BMJ Public Health最新文献

{"title":"Acute kidney injury, the present on admission (POA) indicator and sex disparities: observational study of inpatient real-world data in a Swiss tertiary healthcare system. Explorative analysis","authors":"K. Triep, S. Musy, Michael Simon, O. Endrich","doi":"10.1136/bmjph-2023-000131","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000131","url":null,"abstract":"Regarding kidney disease (KD), sex differences in epidemiology and clinical relevance have been reported. Related to absolute and relative changes of baseline creatinine, different criteria for staging may induce underdiagnosis or overdiagnosis related to sex. At the largest Swiss provider of inpatient acute healthcare, a clinic decision support algorithm ensures exact staging of KD (2012 KDIGO Kidney Disease Improving Global Outcomes Clinical Practice Guideline). Coding of the indicator ‘Present On Admission’ (POA) was introduced at this institution in 2018 to flag postadmission conditions.The explorative analysis aimed at differences in diagnosis groups. Defined indicators and the distribution of stages in acute kidney injury (AKI) were analysed using the POA flag. Sex differences were reported.Retrospective observational study. Explorative analysis. Routinely collected health data, 2019 and 2020 (121 757 cases) on the patient history and intensive care treatment duration, comorbidity levels, coded diagnoses, age and sex.Software and statistic: program R, V.4.1.1, SD; median, IQR; prop.test; standardised mean difference.The reporting of postadmission diagnoses showed more interhospital transfers, more intensive care stays, higher scores of severity and treatment intensity, more often mechanical ventilation, a higher age, a higher number of diagnoses, a higher complexity level of the related cases and mortality. This observation could be made to a lesser degree for the female population. However, for the female population mortality was higher (stage III AKI 41.6%).Using the POA flag, the results reflect the clinical situation of complications and comorbidities evolving unexpectedly. As our results show sex differences, that is, a lower morbidity of female patients for each stage, but a higher mortality, a deeper evaluation of the implied sex differences in staging of KD should follow.The general results confirm the necessity of a diagnosis-onset reporting in health statistics.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"34 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139874024","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":"Exploring the gender difference in type 2 diabetes incidence in a Swiss cohort using latent class analysis: an intersectional approach","authors":"J. M. Barbier, M. Amiguet, Julien Vaucher, Aurélie M Lasserre, Carole Clair, Joëlle Schwarz","doi":"10.1136/bmjph-2023-000472","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000472","url":null,"abstract":"Type 2 diabetes is multifactorial and influenced by the intersection of gender-related variables and other determinants of health. The aim of this study was to highlight the intersectional social position of the participants and disentangle its role from administrative sex in predicting the development of type 2 diabetes.Using CoLaus|PsyCoLaus study, a Swiss single-centre prospective cohort initiated in 2003 and including 6733 participants (age 35–75 years; 54% women) at baseline, we conducted latent class analyses using gender-related variables (eg, risk-taking behaviours, gender roles represented by employment status, etc) and socioeconomic determinants at baseline (2003–2006) to construct intersectional classes and we tested their association with the development of type 2 diabetes at follow-up (2018–2021).Of the 6733 participants enrolled at baseline, 3409 were included in our analyses (50.6%). Over a median follow-up time of 14.5 years, 255 (7.5%) participants developed type 2 diabetes, of which 158 men (62.0%). We identified seven latent classes highlighting different intersectional social position groups (ie,young, fit, educated men (N=413), non-White physically inactive men and women (N=170), highly qualified men, former or current smokers (N=557), working women living alone (N=914), low qualified working men with overweight (N=445), women with obesity, low education and low qualified job or housewives (N=329), low educated retired participants (N=581)). Using the class labelled as ‘young, fit, educated men’ as reference, the risk of incident type 2 diabetes was higher in all other classes (adjusted OR values between 4.22 and 13.47). Classes mostly feminine had a more unfavourable intersectional social position than that of the predominantly masculine classes. The corresponding OR increased in sex-adjusted regressions analyses.We observe cumulative intersectional effects across behavioural and socioeconomic profiles with different risks of developing type 2 diabetes emphasising the deleterious effect of a feminine gender profile. These patterns are only partly captured by traditional sex-stratified analyses.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"122 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139875877","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":"Suitability of paediatric legislation beyond the USA and Europe: a qualitative study on access to paediatric medicines","authors":"Anna Volodina, Albrecht Jahn, Rosa Jahn","doi":"10.1136/bmjph-2023-000264","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000264","url":null,"abstract":"Paediatric legislation has contributed to better access to appropriate treatments in the European Union and the USA by requiring paediatric research in return for financial incentives. This study explored whether similar policies could improve access to medicines in other countries.We conducted 46 interviews with representatives from healthcare practice, patient organisations and health authorities from six countries (Australia, Brazil, Canada, Kenya, Russia and South Africa) as well as multinational pharmaceutical companies exploring their views regarding access barriers to paediatric medicines. Emphasis was placed on regulation-related barriers and the effect of the COVID-19 pandemic. Where participants were familiar with paediatric legislation, views regarding its relevance for domestic context were explored in depth.Insufficient paediatric research and development, regulatory hurdles and reimbursement constraints were reported to be relevant access barriers in all studied settings. In the absence of marketing registration or reimbursement, access to paediatric medicines was associated with increased legal, financial and informational barriers. Brazil, Kenya, Russia and South Africa additionally described overarching deficiencies in medicines provision systems, particularly in procurement and supply. The COVID-19 pandemic was said to have reduced regulatory hurdles while further heightening global access inequalities.Views regarding paediatric legislation were mixed. Concerns regarding the implementation of such policies focused on regulatory resource constraints, enforceability and potential reduction of industry activity.The study findings suggest that paediatric legislation may be most impactful in mature health systems and should be accompanied by measures addressing access barriers beyond marketing registration. This could include strengthening domestic manufacturing capacities and technology transfer for medicines with high public health relevance. Ideally, legislative changes would build on global harmonisation of paediatric legislation, which could be achieved through existing WHO structures.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"10 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139871917","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":"Suicide mortality among individuals in federal prisons compared with the general population: a retrospective cohort study in the USA from 2009 to 2020","authors":"Katherine LeMasters, S. Ranapurwala, M. F. Behne, Emilie Duchesneau, M. Fliss, Jennifer Lao, Lauren Brinkley-Rubinstein","doi":"10.1136/bmjph-2023-000544","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000544","url":null,"abstract":"Suicide is one of the leading causes of death in US prisons. Yet, administrative data lags years behind and reporting rarely accounts for differing age distributions between suicide rates between incarcerated and general populations. Our objective was to compare reported suicides rate among those incarcerated in federal prisons and the general population, accounting for age distributions, before and during the COVID-19 pandemic (2009–2020).Using data from the Federal Bureau of Prison, Bureau of Justice Statistics and the Centers for Disease Control and Prevention WONDER database and a retrospective cohort study design, we estimated age-standardised mortality rates and standardised mortality ratios comparing observed suicide mortality among those incarcerated in federal prisons to the expected mortality if they experienced the same age-specific suicide rates as the general population. We tested for linear trends over calendar year in each population.In federal prisons, 245 deaths were reported as suicides from 2009 to 2020 (5% of federal prison deaths). From 2009 to 2020, the observed suicide rate in prisons increased from 10.57 to 19.01 per 100 000 and the crude suicide rate in the general population increased from 15.41 to 17.26 per 100 000. After age standardisation, the observed suicide rate in prisons was lower than the suicide rate in the general population between 2009 and 2019, but surpassed it in 2020. In 2020, we observed 1.07 (95% CI: 0.74 to 1.57) times the number of suicides than we would expect if the prison population had the same age-stratified risk of suicide as the general population.Increasing suicide mortality in prisons is a public health crisis. In 2020, the age-standardised suicide rate in prison surpassed that of the general population, despite the incarcerated population being under high surveillance. To improve public health, decarceration community-based mental healthcare are promising solutions. Additionally, there is an urgent need for improved cause of death reporting quality in prisons.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"54 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139890574","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":"Estimating rare disease prevalence and costs in the USA: a cohort study approach using the Healthcare Cost Institute claims data","authors":"Christine M. Cutillo, A. Tisdale, Mahdi Baghbanzadeh, Keith A. Crandall, Reva L Stidd, Manpreet S Khural, Laurie J Hartman, Jeff Greenberg, Kevin B Zhang, Ali Rahnavard","doi":"10.1136/bmjph-2023-000346","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000346","url":null,"abstract":"The study capitalised on national insurance claims data to gather information on patient characteristics and associated costs to better understand the diagnosis and treatment of rare diseases (RDs).Data from the Healthcare Cost Institute (HCCI) data enclave were analysed using R statistical software and filtered by the International Classification of Diseases, 10th edition (ICD-10), current procedural terminology codes and the National Drug Code associated with 14 RDs and disease-modifying therapy options. Data were aggregated by prevalence, costs, patient characteristics and effects of treatment modification.The prevalence and costs of RDs in the HCCI commercial claims database varied significantly across the USA and between urban and rural areas. Pharmacy costs increased when a new treatment was initiated, while non-pharmacy costs decreased.Prevalence and cost estimations are highly variable due to the small number of patients with RDs, and the lack of a national healthcare database limits inferences for such patient populations. Accurate assessments require a diverse population, which can likely be achieved by analysing multiple databases. RDs face challenges in prevalence estimation due to a lack of specific disease coding and a small patient population, compounded by issues like data standardisation and privacy concerns. Addressing these through improved data management in healthcare systems, increased research and education will lead to better diagnosis, care management and quality of life for patients with RD.Data on patients with RD in the HCCI database were analysed for prevalence, costs, patient characteristics and treatment modification effects. Significant heterogeneity in each of these factors was found across RDs, geography and locality (eg, urban and rural). Building capabilities to use machine learning to accelerate the diagnosis of RDs would vastly improve with changes to healthcare data, such as standardising data input, linking databases, addressing privacy issues and assigning ICD-10 codes for all RDs, resulting in more robust data for RD analytics.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"22 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139875921","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":"Coping strategies of fathers and siblings of children with cancer: a literature review","authors":"Teresa Rea, Vincenza Sansone, Andrea Zibaldo, Anna Bellingrath, A. Guillari","doi":"10.1136/bmjph-2023-000597","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000597","url":null,"abstract":"The impact of paediatric cancer diagnosis on the family system is universally recognised, as well as the need for the family to find a new balance. Paediatric nurses, being promoters of the care of family and children diagnosed with cancer, need to deepen the experiences of siblings, fathers and mothers to offer better holistic child and family centred care. Although other literature reviews on this topic are present, none of these take into consideration the coping strategies of fathers and siblings in an aggregative way, as we do in this paper. The aim of this study is to look into the coping strategies of healthy siblings and fathers during the therapeutic process of a child with cancer.An aggregative literature review was conducted through the consultation of some of the main electronic databases. Studies satisfying the following criteria were included: (a) primary studies conducted in the last 10 years, (b) published in English or Italian, (c) focusing on coping strategies adopted at diagnosis and during therapy by fathers and siblings of children with cancer.The results were collected in three main categories looking at the problem from the parents’, the siblings’ and eventually the whole family’s points of view. The three categories have in common the expression of contrasting feelings by each member of the family that generates changes in roles and responsibilities.Further studies are needed to better understand how nurses can lead a family centred care approach to improve the general familiar management and coping strategies.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"191 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139824418","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":"Comparing the rate of inpatient admissions of prison residents with COVID-19 to the general population in England in 2020/2021 using Hospital Episode Statistics data","authors":"Miranda Davies, Anjana Roy","doi":"10.1136/bmjph-2023-000515","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000515","url":null,"abstract":"To compare the rate of inpatient admissions of prison residents with COVID-19 to the general population and to consider differences in the use of inpatient and outpatient services by prison residents in England in the first year of the pandemic (2020/2021), to the 12 months prior to the pandemic (2019/2020).The pseudonymised records of patients who accessed admitted patient care and outpatient hospital services from a prison address in England between 1 April 2019 and the 31 March 2021 were extracted from Hospital Episode Statistics data. Descriptive statistics summarise the most common primary admitting diagnosis and the proportion of outpatient appointments attended and not attended. Indirectly standardised adjusted admission rate was calculated to compare the rate of inpatient admissions by prison residents with COVID-19 to the general population.The standardised adjusted admission rate for COVID-19 was 2.2 times higher in prison than the general population. Hospital data highlight continuing challenges regarding high levels of violence and self-harm resulting in hospital admissions during a period when people were spending an increasing amount of time in their cells.Despite efforts to minimise the spread of COVID-19 in secure settings, prison residents in England were significantly more likely to be hospitalised with a COVID-19 diagnosis relative to the general population during the first year of the pandemic. This is in addition to the wider implications of the COVID-19 restrictions, particularly spending extended periods in isolation, on people’s mental health.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"15 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139887267","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":"Cross-sectional survey to explore knowledge, attitude, practices and impact of an intervention programme related to antibiotic misuse and self-medication among general population of Pakistan","authors":"Arifa Saif, Tahir Mehmood Khan, Allah Bukhsh, M. Yaseen, Alia Saif","doi":"10.1136/bmjph-2023-000758","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000758","url":null,"abstract":"The objective of this study is to observe the knowledge, attitude and practices related to antibiotic use, the prevalence of self-medication and non-adherence to the prescribed course of antibiotics across Pakistan.A cross-sectional quantitative study on knowledge, practices, attitude and adherence to antibiotic therapy was conducted from January 2021 to March 2022 among the adult population living in different areas across Pakistan. Individuals with poor knowledge were selected for video-based intervention programme. Video template produced by WHO to create antibiotic awareness was used for this purpose. A postintervention study was conducted to assess the improvement in their knowledge and practices regarding the use of antibiotics. Paired samples t-test was applied to assess the improvement in postintervention survey scores.68.9% (n=340/493) of the participants were female and the majority of the sample population was from urban areas. Our study revealed that 39.2% (n=196) of individuals have undergone self-medication with antibiotics in the last 6 months and 42% (n=207) of the total participants were non-adherent to antibiotic treatment plan. Lack of proper information from healthcare professionals was observed to be the most important barrier to antibiotic treatment adherence. The interventional video was shown to 31.64% (n=156/493) of participants who lack proper knowledge about antibiotic use and its associated problems. There appeared to be a significant improvement in the postintervention mean scores of knowledge, practices, attitude and adherence related to antibiotics.This study highlights the alarming situation of self-medication and non-adherence to antibiotic therapy. To cope with the situation, certain pertinent measures are direly needed before the precious lifesaving antibiotics become useless in eradicating various controllable microbial diseases.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"16 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139871675","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":"Occupational stress and its correlates among healthcare workers of a tertiary level teaching hospital in Kathmandu, Nepal, during COVID-19 pandemic: a cross-sectional study","authors":"Suchana Thapa, P. Pradhan","doi":"10.1136/bmjph-2023-000126","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000126","url":null,"abstract":"Healthcare workers experience high job stress, contributing to negative health outcomes and poor patient care. This study aims to assess occupational stress and its associated factors among healthcare workers at a tertiary hospital during COVID-19 pandemic in Kathmandu, Nepal.A cross-sectional quantitative study was conducted among doctors and nurses in a tertiary hospital. A self-administered questionnaire was used to collect data from 368 participants. Bivariate and multiple linear regression analysis identified the predictors associated with occupational stress.The mean occupational stress index score was 149.56±22.01. It was significantly higher among female participants (151.59±19.12 vs 144.2±27.6, p=0.004), married individuals (152.06±19.79 vs 147.01±23.86, p=0.028), those with over 1 year of employment duration (152.17±21.28 vs 145.45±22.60, p=0.004), health workers attending more than four night shift a month (152.30±19.44 vs 135.52±28.45, p<0.001), those working in rotating shift (151.68±21.12 vs 142.17±23.57, p=0.006), those working 48 hours or more per week (152.39±19.28 vs 145.97±24.66, p=0.005), those lacking support from other staff (157.81±18.70 vs 148.17±22.25, p=0.003) and those who consumed alcohol (152.14±21.25 vs 147.18±22.49, p=0.031). Multiple linear regression revealed associations with employment duration over 1 year (β=0.174, p=0.001), rotating shift (β=−0.106, p=0.006), night shifts (β=0.251, p<0.001), working hours of 48 hours or more per week (β=0.175, p=0.001), lack of support from other staff (β=0.130, p=0.010) and low-wealth quintile (β=0.161, p=0.006).Occupational stress is associated with employment duration, night shift, rotating shift, working hours, support mechanisms and socioeconomic profile among healthcare workers. There is a crucial need to establish evidence-based actions to prevent occupational stress and promote the overall health of healthcare workers.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"26 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139891611","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":"Correction: Association of living condition using urbanisation level and neighbourhood deprivation with loneliness and social isolation during COVID-19 pandemic: a cross-sectional study of the nationwide data in Japan","authors":"","doi":"10.1136/bmjph-2023-000341corr1","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000341corr1","url":null,"abstract":"","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"103 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139825991","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}