Pub Date : 2024-07-01DOI: 10.1136/bmjph-2024-001001
Leila Katirayi, Rose Masaba, Boris Tchounga, James Ndimbii, Muhammed Mbunka, M. Ouma, Kelia N Olughu, Jenna Siehien, Saint-Just Petnga, Martina Casenghi, G. Okomo, Anne-Cécile Zoung-Kanyi Bissek, A. Tiam, Lise Denoeud-Ndam
Paediatric tuberculosis (TB) is often undiagnosed and under-reported. The Catalysing Paediatric TB (CaP-TB) programme provided integrated and decentralised TB screening and diagnosis services through multiple paediatric care entry points. This qualitative evaluation explores acceptability of the CaP-TB programme and existing knowledge and perceptions of paediatric TB. A descriptive qualitative study was conducted in four sites in Kenya and six sites in Cameron. 54 in-depth interviews were conducted with caregivers, community workers (CWs) and CaP-TB programme managers, and 7 focus group discussions with healthcare workers (HCWs) and CWs. Thematic analysis identified emerging recurrent themes across participants’ responses. Data were coded by using MAXQDA V.12. Data were collected during March–September 2021. Caregivers were often not aware that children were at risk for TB. HCWs reported limited knowledge about paediatric TB prior to CaP-TB. Sometimes caregivers refused to have their children tested for paediatric TB, and this was often related to a lack of awareness of paediatric TB and free services, concerns about the testing procedure and treatment and fear of stigma. TB was referred to as disease of ‘shame,’ associated with poverty and poor hygiene. The CaP-TB programme increased HCWs knowledge about symptoms of paediatric TB and motivation to investigate children with clinical presentations consistent with possible TB. Adding screening at all entry points was perceived to be beneficial to caregivers who would not have felt comfortable bringing their child to a TB unit. HCWs also discussed the increased workload with CaP-TB, challenges with medication stock-outs and a need for additional training. CaP-TB illustrated the positive impact of decentralised paediatric TB services, including addressing the awareness and knowledge gap among caregivers and HCWs. Multiple entry points increased opportunities for identification of paediatric TB and increased caregiver comfortability with their child being tested for TB. NCT03862261 .
{"title":"‘We did not even know it was tuberculosis’: a qualitative evaluation of integrating tuberculosis services into paediatric entry points in the CaP-TB programme in Cameroon and Kenya","authors":"Leila Katirayi, Rose Masaba, Boris Tchounga, James Ndimbii, Muhammed Mbunka, M. Ouma, Kelia N Olughu, Jenna Siehien, Saint-Just Petnga, Martina Casenghi, G. Okomo, Anne-Cécile Zoung-Kanyi Bissek, A. Tiam, Lise Denoeud-Ndam","doi":"10.1136/bmjph-2024-001001","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001001","url":null,"abstract":"\u0000\u0000Paediatric tuberculosis (TB) is often undiagnosed and under-reported. The Catalysing Paediatric TB (CaP-TB) programme provided integrated and decentralised TB screening and diagnosis services through multiple paediatric care entry points. This qualitative evaluation explores acceptability of the CaP-TB programme and existing knowledge and perceptions of paediatric TB.\u0000\u0000\u0000\u0000A descriptive qualitative study was conducted in four sites in Kenya and six sites in Cameron. 54 in-depth interviews were conducted with caregivers, community workers (CWs) and CaP-TB programme managers, and 7 focus group discussions with healthcare workers (HCWs) and CWs. Thematic analysis identified emerging recurrent themes across participants’ responses. Data were coded by using MAXQDA V.12. Data were collected during March–September 2021.\u0000\u0000\u0000\u0000Caregivers were often not aware that children were at risk for TB. HCWs reported limited knowledge about paediatric TB prior to CaP-TB. Sometimes caregivers refused to have their children tested for paediatric TB, and this was often related to a lack of awareness of paediatric TB and free services, concerns about the testing procedure and treatment and fear of stigma. TB was referred to as disease of ‘shame,’ associated with poverty and poor hygiene. The CaP-TB programme increased HCWs knowledge about symptoms of paediatric TB and motivation to investigate children with clinical presentations consistent with possible TB. Adding screening at all entry points was perceived to be beneficial to caregivers who would not have felt comfortable bringing their child to a TB unit. HCWs also discussed the increased workload with CaP-TB, challenges with medication stock-outs and a need for additional training.\u0000\u0000\u0000\u0000CaP-TB illustrated the positive impact of decentralised paediatric TB services, including addressing the awareness and knowledge gap among caregivers and HCWs. Multiple entry points increased opportunities for identification of paediatric TB and increased caregiver comfortability with their child being tested for TB.\u0000\u0000\u0000\u0000\u0000NCT03862261\u0000.\u0000\u0000","PeriodicalId":117861,"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":"141712980","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-2023-000858
Cameron MacLellan, Paul Kershaw, Ronald D Kneebone, Lindsay McLaren, Tony Reiman, Robin Urquhart, Daniel J Dutton
Cancer is the leading cause of death in Canada, and cases are expected to rise by 83% between 2012 and 2042. Jurisdictions with higher ratios of social-to-medical spending exhibit better population health outcomes; however, the connection between the ratio and both cancer incidence and mortality is not well established. We aim to determine the association between the ratio and both age-standardised cancer incidence and mortality.Using linear regressions with provincial and yearly fixed effects, we measured associations between the ratio and incidence of the four most common cancers in Canada (ie, lung and bronchus, colorectal, breast and prostate cancer), and mortality from any cancer, from 1992 to 2017 (incidence) and 2000 to 2019 (mortality).A one-cent increase in social spending for each dollar spent on medical services was significantly associated with a decrease in colorectal (−0.2%), breast (−0.1%), and prostate cancer (−0.6%). The relationship is statistically insignificant and negligible for lung cancer incidence and cancer mortality.The ratio was significantly associated with a decrease in three out of four cancer incidence categories, but not mortality. This implies that, consistent with the social determinants of health, preventing cancer incidence might be a function of social spending, whereas medical spending is more relevant for individuals already diagnosed with cancer. This analysis points to the importance of a health-in-all-policies perspective, as social spending might be more important for population health than spending on the medical care system. We provide evidence that morbidity measures are responsive to the ratio, building on a literature focused on mortality.
{"title":"Chasing cancer: does the social-to-medical spending ratio relate to cancer incidence and mortality in Canadian provinces? A retrospective cohort study","authors":"Cameron MacLellan, Paul Kershaw, Ronald D Kneebone, Lindsay McLaren, Tony Reiman, Robin Urquhart, Daniel J Dutton","doi":"10.1136/bmjph-2023-000858","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000858","url":null,"abstract":"Cancer is the leading cause of death in Canada, and cases are expected to rise by 83% between 2012 and 2042. Jurisdictions with higher ratios of social-to-medical spending exhibit better population health outcomes; however, the connection between the ratio and both cancer incidence and mortality is not well established. We aim to determine the association between the ratio and both age-standardised cancer incidence and mortality.Using linear regressions with provincial and yearly fixed effects, we measured associations between the ratio and incidence of the four most common cancers in Canada (ie, lung and bronchus, colorectal, breast and prostate cancer), and mortality from any cancer, from 1992 to 2017 (incidence) and 2000 to 2019 (mortality).A one-cent increase in social spending for each dollar spent on medical services was significantly associated with a decrease in colorectal (−0.2%), breast (−0.1%), and prostate cancer (−0.6%). The relationship is statistically insignificant and negligible for lung cancer incidence and cancer mortality.The ratio was significantly associated with a decrease in three out of four cancer incidence categories, but not mortality. This implies that, consistent with the social determinants of health, preventing cancer incidence might be a function of social spending, whereas medical spending is more relevant for individuals already diagnosed with cancer. This analysis points to the importance of a health-in-all-policies perspective, as social spending might be more important for population health than spending on the medical care system. We provide evidence that morbidity measures are responsive to the ratio, building on a literature focused on mortality.","PeriodicalId":117861,"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":"141710200","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-2024-000920
Sabahat Naz, Samreen Jamal, Ali Jaffar, Iqbal Azam, Subhash Chandir, Rahat Qureshi, Neelofur Babar, Aisha Syed Wali, Romaina Iqbal
The prevalence of gestational diabetes mellitus (GDM) is on the rise in low-income and middle-income countries, such as Pakistan. Therefore, the development of a risk score that is simple, affordable and easy to administer is needed. Our study aimed to develop a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for GDM screening in Pakistani pregnant women based on risk factors reported in the literature.Using a cross-sectional study design, we enrolled 500 pregnant women who attended antenatal clinics at one tertiary and two secondary care hospitals in Karachi between the 28th and 32nd weeks of gestation. We randomly divided data into derivation (n=404; 80%) and validation datasets (n=96; 20%). We conducted interviews to collect information on sociodemographic factors and family history of diabetes, measured mid-upper arm circumference (MUAC) and reviewed the medical records of women for obstetric history and oral glucose tolerance test (OGTT) results. We performed a multivariable logistic regression analysis to obtain coefficients of selected predictors for GDM in the derivation dataset. Calibration was estimated using Pearson’s χ2 goodness of fit test while discrimination was checked using the area under the curve (AUC) in the validation dataset.Overall, the GDM prevalence was 26% (n=130). INSPIRE was based on six predictors: maternal age, MUAC, family history of diabetes, a history of GDM, previous bad obstetrical outcome and a history of macrosomia. INSPIRE achieved a good calibration (Pearson’s χ2=29.55, p=0.08) and acceptable discrimination with an AUC of 0.721 (95% CI 0.61 to 0.83) with a sensitivity of 74.1% and specificity of 59.4% in the validation dataset.We developed and validated an INSPIRE that efficiently differentiates Pakistani pregnant women at high risk of GDM from those at low risk, thus reducing the unnecessary burden of the OGTT test.
{"title":"Development and validation of a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for the screening of high-risk pregnant women for gestational diabetes mellitus in Pakistan","authors":"Sabahat Naz, Samreen Jamal, Ali Jaffar, Iqbal Azam, Subhash Chandir, Rahat Qureshi, Neelofur Babar, Aisha Syed Wali, Romaina Iqbal","doi":"10.1136/bmjph-2024-000920","DOIUrl":"https://doi.org/10.1136/bmjph-2024-000920","url":null,"abstract":"The prevalence of gestational diabetes mellitus (GDM) is on the rise in low-income and middle-income countries, such as Pakistan. Therefore, the development of a risk score that is simple, affordable and easy to administer is needed. Our study aimed to develop a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for GDM screening in Pakistani pregnant women based on risk factors reported in the literature.Using a cross-sectional study design, we enrolled 500 pregnant women who attended antenatal clinics at one tertiary and two secondary care hospitals in Karachi between the 28th and 32nd weeks of gestation. We randomly divided data into derivation (n=404; 80%) and validation datasets (n=96; 20%). We conducted interviews to collect information on sociodemographic factors and family history of diabetes, measured mid-upper arm circumference (MUAC) and reviewed the medical records of women for obstetric history and oral glucose tolerance test (OGTT) results. We performed a multivariable logistic regression analysis to obtain coefficients of selected predictors for GDM in the derivation dataset. Calibration was estimated using Pearson’s χ2 goodness of fit test while discrimination was checked using the area under the curve (AUC) in the validation dataset.Overall, the GDM prevalence was 26% (n=130). INSPIRE was based on six predictors: maternal age, MUAC, family history of diabetes, a history of GDM, previous bad obstetrical outcome and a history of macrosomia. INSPIRE achieved a good calibration (Pearson’s χ2=29.55, p=0.08) and acceptable discrimination with an AUC of 0.721 (95% CI 0.61 to 0.83) with a sensitivity of 74.1% and specificity of 59.4% in the validation dataset.We developed and validated an INSPIRE that efficiently differentiates Pakistani pregnant women at high risk of GDM from those at low risk, thus reducing the unnecessary burden of the OGTT test.","PeriodicalId":117861,"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":"141702474","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-2023-000776
Z. Kwena, Elizabeth A. Bukusi, Linet Ongeri, S. Shade, Maya Vijayaraghavan, Francesca A Odhiambo, Cirilus O Ogala, Craig R Cohen, Peter Magati, Yvonne A Olando, Greshon Rota, Purba Chatterjee, Christine A Osula, J. J. Nutor, Stella S Bialous
Healthcare providers are required to support people living with HIV (PLHIV) to quit tobacco use for improved health outcomes, but it is unclear to what extent they adhere to these requirements. We examined HIV care providers and PLHIV’s perceptions of support, and barriers, to providing tobacco cessation.This qualitative investigation was part of a larger study seeking to integrate tobacco cessation into HIV care in Western Kenya (NCT05351606). We conducted 22 key informant interviews with HIV care providers and managers and four focus group discussions (n=28) with PLHIV. The interviews and discussions were audio-recorded, and audio files were transcribed and, when necessary, translated into English for coding and analysis.PLHIV rarely disclose or are screened for tobacco use unless a complaint or clinical finding prompts a provider. Despite PLHIV wanting to receive support to quit tobacco use, they feared negative reactions from their providers if they disclosed their tobacco use status. Providers cited several system-related barriers to screening for and providing cessation support for PLHIV, including workload pressure, lack of job aids, tobacco use screening not included as a performance indicator and lack of adequate counselling skills to address tobacco use.PLHIV are not routinely screened for tobacco use despite their knowledge of the negative impact of tobacco use on overall health outcomes and desire to quit. System-related barriers hinder providers from providing cessation support. Providers should be trained and equipped with additional skills and resources to integrate tobacco cessation support into routine HIV care.
医疗服务提供者必须支持艾滋病病毒感染者（PLHIV）戒烟以改善健康状况，但目前尚不清楚他们在多大程度上遵守了这些要求。这项定性调查是一项大型研究的一部分，该研究旨在将戒烟纳入肯尼亚西部的艾滋病关怀项目（NCT05351606）。我们对 HIV 医疗服务提供者和管理者进行了 22 次关键信息提供者访谈，并与 PLHIV 进行了 4 次焦点小组讨论（n=28）。我们对访谈和讨论进行了录音，并对音频文件进行了转录，必要时还翻译成英文进行编码和分析。除非有投诉或临床发现促使医疗服务提供者，否则PLHIV很少披露或接受烟草使用筛查。尽管PLHIV希望获得戒烟支持，但他们担心如果披露自己的吸烟状况，会遭到医疗服务提供者的负面反应。医疗服务提供者在筛查PLHIV并为其提供戒烟支持时遇到了一些与系统相关的障碍，包括工作压力、缺乏工作辅助工具、烟草使用筛查未被列为绩效指标以及缺乏足够的咨询技能来解决烟草使用问题等。尽管PLHIV知道烟草使用对整体健康结果的负面影响并有戒烟意愿，但他们并没有接受常规的烟草使用筛查。与系统相关的障碍阻碍了医疗服务提供者提供戒烟支持。应该对医疗服务提供者进行培训，并为其配备更多的技能和资源，以便将戒烟支持纳入常规的艾滋病医疗服务中。
{"title":"Understanding HIV care providers’ support for tobacco cessation among people living with HIV in Western Kenya: a formative qualitative study","authors":"Z. Kwena, Elizabeth A. Bukusi, Linet Ongeri, S. Shade, Maya Vijayaraghavan, Francesca A Odhiambo, Cirilus O Ogala, Craig R Cohen, Peter Magati, Yvonne A Olando, Greshon Rota, Purba Chatterjee, Christine A Osula, J. J. Nutor, Stella S Bialous","doi":"10.1136/bmjph-2023-000776","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000776","url":null,"abstract":"Healthcare providers are required to support people living with HIV (PLHIV) to quit tobacco use for improved health outcomes, but it is unclear to what extent they adhere to these requirements. We examined HIV care providers and PLHIV’s perceptions of support, and barriers, to providing tobacco cessation.This qualitative investigation was part of a larger study seeking to integrate tobacco cessation into HIV care in Western Kenya (NCT05351606). We conducted 22 key informant interviews with HIV care providers and managers and four focus group discussions (n=28) with PLHIV. The interviews and discussions were audio-recorded, and audio files were transcribed and, when necessary, translated into English for coding and analysis.PLHIV rarely disclose or are screened for tobacco use unless a complaint or clinical finding prompts a provider. Despite PLHIV wanting to receive support to quit tobacco use, they feared negative reactions from their providers if they disclosed their tobacco use status. Providers cited several system-related barriers to screening for and providing cessation support for PLHIV, including workload pressure, lack of job aids, tobacco use screening not included as a performance indicator and lack of adequate counselling skills to address tobacco use.PLHIV are not routinely screened for tobacco use despite their knowledge of the negative impact of tobacco use on overall health outcomes and desire to quit. System-related barriers hinder providers from providing cessation support. Providers should be trained and equipped with additional skills and resources to integrate tobacco cessation support into routine HIV care.","PeriodicalId":117861,"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":"141707761","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-2023-000751
I. Liberty, Indri Seta Septadina, M. Q. Rizqie, Mariana Mariana, Pariyana Pariyana, Resy Amalia, Hamzah Hasyim
Representative anthropometric epidemiological data are needed to formulate screening and intervention methods to prevent obesity in children. This study aims to conduct community childhood obesity assessment in elementary school based on anthropometric measurements and evaluate its predictive value.This cross-sectional study was carried out in Palembang, Indonesia, and involved 1180 elementary school students. The anthropometric parameters were divided into (1) basic data: stature, weight and waist circumference (WC), hip circumference (HC); (2) structural dimensions: the segmental dimensions of head-neck, trunk, upper extremity, hand, lower extremity and foot and (3) postural dimensions: the relative spacial dimensions when standing. Six anthropometric indices were considered: body mass index, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), Conicity Index (CI), Body Adiposity Index (BAI) and Tri-ponderal Mass Index (TMI).The proportion of overweight and obesity was 50.17% (n=592) and normal weight was 49.83% (n=588). The mean age was 8.26±1.71 years. The averages of all measured indices in overweight/obese versus normal weight were significant difference among boys and girls in height, weight, WC, HC, neck circumference, WHR, WHtR, neck-to-height ratio, BAI, TMI and CI (p<0.05 for all). TMI was the best predictor of obesity based on area under the curve (AUC) values, both in boys (sensitivity=90.48; specificity=91.53; AUC=0.975) and in girls (sensitivity=90.28; specificity=90.00; AUC=0.968).A trustworthy anthropometric database of primary school students might be a helpful local resource when working on projects involving children. In order to improve the quality of life through better-suited and secure products and environmental designs, it is crucial to build an anthropometric database.
{"title":"Community childhood obesity assessment in elementary school, anthropometric indices as screening tools: a community cross-sectional study in Indonesia","authors":"I. Liberty, Indri Seta Septadina, M. Q. Rizqie, Mariana Mariana, Pariyana Pariyana, Resy Amalia, Hamzah Hasyim","doi":"10.1136/bmjph-2023-000751","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000751","url":null,"abstract":"Representative anthropometric epidemiological data are needed to formulate screening and intervention methods to prevent obesity in children. This study aims to conduct community childhood obesity assessment in elementary school based on anthropometric measurements and evaluate its predictive value.This cross-sectional study was carried out in Palembang, Indonesia, and involved 1180 elementary school students. The anthropometric parameters were divided into (1) basic data: stature, weight and waist circumference (WC), hip circumference (HC); (2) structural dimensions: the segmental dimensions of head-neck, trunk, upper extremity, hand, lower extremity and foot and (3) postural dimensions: the relative spacial dimensions when standing. Six anthropometric indices were considered: body mass index, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), Conicity Index (CI), Body Adiposity Index (BAI) and Tri-ponderal Mass Index (TMI).The proportion of overweight and obesity was 50.17% (n=592) and normal weight was 49.83% (n=588). The mean age was 8.26±1.71 years. The averages of all measured indices in overweight/obese versus normal weight were significant difference among boys and girls in height, weight, WC, HC, neck circumference, WHR, WHtR, neck-to-height ratio, BAI, TMI and CI (p<0.05 for all). TMI was the best predictor of obesity based on area under the curve (AUC) values, both in boys (sensitivity=90.48; specificity=91.53; AUC=0.975) and in girls (sensitivity=90.28; specificity=90.00; AUC=0.968).A trustworthy anthropometric database of primary school students might be a helpful local resource when working on projects involving children. In order to improve the quality of life through better-suited and secure products and environmental designs, it is crucial to build an anthropometric database.","PeriodicalId":117861,"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":"141696362","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-2023-000725
Jason M Glanz, Shane R Mueller, Komal Narwaney, Nicole M Wagner, Stanley Xu, Courtney R Kraus, Kris Wain, Sheila Botts, Ingrid A. Binswanger
Public health efforts to reduce opioid overdose fatalities include educating people at risk and expanding access to naloxone, a medication that reverses opioid-induced respiratory depression. People receiving long-term opioid therapy (LTOT) are at increased risk for overdose, yet naloxone uptake in this population remains low. The objective of this study was to determine if a targeted, digital health intervention changed patient risk behaviour, increased naloxone uptake and increased knowledge about opioid overdose prevention and naloxone.We conducted a pragmatic randomised clinical trial among patients prescribed LTOT in a healthcare delivery system in Colorado. Participants were randomly assigned to receive an animated overdose prevention and naloxone educational video (intervention arm) or usual care (control arm). The 6 min video was designed to educate patients about opioid overdose and naloxone, increase overdose risk perception and prompt them to purchase naloxone from the pharmacy. Over an 8-month follow-up, opioid risk behaviour was assessed with the Opioid-Related Behaviours in Treatment survey instrument, and overdose and naloxone knowledge was measured with the Prescription Opioid Overdose Knowledge Scale after viewing the video at baseline. Naloxone dispensations were evaluated using pharmacy data over a 12-month period. Data were analysed with generalised linear mixed effects and log-binomial regression models.There were 519 participants in the intervention arm and 485 participants in the usual care arm. Opioid risk behaviour did not differ between the study arms over time (study arm by time interaction p=0.93). There was no difference in naloxone uptake between the arms (risk ratio 1.13, 95% CI 0.77 to 1.66). Knowledge was significantly greater in the intervention arm compared with usual care (p<0.001).A targeted, digital health intervention video effectively increased knowledge about opioid overdose and naloxone, without increasing opioid risk behaviour. Naloxone uptake did not differ between the intervention and usual care arms.NCT03337009.
{"title":"Effectiveness of direct patient outreach with a narrative naloxone and overdose prevention video to patients prescribed long-term opioid therapy in the USA: the Naloxone Navigator randomised clinical trial","authors":"Jason M Glanz, Shane R Mueller, Komal Narwaney, Nicole M Wagner, Stanley Xu, Courtney R Kraus, Kris Wain, Sheila Botts, Ingrid A. Binswanger","doi":"10.1136/bmjph-2023-000725","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000725","url":null,"abstract":"Public health efforts to reduce opioid overdose fatalities include educating people at risk and expanding access to naloxone, a medication that reverses opioid-induced respiratory depression. People receiving long-term opioid therapy (LTOT) are at increased risk for overdose, yet naloxone uptake in this population remains low. The objective of this study was to determine if a targeted, digital health intervention changed patient risk behaviour, increased naloxone uptake and increased knowledge about opioid overdose prevention and naloxone.We conducted a pragmatic randomised clinical trial among patients prescribed LTOT in a healthcare delivery system in Colorado. Participants were randomly assigned to receive an animated overdose prevention and naloxone educational video (intervention arm) or usual care (control arm). The 6 min video was designed to educate patients about opioid overdose and naloxone, increase overdose risk perception and prompt them to purchase naloxone from the pharmacy. Over an 8-month follow-up, opioid risk behaviour was assessed with the Opioid-Related Behaviours in Treatment survey instrument, and overdose and naloxone knowledge was measured with the Prescription Opioid Overdose Knowledge Scale after viewing the video at baseline. Naloxone dispensations were evaluated using pharmacy data over a 12-month period. Data were analysed with generalised linear mixed effects and log-binomial regression models.There were 519 participants in the intervention arm and 485 participants in the usual care arm. Opioid risk behaviour did not differ between the study arms over time (study arm by time interaction p=0.93). There was no difference in naloxone uptake between the arms (risk ratio 1.13, 95% CI 0.77 to 1.66). Knowledge was significantly greater in the intervention arm compared with usual care (p<0.001).A targeted, digital health intervention video effectively increased knowledge about opioid overdose and naloxone, without increasing opioid risk behaviour. Naloxone uptake did not differ between the intervention and usual care arms.NCT03337009.","PeriodicalId":117861,"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":"141690575","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-2023-000615
Nishika Aryal, Anuja Rajbhandari
Excessive social media (SM) usage is the foremost factor contributing to anxiety. While these platforms facilitate connection and entertainment, their overuse can negatively impact adolescents' mental well-being. The study aimed to evaluate both SM usage and levels of anxiety while assessing potential associations between the two.A cross-sectional descriptive study was conducted among 401 school-age adolescents (14–17 years) in grades 9 and 10 through self-administered questionnaires. Kruskal-Wallis test was used as a non-parametric test to compare the groups, and ordinal logistic regression was used to model the relationship between ordinal dependent and independent variables.The study reported high SM usage (43.6% spent 4–8 hours daily). Females and grade 9 students were more prone to severe anxiety (45.2% and 34.3%, respectively). Despite privacy concerns (93.3%), 37.9% shared their accounts. Severe anxiety was prevalent (35.4%), with males exhibiting less odds of severe anxiety compared with females (OR=0.37, p value <0.001) and higher usage frequency and duration associated with increased anxiety (p<0.001 in the Kruskal-Wallis test). Those dependent on SM had 1.15 times higher odds of severe anxiety, while those not taking breaks showed lesser anxiety (OR=0.89, β=−0.10).Involvement of adolescents in SM is associated with their anxiety levels, with factors like gender, usage patterns, and behaviours on these platforms playing important roles. This emphasises the need to understand how SM affects mental well-being and highlights the impact of their usage behaviours and concerns about privacy.
{"title":"Social media use and anxiety levels among school adolescents: a cross-sectional study in Kathmandu, Nepal","authors":"Nishika Aryal, Anuja Rajbhandari","doi":"10.1136/bmjph-2023-000615","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000615","url":null,"abstract":"Excessive social media (SM) usage is the foremost factor contributing to anxiety. While these platforms facilitate connection and entertainment, their overuse can negatively impact adolescents' mental well-being. The study aimed to evaluate both SM usage and levels of anxiety while assessing potential associations between the two.A cross-sectional descriptive study was conducted among 401 school-age adolescents (14–17 years) in grades 9 and 10 through self-administered questionnaires. Kruskal-Wallis test was used as a non-parametric test to compare the groups, and ordinal logistic regression was used to model the relationship between ordinal dependent and independent variables.The study reported high SM usage (43.6% spent 4–8 hours daily). Females and grade 9 students were more prone to severe anxiety (45.2% and 34.3%, respectively). Despite privacy concerns (93.3%), 37.9% shared their accounts. Severe anxiety was prevalent (35.4%), with males exhibiting less odds of severe anxiety compared with females (OR=0.37, p value <0.001) and higher usage frequency and duration associated with increased anxiety (p<0.001 in the Kruskal-Wallis test). Those dependent on SM had 1.15 times higher odds of severe anxiety, while those not taking breaks showed lesser anxiety (OR=0.89, β=−0.10).Involvement of adolescents in SM is associated with their anxiety levels, with factors like gender, usage patterns, and behaviours on these platforms playing important roles. This emphasises the need to understand how SM affects mental well-being and highlights the impact of their usage behaviours and concerns about privacy.","PeriodicalId":117861,"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":"141693235","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}
Workplace violence (WPV) against healthcare workers (HCWs) has become a global concern. Our aim was to investigate the firsthand experience of HCWs who faced physical WPV from patients or their relatives in Nepal and to identify the factors that contribute to WPV, its consequences, as well as recommendations from HCWs on preventing and managing WPV in healthcare settings.We conducted semistructured in-depth interviews of 12 HCWs who faced physical WPV from patients or their relatives in the last 2 years in Nepal. We recruited participants by announcing volunteer participation on social media and reaching out to HCWs who had experienced WPV through a review of national news archives. All interviews were conducted between September and November 2022. We analysed the data using a hybrid thematic analysis.Most participants were male (9/12). The average age of participants was 31.6 years with an average experience of 8.3 years. We generated three domains: (1) factors contributing to WPV, (2) response to WPV and (3) recommendations. Within these three domains, we identified a total of nine themes: two themes (proximal and distal factors) under domain 1, four themes (personal response, hospital administration response, police response and other responses) under domain 2 and three themes (recommendations at personal, organisational and policy level) under domain 3. We found that physical WPV against HCWs is multifactorial. Most HCWs did not receive expected support from hospital and police administration. They had a wide range of recommendations at personal, organisational and policy level. The most important recommendation was to ensure safety and security of HCWs.This qualitative study showed that experiences of HCWs who faced physical WPV in Nepal were traumatic. The concerned stakeholders should carefully consider the recommendations from HCWs to establish a safe, secure and supportive working environment.
{"title":"Experiences of healthcare workers who faced physical workplace violence from patients or their relatives in Nepal: a qualitative study","authors":"Mukesh Adhikari, Dinesh Timalsena, Kalpana Chaudhary","doi":"10.1136/bmjph-2024-001032","DOIUrl":"https://doi.org/10.1136/bmjph-2024-001032","url":null,"abstract":"Workplace violence (WPV) against healthcare workers (HCWs) has become a global concern. Our aim was to investigate the firsthand experience of HCWs who faced physical WPV from patients or their relatives in Nepal and to identify the factors that contribute to WPV, its consequences, as well as recommendations from HCWs on preventing and managing WPV in healthcare settings.We conducted semistructured in-depth interviews of 12 HCWs who faced physical WPV from patients or their relatives in the last 2 years in Nepal. We recruited participants by announcing volunteer participation on social media and reaching out to HCWs who had experienced WPV through a review of national news archives. All interviews were conducted between September and November 2022. We analysed the data using a hybrid thematic analysis.Most participants were male (9/12). The average age of participants was 31.6 years with an average experience of 8.3 years. We generated three domains: (1) factors contributing to WPV, (2) response to WPV and (3) recommendations. Within these three domains, we identified a total of nine themes: two themes (proximal and distal factors) under domain 1, four themes (personal response, hospital administration response, police response and other responses) under domain 2 and three themes (recommendations at personal, organisational and policy level) under domain 3. We found that physical WPV against HCWs is multifactorial. Most HCWs did not receive expected support from hospital and police administration. They had a wide range of recommendations at personal, organisational and policy level. The most important recommendation was to ensure safety and security of HCWs.This qualitative study showed that experiences of HCWs who faced physical WPV in Nepal were traumatic. The concerned stakeholders should carefully consider the recommendations from HCWs to establish a safe, secure and supportive working environment.","PeriodicalId":117861,"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":"141704978","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-2023-000622
Nicola Firman, Carol Dezateux, Vanessa Muirhead
Dental extraction under general anaesthetic (DGA) is the most severe and irreversible dental treatment for childhood tooth decay. We investigated inequalities in DGA in an ethnically diverse, disadvantaged school-age population and associations of DGA with prior excess weight.We identified 608 278 children aged 5–16 years in 2017–2022 from linked hospital and primary care electronic health records (EHRs) for a London, UK region. We estimated ORs (95% CI) for DGA, adjusting for sex, ethnicity, locality and deprivation. We linked 120 985 EHRs to school weight records and estimated HRs (95% CI) for DGA by excess weight (body mass index ≥91st centile) using Cox’s proportional regression.3034 children had at least one DGA (0.50%; 95% CI 0.48 to 0.52). Children from white Irish (OR: 1.96; 95% CI 1.17 to 3.29), other Asian (1.23; 95% CI 1.01 to 1.50), Bangladeshi (1.49; 95% CI 1.30 to 1.70) and Pakistani (1.41; 95% CI 1.21 to 1.65) ethnicities were more likely and those from Chinese (0.48; 95% CI 0.27 to 0.86), white and black African (0.59; 95% CI 0.35 to 0.98), other mixed (0.69; 95% CI 0.50 to 0.95), Indian (0.65; 95% CI 0.53 to 0.81), black African (0.79; 95% CI 0.66 to 0.93) and other black (0.62; 95% CI 0.48 to 0.82) ethnicities and living in less deprived areas less likely, to have had a DGA. Five- (HR: 0.80; 95% CI 0.66 to 0.94) and 11- year-olds (0.78; 95% CI 0.62 to 0.99) with excess weight were less likely to have had a DGA.We found marked ethnic and socioeconomic inequalities in childhood DGA. Further research is needed to understand factors mediating inequalities in DGA. These findings emphasise the importance of targeting the wider determinants of inequalities in tooth extraction and ensuring equitable access to preventive and restorative dentistry.
全身麻醉下拔牙（DGA）是治疗儿童蛀牙最严重、最不可逆的牙科治疗方法。我们从英国伦敦地区的医院和初级保健电子健康记录（EHR）中识别出 2017-2022 年间年龄在 5-16 岁之间的 608 278 名儿童。我们估算了 DGA 的 ORs（95% CI），并对性别、种族、地区和贫困程度进行了调整。我们将 120 985 份电子病历与学校体重记录联系起来，并使用 Cox 比例回归法按超重（体重指数≥第 91 百分位数）估算了 DGA 的 HRs（95% CI）。爱尔兰白人 (OR: 1.96; 95% CI 1.17 to 3.29)、其他亚洲人 (1.23; 95% CI 1.01 to 1.50)、孟加拉人 (1.49; 95% CI 1.30 to 1.70) 和巴基斯坦人 (1.41; 95% CI 1.21 to 1.65) 族裔的儿童更有可能患病，而中国人 (0.48; 95% CI 0.27 to 0.86)、白人和非洲黑人 (0.59; 95% CI 0.35 to 0.98）、其他混血（0.69; 95% CI 0.50 to 0.95）、印度（0.65; 95% CI 0.53 to 0.81）、非洲黑人（0.79; 95% CI 0.66 to 0.93）和其他黑人（0.62; 95% CI 0.48 to 0.82）族裔以及生活在较贫困地区的人患 DGA 的可能性较低。体重超标的 5 岁儿童（HR：0.80；95% CI 0.66 至 0.94）和 11 岁儿童（0.78；95% CI 0.62 至 0.99）患 DGA 的可能性较低。我们发现在儿童 DGA 方面存在着明显的种族和社会经济不平等现象，需要进一步研究以了解导致 DGA 不平等的因素。这些发现强调了针对造成拔牙不平等的更广泛决定因素以及确保公平获得预防和修复牙科服务的重要性。
{"title":"Inequalities in children’s tooth decay requiring dental extraction under general anaesthetic: a longitudinal study using linked electronic health records","authors":"Nicola Firman, Carol Dezateux, Vanessa Muirhead","doi":"10.1136/bmjph-2023-000622","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000622","url":null,"abstract":"Dental extraction under general anaesthetic (DGA) is the most severe and irreversible dental treatment for childhood tooth decay. We investigated inequalities in DGA in an ethnically diverse, disadvantaged school-age population and associations of DGA with prior excess weight.We identified 608 278 children aged 5–16 years in 2017–2022 from linked hospital and primary care electronic health records (EHRs) for a London, UK region. We estimated ORs (95% CI) for DGA, adjusting for sex, ethnicity, locality and deprivation. We linked 120 985 EHRs to school weight records and estimated HRs (95% CI) for DGA by excess weight (body mass index ≥91st centile) using Cox’s proportional regression.3034 children had at least one DGA (0.50%; 95% CI 0.48 to 0.52). Children from white Irish (OR: 1.96; 95% CI 1.17 to 3.29), other Asian (1.23; 95% CI 1.01 to 1.50), Bangladeshi (1.49; 95% CI 1.30 to 1.70) and Pakistani (1.41; 95% CI 1.21 to 1.65) ethnicities were more likely and those from Chinese (0.48; 95% CI 0.27 to 0.86), white and black African (0.59; 95% CI 0.35 to 0.98), other mixed (0.69; 95% CI 0.50 to 0.95), Indian (0.65; 95% CI 0.53 to 0.81), black African (0.79; 95% CI 0.66 to 0.93) and other black (0.62; 95% CI 0.48 to 0.82) ethnicities and living in less deprived areas less likely, to have had a DGA. Five- (HR: 0.80; 95% CI 0.66 to 0.94) and 11- year-olds (0.78; 95% CI 0.62 to 0.99) with excess weight were less likely to have had a DGA.We found marked ethnic and socioeconomic inequalities in childhood DGA. Further research is needed to understand factors mediating inequalities in DGA. These findings emphasise the importance of targeting the wider determinants of inequalities in tooth extraction and ensuring equitable access to preventive and restorative dentistry.","PeriodicalId":117861,"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":"141699055","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}
Beyond its effects on physical health, COVID-19 psychosocial stigma has emerged as a result of this global crisis, making people feel ashamed, alone and discriminated against. This comparative study aims to assess the psychosocial health stigma of COVID-19, and to evaluate the perceived stigma according to the sociodemographic variables during the pandemic in Jordan.A study in Jordan compared stigma between 112 COVID-19 patients (52 males and 60 females) and 118 healthy controls (56 males and 62 females), with participants ranging from 18 to over 60 years old in both groups.According to the data, 27% of COVID-19 patients had high-level stigma, with total stigma scores ranging from 46 to 111 and a mean of 80.23 (SD=12.79). Quartile results showed 50% scored 80, 25% over 88 and 75% over 78, indicating moderate stigma within a 0–160 range. On the other hand, the total scores of stigma among the healthy controls ranged from 40 to 112, with a mean of 78.55 (SD=12.41). 30.3% report high levels of stigma. Quartile results showed 50% scored 78, 25% over 85 and 75% over 71, indicating moderate stigma. No significant stigma score difference was found between patients and controls (t=1.09, p=0.28). No significant correlation with demographics, except among medical workers (t=−3.32, p=0.001).The study revealed negligible differences in stigma between the two groups, but greater stigma among medical field workers highlighting the need for integrated community and policy support to fight stigma.
{"title":"Psychosocial health stigma related to COVID-19 disease among COVID-19 patients in Jordan: a comparative study","authors":"Lina Jalal Daoud, Mamdouh El‐Hneiti, Mahmoud Ogla Al-Hussami","doi":"10.1136/bmjph-2023-000165","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000165","url":null,"abstract":"Beyond its effects on physical health, COVID-19 psychosocial stigma has emerged as a result of this global crisis, making people feel ashamed, alone and discriminated against. This comparative study aims to assess the psychosocial health stigma of COVID-19, and to evaluate the perceived stigma according to the sociodemographic variables during the pandemic in Jordan.A study in Jordan compared stigma between 112 COVID-19 patients (52 males and 60 females) and 118 healthy controls (56 males and 62 females), with participants ranging from 18 to over 60 years old in both groups.According to the data, 27% of COVID-19 patients had high-level stigma, with total stigma scores ranging from 46 to 111 and a mean of 80.23 (SD=12.79). Quartile results showed 50% scored 80, 25% over 88 and 75% over 78, indicating moderate stigma within a 0–160 range. On the other hand, the total scores of stigma among the healthy controls ranged from 40 to 112, with a mean of 78.55 (SD=12.41). 30.3% report high levels of stigma. Quartile results showed 50% scored 78, 25% over 85 and 75% over 71, indicating moderate stigma. No significant stigma score difference was found between patients and controls (t=1.09, p=0.28). No significant correlation with demographics, except among medical workers (t=−3.32, p=0.001).The study revealed negligible differences in stigma between the two groups, but greater stigma among medical field workers highlighting the need for integrated community and policy support to fight stigma.","PeriodicalId":117861,"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":"141689457","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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