BMJ public health最新文献

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Multiagency approaches to preventing sudden unexpected death in infancy (SUDI): a review and analysis of UK policies 预防婴儿意外猝死的多机构方法:对联合王国政策的审查和分析

BMJ public health

Pub Date : 2023-06-01 DOI: 10.1136/bmjph-2023-000017

Helen L. Ball, Alice-Amber Keegan, Daniel R Whitehouse, Louise S Cooper, Sophie R Lovell-Kennedy, Laura M Murray, D. Newbury-Birch, N. Cleghorn, A. Healy

Recent reviews of sudden unexpected deaths in infancy (SUDI) in England recommend a multiagency working (MAW) approach to prevention but lack clear guidance around how this might be implemented.In England, local authorities commission and oversee public health services. This review examines how local authority policies address implementation of MAW for SUDI prevention to understand local variations and identify strengths and weaknesses.Using a comprehensive list of all metropolitan, county, unitary councils and London boroughs in England, we systematically searched local authority websites for relevant published documents and submitted freedom of information (FOI) requests where policies or guidance for SUDI prevention had not been sourced online. We extracted data from documents using a standardised form to summarise policy contents which were then collated, described and appraised.We searched the websites of 152 council and London boroughs, identifying 36 relevant policies and guidelines for staff. We submitted 116 FOI requests which yielded 64 responses including six valid documents: 45% (52/116) of local authorities did not respond. Seventeen councils shared the same guidance under safeguarding partnerships; removal of duplicates resulted in 26 unique documents. Only 15% (4/26) of the documents included a detailed plan for how MAW approaches were to be implemented despite 73% (19/26) of the documents mentioning the importance of engaging the MAW in raising awareness of safe sleep for babies with vulnerable families. Five areas of variation were identified across policies: (1) scope, (2) responsibilities, (3) training, (4) implementation and (5) evaluation.There are discrepancies between local authorities in England in whether and how MAW for SUDI prevention is carried out. Strengths and weaknesses of approaches are identified to inform future development of MAW for SUDI prevention.

最近对英国婴儿猝死(SUDI)的审查建议采取多机构工作(MAW)方法进行预防，但缺乏关于如何实施这一方法的明确指导。在英格兰，地方当局委托并监督公共卫生服务。本综述研究了地方当局的政策如何解决预防SUDI的MAW实施问题，以了解地方差异并确定优势和劣势。利用英国所有大都会、郡、单一议会和伦敦自治市的综合名单，我们系统地搜索了地方当局网站上的相关公开文件，并提交了信息自由(FOI)请求，这些请求没有在网上找到预防SUDI的政策或指导。我们使用标准化表格从文件中提取数据，总结政策内容，然后对其进行整理、描述和评估。我们搜索了152个议会和伦敦自治市的网站，确定了36项有关员工的政策和指导方针。我们提交了116份《信息自由法》请求，得到64份回复，包括6份有效文件:45%(52/116)的地方当局没有回应。17个理事会在保护伙伴关系方面分享了相同的指导意见;删除重复的文件产生了26个独特的文件。只有15%(4/26)的文件包括了如何实施MAW方法的详细计划，尽管73%(19/26)的文件提到了让MAW参与提高弱势家庭婴儿安全睡眠意识的重要性。在政策中确定了五个变化领域:(1)范围，(2)责任，(3)培训，(4)实施和(5)评估。英格兰地方当局在是否以及如何实施预防SUDI的MAW方面存在差异。确定了各种方法的优点和缺点，以便为未来发展预防SUDI的MAW提供信息。

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引用次数: 0

Ongoing symptoms and functional impairment 12 weeks after testing positive to SARS-CoV-2 or influenza in Australia: an observational cohort study 澳大利亚SARS-CoV-2或流感检测呈阳性12周后持续出现症状和功能障碍:一项观察性队列研究

BMJ public health

Pub Date : 2023-04-17 DOI: 10.1101/2023.04.16.23288205

M. Brown, J. Gerrard, L. McKinlay, J. Marquess, T. Sparrow, R. Andrews

Objective In a highly vaccinated Australian population we aimed to compare ongoing symptoms and functional impairment 12 weeks after PCR-confirmed COVID-19 infection with PCR-confirmed influenza infection. Methods and Analysis The study commenced upon a positive PCR test for either COVID-19 or influenza in June 2022 during concurrent waves of both viruses. Participants were followed up 12 weeks later in September 2022 and self-reported ongoing symptoms and functional impairment. We conducted a multivariate logistic regression analysis, controlling for age, sex, First Nations status, vaccination status, and socio-economic profile. Results There were 2 195 and 951 participants in the COVID-19 and influenza-positive cohorts respectively. After controlling for potential predictor variables, we found no evidence to suggest adults with COVID-19 were more likely to have ongoing symptoms (21.4% vs 23.0%, aOR 1.18; 95% CI 0.92-1.50) or moderate to severe functional impairment (4.1% vs 4.4%, OR 0.81; 95% CI 0.55-1.20) at 12 weeks after their diagnosis than adults who had influenza. Conclusions In a highly vaccinated population exposed to the SARS-CoV-2 omicron variant, long COVID may manifest as a post-viral syndrome of no greater severity than seasonal influenza but differing in terms of the volume of people affected and the potential impact on health systems. This study underscores the importance of long COVID research featuring an appropriate comparator group.

在高度接种疫苗的澳大利亚人群中，我们旨在比较pcr确诊的COVID-19感染与pcr确诊的流感感染后12周持续的症状和功能损害。该研究是在2022年6月两种病毒同时流行期间对COVID-19或流感进行PCR检测呈阳性的情况下开始的。参与者在12周后的2022年9月接受了随访，并自我报告了持续的症状和功能障碍。我们进行了多变量logistic回归分析，控制了年龄、性别、原住民身份、疫苗接种状况和社会经济状况。结果COVID-19和流感阳性队列分别有2 195人和951人。在控制了潜在的预测变量后，我们发现没有证据表明患有COVID-19的成年人更有可能出现持续症状(21.4%对23.0%，aOR为1.18;95% CI 0.92-1.50)或中度至重度功能障碍(4.1% vs 4.4%， or 0.81;95% CI 0.55-1.20)在诊断后12周比患流感的成年人。在暴露于SARS-CoV-2组粒变异的高度接种疫苗人群中，长冠状病毒可能表现为一种病毒后综合征，其严重程度不高于季节性流感，但在受感染人数和对卫生系统的潜在影响方面有所不同。这项研究强调了长期COVID研究的重要性，其中包括适当的比较组。

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引用次数: 1

BMJ Public Health: a new public health journal from BMJ 英国医学杂志公共卫生:英国医学杂志新出版的公共卫生杂志

BMJ public health

Pub Date : 2023-04-01 DOI: 10.1136/bmjph-2023-000008

Adrian Aldcroft, Amy Branch-Hollis, Thomas Phillips, Richard Sands

引用次数: 1

Myocardial infarction and physical function: the REasons for Geographic And Racial Differences in Stroke prospective cohort study. 心肌梗死与身体功能：卒中中地理和种族差异的REasons前瞻性队列研究。

BMJ public health

Pub Date : 2023-01-01 Epub Date: 2023-10-12 DOI: 10.1136/bmjph-2023-000107

Emily B Levitan, Parag Goyal, Joanna Bryan Ringel, Orysya Soroka, Madeline R Sterling, Raegan W Durant, Todd M Brown, C Barrett Bowling, Monika M Safford

Objective: To examine associations between myocardial infarction (MI) and multiple physical function metrics.

Methods: Among participants aged ≥45 years in the REasons for Geographic And Racial Differences in Stroke prospective cohort study, instrumental activities of daily living (IADL), activities of daily living (ADL), gait speed, chair stands, and Short Form-12 physical component summary (PCS) were assessed after approximately 10 years of follow-up. We examined associations between MI and physical function (no MI [n = 9,472], adjudicated MI during follow-up [n = 288, median 4.7 years prior to function assessment], history of MI at baseline [n = 745], history of MI at baseline and adjudicated MI during follow-up [n = 70, median of 6.7 years prior to function assessment]). Models were adjusted for sociodemographic characteristics, health behaviours, depressive symptoms, cognitive impairment, body mass index, diabetes, hypertension, and urinary albumin to creatinine ratio. We examined subgroups defined by age, gender, and race.

Results: The average age at baseline was 62 years old, 56% were women, and 35% Black. MI was significantly associated with worse IADL and ADL scores, IADL dependency, chair stands, and PCS, but not ADL dependency or gait speed. For example, compared to participants without MI, IADL scores (possible range 0-14, higher score represents worse function) were greater for participants with MI during follow-up (difference: 0.37 [95% CI 0.16, 0.59]), MI at baseline (0.26 [95% CI 0.12, 0.41]), and MI at baseline and follow-up (0.71 [95% CI 0.15, 1.26]), p < 0.001. Associations tended to be greater in magnitude among participants who were women and particularly Black women.

Conclusion: MI was associated with various measures of physical function. These decrements in function associated with MI may be preventable or treatable.

目的：探讨心肌梗死（MI）与多种生理功能指标之间的关系。方法：在脑卒中地理和种族差异REasons前瞻性队列研究中，年龄≥45岁的参与者中，在大约10年的随访后，对日常生活工具活动（IADL）、日常生活活动（ADL）、步态速度、椅子站立和简式12身体成分总结（PCS）进行评估。我们研究了心肌梗死与身体功能之间的关系（无心肌梗死[n=9472]，随访期间判定的心肌梗死[n=288，功能评估前中值4.7年]，基线时心肌梗死史[n=745]，基线心肌梗死史和随访期间判定心肌梗死[n=70，功能评估后中值6.7年]）。模型根据社会人口统计学特征、健康行为、抑郁症状、认知障碍、体重指数、糖尿病、高血压和尿白蛋白与肌酐的比值进行了调整。我们研究了按年龄、性别和种族定义的亚组。结果：基线时的平均年龄为62岁，56%为女性，35%为黑人。MI与较差的IADL和ADL评分、IADL依赖性、椅子站立和PCS显著相关，但与ADL依赖性或步态速度无关。例如，与无MI的参与者相比，随访期间患有MI的参与者的IADL得分（可能在0-14之间，得分越高表示功能越差）越高（差异：0.37[95%CI 0.16，0.59]），基线时的MI得分（0.26[95%CI 0.12，0.41]），基线和随访时的MI分（0.71[95%CI 0.15，1.26]），p<0.001。女性，尤其是黑人女性参与者之间的关联往往更大。结论：MI与多种生理功能指标有关。这些与心肌梗死相关的功能下降可能是可以预防或治疗的。

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引用次数: 0

Sick individuals, sick populations revisited: a test of the Rose hypothesis for type 2 diabetes disparities. 病态个体、病态人群再审视：2 型糖尿病差异的罗斯假设检验。

BMJ public health

Pub Date : 2023-01-01 Epub Date: 2023-12-26 DOI: 10.1136/bmjph-2023-000655

Sonali Gupta, I King Jordan, Leonardo Mariño-Ramírez

Introduction: The Rose hypothesis predicts that since genetic variation is greater within than between populations, genetic risk factors will be associated with individuals' risk of disease but not population disparities, and since socioenvironmental variation is greater between than within populations, socioenvironmental risk factors will be associated with population disparities but not individuals' disease risk.

Methods: We used the UK Biobank to test the Rose hypothesis for type 2 diabetes (T2D) ethnic disparities in the UK. Our cohort consists of 26 912 participants from Asian, black and white ethnic groups. Participants were characterised as T2D cases or controls based on the presence or absence of T2D diagnosis codes in electronic health records. T2D genetic risk was measured using a polygenic risk score (PRS), and socioeconomic deprivation was measured with the Townsend Index (TI). The variation of genetic (PRS) and socioeconomic (TI) risk factors within and between ethnic groups was calculated using analysis of variance. Multivariable logistic regression was used to associate PRS and TI with T2D cases, and mediation analysis was used to analyse the effect of PRS and TI on T2D ethnic group disparities.

Results: T2D prevalence differs for Asian 23.34% (OR=5.14, CI=4.68 to 5.65), black 16.64% (OR=3.81, CI=3.44 to 4.22) and white 7.35% (reference) ethnic groups in the UK. Both genetic and socioenvironmental T2D risk factors show greater within (w) than between (b) ethnic group variation: PRS w=64.60%, b=35.40%; TI w=71.18%, b=28.19%. Nevertheless, both genetic risk (PRS OR=1.96, CI=1.87 to 2.07) and socioeconomic deprivation (TI OR=1.09, CI=1.08 to 1.10) are associated with T2D individual risk and mediate T2D ethnic disparities (Asian PRS=22.5%, TI=9.8%; black PRS=32.0%, TI=25.3%).

Conclusion: A relative excess of within-group versus between-group variation does not preclude T2D risk factors from contributing to T2D ethnic disparities. Our results support an integrative approach to health disparities research that includes both genetic and socioenvironmental risk factors.

导言：罗斯假说预测，由于种群内部的遗传变异大于种群之间的遗传变异，遗传风险因素将与个体的疾病风险相关，但与种群差异无关；由于种群之间的社会环境差异大于种群内部的社会环境差异，社会环境风险因素将与种群差异相关，但与个体的疾病风险无关：我们利用英国生物库来检验英国 2 型糖尿病（T2D）种族差异的罗斯假说。我们的队列由来自亚裔、黑人和白人群体的 26 912 名参与者组成。根据电子健康记录中是否存在 T2D 诊断代码，将参与者划分为 T2D 病例或对照组。T2D遗传风险采用多基因风险评分（PRS）进行测量，社会经济贫困程度采用汤森指数（TI）进行测量。遗传（PRS）和社会经济（TI）风险因素在族群内部和族群之间的差异采用方差分析法进行计算。采用多变量逻辑回归将 PRS 和 TI 与 T2D 病例联系起来，并采用中介分析法分析 PRS 和 TI 对 T2D 族群差异的影响：英国亚裔 23.34%（OR=5.14，CI=4.68 至 5.65）、黑人 16.64%（OR=3.81，CI=3.44 至 4.22）和白人 7.35%（参考值）的 T2D 患病率存在差异。遗传和社会环境 T2D 风险因素在族群内部（w）的差异大于族群之间（b）的差异：PRS w=64.60%，b=35.40%；TI w=71.18%，b=28.19%。尽管如此，遗传风险（PRS OR=1.96，CI=1.87 至 2.07）和社会经济贫困（TI OR=1.09，CI=1.08 至 1.10）都与 T2D 的个体风险有关，并介导了 T2D 的种族差异（亚裔 PRS=22.5%，TI=9.8%；黑人 PRS=32.0%，TI=25.3%）：组内变异相对于组间变异的相对过剩并不排除 T2D 风险因素导致 T2D 的种族差异。我们的研究结果支持对健康差异进行综合研究，包括遗传和社会环境风险因素。

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引用次数: 0

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全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

BMJ public health

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