BMJ Public Health最新文献

{"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":"78 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139812003","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":"Responsiveness of services rendered at primary healthcare facilities of Bharatpur, Nepal: a cross-sectional study","authors":"Anup Adhikari, D. Paneru, A. Pokhrel","doi":"10.1136/bmjph-2023-000546","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000546","url":null,"abstract":"Responsiveness of services refers to the way healthcare systems and providers interact with patients and how well they meet patients’ non-clinical expectations and needs. The responsiveness is a crucial aspect of a well-functioning health system while primary healthcare is considered as its foundational cornerstone. However, in low and middle-income countries, there are numerous obstacles to its efficient operation and a very limited understanding of the concept of service responsiveness. This study aimed to assess the responsiveness of services and identify associated factors at primary healthcare facilities of Bharatpur, Nepal.A facility-based cross-sectional study was carried out among 358 patients visiting outpatient department (OPD) of primary healthcare facilities of Bharatpur. A pretested structured interview schedule was used to conduct a face-to-face interview to obtain the information per the study’s objective. Univariate as well as bivariable and multivariable logistic regressions were carried out to obtain the result per our objectives.The overall performance of the responsiveness of services was 74.6% (95% CI 70.1 to 78.8), dignity being the highest performing domain (97.2%) and choice being the lowest (22.6%). Respondents aged more than or equal to 50 (adjusted OR (AOR)=4.107, 95% CI 1.28 to 13.14), those who are satisfied with the service (AOR=7.02, 95% CI 3.21 to 15.36), those who perceive high quality of care (AOR=5.69, 95% CI 2.54 to 12.73) and those who did not have to pay for transportation (AOR=4.63, 95% CI 2.20 to 9.72) showed higher responsiveness.The primary healthcare facilities of Bharatpur, Nepal demonstrated nearly three-quarters of the respondents reporting good responsiveness of services at OPD. To further enhance the level of responsiveness, strengthening the referral networks, empowering patients in decision-making and prioritising patient satisfaction and quality of services can help.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"12 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139818665","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":"Multimodal strategies to hand hygiene in Ghanaian hospitals: a cross-sectional study in the Eastern Region of Ghana","authors":"S. D. Dubik, Kingsly E Amegah, A. A. Owusu-Asare, Akosua Takyiwa Kwakye, Christiana Akufo, Joyce Amponsah, H. Awekeya, Leslie Vander Puije, Jocelyn Asibey, Seth Twum, Francis Mensa Akwetey, Portia Sam, W. Ofosu, A. Ackon, Sofonias Asrat, Hedidor George Kwesi, S. Ohene, M. Ashinyo","doi":"10.1136/bmjph-2023-000606","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000606","url":null,"abstract":"Hand hygiene (HH) is one of the core components of infection prevention and control and is critical for a high quality of care. Multimodal approaches are recommended to strengthen and drive HH systems in healthcare facilities (HCFs). We aimed to assess the extent of implementation of the WHO HH multimodal improvement strategy in HCFs in the Eastern Region of Ghana.This study was a descriptive cross-sectional study involving 22 HCFs from 17 districts in the Eastern Region of Ghana. We collected data from 22 hospitals using the WHO Hand Hygiene Self-Assessment Framework (HHSAF). Data were analysed through descriptive statistics.The HHSAF median score denotes an intermediate HH implementation level (53.5%, IQR 48.8%–58.3%). Fourteen HCFs attained an intermediate level, five attained basic level, one attained advanced level and no facility exhibited inadequate HH implementation level. Evaluation and feedback had the highest score (64.3%, IQR 50%–71.4%), as ward-based audits for the availability of HH resources have become standard practice in many of the HCFs. Reminders in the workplace had the lowest score (33.3%, IQR 25.9%–37.0%), whereby less than half (46%) of the HCFs had posters explaining the indications for HH and the correct use of alcohol-based hand rubs. HH implementation level did not differ significantly among government (M=49.97, SD=12.30) and non-government (M=53.32, SD=18.73) facilities, (t (20)=−0.503, p=0.621).Most HCFs had an intermediate HH implementation level. The provision of HH resources, including posters, HH rounds in patient care areas, introduction of HH corners, leadership, financial and organisational support are key elements for increased compliance with the WHO HH multimodal improvement strategy.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"49 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139828384","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":"928 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139831517","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":"172 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139884199","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":"Sleeplessness and incident diabetes above the Arctic circle: a secondary analysis of cohort data from the Tromsø Study","authors":"Nick Chindanai Uthaikhaifar, Olena Iakunchykova, Sarah Cook, Charlotte Warren-Gash","doi":"10.1136/bmjph-2023-000644","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000644","url":null,"abstract":"Circadian misalignment and sleep quality are intertwined processes that are both associated with diabetes. The association between sleep quality and incident diabetes has not been previously investigated in populations living at polar latitudes who experience extreme seasonal daylight variation and may be at greater risk of circadian misalignment. Using data from adult residents of Tromsø, Norway, this study investigates the association of poor sleep quality, as indicated by self-reported sleeplessness, and incident diabetes above the Arctic circle.Secondary analysis of cohort data from the Tromsø Study. The study cohort consists of adults who attended both the fourth (Tromsø4) and seventh (Tromsø7) surveys conducted in 1995 and 2016, respectively. Only individuals with complete data were included. Multivariable logistic regression was used to examine the association between sleeplessness measured in Tromsø4 and incident diabetes measured in participants followed up to Tromsø7, adjusted for other diabetes risk factors.Among 10 875 individuals (mean 41 years of age at baseline, 53.6% women), 21.2% (n=2302) reported experiencing sleeplessness at baseline. Diabetes incidence risk over follow-up (20 years) was 7.2% (n=784); incidence risk among individuals reporting sleeplessness was 8.8%, compared with 6.8% among unexposed individuals. After adjustment, sleeplessness-exposed individuals in the study cohort were found to have 23% greater odds (ORadj1.23, 95% CI 1.03 to 1.47, p=0.022) of incident diabetes.Sleep quality is associated with incident diabetes in a population living above the Arctic circle. The direction and strength of association is consistent with findings from other geographical regions.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"32 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139455475","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":"Unmet need for healthcare in the Russian Federation: subnational retrospective modelling analysis (2014–2018)","authors":"Z. Nikoloski, A. Somanathan, V. Shkolnikov, Igor Sheiman, Elias Mossialos","doi":"10.1136/bmjph-2023-000173","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000173","url":null,"abstract":"Unmet need for healthcare is a proxy indicator used to assess the performance of healthcare systems throughout the world. While the Russian Federation is committed to improving healthcare for its citizens, barriers to access remain.Using data from a region-level survey, we document and analyse the extent of the unmet need for healthcare at both national and subnational levels in the Russian Federation for the years 2014–2018. We used a panel fixed effects modelling approach to examine the link between unmet need and its correlates at the subnational level. We also used data from various sources that addressed the reasons underlying unmet need to interpret the findings from the modelling analysis.Approximately one-third of the Russian population (34.7% in 2018) reported that healthcare was not received when it was needed with little change observed between 2014 and 2018. We observed significant variation across the various regions in Russia. The prevalence of unmet need was substantially higher in the regions of the Volga, Siberia and Far East Federal Districts. Our analysis revealed that the density of hospital beds and economic development across regions were correlated with the prevalence of unmet need. Dissatisfaction with healthcare services, perceived lack of effective treatments and financial constraints were the main reasons offered for forgoing healthcare when needed.An unanticipated positive link between unmet need and hospital bed density might be attributed to the low accessibility and quality of primary healthcare. High demand and supply of inpatient care do not compensate for the structural imbalances of the current healthcare model. Strengthening and improving the quality of primary care might significantly reduce the prevalence of unmet need.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"46 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139456459","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":"Healthy enough to work up to age 67 and beyond? A longitudinal population-based study on time trends in working life expectancy free of cardiovascular diseases based on German health insurance data","authors":"Jelena Epping, Fabian Tetzlaff, Lieselotte Mond, Juliane Tetzlaff","doi":"10.1136/bmjph-2023-000400","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000400","url":null,"abstract":"Due to the rising life expectancy in Western countries, the discussion about the increase in the retirement age is becoming more important. However, the prolongation of working lives cannot be implemented successfully without considering the health status of the (potential) employees. In this study, time trends in working life expectancy (WLE) free of widespread cardiovascular diseases (CVD) as well as the proportion of CVD-free working life years are reported.Claims data from a German statutory health insurance provider is used to analyse CVD-free WLE. Three periods were defined to assess time trends: 2006–2008 (n=2 075 248), 2011–2013 (n=2 302 127) and 2016–2018 (n=2 579 985). Based on transition rates between the states labour force, non-labour force, CVD and death, CVD-free years spent in the labour force were estimated for each age using multistate life table analyses.The length of CVD-free WLE increased over time. This increase was stronger in women than in men (+6.4 years vs +2.4 years at age 18). Given the increase in total WLE of the study population, the proportion of CVD-free WLE in total WLE remained stable over time.The results show that working life years free of CVD increased strongly over the last 13 years and can keep pace with the increase in the length of working lives. Healthier working conditions as well as more efforts in promoting healthy nutrition and less sedentary behaviour could help to further reduce the incidence of CVD and thus contribute to longer healthy working lives.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"33 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139456487","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":"Perceived social support and the experience of intimate partner violence among married and cohabiting young women in urban slums, Ibadan, Nigeria: a descriptive study","authors":"Omowumi O. Okedare, O. Fawole","doi":"10.1136/bmjph-2023-000425","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000425","url":null,"abstract":"Social support is an important factor for improving the outcome of intimate partner violence (IPV) among abused women. Gaps exist on the role of social support among young women who have experienced IPV in Nigeria. Therefore, this study examined the influence of social support on the experience of IPV married and cohabiting young women in urban slums of Ibadan, Nigeria.This study was a community-based household survey conducted in ten slum communities in the five local government areas of Ibadan municipality among 314 young women. Outcome variable was the experience of physical, psychological and any IPV. Socio-demographic characteristics were summarised using frequency and percentage. Level of statistical significance was set at α0.05.The mean age of respondents was 22.25±1.75 years and the mean spousal age difference was 7.15±3.87 years. Majority of the respondents were married (62.1%), and have been in a union for 0–4 years (68.8%). More than half (56.4%) justified IPV perpetration. Majority of the respondents reported having experienced psychological IPV (66.6%) and at least one form of IPV (86.3%) but have never told anyone about their IPV experience (58.1%). Social support was a predictor of psychological and any IPV, but not physical IPV. Type of union and duration of union significantly predicted all forms of IPV.Prevalence of IPV is higher among women in cohabiting relationships. Social support from family and friends helps abused women cope with the experience of IPV. Thus, IPV prevention should target the social support system available to abused women.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"23 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139456756","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":"Impact of the COVID-19 pandemic on young people living with HIV in Lesotho: a qualitative study","authors":"Thomas Shepherd, Michelle E Robinson, Maema Ramaema, Moraoetsi Rakuoane, Ntoli Moletsane, Rafiloe Mpholo, Christian Mallen, Graham Leigh","doi":"10.1136/bmjph-2023-000414","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000414","url":null,"abstract":"There is a growing body of research evidencing the detrimental impact of the COVID-19 pandemic on the mental health and well-being of young people. This impact may be worse in low-resource settings, especially those in sub-Saharan Africa, where pandemic impacts may be exacerbated by poverty, limited healthcare access and other health epidemics including HIV. We explored the COVID-19 pandemic impacts on young people living with HIV in Lesotho to understand the experiences of HIV management, well-being, financial stability and education status.Thirty-one semistructured, face-to-face interviews were conducted with young people aged 15–19 years of age living with HIV from eight districts across Lesotho. Interviews were conducted in Sesotho, audio-recorded, later transcribed and translated to English prior to analysis. Analysis consisted of a thematic analysis using principles of constant comparison to explore key and emerging themes.Analysis revealed five major themes: ‘financial instability and food insecurity’, ‘challenges to health and well-being’, ‘changing relationship dynamics’, ‘loss of educational opportunities’ and ‘understanding the threat of COVID-19’.While participants discussed being able to access antiretroviral therapy, this study highlights the significant impact of the COVID-19 pandemic and associated lockdown measures on the mental health and well-being, financial stability and educational development of young people living with HIV in Lesotho.","PeriodicalId":505519,"journal":{"name":"BMJ Public Health","volume":"90 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139454409","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}