = 0.31 vs. 0.28; adjusted difference = 0.021; P < 0.0001), but no significant change in discontinuation rate. Hypertension-related costs decreased by 19.5% (1509.2 vs. 1804.8 Chinese Yuan; P < 0.0001) for the post-policy cohort, entirely attributed to saving in costs of NVBP medicines (480.6 vs. 772.6 Chinese Yuan; adjusted difference = -47.5%; P < 0.0001). No significant difference was observed in costs for other medicines and services. The cost saving was equally borne by patients and health plans.</p><p><strong>Conclusions: </strong>China's NVBP modestly improved adherence and significantly reduced the economic burden for patients. To fully deliver patient-centred benefits of pooled procurement for chronic disease medicines beyond price cuts, it should be paired with supply- and demand-side auxiliary measures. China's experience, including financial incentives, regulatory oversight, favourable reimbursement policies and public campaigns, may offer lessons for other settings. Longer-term studies in broader populations are needed to further research.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04229"},"PeriodicalIF":4.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HLA-B*58:01 screening in Asia-Pacific is an ethical imperative - not just a cost question.","authors":"Wei Leik Ng, Emily Tsui Yee Tse, Prawira Oka, Hooi Min Lim, Sky Wei Chee Koh, Rizawati Ramli, Hung Chiun Lau, Benjamin Chih Chiang Lam, Laurie J Goldsmith, Adina Abdullah, Lay Hoon Goh","doi":"10.7189/jogh.15.03037","DOIUrl":"https://doi.org/10.7189/jogh.15.03037","url":null,"abstract":"<p><p>Allopurinol remains the first-line treatment for gout; however, it carries a risk of severe cutaneous adverse reactions (SCARs), particularly among carriers of the HLA-B*58:01 allele. In the Asia-Pacific region, screening practices vary widely due to infrastructure gaps, cost concerns, and differing health policies. For example, while cost-effectiveness analyses have influenced screening decisions in some countries, they often overlook long-term health system burdens and ethical imperatives. Therefore, screenings should not be withheld solely on economic grounds, especially when they can prevent life-threatening outcomes. For that reason, a targeted, risk-based approach that integrates genetic and clinical factors could offer a practical and equitable path forward, improving pharmacogenomic literacy, expanding access to testing, developing regional data-sharing platforms, and involving patients in co-designing screening strategies. Rapid point-of-care testing and integration of screening process with existing care pathway may further support this implementation. However, a coordinated regional effort is needed to ensure safer prescribing and equitable access to pharmacogenomic screening across diverse healthcare settings.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"03037"},"PeriodicalIF":4.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}