Lancet Public Health最新文献

{"title":"A new perspective on the health of people experiencing homelessness","authors":"Maurizio Marceca, Giulia Civitelli, Serafina Torchiaro, Giuseppinanna Merlino, Salvatore Geraci","doi":"10.1016/s2468-2667(25)00063-5","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00063-5","url":null,"abstract":"As noted by Di Simone and colleagues in their Correspondence,<span><span>¹</span></span> the change in Italian law introducing the right to public primary health care for people experiencing homelessness through registration with a general practitioner (GP) represents an important first step against inequities in health care.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"58 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective interventions for active workplaces: time to get evidence into practice","authors":"Elizabeth Goyder, Kelly Mackenzie","doi":"10.1016/s2468-2667(25)00046-5","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00046-5","url":null,"abstract":"No Abstract","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"56 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the COVID-19 pandemic on incarceration and tuberculosis","authors":"Emma H Plugge, Nicola Cocco","doi":"10.1016/s2468-2667(25)00012-x","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00012-x","url":null,"abstract":"Although preventable and curable, 10·8 million people were diagnosed with tuberculosis and 1·25 million people died from tuberculosis in 2023.<span><span>¹</span></span> It is a disease that disproportionately affects marginalised groups—for instance, it has been clearly shown that there is a high tuberculosis incidence and low case detection rate in prison populations globally.<span><span>²</span></span> Indeed, WHO has identified incarcerated people as an important population who should be prioritised for tuberculosis control efforts.<span><span>³</span></span> However, although data show an adverse effect of the COVID-19 pandemic on the years of progress tackling tuberculosis at global, regional, and country levels,<span><span>⁴</span></span> there has been a paucity of data investigating the effect on specific marginalised populations. Amy Zheng and colleagues’ study,<span><span>⁴</span></span> which examined annual trends in incarceration rates and tuberculosis notifications among incarcerated people in Europe and the Americas before (pre-2020) and during (2020–22) the COVID-19 pandemic, is therefore an important contribution to the understanding of disease control in prisons during the pandemic.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"38 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State of health and inequalities among Italian regions from 2000 to 2021: a systematic analysis based on the Global Burden of Disease Study 2021","authors":"Mohsen Naghavi","doi":"10.1016/s2468-2667(25)00045-3","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00045-3","url":null,"abstract":"<h3>Background</h3>Over the past two decades, the Italian National Health Service has been gradually decentralised, with Italy's 21 regional governments now responsible for managing their health services. This change, coupled with austerity measures and a steadily ageing population, has adversely affected universal health coverage and equity, exacerbating inequalities and regional disparities. This study aimed to analyse time trends and subnational differences in the burden of disease from 2000 to 2019, and from 2019 to 2021 to capture the effects of the COVID-19 pandemic.<h3>Methods</h3>This study uses estimates for Italy from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. We analyse trends and geographical differences in disease burden from 2000 to 2021. Metrics include life expectancy, health-adjusted life expectancy (HALE), years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) observed at national, macroregional, and subnational levels. Percent changes in rates, with both all-age and age-standardised rates, and 95% uncertainty intervals (95% UIs) are reported.<h3>Findings</h3>Life expectancy at birth in Italy increased from 79·6 years in 2000 to 83·4 years in 2019, dropped to 82·2 years in 2020 due to COVID-19, and recovered slightly to 82·7 years in 2021. HALE was 70·9 years (95% UI 67·4–73·8) in 2021. Substantial regional disparities were observed: in general, despite higher YLD rates, northern regions had better health outcomes, with higher life expectancy and HALE and lower YLL rates compared with southern regions. Overall, the top causes of YLDs were low back pain (1556·5 [1098·5–2080·2]), falls (926·2 [638·8–1253·8]), and headache disorders (858·0 [173·7–1808·2]). Anxiety and depressive disorders both had substantial increases in the period from 2019 to 2021 (19·8% and 17·3%, respectively). YLDs for Alzheimer's disease and diabetes increased substantially from 2000 to 2019 and 2019 to 2021 (70·6% and 3·0% for Alzheimer's disease and 46·8% and 7·9%, respectively for each timepoint). YLL rates declined for ischaemic heart disease from 2000 (–29·9% in 2019), but increased for Alzheimer's disease and other dementias (54·5%). DALY rates decreased overall from 2000 to 2019, but rose again in 2021 due to the COVID-19 pandemic.<h3>Interpretation</h3>The study highlights considerable regional disparities in Italy's health outcomes, driven by demography, heterogeneous health service quality, and economic inequalities. Addressing the increasing burden of Alzheimer's disease, diabetes, and mental health disorders, as well as regional disparities, requires strengthened preventive measures, equitable health service access, and socioeconomic policies, both at the national and regional levels.<h3>Funding</h3>Bill &amp; Melinda Gates Foundation.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"33 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of workplace interventions on sedentary behaviour and physical activity: an umbrella review with meta-analyses and narrative synthesis","authors":"Thomas Rouyard, Emilie Yoda, Katika Akksilp, Anna Valeria Dieterich, Sarin Kc, Saudamini V Dabak, Andre Matthias Müller","doi":"10.1016/s2468-2667(25)00038-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00038-6","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;Physical inactivity is rising globally, exacerbating the burden of preventable deaths and diseases. Despite extensive research on promoting physical activity in the workplace, synthesising the existing literature is challenging due to the wide variety of interventions and outcomes. This study aims to provide a comprehensive synthesis of intervention effects to inform health promotion initiatives and guide future research efforts.&lt;h3&gt;Methods&lt;/h3&gt;In this umbrella review, we conducted systematic searches of six databases (Cochrane, MEDLINE, Embase, CINAHL, Scopus, and Web of Science) for systematic reviews and meta-analyses published between Jan 1, 2000, and May 31, 2024, evaluating workplace interventions targeting sedentary behaviour or physical activity in working adults aged 18 years and older without specific health conditions or mobility impairments. Outcomes encompassed any behavioural changes related to sedentary behaviour or physical activity. Evidence for each relevant combination of intervention and outcome categories was summarised using either meta-analysis or narrative synthesis, with primary study data extracted as needed. This study is registered with PROSPERO, CRD42020171774.&lt;h3&gt;Findings&lt;/h3&gt;We included 36 systematic reviews and meta-analyses covering 214 unique primary studies. Despite considerable heterogeneity in the evidence, several effect trends emerged with moderate-to-high confidence. First, sit-to-stand workstations produced the largest reductions in sedentary time, decreasing it by up to 75 min per day (95% CI –109 to –41) when used alone, with reductions increasing by up to 33% when paired with psychosocial strategies. However, these interventions did not significantly increase physical activity at any intensity. Second, self-monitoring combined with psychosocial strategies yielded the largest increases in step count, with average gains of 1056 steps per day (371 to 1740). Third, no specific strategy consistently increased moderate-to-vigorous physical activity, although the available evidence remains sparse. Additional trends were observed but with lower confidence levels. Analysis of publication bias suggested an inflated effect of environmental-level interventions on occupational sedentary time. Adjusting for this bias using the trim-and-fill method only slightly reduced the effect size, but this result should be interpreted with caution due to high heterogeneity (&lt;em&gt;I&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=84·80%).&lt;h3&gt;Interpretation&lt;/h3&gt;Current evidence highlights the modest effect of existing workplace interventions on physical activity. Some strategies, such as sit-to-stand workstations and gamified interventions, effectively reduce sedentary behaviour and encourage lighter forms of physical activity, but none consistently improves moderate-to-vigorous physical activity, which provides the greatest health benefits. With many countries falling short of the WHO target to reduce physical inactivity prevalence by 15% from","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"72 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public health under Trump 2.0: the first 50 days","authors":"","doi":"10.1016/s2468-2667(25)00071-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00071-4","url":null,"abstract":"Jan 20, 2025, US President Donald Trump took charge of the Oval Office and began by signing an array of executive orders spanning from withdrawal from WHO and the Paris Climate Agreement to freezing trillions of US$ worth of federal funding and a ban on diversity, equity, and inclusion programmes. The new US Administration's onslaught on some of the world's most respected scientific public health institutions such as the Centers for Disease Control and Prevention (CDC) and National Institutes of Health threatens to undermine decades of progress and leadership. The immediate results are confusion, fear, uncertainty, disruption, and chaos; in the longer term: a disaster for domestic and international public health.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"26 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three decades of population health changes in Japan, 1990–2021: a subnational analysis for the Global Burden of Disease Study 2021","authors":"","doi":"10.1016/s2468-2667(25)00044-1","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00044-1","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;Given Japan's rapidly ageing demographic structure, comprehensive and long-term evaluations of its national and subnational health progress are important to inform public health policy. This study aims to assess Japan's population health, using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to analyse the country's evolving disease patterns.&lt;h3&gt;Methods&lt;/h3&gt;GBD 2021 used Japanese data from 1474 sources, covering 371 diseases, including COVID-19, and 88 risk factors. The analysis included estimates of life expectancy, mortality, and disability-adjusted life-years (DALYs). Estimates were generated using the standardised GBD methodology, which incorporates various data sources through statistical modelling, including the Cause Of Death Ensemble Model for mortality, Bayesian Meta-Regression Disease Model for non-fatal outcomes, and risk factor estimation frameworks to quantify attributable burdens. Life expectancy decomposition by cause of death and annualised rates of change of age-standardised mortality and DALYs were calculated for 1990–2005, 2005–15, and 2015–21.&lt;h3&gt;Findings&lt;/h3&gt;Between 1990 and 2021, life expectancy in Japan rose from 79·4 years (95% uncertainty interval 79·3–79·4) to 85·2 years (85·1–85·2), with prefecture-level disparities widening. Gains were primarily driven by reduced mortality from stroke (adding 1·5 years to life expectancy), ischaemic heart disease (1·0 years), and neoplasms, particularly stomach cancer (0·5 years), with variation across prefectures. Leading causes of death in 2021 were Alzheimer's disease and other dementias (135·3 deaths [39·5–312·3] per 100 000 population), stroke (114·9 [89·8–129·3] per 100 000), ischaemic heart disease (96·5 [77·7–106·7] per 100 000), and lung cancer (72·1 [61·8–77·5] per 100 000). Age-standardised mortality for major non-communicable diseases declined, but the pace of this decline has slowed. All-cause annualised rate of change in mortality rate decreased from –1·6% for 2005–15 to –1·1% for 2015–21. Age-standardised COVID-19 mortality rates were 0·8 deaths (0·7–0·9) per 100 000 population (accounting for 0·3% of all deaths) in 2020 and 3·0 (2·5–3·7) per 100 000 population in 2021 (1·0% of deaths). Age-standardised DALY rates for diabetes worsened, with annualised rate of change increasing from 0·1% for 2005–15 to 2·2% for 2015–21. This change parallels worsening trends in major risk factors, particularly high fasting plasma glucose (annualised rate of change of attributable DALYs –0·8% for 2005–15 and 0·8% for 2015–21) and high BMI (0·2% and 1·4%, respectively). Age-standardised DALYs attributable to other major risk factors continued to decrease, albeit slower.&lt;h3&gt;Interpretation&lt;/h3&gt;Japan's health gains over the past 30 years are now stalling, with rising regional disparities. The increasing burdens of Alzheimer's disease and other dementias and diabetes, alongside high fasting plasma glucose and high BMI, highlight areas needing focus","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"1 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abortion care in Alberta, Canada, from 2012 to 2023: a population-based, cross-sectional analysis of use and geographical access","authors":"Erin A Brennand, Beili Huang, Natalie V Scime, Jadine Paw, Erin L Nelson","doi":"10.1016/s2468-2667(25)00010-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00010-6","url":null,"abstract":"<h3>Background</h3>Equitable access to abortion care remains a challenge in public health. Current Canadian abortion reporting overlooks modern practices such as mifepristone medication abortion and has no access and equity metrics. We aimed to comprehensively analyse abortion care provision in Alberta (the fourth largest province in Canada, home to more than 4 million people) focusing on temporal trends in annual abortion rates and access disparities.<h3>Methods</h3>In this population-based, repeated cross-sectional study using linked administrative databases (Practitioner Claims, Discharge Abstract Database, National Ambulatory Care Reporting System, and Pharmaceutical Information Network) in Alberta, Canada, we examined abortion use across the province over a 10-year period. Our data included all females of reproductive age (12–49 years) who received abortion care from Jan 1, 2012, to June 30, 2023. The primary outcome was abortion rate, calculated as the annual number of abortions per 1000 females of reproductive age (15–49 years), trimming data for those younger than 15 years. We descriptively analysed abortions (procedural, medication, and induction of labour) using temporal and geospatial analysis by Alberta's five geographical zones and 35 subzones.<h3>Findings</h3>During the study period, 130 755 abortions occurred in Alberta, of which 120 326 (92·0%) were procedural (118 063 [98·1%] of 120 326 first trimester; 2263 [1·9%] second trimester), 7395 (5·7%) were medication abortions, and 3034 (2·3%) were induction of labour. Abortion declined steadily between 2012 and 2023, with a change of –0·42 abortions per 1000 reproductive-aged females per year (95% CI –0·49 to –0·36). Medication abortion increased following the introduction of mifepristone and comprised 1489 (13·8%) of 10 765 abortions by 2022. Nearly all (8440 [99·7%] of 8462) procedural abortions in 2022 were provided in Edmonton and Calgary. 14 882 (11·5%) of 129 527 individuals accessing abortion in Alberta travelled more than 3 h from home to receive care; 18 864 (14·6%) travelled more than 200 km.<h3>Interpretation</h3>Our findings suggest that annual rates of abortion in Alberta are declining; however, overall access to abortion care has minimally improved in the past decade. Abortion in Alberta remains highly procedural and concentrated in Alberta's two major cities, resulting in poor access outside metropolitan centres. Mismatch between use of abortion care and local provision of care results in substantial travel. Policy should focus on expansion of patient-preferred, evidence-based medication abortion services.<h3>Funding</h3>Canadian Institutes of Health Research; Women and Gender Equality Canada","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"49 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to tackle obesogenic environments","authors":"","doi":"10.1016/s2468-2667(25)00049-0","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00049-0","url":null,"abstract":"March 4th is <span><span>World Obesity Day</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, a unified day of action calling for a response to the obesity crisis. Obesity is one of the most concerning public health crises globally. According to <span><span>WHO</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, since 1990, obesity has more than doubled in adults and quadrupled in adolescents. In 2022, 2·5 billion adults had overweight, including 890 million with obesity, and 390 million children and adolescents aged 5–19 years had overweight, including 160 million with obesity. Overweight and obesity are associated with other major chronic diseases such as type 2 diabetes, coronary heart disease, stroke, hypertension, and cancer. 1·9 billion people are projected to be living with obesity by 2035, including a doubling of childhood obesity from 2020 levels by 2035. Urgent response and action by stakeholders needs to be prioritised to prevent this worsening health crisis.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"28 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The responsibility of health: shifting the focus from individuals to systems","authors":"Sandy Tubeuf, Alejandro Valdivia, Lara Tavoschi, Jean-Philippe Empana, Eivind Engebretsen","doi":"10.1016/s2468-2667(25)00013-1","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00013-1","url":null,"abstract":"Social determinants of health, although widely acknowledged, tend to be poorly translated into policy. Health programme initiatives too often underline individual accountability, which reinforces a flawed narrative that overlooks structural barriers—poverty, inequitable access to resources, unsafe environments, and harmful commercial practices—which shape health behaviours.<span><span>¹</span></span>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"34 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}