Pub Date : 2024-07-01DOI: 10.1136/bmjph-2024-000985
B. Trejo, Yvonne L. Michael, Ana V. Diez Roux, Brisa N. Sánchez, Nina Sun, Heidi Stöckl, Dèsirée Vidaña-Pérez, Catalina Correa-Salazar, A. Ortigoza, A. A. de Lima Friche, Vanessa DiCecco, Mónica Mazariegos, U. Bilal
Latin America is burdened by high levels of violence. Although boys and men often experience more violence and fatalities, girls and women face a greater risk of being killed by family members or intimate partners due to their gender, a phenomenon known as femicide. Our study estimates femicide rates in Latin America across age groups, examining city-level variations and temporal trends.Utilising data from theSalud Urbana en America Latinaproject, we analysed mortality data from 343 cities in nine countries between 2000 and 2019. We calculate the variability between and within countries using data from 2015 to 2019. We then describe time trends using femicide counts by year and city and fitting a three-level negative binomial model with a random intercept for country, fixed effects for age categories, and city-level and country-level random slopes for time (scaled to decades). Finally, we assess longitudinal time trends by age by including an interaction term for age and time (scaled to decades).Our results highlight substantial heterogeneity in femicide rates within and between countries. Additionally, we find that women 15–29 and 30–44 years of age experience the highest femicide rates across all countries. While our findings suggest a slight decline in femicide rates per additional decade (RR 0.95, 95% CI: 0.74 to 1.24) between 2000 and 2019, the trends diverge in different countries, suggesting increasing rates in some countries like Mexico. Age-specific trends suggest the persistence of higher rates among women 15–29 and 30–44 years of age over time.We underscore the need to consider gender dynamics in understanding and preventing femicides, focusing on city-level interventions to address the multifaceted causes of violence against girls and women in the region.
拉丁美洲暴力事件频发。虽然男孩和男人往往遭受更多的暴力侵害和死亡，但女孩和妇女因其性别而面临被家庭成员或亲密伴侣杀害的更大风险，这种现象被称为杀戮女性。我们的研究估算了拉丁美洲各年龄组的杀戮女性率，研究了城市层面的差异和时间趋势。利用拉丁美洲城市研究项目（Salud Urbana en America Latin）的数据，我们分析了九个国家 343 个城市在 2000 年至 2019 年期间的死亡率数据。我们利用 2015 年至 2019 年的数据计算了国家之间和国家内部的变异性。然后，我们使用按年份和城市分列的杀戮女性人数来描述时间趋势，并拟合了一个三级负二叉模型，其中国家为随机截距，年龄类别为固定效应，城市级和国家级时间为随机斜率（缩放为几十年）。最后，我们通过加入年龄与时间的交互项（以十年为单位）来评估各年龄段的纵向时间趋势。此外，我们还发现，在所有国家中，15-29 岁和 30-44 岁女性的杀戮女性比率最高。虽然我们的研究结果表明，在 2000 年至 2019 年期间，杀戮女性比率每增加 10 年就会略有下降（RR 0.95，95% CI：0.74 至 1.24），但不同国家的趋势却不尽相同，这表明墨西哥等一些国家的杀戮女性比率在上升。我们强调，在了解和预防杀戮女性事件时需要考虑性别动态，重点关注城市一级的干预措施，以解决该地区暴力侵害女童和妇女的多方面原因。
{"title":"Characterising the killing of girls and women in urban settings in Latin America, 2000–2019: an analysis of variability and time trends using mortality data from vital registration systems","authors":"B. Trejo, Yvonne L. Michael, Ana V. Diez Roux, Brisa N. Sánchez, Nina Sun, Heidi Stöckl, Dèsirée Vidaña-Pérez, Catalina Correa-Salazar, A. Ortigoza, A. A. de Lima Friche, Vanessa DiCecco, Mónica Mazariegos, U. Bilal","doi":"10.1136/bmjph-2024-000985","DOIUrl":"https://doi.org/10.1136/bmjph-2024-000985","url":null,"abstract":"Latin America is burdened by high levels of violence. Although boys and men often experience more violence and fatalities, girls and women face a greater risk of being killed by family members or intimate partners due to their gender, a phenomenon known as femicide. Our study estimates femicide rates in Latin America across age groups, examining city-level variations and temporal trends.Utilising data from theSalud Urbana en America Latinaproject, we analysed mortality data from 343 cities in nine countries between 2000 and 2019. We calculate the variability between and within countries using data from 2015 to 2019. We then describe time trends using femicide counts by year and city and fitting a three-level negative binomial model with a random intercept for country, fixed effects for age categories, and city-level and country-level random slopes for time (scaled to decades). Finally, we assess longitudinal time trends by age by including an interaction term for age and time (scaled to decades).Our results highlight substantial heterogeneity in femicide rates within and between countries. Additionally, we find that women 15–29 and 30–44 years of age experience the highest femicide rates across all countries. While our findings suggest a slight decline in femicide rates per additional decade (RR 0.95, 95% CI: 0.74 to 1.24) between 2000 and 2019, the trends diverge in different countries, suggesting increasing rates in some countries like Mexico. Age-specific trends suggest the persistence of higher rates among women 15–29 and 30–44 years of age over time.We underscore the need to consider gender dynamics in understanding and preventing femicides, focusing on city-level interventions to address the multifaceted causes of violence against girls and women in the region.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838525","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}
Pub Date : 2024-07-01DOI: 10.1136/bmjph-2024-001125
A. Bai, Jinjian Li, Yuhang Pan, Yu Jiang
The COVID-19 pandemic has exacerbated suicide risk factors in Hong Kong, which faces economic shocks and strict travel restrictions due to its unique economic structure and geographical location. However, there is a scarcity of reliable empirical evidence regarding the relationship between the pandemic and suicide mortality. This study examines whether changes in the suicide rate align with COVID-19 situations and anti-COVID-19 policy events in Hong Kong, focusing on vulnerable population groups based on demographic and socioeconomic characteristics.Suicide data spanning 1 January 2019 to 31 December 2022 were sourced from the Hong Kong Suicide Press Database. Case-level data were aggregated monthly by district. Population-weighted Poisson regression with district-level fixed effects was employed to analyse suicide patterns and their association with COVID-19 developments. Robustness checks and demographic-based heterogeneity analysis were conducted, distinguishing suicide risk among different population groups.A total of 4061 suicide cases were analysed, encompassing deaths and attempts. The first wave of the pandemic saw a 30% decline in suicide cases compared with the 2019 average, while the second and fifth waves witnessed increases of 33% and 51% in suicide rates, respectively. Older adults and individuals with lower socioeconomic status were particularly susceptible to the adverse effects, as evidenced by a significant rise in suicides during the fifth wave.The findings underscore the importance of targeted interventions to address the mental health needs of vulnerable populations during pandemics, highlighting the impact of COVID-19 situations and antipandemic policies on the suicide rate.
{"title":"Suicide in Hong Kong during the COVID-19 pandemic: an observational study","authors":"A. Bai, Jinjian Li, Yuhang Pan, Yu Jiang","doi":"10.1136/bmjph-2024-001125","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001125","url":null,"abstract":"The COVID-19 pandemic has exacerbated suicide risk factors in Hong Kong, which faces economic shocks and strict travel restrictions due to its unique economic structure and geographical location. However, there is a scarcity of reliable empirical evidence regarding the relationship between the pandemic and suicide mortality. This study examines whether changes in the suicide rate align with COVID-19 situations and anti-COVID-19 policy events in Hong Kong, focusing on vulnerable population groups based on demographic and socioeconomic characteristics.Suicide data spanning 1 January 2019 to 31 December 2022 were sourced from the Hong Kong Suicide Press Database. Case-level data were aggregated monthly by district. Population-weighted Poisson regression with district-level fixed effects was employed to analyse suicide patterns and their association with COVID-19 developments. Robustness checks and demographic-based heterogeneity analysis were conducted, distinguishing suicide risk among different population groups.A total of 4061 suicide cases were analysed, encompassing deaths and attempts. The first wave of the pandemic saw a 30% decline in suicide cases compared with the 2019 average, while the second and fifth waves witnessed increases of 33% and 51% in suicide rates, respectively. Older adults and individuals with lower socioeconomic status were particularly susceptible to the adverse effects, as evidenced by a significant rise in suicides during the fifth wave.The findings underscore the importance of targeted interventions to address the mental health needs of vulnerable populations during pandemics, highlighting the impact of COVID-19 situations and antipandemic policies on the suicide rate.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853806","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}
Pub Date : 2024-07-01DOI: 10.1136/bmjph-2024-000964
B. Goodair, A. Bach-Mortensen, Aaron Reeves
To understand the relationship between increasing privatisation of the NHS and austerity cuts to public funding.Longitudinal analysis.170 Clinical Commissioning Groups (CCGs) in England between 2013 and 2020.The UK austerity programme, spearheaded by the conservative-led governments of the 2010s, leveraged the 2008 financial crisis to roll-back spending to local government and social security spending. They also restricted the rate of growth in NHS spending—but cuts varied for different areas, often impacting deprived areas hardest.For-profit outsourcing by NHS commissioners. After the implementation of the 2012 Health and Social Care act commissioners were encouraged and obliged to open contracts to the private sector. The uptake of for-profit outsourcing varied massively. Some CCGs contracted out almost half of their activity, and others almost none.We calculate the size of austerity across all CCGs. The financial restrictions meant that commissioners had, on average, £21.2 m more debt by 2021 than in 2014 in real terms. We find that there is a null and very small effect of changes to local NHS funding on for-profit outsourcing. A decrease in £100 per capita of NHS funding corresponds in a decrease in 0.441 percentage points (95% CI −0.240 to 1.121) of for-profit expenditure. We also find that local changes to public expenditure on the NHS, local government and social security do not confound the relationship between for-profit outsourcing and treatable mortality rates.NHS privatisation at the local level does not appear to be a direct response to or result of austerity. That does not mean that it is unproblematic. Rather than being confounded by funding levels, the deteriorating health outcomes associated with privatisation should be considered as a distinct concern to the disastrous health effects of austerity policies.
{"title":"‘Two sides of the same coin’? A longitudinal analysis evaluating whether financial austerity accelerated NHS privatisation in England 2013-2020","authors":"B. Goodair, A. Bach-Mortensen, Aaron Reeves","doi":"10.1136/bmjph-2024-000964","DOIUrl":"https://doi.org/10.1136/bmjph-2024-000964","url":null,"abstract":"To understand the relationship between increasing privatisation of the NHS and austerity cuts to public funding.Longitudinal analysis.170 Clinical Commissioning Groups (CCGs) in England between 2013 and 2020.The UK austerity programme, spearheaded by the conservative-led governments of the 2010s, leveraged the 2008 financial crisis to roll-back spending to local government and social security spending. They also restricted the rate of growth in NHS spending—but cuts varied for different areas, often impacting deprived areas hardest.For-profit outsourcing by NHS commissioners. After the implementation of the 2012 Health and Social Care act commissioners were encouraged and obliged to open contracts to the private sector. The uptake of for-profit outsourcing varied massively. Some CCGs contracted out almost half of their activity, and others almost none.We calculate the size of austerity across all CCGs. The financial restrictions meant that commissioners had, on average, £21.2 m more debt by 2021 than in 2014 in real terms. We find that there is a null and very small effect of changes to local NHS funding on for-profit outsourcing. A decrease in £100 per capita of NHS funding corresponds in a decrease in 0.441 percentage points (95% CI −0.240 to 1.121) of for-profit expenditure. We also find that local changes to public expenditure on the NHS, local government and social security do not confound the relationship between for-profit outsourcing and treatable mortality rates.NHS privatisation at the local level does not appear to be a direct response to or result of austerity. That does not mean that it is unproblematic. Rather than being confounded by funding levels, the deteriorating health outcomes associated with privatisation should be considered as a distinct concern to the disastrous health effects of austerity policies.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841219","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}
Pub Date : 2024-07-01DOI: 10.1136/bmjph-2023-000754
Ryan McBain, Adeyemi Okunogbe, Violet Gwokyalya, R. Wanyenze, Glenn Wagner
We conducted a cost-effectiveness analysis of an evidence-based collaborative care model for treatment of perinatal depression among women living with HIV in Uganda.Maternal Depression Treatment in HIV (M-DEPTH) is a cluster randomised controlled trial implemented from July 2019 to August 2023, during which 391 pregnant women with mild-to-severe depressive symptoms were randomised to receive stepped care for depression (M-DEPTH: behavioural and pharmacological treatments) or care as usual (CAU: hospital referral for severe cases), at one of eight public health facilities in Uganda.We implemented time-driven, activity-based costing to determine the economic cost of M-DEPTH from a societal perspective, compared with CAU. Change in the prevalence of depressive disorder—from enrolment to 18 months postpartum—was quantified using the Patient Health Questionnaire, with depressive disorder assigned a disability weight according to the Global Burden of Disease project. Incremental cost-effectiveness ratios (ICERs) were expressed as cost per disability-adjusted life years (DALY) averted.The estimated economic cost of M-DEPTH was US$128.82 per participant, compared with $1.53 per participant for CAU. At baseline, prevalence of depressive disorder did not differ according to treatment assignment. Remission of depressive disorder was more prevalent among those assigned to M-DEPTH—across all time periods, including 18-month follow-up (aOR: 0.09; 95% CI 0.05 to 0.16; p<0.001). This yielded an ICER of $397 per DALY averted, when limiting benefits to those accrued over the study period. Sensitivity analyses generated estimates ranging from $162 to $418 per DALY averted.M-DEPTH represents a financially feasible task-shifted model of evidence-based perinatal depression screening and treatment. The intervention is cost-effective at a willingness-to-pay threshold of less than half of median gross domestic product per capita in Uganda.NCT03892915.
{"title":"Economic evaluation of Maternal Depression Treatment in HIV (M-DEPTH) for perinatal depression among women living with HIV in Uganda: a cost-effectiveness analysis","authors":"Ryan McBain, Adeyemi Okunogbe, Violet Gwokyalya, R. Wanyenze, Glenn Wagner","doi":"10.1136/bmjph-2023-000754","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000754","url":null,"abstract":"We conducted a cost-effectiveness analysis of an evidence-based collaborative care model for treatment of perinatal depression among women living with HIV in Uganda.Maternal Depression Treatment in HIV (M-DEPTH) is a cluster randomised controlled trial implemented from July 2019 to August 2023, during which 391 pregnant women with mild-to-severe depressive symptoms were randomised to receive stepped care for depression (M-DEPTH: behavioural and pharmacological treatments) or care as usual (CAU: hospital referral for severe cases), at one of eight public health facilities in Uganda.We implemented time-driven, activity-based costing to determine the economic cost of M-DEPTH from a societal perspective, compared with CAU. Change in the prevalence of depressive disorder—from enrolment to 18 months postpartum—was quantified using the Patient Health Questionnaire, with depressive disorder assigned a disability weight according to the Global Burden of Disease project. Incremental cost-effectiveness ratios (ICERs) were expressed as cost per disability-adjusted life years (DALY) averted.The estimated economic cost of M-DEPTH was US$128.82 per participant, compared with $1.53 per participant for CAU. At baseline, prevalence of depressive disorder did not differ according to treatment assignment. Remission of depressive disorder was more prevalent among those assigned to M-DEPTH—across all time periods, including 18-month follow-up (aOR: 0.09; 95% CI 0.05 to 0.16; p<0.001). This yielded an ICER of $397 per DALY averted, when limiting benefits to those accrued over the study period. Sensitivity analyses generated estimates ranging from $162 to $418 per DALY averted.M-DEPTH represents a financially feasible task-shifted model of evidence-based perinatal depression screening and treatment. The intervention is cost-effective at a willingness-to-pay threshold of less than half of median gross domestic product per capita in Uganda.NCT03892915.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849664","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}
Pub Date : 2024-07-01DOI: 10.1136/bmjph-2023-000539
Rahma Said Al Hadhrami, Rehab Al Kaabi, Hajer Juma Al Shuaibi, Rawan Salim Al Abdulsalam
Vitamin D deficiency, a circulating level of 25-hydroxyvitamin D <30 nmol/L, has become an emerging public health issue in recent years. Despite being a sun-rich country, vitamin D deficiency is widespread in Oman (87.5%).This study aimed to evaluate knowledge, attitudes and practices regarding vitamin D among university students in Oman to assess the need for additional awareness campaigns.This descriptive, cross-sectional study was conducted from September to December 2022 and involved 399 students enrolled in various degree programmes at the Sultan Qaboos University (SQU) in Muscat, Oman, using self-administered, 38-item vitamin D-related KAP (D-KAP-38) questionnaire to collect information regarding the participants’ vitamin D-related general knowledge, nutritional knowledge, attitudes and practices.Of the 399 college students, 384 (96.2%) were Omani nationals, 283 (70.9%) were women and 255 (64.1%) were between the ages of 20 and 26 years. Overall, the participants demonstrated moderate general knowledge (mean D-KAP-38 score: 77.3), poor nutritional knowledge (mean D-KAP-38 score: 45.1), moderate attitudes (mean D-KAP-38 score: 64.4) and average practices (mean D-KAP-38 score: 60.0). In general, female students demonstrated greater general knowledge (p=0.004) and more positive attitudes (p=0.007) compared with males; however, males more frequently reported better practices (p<0.001). In addition, participants who lived off-campus reported better practices compared with those living on-campus (p<0.001).University students in Oman demonstrated moderate vitamin D-related general knowledge, attitudes and practices, while nutritional knowledge was poor.
维生素 D 缺乏症（25-羟基维生素 D 循环水平低于 30 nmol/L）近年来已成为一个新出现的公共卫生问题。尽管阿曼是一个阳光充足的国家，但维生素 D 缺乏症在阿曼却很普遍（87.5%）。本研究旨在评估阿曼大学生对维生素 D 的认识、态度和做法，以评估是否需要开展更多的宣传活动。这项描述性横断面研究于2022年9月至12月进行，涉及阿曼马斯喀特苏丹卡布斯大学（Sultan Qaboos University）各种学位课程的399名学生，采用自制的38项维生素D相关KAP（D-KAP-38）问卷，收集参与者的维生素D相关常识、营养知识、态度和做法等信息。在 399 名大学生中，384 人（96.2%）为阿曼国民，283 人（70.9%）为女性，255 人（64.1%）年龄在 20 岁至 26 岁之间。总体而言，参与者的常识水平中等（D-KAP-38 平均得分为 77.3 分），营养知识水平较低（D-KAP-38 平均得分为 45.1 分），态度水平中等（D-KAP-38 平均得分为 64.4 分），实践水平一般（D-KAP-38 平均得分为 60.0 分）。总体而言，与男生相比，女生表现出更多的常识（p=0.004）和更积极的态度（p=0.007）；然而，男生更经常地报告了更好的实践（p<0.001）。此外，与住在校内的学生相比，住在校外的学生报告了更好的做法（p<0.001）。阿曼的大学生在维生素 D 相关的常识、态度和做法方面表现出中等水平，而营养知识则较差。
{"title":"Assessment of vitamin D-related knowledge, attitudes and practices among Sultan Qaboos University students in Oman: a cross-sectional study","authors":"Rahma Said Al Hadhrami, Rehab Al Kaabi, Hajer Juma Al Shuaibi, Rawan Salim Al Abdulsalam","doi":"10.1136/bmjph-2023-000539","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000539","url":null,"abstract":"Vitamin D deficiency, a circulating level of 25-hydroxyvitamin D <30 nmol/L, has become an emerging public health issue in recent years. Despite being a sun-rich country, vitamin D deficiency is widespread in Oman (87.5%).This study aimed to evaluate knowledge, attitudes and practices regarding vitamin D among university students in Oman to assess the need for additional awareness campaigns.This descriptive, cross-sectional study was conducted from September to December 2022 and involved 399 students enrolled in various degree programmes at the Sultan Qaboos University (SQU) in Muscat, Oman, using self-administered, 38-item vitamin D-related KAP (D-KAP-38) questionnaire to collect information regarding the participants’ vitamin D-related general knowledge, nutritional knowledge, attitudes and practices.Of the 399 college students, 384 (96.2%) were Omani nationals, 283 (70.9%) were women and 255 (64.1%) were between the ages of 20 and 26 years. Overall, the participants demonstrated moderate general knowledge (mean D-KAP-38 score: 77.3), poor nutritional knowledge (mean D-KAP-38 score: 45.1), moderate attitudes (mean D-KAP-38 score: 64.4) and average practices (mean D-KAP-38 score: 60.0). In general, female students demonstrated greater general knowledge (p=0.004) and more positive attitudes (p=0.007) compared with males; however, males more frequently reported better practices (p<0.001). In addition, participants who lived off-campus reported better practices compared with those living on-campus (p<0.001).University students in Oman demonstrated moderate vitamin D-related general knowledge, attitudes and practices, while nutritional knowledge was poor.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850116","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}
Pub Date : 2024-07-01DOI: 10.1136/bmjph-2024-000929corr1
{"title":"Correction: Improving influenza vaccine uptake in clinical risk groups: patient, provider and commissioner perspectives on the acceptability and feasibility of expanding delivery pathways in England","authors":"","doi":"10.1136/bmjph-2024-000929corr1","DOIUrl":"https://doi.org/10.1136/bmjph-2024-000929corr1","url":null,"abstract":"","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840920","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}
Pub Date : 2024-07-01DOI: 10.1136/bmjph-2023-000791
Shilpa Khullar Sood, Megha Jain, Manu Raj, Sakshi Sharma
Nurses play an integral part in the comprehensive delivery of healthcare services and contribute significantly to the success of public health initiatives. The knowledge, attitude and practices of nurses in the domain of oral health influence their own oral hygiene as well as that of the community. Their impact on overall oral health of the community is due to the fact that they provide health education as the primary contact of patients and their family members. The objective of this study was to evaluate the oral health knowledge, attitude and practice among nurses of a tertiary healthcare facility.We conducted a cross-sectional questionnaire-based study among nurses working at a tertiary healthcare setting in Faridabad, India, to assess their oral health-related knowledge, attitude and practice.We recruited a total of 300 nurses from the study institution. Among participants, 235 (78.4 %) were females. In the study population, 220 (73.4%) were nursing diploma holders, 55 (18.6%) had a bachelor’s degree, 20 (6.6%) had a post-graduate nursing diploma and 5 (1.5%) completed their master’s degree. Overall oral health-related knowledge was found to be good in 270 (90%) of participants. Overall oral health-related attitude was satisfactory in 270 (90%) participants. Among participants, 225 (75%) brushed their teeth using fluoridated toothpaste. In addition, 247 (82.6%) participants reported brushing in circular direction, 256 (85.6%) reported spending 2 min to clean their teeth and 285 (95%) reported cleaning their tongue daily.Nurses demonstrated good knowledge, good attitude and a positive outlook related to oral health. They contributed significantly towards maintenance of healthy practices regarding oral health and hygiene in the community. This was primarily by taking up an active role in motivating family and friends to have regular dental check-ups.
{"title":"Oral health-related knowledge, attitude and practices among nurses: a hospital-based questionnaire survey from a tertiary healthcare setting in Faridabad, India","authors":"Shilpa Khullar Sood, Megha Jain, Manu Raj, Sakshi Sharma","doi":"10.1136/bmjph-2023-000791","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000791","url":null,"abstract":"Nurses play an integral part in the comprehensive delivery of healthcare services and contribute significantly to the success of public health initiatives. The knowledge, attitude and practices of nurses in the domain of oral health influence their own oral hygiene as well as that of the community. Their impact on overall oral health of the community is due to the fact that they provide health education as the primary contact of patients and their family members. The objective of this study was to evaluate the oral health knowledge, attitude and practice among nurses of a tertiary healthcare facility.We conducted a cross-sectional questionnaire-based study among nurses working at a tertiary healthcare setting in Faridabad, India, to assess their oral health-related knowledge, attitude and practice.We recruited a total of 300 nurses from the study institution. Among participants, 235 (78.4 %) were females. In the study population, 220 (73.4%) were nursing diploma holders, 55 (18.6%) had a bachelor’s degree, 20 (6.6%) had a post-graduate nursing diploma and 5 (1.5%) completed their master’s degree. Overall oral health-related knowledge was found to be good in 270 (90%) of participants. Overall oral health-related attitude was satisfactory in 270 (90%) participants. Among participants, 225 (75%) brushed their teeth using fluoridated toothpaste. In addition, 247 (82.6%) participants reported brushing in circular direction, 256 (85.6%) reported spending 2 min to clean their teeth and 285 (95%) reported cleaning their tongue daily.Nurses demonstrated good knowledge, good attitude and a positive outlook related to oral health. They contributed significantly towards maintenance of healthy practices regarding oral health and hygiene in the community. This was primarily by taking up an active role in motivating family and friends to have regular dental check-ups.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853170","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}
Pub Date : 2024-07-01DOI: 10.1136/bmjph-2024-000935
Eva Kidabulo, Lilian Nkinda, D. Mwakawanga, Agricola Joachim
The COVID-19 pandemic has caused substantial disruption on HIV care and treatment programmes, especially for adolescents living with HIV (ALHIV) who are known to have poorer health outcomes compared with adults. Efforts made to overcome the pre-existing challenges were hampered by the emergence of the pandemic which interrupted adolescent-friendly healthcare services. Therefore, the aim of this study was to assess the impacts of the pandemic on HIV care and treatment services from healthcare providers and adolescents’ experiences at a tertiary hospital in Dar es Salaam, Tanzania.A descriptive qualitative study using in-depth interviews was conducted with 17 study participants. Purposive and convenient sampling techniques were used to recruit healthcare providers and adolescents, respectively. Swahili semistructured interview guide was used to conduct interviews. Thematic analysis was conducted to generate themes and subthemes describing the experiences on effects brought by COVID-19 on HIV care and treatment among adolescents.The study revealed that alteration of approach in delivery of healthcare and limited human and non-human resources in healthcare facilities during the COVID-19 pandemic decreased effectiveness and quality of care which resulted in adolescent’s poor adherence to medication and loss to follow-up. Loss of family income, food insecurity and limited socialisation posed threat to adolescent’s mental health and overall quality of life.Our findings underscore the impacts of COVID-19 and its immediate responses that significantly affected adolescent HIV care and treatment services. Reinforcement of sustainable ALHIV programmes and funding supports to these programmes are essential to promote retention and engagement to care during pandemics.
{"title":"Impacts of the COVID-19 pandemic on HIV care and treatment services among adolescents attending a tertiary hospital in Dar es Salaam, Tanzania: a qualitative study","authors":"Eva Kidabulo, Lilian Nkinda, D. Mwakawanga, Agricola Joachim","doi":"10.1136/bmjph-2024-000935","DOIUrl":"https://doi.org/10.1136/bmjph-2024-000935","url":null,"abstract":"The COVID-19 pandemic has caused substantial disruption on HIV care and treatment programmes, especially for adolescents living with HIV (ALHIV) who are known to have poorer health outcomes compared with adults. Efforts made to overcome the pre-existing challenges were hampered by the emergence of the pandemic which interrupted adolescent-friendly healthcare services. Therefore, the aim of this study was to assess the impacts of the pandemic on HIV care and treatment services from healthcare providers and adolescents’ experiences at a tertiary hospital in Dar es Salaam, Tanzania.A descriptive qualitative study using in-depth interviews was conducted with 17 study participants. Purposive and convenient sampling techniques were used to recruit healthcare providers and adolescents, respectively. Swahili semistructured interview guide was used to conduct interviews. Thematic analysis was conducted to generate themes and subthemes describing the experiences on effects brought by COVID-19 on HIV care and treatment among adolescents.The study revealed that alteration of approach in delivery of healthcare and limited human and non-human resources in healthcare facilities during the COVID-19 pandemic decreased effectiveness and quality of care which resulted in adolescent’s poor adherence to medication and loss to follow-up. Loss of family income, food insecurity and limited socialisation posed threat to adolescent’s mental health and overall quality of life.Our findings underscore the impacts of COVID-19 and its immediate responses that significantly affected adolescent HIV care and treatment services. Reinforcement of sustainable ALHIV programmes and funding supports to these programmes are essential to promote retention and engagement to care during pandemics.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853711","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}
Pub Date : 2024-07-01DOI: 10.1136/bmjph-2023-000625
Stéphanie Black, Sarah Watt, Mark Gilbert, Heather Nicole Pedersen, Aidan Ablona, Hsiu-Ju Chang, T. Salway
We sought to explore sexual health service clients’ perspectives, preferences and suggestions for how to better address or alleviate anxiety among clients of sexual health services (eg, sexually transmitted infection testing) regarding both online and in-person sexual health services among those who experience persistent anxiety.We conducted qualitative interviews with 27 sexual health service clients with persistent experiences of anxiety in British Columbia, Canada. Participants were recruited from respondents to a COVID-19-related sexual health survey who consented to follow up. Interviews were conducted via Zoom, recorded and transcribed. Transcripts were coded and analysed using thematic analysis by searching for themes in order to summarise the experiences and needs of participants.The median participant age was 34. 16 participants identified as women, 10 as men and 1 each as non-binary and gender fluid. Participants described anxiety related to sexual health service access and experiences due to sexual health-related stigma and privacy concerns; provider judgement and lack of communication or information regarding test results. They suggested that routinely integrating discussions with providers about mental health in sexually transmitted and bloodborne infection (STBBI) testing appointments may help clients feel safer and could connect them to support. They highlighted the need for personal and genuine interactions with providers (eg, making appointments feel less perfunctory, asking clients how they are feeling about why they are there) and sufficient time with providers (eg, not feeling rushed through the appointment, time to discuss resources, testing and advice).Disease-specialised health services may not adequately address the multifaceted and inter-related mental health needs of people accessing services. In STBBI testing service settings, more personalised appointments, additional communication with providers and easier access to results can help improve both the service experiences of people experiencing persistent anxiety and their connections to appropriate mental health support.
{"title":"Client perspectives on creating supportive sexual health environments for people with persistent anxiety: a qualitative study","authors":"Stéphanie Black, Sarah Watt, Mark Gilbert, Heather Nicole Pedersen, Aidan Ablona, Hsiu-Ju Chang, T. Salway","doi":"10.1136/bmjph-2023-000625","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000625","url":null,"abstract":"We sought to explore sexual health service clients’ perspectives, preferences and suggestions for how to better address or alleviate anxiety among clients of sexual health services (eg, sexually transmitted infection testing) regarding both online and in-person sexual health services among those who experience persistent anxiety.We conducted qualitative interviews with 27 sexual health service clients with persistent experiences of anxiety in British Columbia, Canada. Participants were recruited from respondents to a COVID-19-related sexual health survey who consented to follow up. Interviews were conducted via Zoom, recorded and transcribed. Transcripts were coded and analysed using thematic analysis by searching for themes in order to summarise the experiences and needs of participants.The median participant age was 34. 16 participants identified as women, 10 as men and 1 each as non-binary and gender fluid. Participants described anxiety related to sexual health service access and experiences due to sexual health-related stigma and privacy concerns; provider judgement and lack of communication or information regarding test results. They suggested that routinely integrating discussions with providers about mental health in sexually transmitted and bloodborne infection (STBBI) testing appointments may help clients feel safer and could connect them to support. They highlighted the need for personal and genuine interactions with providers (eg, making appointments feel less perfunctory, asking clients how they are feeling about why they are there) and sufficient time with providers (eg, not feeling rushed through the appointment, time to discuss resources, testing and advice).Disease-specialised health services may not adequately address the multifaceted and inter-related mental health needs of people accessing services. In STBBI testing service settings, more personalised appointments, additional communication with providers and easier access to results can help improve both the service experiences of people experiencing persistent anxiety and their connections to appropriate mental health support.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843421","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}
Pub Date : 2024-01-01DOI: 10.1136/bmjph-2023-000212
R. Baggaley, G. Gon, Said Mohammed Ali, Salma Abdi Mahmoud, Farhat Jowhar, Carolin Vegvari
The WHO has issued the global target of reducing maternal mortality rates by two-thirds of 2010 baseline levels by 2030. In low-income settings, high birth rates and a relative lack of medical resources mean that an efficient use of resources and skilled staff is important in ensuring quality of intrapartum and postpartum care.We use a stochastic, individual-based model to explore whether WHO resourcing benchmarks are sufficient to ensure consistent quality of care. We simulate all deliveries occurring in a region over a year, with date and time of presentation of each woman delivering at a facility assigned at random. Each woman stays in the delivery room for an assigned duration before her delivery, then moves to the maternity ward, followed by discharge. We explore the potential impact of seasonality of births on our findings and then apply the model to a real-world setting using 2014 data from Emergency Obstetric Care (EmOC) facilities in Zanzibar, United Republic of Tanzania.We find that small EmOCs are frequently empty, while larger EmOCs are at risk of temporarily falling below minimum recommended staff-to-patient ratios. Similarly for Zanzibar, capacity of EmOCs in terms of beds is rarely exceeded. Where over-capacity occurs, it is generally smaller, basic EmOCs (BEmOCs) that are affected. In contrast, capacity in terms of staffing (skilled birth attendants:women in labour ratio) is exceeded almost 50% of the time in larger Comprehensive EmOCs (CEmOCs).Our findings suggest that increasing staffing levels of CEmOCs while maintaining fewer small BEmOCs may improve quality of care (by increasing the staff-to-patient ratio for the most frequently used facilities), provided that timely access to EmOCs for all women can still be guaranteed. Alternatively, BEmOCs may need to be upgraded to ensure that women trust and choose these facilities for giving birth, thus relieving pressure on CEmOCs.
{"title":"Do current maternal health staffing and bed occupancy benchmarks work in practice? Results from a simulation model","authors":"R. Baggaley, G. Gon, Said Mohammed Ali, Salma Abdi Mahmoud, Farhat Jowhar, Carolin Vegvari","doi":"10.1136/bmjph-2023-000212","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000212","url":null,"abstract":"The WHO has issued the global target of reducing maternal mortality rates by two-thirds of 2010 baseline levels by 2030. In low-income settings, high birth rates and a relative lack of medical resources mean that an efficient use of resources and skilled staff is important in ensuring quality of intrapartum and postpartum care.We use a stochastic, individual-based model to explore whether WHO resourcing benchmarks are sufficient to ensure consistent quality of care. We simulate all deliveries occurring in a region over a year, with date and time of presentation of each woman delivering at a facility assigned at random. Each woman stays in the delivery room for an assigned duration before her delivery, then moves to the maternity ward, followed by discharge. We explore the potential impact of seasonality of births on our findings and then apply the model to a real-world setting using 2014 data from Emergency Obstetric Care (EmOC) facilities in Zanzibar, United Republic of Tanzania.We find that small EmOCs are frequently empty, while larger EmOCs are at risk of temporarily falling below minimum recommended staff-to-patient ratios. Similarly for Zanzibar, capacity of EmOCs in terms of beds is rarely exceeded. Where over-capacity occurs, it is generally smaller, basic EmOCs (BEmOCs) that are affected. In contrast, capacity in terms of staffing (skilled birth attendants:women in labour ratio) is exceeded almost 50% of the time in larger Comprehensive EmOCs (CEmOCs).Our findings suggest that increasing staffing levels of CEmOCs while maintaining fewer small BEmOCs may improve quality of care (by increasing the staff-to-patient ratio for the most frequently used facilities), provided that timely access to EmOCs for all women can still be guaranteed. Alternatively, BEmOCs may need to be upgraded to ensure that women trust and choose these facilities for giving birth, thus relieving pressure on CEmOCs.","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139537382","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}
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