BMJ public health最新文献

Objectives: This study investigates the longitudinal trajectory of employment prospects, before, during and after the COVID-19 pandemic for individuals with work disabilities in the Netherlands.

Methods: We conducted a longitudinal cohort study using monthly administrative data between 2018 and 2022 on work and income from all Dutch individuals with a registered work disability in December 2019. Monthly employment probabilities were modelled with longitudinal multivariate Generalised Estimating Equations analysis, where the dependent binomial variable was 'employment status'. Employment prospects in permanent versus flexible contracts were estimated as two potential outcomes. We stratified our analyses by sex, age, educational attainment, migration background and sector.

Results: Our cohort consisted of 476 617 individuals. Employment probabilities gradually increased between 2018 and 2019, but substantially decreased in the year of the COVID-19 pandemic, mainly in flexible contracts. Strikingly, these downturns took place before the start of lockdowns in March 2020. Especially older aged workers (55-63 year) and workers with lower educational attainment were confronted with a lower likelihood of being employed during the first year of the pandemic.

Conclusions: Our results suggest that the lower employment probabilities seem not to be solely due to the COVID-19 pandemic. It is likely that the introduction of new Dutch regulations for employers, effective from 1 January 2020, has strongly decreased the number of workers with work disabilities in flexible contracts. Further research will need to determine whether such effects align with those in the total working population or were restricted to individuals with work disabilities.

Background: Cannabis use is far more common among adults who smoke tobacco than adults who do not, and its use is increasing among people who smoke tobacco with children living in the home. Given the well-established evidence that caregiver smoking is the primary source of children's secondhand exposures to these products, the increasing trend in caregiver co-use is raising public health concerns about children's co-exposure. Emerging data indicates that adult co-use is linked to additive health consequences, such as elevated nicotine and other tobacco-related toxicant blood levels, relative to use of only tobacco. It is unknown whether children's co-exposure leads to similar additive consequences. This study examined whether children's co-exposure to secondhand tobacco and cannabis smoke related to higher urinary levels of cotinine (the primary nicotine metabolite) relative to children exposed to only tobacco smoke.

Methods: This study performed a cross-sectional analysis of baseline data from the 'Babies Living Safe and Smokefree' tobacco intervention randomised controlled trial. All participants (N=396) included low-income mothers who smoked tobacco daily and were primary caretakers of young children (<6 years old). Multivariable regression was performed to test the hypothesis that maternal co-smoking would relate to children's elevated cotinine levels in a model including potential confounding variables (eg, children's mean daily tobacco smoke exposure, maternal nicotine dependence level).

Results: Mean participant age was 30.11+6.52 years old, and their children's age was 30.24+20.0 months old. In the past 7 days, 146 (36.9%) participants reported smoking cannabis on at least 1 day. Multivariable regression modelling showed that maternal co-smoking was associated with higher children's cotinine levels (p=0.04).

Conclusions: Maternal co-use of tobacco and cannabis, relative to tobacco smoking only, is associated with higher cotinine levels in their children. Given that caregiver smoking is the primary source of young children's exposure to both tobacco and cannabis, clinicians and the public could be better informed about the potential additive health risks of co-exposure without diluting existing health messaging and prevention efforts focused on use and exposure risks related to each product independently. Results point to the need for sustained public health efforts to reduce children's exposure to these toxicants.

Introduction: Congenital cytomegalovirus (cCMV) is a common infection at birth with the potential to cause significant and permanent morbidity, most commonly hearing loss. Targeted cCMV testing programmes use hearing loss as an indicator of an infant being at high risk of the infection and thereby can 'target' or focus testing on those at greatest risk. Australian and International guidelines recommend that high-risk infants be offered cCMV testing, yet across Australia, a formal testing system does not exist. This paper presents the results of a Western Australian (WA) targeted testing study, detailing its methodology, strengths and challenges to evaluate the feasibility of a targeted cCMV testing programme in WA.

Methods: A 2-year statewide observational study was conducted in WA from 2020 to 2022. The study used the established universal infant hearing-screening programme to identify infants at high risk of cCMV. Infants who failed their newborn hearing test were recruited to the study and underwent saliva PCR testing. Confirmatory testing was via urine PCR for CMV. This study examines the first 12 months of data.Data collected included the timeliness of testing and results, both integral to effective cCMV diagnosis and treatment. The reasons for high-risk infants being ineligible for testing were explored, and for cCMV-positive infants, the timeliness of reviews and investigations was evaluated.

Results: During the study period, 212 infants at high risk of cCMV were identified. Of these, 134 (63%) met inclusion criteria and 103 (77%) consented to participate. The study achieved complete and timely cCMV testing, along with timely review and investigation of cCMV-positive infants. Barriers to testing eligibility among high-risk infants (n=78) were assessed to inform strategies to improve testing access.

Conclusions: WA currently lacks a structured, targeted cCMV testing programme, resulting in missed diagnosis and early intervention opportunities for high-risk infants. The study findings indicate that a structured, targeted cCMV testing programme is feasible and would ensure affected children receive care that aligns with national and international standards.

Objectives: Worldwide, nursing homes are increasingly becoming a place for the last phase of life, with residents often being hospitalised near death. This might have changed by implementing end-of-life care structures more widely over years. Therefore, we aimed to systematically investigate trends in end-of-life hospitalisations among nursing home residents.

Design: Systematic review.

Data sources: MEDLINE (via PubMed), CINAHL and EMBASE were searched from inception to 24 April 2025, supplemented by citation searching.

Eligibility criteria: Observational studies with ≥100 deceased residents reporting proportions of in-hospital deaths or hospitalisations in the last month of life for at least two observations being at least 3 years apart were included.

Data extraction and synthesis: Studies were summarised descriptively. Percentage point changes between the initial and last observations of end-of-life hospitalisations were calculated. Study quality was assessed using the Joanna Briggs Institute's tool.

Results: We screened 4122 records for eligibility and included 12 studies published in 13 articles covering data from Belgium, Germany, Japan and the USA. Reported number of included residents ranged from 1647 to 2 954 276 and most studies assessed only one period in the month before death, mostly in-hospital deaths. 10 studies assessed trends in in-hospital deaths; those with higher initial proportions (from 30.3% to 79.2%, n=8) indicated a decrease (-2.0 to -23.5 percentage points). Trends on hospitalisations in the last month of life (n=5) were heterogeneous. Only three studies stratified findings by age, sex or presence of dementia. End-of-life hospitalisations for all age groups and both sexes have decreased over time, but this trend is inconclusive for residents with and without dementia.

Conclusions: Trends in end-of-life hospitalisations vary between countries. As more policies have been implemented worldwide in recent years aiming to improve end-of-life care in nursing homes, longitudinal studies investigating trends from other countries are needed.

Prospero registration number: CRD420251038131.

Introduction: This study investigates the relationship between telework and mental health, focusing on mediating factors.

Methods: A sample was drawn from the June 2023 wave of the BELHEALTH study, which monitors mental health trends in Belgium. The sample included 2323 employed participants aged 18-64 years. Interventional effects mediation analyses were conducted to explore the relationship between the frequency of telework (monthly, weekly, and daily) and mental health outcomes including anxiety (Generalised Anxiety Disorder-7, binary), depression (Patient Health Questionnaire-9, binary), burnout (Burnout Assessment Tool-12, scale 1-5) and work engagement (Utrecht Work Engagement Scale-3, scale 1-5) through the following mediators: workload, emotional load, role conflict, autonomy, social support and skills use.

Results: Telework had both direct and indirect effects on mental health. The total effect of weekly telework on work engagement was -0.1614 (95% CI -0.2286 to -0.0972; p<0.01), indicating an overall decrease in work engagement when considering indirect and direct effects. While weekly telework was not significantly associated with anxiety and depression, it was directly associated with an average increase in burnout (0.1339, 95% CI 0.0875 to 0.1801; p<0.01), and a direct decrease in average work engagement (-0.2158, 95% CI -0.2783 to -0.1505; p<0.01). Indirectly, weekly telework was linked with burnout through various job demands and resources. For example, emotional load (-0.0427, 95% CI -0.0600 to -0.0272, p<0.01), and role conflict (-0.0266, 95% CI -0.0419 to -0.0122, p<0.05) were significant mediators of burnout.

Conclusions: It is essential to consider the job characteristics of employees who telework, and the resources they have available to foster healthy workplaces.

Introduction: Vaccine hesitancy is a global issue, and the important role of healthcare workers in addressing vaccine hesitancy is well documented. However, there is limited theory-guided research on the uptake of COVID-19 vaccinations among healthcare workers in low- and middle-income countries (LMICs). This study examined COVID-19 vaccine uptake among healthcare workers in Sierra Leone and assessed the relevance of the 5C model-which posits that vaccine uptake is shaped by confidence, complacency, constraints, calculation and collective responsibility-in explaining their vaccination attitudes, intentions and behaviours.

Methods: 24 indepth interviews were conducted in 2022 with healthcare workers in Freetown, Makeni and Kenema. The resulting narratives were thematically analysed to identify factors that promoted or deterred COVID-19 vaccination.

Findings: Key facilitators of COVID-19 vaccine uptake included positive views on adult vaccines, self-protection and the desire to be role models. Major barriers were complacency, distrust in available vaccines and safety concerns. Additionally, participants' perspectives were informed by their experiences with the Ebola outbreak, indicating that prior epidemic memory influenced how the 5C domains were interpreted and operationalised in relation to vaccine uptake in contexts such as Sierra Leone.

Conclusions: This paper examines social determinants of vaccine uptake and offers policy recommendations to enhance vaccine uptake among trusted messengers in the region, thereby supporting global COVID-19 recovery and improving LMIC preparedness for future outbreaks. Future responses to public health emergencies in LMICs should be informed by local contextual experiences, and vaccine programmes must consider these factors during planning and implementation.

Introduction: Smoking before and during pregnancy has long-lasting adverse effects for children's health and development. Financial stress is an important risk factor for maternal smoking, but there is little evidence on how economic policies affect tobacco use. We examined whether increases in state minimum wages had an impact on maternal smoking and cessation.

Methods: This was a secondary analysis of cross-sectional surveillance data from 46 states between 2004 and 2019. Our analysis sample included women without college education. Outcomes were use of cigarettes in the 3 months before pregnancy, the last 3 months of pregnancy, and in the postpartum period, as well as cessation of smoking during and after pregnancy. For the main analysis, a two-way fixed effects difference-in-differences analysis was used to estimate the effects of state-level minimum wage policies on outcomes, adjusting for individual covariates (age, race and ethnicity, marital status, parity, education and month of birth), state-level economic and tobacco policies, and state and year fixed effects. We also explored robustness to de Chaisemartin & D'Haultfœuille (dCDH)'s heterogeneity-robust alternative estimator. Subgroup analysis examined heterogeneous impacts by race and ethnicity, age, marital status and pregnancy intention. We tested differences by subgroup using interaction models and testing the joint null hypothesis of coefficients. We used the Benjamini-Hochberg procedure to adjust p values for multiple comparisons.

Results: The study analysed 421 884 women of whom 28% smoked in the 3 months prior to pregnancy. A 10% increase in the minimum wage was associated with a 0.75 (95% CI -1.32 to -0.19) percentage point decrease in the probability of smoking before pregnancy. Associations were strongest for women who were American Indian/Alaska Native, non-Hispanic White, married and had an unintended pregnancy. Two-way fixed effect results were consistent when using the dCDH estimator. There were no significant associations between minimum wages and smoking during pregnancy or postpartum, or on smoking cessation. The conclusions of the analysis do not change when adjusted for multiple hypothesis testing.

Conclusions: Estimates suggest that an increase from the current federal minimum wage of US$7.25-US$14 would be associated with a 17% decrease in smoking prior to pregnancy in a demographic group that is disproportionately affected by poor health outcomes.

Introduction: Preconception care (PCC) is an important health promotion intervention aimed at optimising the health of women of reproductive age before pregnancy to reduce maternal mortality. However, the quest for its implementation within the healthcare system remains a significant challenge in Ghana. Understanding the views of healthcare professionals and hospital administrative managers is vital for identifying feasible strategies to address challenges. The study sought to explore factors influencing the non-implementation of PCC interventions at Agogo Presbyterian Hospital.

Methods: A qualitative exploratory approach was used. 10 healthcare professionals and three hospital administrative managers with experience in providing maternal healthcare services and the ability to provide information on maternal health issues at Agogo Presbyterian Hospital were interviewed. Data analysis was conducted using Braun and Clarke's thematic content analysis approach.

Result: The study identified key barriers to PCC implementation within the healthcare system. The participants described knowledge gaps among care providers, excessive workload, role confusion, the unavailability of PCC guidelines and infrastructure, inadequate human and financial resources and a lack of support and motivation of staff as hurdles to PCC implementation in the healthcare system. They suggested the need for capacity building of human resources, specific PCC guidelines, job descriptions and sustainable funding mechanisms to strengthen the healthcare system for effective PCC implementation.

Conclusion: The challenges revealed by this study provide policymakers and healthcare institutions with insights to address the implicit barriers in the healthcare system to promote the practice of PCC as part of maternal healthcare services to ensure optimal maternal health before conception and to decrease maternal mortality rates.

Introduction: Long COVID is a frequent post-infectious chronic condition that impacts quality of life and work performance. Whether individuals with comorbidities experience a greater functional impact of long COVID is unknown. We evaluated the functional impact of long COVID among healthcare workers (HCWs) with chronic cardiovascular diseases, chronic respiratory diseases, obesity or a history of depression, and compared it with that of HCWs without comorbidities.

Methods: We conducted a cross-sectional study in Quebec, Canada. We compared self-reported long COVID cases to COVID-19-infected controls without long COVID on work ability, work functioning, health-related absenteeism, dyspnoea-associated impairment and psychological distress among HCWs (a) with at least one of the four comorbidities, (b) with each of the four comorbidities and (c) without comorbidities. We used inverse probability of exposure and robust Poisson regressions to estimate adjusted prevalence differences (aPD) and prevalence ratios. Comorbidity data were obtained from the Quebec integrated chronic disease surveillance system.

Results: A total of 3754 and 8439 HCWs with and without comorbidities, respectively, were included. Among HCWs with at least one of the four comorbidities, long COVID was associated with higher prevalence of low work ability (aPD=15%, 95% CI: 12% to 18%), low work functioning (aPD=27%, 95% CI: 22% to 31%), health-related long-term absenteeism (aPD=8%, 95% CI: 5% to 11%), dyspnoea-associated impairment (aPD=23%, 95% CI: 19% to 26%) and psychological distress (aPD=24%, 95% CI: 20% to 28%). aPDs were greater among HCWs with comorbidities than among those without for low work ability (p=0.013 for interaction), for low work functioning (p=0.034) and for dyspnoea-associated impairment (p<0.001).

Conclusion: Long COVID is associated with significant functional impairment among HCWs with pre-existing chronic conditions. HCWs with at least one of the four comorbidities experience lower work ability, lower work functioning and more dyspnoea-associated impairment compared with those without comorbidities.

Introduction: Prostate cancer testing is associated with both individual and area-level socioeconomic position (SEP), but the multilevel nature of this association is unclear and contribution of SEP to the spatial variation is unknown. This study investigated the association of widespread opportunistic prostate-specific antigen (PSA) testing with SEP measures and quantified the extent to which multilevel measures of SEP contributed to the observed spatial variation in PSA testing.

Methods: A population-based register study was conducted, encompassing 471 335 men aged 40 years and older without a prior prostate cancer diagnosis residing in the Stockholm region in 2016. We used hierarchical Bayesian logistic regression models with spatial random effects to estimate the associations between PSA testing and SEP measures.

Results: Men aged 70-79 in the highest income quartile had the highest proportion (35.2%, 95% CI 34.5% to 35.9%) of PSA testing in 2016. Adjusting for age and spatial variation, men with at least 12 years of education for having a PSA test had a 22% (95% CI 19% to 25%) higher odds compared with men with less than 9 years of education. For small area level variance in PSA testing, the highest proportion (42.0%) explained was seen for income.

Conclusions: The findings suggest a moderate association between opportunistic prostate cancer testing and SEP measures at the individual and area levels. The SEP measures at the individual and area levels substantially explained the spatial variation in PSA testing, where income was the strongest driver. Future strategies for prostate cancer testing should be aware of SEP differentials at both individual and area level to reduce socioeconomic inequities in incidence and mortality.