Pub Date : 2024-03-01DOI: 10.1136/bmjph-2023-000289
Z. Rygner, Christina Ellervik, Mads Rasmussen, Christian Torp-Pedersen, Henrik E Poulsen, Anders Jorgensen
The impact of non-participation due to psychiatric illness on study outcomes in general population studies is insufficiently investigated. Here, we investigate the mental health bias in a population study and the potential impact on estimates of cardiovascular morbidity and overall survival.Data were retrieved from nationwide registries.The Danish General Suburban Population Study (GESUS), a cross-sectional community study conducted in Naestved Municipality, Denmark, from 2010 to 2013.49 707 subjects invited to participate in GESUS.Factors related to non-participation were examined using multivariable logistic regression and time-to-event data using Cox proportional hazards models.Of 21 203 (43%) participants, 823 (3.9%) had a psychiatric diagnosis. Of 28 504 non-participants, 2453 (8.6%) had a psychiatric diagnosis (OR for non-participation 1.84 (95% CI 1.69 to 2.00)). The most under-represented psychiatric disorders in participants were organic mental disorders (5.76 (3.90 to 8.48)), substance abuse (3.12 (2.14 to 4.54)) and schizophrenia (3.12 (2.33 to 4.18)). Overall, more non-participants used psychotropic drugs than participants (1.26 (1.21 to 1.31)), and psychiatric non-participants had higher psychiatric hospital service utilisation than psychiatric participants. Compared with non-psychiatric participants in a 5-year follow-up, psychiatric non-participants had higher rates of cardiovascular events (HR 2.30 (2.07 to 2.56)) and all-cause mortality (3.37 (3.01 to 3.78)) than non-psychiatric non-participants (1.65 (1.48 to 1.83) and 2.26 (2.02 to 2.54), respectively) and psychiatric participants (1.39 (1.21 to 1.59) and 1.23 (1.05 to 1.44), respectively), pinteraction<0.0001 for both outcomes.This study demonstrates a considerable non-participation bias due to psychiatric illness in a general population health study, potentially leading to distorted estimates of somatic morbidity and mortality. Strategies for better-representing individuals with psychiatric illnesses in population health studies are needed.
{"title":"Impact of non-participation bias due to psychiatric illness on mortality and cardiovascular event estimates: a Danish longitudinal population study","authors":"Z. Rygner, Christina Ellervik, Mads Rasmussen, Christian Torp-Pedersen, Henrik E Poulsen, Anders Jorgensen","doi":"10.1136/bmjph-2023-000289","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000289","url":null,"abstract":"The impact of non-participation due to psychiatric illness on study outcomes in general population studies is insufficiently investigated. Here, we investigate the mental health bias in a population study and the potential impact on estimates of cardiovascular morbidity and overall survival.Data were retrieved from nationwide registries.The Danish General Suburban Population Study (GESUS), a cross-sectional community study conducted in Naestved Municipality, Denmark, from 2010 to 2013.49 707 subjects invited to participate in GESUS.Factors related to non-participation were examined using multivariable logistic regression and time-to-event data using Cox proportional hazards models.Of 21 203 (43%) participants, 823 (3.9%) had a psychiatric diagnosis. Of 28 504 non-participants, 2453 (8.6%) had a psychiatric diagnosis (OR for non-participation 1.84 (95% CI 1.69 to 2.00)). The most under-represented psychiatric disorders in participants were organic mental disorders (5.76 (3.90 to 8.48)), substance abuse (3.12 (2.14 to 4.54)) and schizophrenia (3.12 (2.33 to 4.18)). Overall, more non-participants used psychotropic drugs than participants (1.26 (1.21 to 1.31)), and psychiatric non-participants had higher psychiatric hospital service utilisation than psychiatric participants. Compared with non-psychiatric participants in a 5-year follow-up, psychiatric non-participants had higher rates of cardiovascular events (HR 2.30 (2.07 to 2.56)) and all-cause mortality (3.37 (3.01 to 3.78)) than non-psychiatric non-participants (1.65 (1.48 to 1.83) and 2.26 (2.02 to 2.54), respectively) and psychiatric participants (1.39 (1.21 to 1.59) and 1.23 (1.05 to 1.44), respectively), pinteraction<0.0001 for both outcomes.This study demonstrates a considerable non-participation bias due to psychiatric illness in a general population health study, potentially leading to distorted estimates of somatic morbidity and mortality. Strategies for better-representing individuals with psychiatric illnesses in population health studies are needed.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"249 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140274242","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 : 2024-03-01DOI: 10.1136/bmjph-2023-000378
M. Reiss, Markus Kraus, Monika Riedel, T. Czypionka
The COVID-19 pandemic posed an unprecedented challenge, which caught many health systems widely unprepared. The aim of this research was to develop a comprehensive analytical framework on health system resilience in the context of pandemics. In addition to serving as a tool to analyse the preparedness and resilience of health systems, the framework is intended to provide guidance to decision-makers in health policy.The analytical framework was developed based on a multitiered approach. A comprehensive review of the existing literature was conducted to identify relevant frameworks on health system resilience (published between 1 January 2000 and 30 November 2021) and determinants of resilience that emerged during the COVID-19 pandemic. Input was then gathered in several rounds of consultations with designated field experts and stakeholders, drawing on their experiences from the pandemic. Finally, the framework was empirically validated in several case studies.The framework distinguishes between prerequisites of resilience, pertaining to precautions to be taken in ‘normal’ times, and response strategies in the face of shocks. Both sections are further divided into six building blocks that were adapted from the WHO health system framework: governance and leadership, information and research, financing, physical resources, human resources, and service delivery. An overarching component on contextual factors—subdivided into situational, structural, cultural and international factors—represents an important addition to the existing spectrum of resilience frameworks.Foundations for a resilient health system must be laid in ‘normal’ times and in all areas of the health system. In the face of a shock, adequate response strategies need to be developed. An essential learning from the COVID-19 pandemic has been that contextual factors of societies and subgroups play a major role in the ability of health systems to overcome a shock, as they impact the implementation and effectiveness of crisis management policies.
{"title":"What makes health systems resilient? An analytical framework drawing on European learnings from the COVID-19 pandemic based on a multitiered approach","authors":"M. Reiss, Markus Kraus, Monika Riedel, T. Czypionka","doi":"10.1136/bmjph-2023-000378","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000378","url":null,"abstract":"The COVID-19 pandemic posed an unprecedented challenge, which caught many health systems widely unprepared. The aim of this research was to develop a comprehensive analytical framework on health system resilience in the context of pandemics. In addition to serving as a tool to analyse the preparedness and resilience of health systems, the framework is intended to provide guidance to decision-makers in health policy.The analytical framework was developed based on a multitiered approach. A comprehensive review of the existing literature was conducted to identify relevant frameworks on health system resilience (published between 1 January 2000 and 30 November 2021) and determinants of resilience that emerged during the COVID-19 pandemic. Input was then gathered in several rounds of consultations with designated field experts and stakeholders, drawing on their experiences from the pandemic. Finally, the framework was empirically validated in several case studies.The framework distinguishes between prerequisites of resilience, pertaining to precautions to be taken in ‘normal’ times, and response strategies in the face of shocks. Both sections are further divided into six building blocks that were adapted from the WHO health system framework: governance and leadership, information and research, financing, physical resources, human resources, and service delivery. An overarching component on contextual factors—subdivided into situational, structural, cultural and international factors—represents an important addition to the existing spectrum of resilience frameworks.Foundations for a resilient health system must be laid in ‘normal’ times and in all areas of the health system. In the face of a shock, adequate response strategies need to be developed. An essential learning from the COVID-19 pandemic has been that contextual factors of societies and subgroups play a major role in the ability of health systems to overcome a shock, as they impact the implementation and effectiveness of crisis management policies.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"38 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277633","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 : 2024-03-01DOI: 10.1136/bmjph-2023-000146
Richard Mugo, T. Pliakas, J. Kamano, L. Sanga, Ellen Nolte, Antonio Gasparrini, E. Barasa, Anthony Etyang, P. Perel
In Kenya, non-communicable diseases (NCDs) are estimated to account for almost one-third of all deaths and this is likely to rise by over 50% in the next 10 years. The Primary Health Integrated Care for Chronic Conditions (PIC4C) project aims to strengthen primary care by integrating comprehensive NCD care into existing HIV primary care platform. This paper evaluates the association of PIC4C implementation on clinical outcomes.Outcomes included proportion of new patients, systolic blood pressure (SBP), fasting plasma glucose (FPG), diastolic blood pressure, hypertension control, random plasma glucose, diabetes control, viral load and HIV viral suppression. We used interrupted time series and binomial regression with random effects for facility-level data and generalised mixed-effects regression for visit-level data to examine the association between PIC4C and outcomes between January 2017 and December 2021. We conducted sensitivity analysis with restrictions on sites and the number of visits.Data from 66 641 visits of 13 046 patients with hypertension, 24 005 visits of 7267 patients with diabetes and 84 855 visits of 21 186 people with HIV were analysed. We found evidence of association between PIC4C and increase in proportion of new patients per month with hypertension (adjusted OR (aOR) 1.57, 95% CI 1.39 to 1.78) and diabetes (aOR 1.31, 95% CI 1.19 to 1.45), small increase in SBP (adjusted beta (aB) 1.7, 95% CI 0.8 to 2.7) and FPG (aB 0.6, 95% CI 0.0 to 1.1). There was no strong evidence of association between PIC4C and viral suppression (aOR 1.20, 95% CI 0.98 to 1.47). In sensitivity analysis, there was no strong evidence of association between PIC4C and SBP (aB 1.74, 95% CI −0.70 to 4.17) or FPG (aB 0.52, 95% CI −0.64 to 1.67)PIC4C implementation was associated with increase in proportion of new patients attending clinics and a slight increase in SBP and FPG. The immediate post-PIC4C implementation period coincided with the COVID-19 pandemic, which is likely to explain some of our findings.
据估计，在肯尼亚，非传染性疾病（NCD）造成的死亡人数几乎占总死亡人数的三分之一，而且在未来 10 年内，这一比例可能会上升 50%以上。慢性病初级保健综合护理（PIC4C）项目旨在通过将非传染性疾病综合护理纳入现有的艾滋病初级保健平台来加强初级保健。结果包括新患者比例、收缩压、空腹血浆葡萄糖、舒张压、高血压控制、随机血浆葡萄糖、糖尿病控制、病毒载量和艾滋病病毒抑制。我们使用间断时间序列和二项随机效应回归来处理机构级数据，并使用广义混合效应回归来处理就诊级数据，以检验 2017 年 1 月至 2021 年 12 月期间 PIC4C 与结果之间的关联。我们分析了 13 046 名高血压患者的 66 641 次就诊数据、7267 名糖尿病患者的 24 005 次就诊数据以及 21 186 名艾滋病患者的 84 855 次就诊数据。我们发现，有证据表明 PIC4C 与每月新增高血压患者比例的增加（调整后 OR (aOR) 1.57，95% CI 1.39 至 1.78）和糖尿病患者比例的增加（aOR 1.31，95% CI 1.19 至 1.45）、SBP 的小幅增加（调整后 beta (aB) 1.7，95% CI 0.8 至 2.7）和 FPG 的增加（aB 0.6，95% CI 0.0 至 1.1）有关。没有强有力的证据表明 PIC4C 与病毒抑制之间存在关联（aOR 1.20，95% CI 0.98 至 1.47）。在敏感性分析中，没有强有力的证据表明 PIC4C 与 SBP（aB 1.74，95% CI -0.70 至 4.17）或 FPG（aB 0.52，95% CI -0.64 至 1.67）之间存在关联。PIC4C实施后的第一阶段恰逢COVID-19大流行，这可能是我们的一些发现的原因。
{"title":"Evaluating the implementation of the Primary Health Integrated Care Project for Chronic Conditions: a cohort study from Kenya","authors":"Richard Mugo, T. Pliakas, J. Kamano, L. Sanga, Ellen Nolte, Antonio Gasparrini, E. Barasa, Anthony Etyang, P. Perel","doi":"10.1136/bmjph-2023-000146","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000146","url":null,"abstract":"In Kenya, non-communicable diseases (NCDs) are estimated to account for almost one-third of all deaths and this is likely to rise by over 50% in the next 10 years. The Primary Health Integrated Care for Chronic Conditions (PIC4C) project aims to strengthen primary care by integrating comprehensive NCD care into existing HIV primary care platform. This paper evaluates the association of PIC4C implementation on clinical outcomes.Outcomes included proportion of new patients, systolic blood pressure (SBP), fasting plasma glucose (FPG), diastolic blood pressure, hypertension control, random plasma glucose, diabetes control, viral load and HIV viral suppression. We used interrupted time series and binomial regression with random effects for facility-level data and generalised mixed-effects regression for visit-level data to examine the association between PIC4C and outcomes between January 2017 and December 2021. We conducted sensitivity analysis with restrictions on sites and the number of visits.Data from 66 641 visits of 13 046 patients with hypertension, 24 005 visits of 7267 patients with diabetes and 84 855 visits of 21 186 people with HIV were analysed. We found evidence of association between PIC4C and increase in proportion of new patients per month with hypertension (adjusted OR (aOR) 1.57, 95% CI 1.39 to 1.78) and diabetes (aOR 1.31, 95% CI 1.19 to 1.45), small increase in SBP (adjusted beta (aB) 1.7, 95% CI 0.8 to 2.7) and FPG (aB 0.6, 95% CI 0.0 to 1.1). There was no strong evidence of association between PIC4C and viral suppression (aOR 1.20, 95% CI 0.98 to 1.47). In sensitivity analysis, there was no strong evidence of association between PIC4C and SBP (aB 1.74, 95% CI −0.70 to 4.17) or FPG (aB 0.52, 95% CI −0.64 to 1.67)PIC4C implementation was associated with increase in proportion of new patients attending clinics and a slight increase in SBP and FPG. The immediate post-PIC4C implementation period coincided with the COVID-19 pandemic, which is likely to explain some of our findings.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"311 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402538","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 : 2024-03-01DOI: 10.1136/bmjph-2023-000534
B. M. Martin, A. C. Cadavid Restrepo, H. Mayfield, Colleen L. Lau
In recent decades, spatial epidemiology has increasingly been used to study neglected tropical diseases (NTDs). Spatial methods are particularly relevant when transmission is strongly driven by sociodemographic and environmental factors, resulting in heterogeneous disease distribution. We use lymphatic filariasis (LF)—an NTD targeted for global elimination—as a case study to examine how spatial epidemiology has been used to enhance NTD surveillance.We conducted a systematic literature review of spatial analytical studies of LF published in English across PubMed, Embase, Web of Science and Scopus databases, before 15 November 2022. Additional papers were identified from experts’ suggestions. Studies that employed spatial analytical methods were included, but those that applied only visualisation tools were excluded.Sixty-one eligible studies published between 1997 and 2023 were identified. The studies used a wide range of spatial methods. Thirty-one (50.8%) studies used spatial statistical modelling, with model-based geostatistics being the most common method. Spatial autocorrelation and hotspot analysis were applied in 30 studies (49.2%). The most frequent model outputs were prevalence maps (17 studies, 27.9%), followed by risk maps based on environmental suitability (7 studies, 11.5%) and maps of the odds of seroprevalence being above a predetermined threshold (7 studies, 11.5%).By demonstrating the applicability of spatial methods for investigating transmission drivers, identifying clusters and predicting hotspots, we highlight innovative ways in which spatial epidemiology has provided valuable evidence to support LF elimination. Spatial analysis is particularly useful in low-prevalence settings for improving hotspot detection and enhancing postelimination surveillance.CRD42022333804.
{"title":"Towards global elimination of lymphatic filariasis: a systematic review of the application of spatial epidemiological methods to enhance surveillance and support elimination programmes","authors":"B. M. Martin, A. C. Cadavid Restrepo, H. Mayfield, Colleen L. Lau","doi":"10.1136/bmjph-2023-000534","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000534","url":null,"abstract":"In recent decades, spatial epidemiology has increasingly been used to study neglected tropical diseases (NTDs). Spatial methods are particularly relevant when transmission is strongly driven by sociodemographic and environmental factors, resulting in heterogeneous disease distribution. We use lymphatic filariasis (LF)—an NTD targeted for global elimination—as a case study to examine how spatial epidemiology has been used to enhance NTD surveillance.We conducted a systematic literature review of spatial analytical studies of LF published in English across PubMed, Embase, Web of Science and Scopus databases, before 15 November 2022. Additional papers were identified from experts’ suggestions. Studies that employed spatial analytical methods were included, but those that applied only visualisation tools were excluded.Sixty-one eligible studies published between 1997 and 2023 were identified. The studies used a wide range of spatial methods. Thirty-one (50.8%) studies used spatial statistical modelling, with model-based geostatistics being the most common method. Spatial autocorrelation and hotspot analysis were applied in 30 studies (49.2%). The most frequent model outputs were prevalence maps (17 studies, 27.9%), followed by risk maps based on environmental suitability (7 studies, 11.5%) and maps of the odds of seroprevalence being above a predetermined threshold (7 studies, 11.5%).By demonstrating the applicability of spatial methods for investigating transmission drivers, identifying clusters and predicting hotspots, we highlight innovative ways in which spatial epidemiology has provided valuable evidence to support LF elimination. Spatial analysis is particularly useful in low-prevalence settings for improving hotspot detection and enhancing postelimination surveillance.CRD42022333804.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"159 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140282156","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 : 2024-03-01DOI: 10.1136/bmjph-2023-000072
Man Yee Ho, E. Worthington, R. Cowden, A. O. Bechara, Zhuo Job Chen, Elly Yuliandari Gunatirin, S. Joynt, Viacheslav V Khalanskyi, H. Korzhov, N. Kurniati, Nicole Rodriguez, Anastasiya Anastasiya Salnykova, Liudmyla Shtanko, Sergiy Tymchenko, Vitaliy L Voytenko, Anita Zulkaida, Maya B. Mathur, T. VanderWeele
To determine whether a brief self-directed forgiveness workbook intervention could alter forgiveness, depression symptoms, and anxiety symptoms.A multisite randomised waitlist-controlled trial was conducted among 4598 participants. Recruitment occurred from 11 February 2020 to 30 September 2021. Final follow-up occurred on 25 October 2021.Participants were recruited from community-based samples in sites in Colombia, Hong Kong, Indonesia, South Africa, and Ukraine.Individuals (n=7837) were screened for eligibility. For inclusion, participants needed to be ≥18 years and have experienced an interpersonal transgression. The analytic sample consisted of n=4598 participants, median age 26 and 73% female.At each site, participants were randomly assigned to either immediate receipt of a self-directed forgiveness workbook intervention, or to receipt after a 2 week delay.The primary outcomes were unforgiveness (Transgression-Related Interpersonal Motivations Inventory-18), depression symptoms, and anxiety symptoms (Brief Symptom Inventory-18) measured at 2 weeks following intervention assignment.At 2 weeks follow-up, unforgiveness was lower among the immediate-treatment group compared with the delayed-treatment group (standardised mean difference=−0.53 (95% CI=−0.58 to –0.47)); similar patterns were found for depression (standardised mean difference=−0.22 (95% CI=−0.28 to –0.16)) and anxiety symptoms (standardised mean difference=−0.21 (95% CI=−0.27 to –0.15)).A brief workbook intervention promoted forgiveness and reduced depression and anxiety symptoms. The promotion of forgiveness with such workbooks has the potential for widespread dissemination to improve global mental health.NCT04257773.
研究人员在4598名参与者中开展了一项多地点随机候选对照试验。招募时间为 2020 年 2 月 11 日至 2021 年 9 月 30 日。参与者是从哥伦比亚、香港、印度尼西亚、南非和乌克兰的社区样本中招募的。参与者的年龄需≥18 岁，并经历过人际交往中的越轨行为。分析样本包括4598名参与者，年龄中位数为26岁，73%为女性。在每个地点，参与者被随机分配到立即接受自我指导的宽恕工作簿干预，或延迟2周后接受干预。主要结果是干预分配后2周测量的不宽恕（与越轨有关的人际动机量表-18）、抑郁症状和焦虑症状（简易症状量表-18）。在两周的随访中，即时治疗组的不宽恕率低于延迟治疗组（标准化平均差异=-0.53 (95% CI=-0.58 to -0.47)）；抑郁症状（标准化平均差异=-0.22 (95% CI=-0.28 to -0.16)）和焦虑症状（标准化平均差异=-0.21 (95% CI=-0.27 to -0.15)）的情况也类似。通过这种工作手册促进宽恕有可能得到广泛传播，从而改善全球心理健康。
{"title":"International REACH forgiveness intervention: a multisite randomised controlled trial","authors":"Man Yee Ho, E. Worthington, R. Cowden, A. O. Bechara, Zhuo Job Chen, Elly Yuliandari Gunatirin, S. Joynt, Viacheslav V Khalanskyi, H. Korzhov, N. Kurniati, Nicole Rodriguez, Anastasiya Anastasiya Salnykova, Liudmyla Shtanko, Sergiy Tymchenko, Vitaliy L Voytenko, Anita Zulkaida, Maya B. Mathur, T. VanderWeele","doi":"10.1136/bmjph-2023-000072","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000072","url":null,"abstract":"To determine whether a brief self-directed forgiveness workbook intervention could alter forgiveness, depression symptoms, and anxiety symptoms.A multisite randomised waitlist-controlled trial was conducted among 4598 participants. Recruitment occurred from 11 February 2020 to 30 September 2021. Final follow-up occurred on 25 October 2021.Participants were recruited from community-based samples in sites in Colombia, Hong Kong, Indonesia, South Africa, and Ukraine.Individuals (n=7837) were screened for eligibility. For inclusion, participants needed to be ≥18 years and have experienced an interpersonal transgression. The analytic sample consisted of n=4598 participants, median age 26 and 73% female.At each site, participants were randomly assigned to either immediate receipt of a self-directed forgiveness workbook intervention, or to receipt after a 2 week delay.The primary outcomes were unforgiveness (Transgression-Related Interpersonal Motivations Inventory-18), depression symptoms, and anxiety symptoms (Brief Symptom Inventory-18) measured at 2 weeks following intervention assignment.At 2 weeks follow-up, unforgiveness was lower among the immediate-treatment group compared with the delayed-treatment group (standardised mean difference=−0.53 (95% CI=−0.58 to –0.47)); similar patterns were found for depression (standardised mean difference=−0.22 (95% CI=−0.28 to –0.16)) and anxiety symptoms (standardised mean difference=−0.21 (95% CI=−0.27 to –0.15)).A brief workbook intervention promoted forgiveness and reduced depression and anxiety symptoms. The promotion of forgiveness with such workbooks has the potential for widespread dissemination to improve global mental health.NCT04257773.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"202 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140282214","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 : 2024-03-01DOI: 10.1136/bmjph-2023-000307
Getachew Tadegew¶, T. Chane, Eyob Ketema Bogale¶
To assess the magnitude of parental hygienic complementary feeding practices (PHCFPs) and their associated factors among mothers with children aged 6–23 months in Antsokia Gemza district, Ethiopia, in 2022.A community-based cross-sectional study was conducted in Antsokia Gemza district, North Shoa, Ethiopia, from 25 June to 22 July 2022. A systematic random sampling technique was applied to select study participants. A total of 391 respondents participated in the study. All mothers (biological mothers, grandmothers, sisters and others) taking responsibility for caring for a child of age 6–23 months were included in the study. Data were collected by using interviewer-administrated questionnaires. Data were entered into Epi-Data V.3.1 and exported to SPSS V.25 for data cleaning and further analysis. Bivariable and multivariable binary logistic regression were employed to identify predictor variables of hygienic practice in complementary feeding with a p value <0.25 entered into the multivariable logistic regression model. Independent variables with a 95% CI and p values <0.05 in multivariable logistic regression were considered statistically significant.The magnitude of good parental hygienic practice during complementary feeding of their children aged 6–23 months was 45.3%, with a 95% CI (40.2%–50%). Maternal age of 34–41 years (adjusted odd ratio (AOR): 2.75, 95% CI (1.16–6.53)), secondary school educated mothers (AOR: 8.2, 95% CI (3.26–20.97)), daily laborer mothers (AOR: 0.22, 95% CI (0.06–0.83)), access to pipe water (AOR: 7.1, 95% CI (3.98–12.66)), access to media (AOR: 2.8, 95% CI (1.4–5.7)), and having a positive attitude (AOR: 8.6, 95% CI (2.43–31.0)) were significant predictors of maternal hygienic complementary feeding practice .The magnitude of good maternal hygienic complementary feeding practice was low. Hence, the district health office, education office, communication office and water and energy office should work hard jointly on maternal education, pipe water supply, awareness creation and information dissemination.
{"title":"Hygienic complementary feeding practice and its associated factors among mothers having children aged 6–23 months in Antsokia Gemza district, Ethiopia: a cross-sectional survey","authors":"Getachew Tadegew¶, T. Chane, Eyob Ketema Bogale¶","doi":"10.1136/bmjph-2023-000307","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000307","url":null,"abstract":"To assess the magnitude of parental hygienic complementary feeding practices (PHCFPs) and their associated factors among mothers with children aged 6–23 months in Antsokia Gemza district, Ethiopia, in 2022.A community-based cross-sectional study was conducted in Antsokia Gemza district, North Shoa, Ethiopia, from 25 June to 22 July 2022. A systematic random sampling technique was applied to select study participants. A total of 391 respondents participated in the study. All mothers (biological mothers, grandmothers, sisters and others) taking responsibility for caring for a child of age 6–23 months were included in the study. Data were collected by using interviewer-administrated questionnaires. Data were entered into Epi-Data V.3.1 and exported to SPSS V.25 for data cleaning and further analysis. Bivariable and multivariable binary logistic regression were employed to identify predictor variables of hygienic practice in complementary feeding with a p value <0.25 entered into the multivariable logistic regression model. Independent variables with a 95% CI and p values <0.05 in multivariable logistic regression were considered statistically significant.The magnitude of good parental hygienic practice during complementary feeding of their children aged 6–23 months was 45.3%, with a 95% CI (40.2%–50%). Maternal age of 34–41 years (adjusted odd ratio (AOR): 2.75, 95% CI (1.16–6.53)), secondary school educated mothers (AOR: 8.2, 95% CI (3.26–20.97)), daily laborer mothers (AOR: 0.22, 95% CI (0.06–0.83)), access to pipe water (AOR: 7.1, 95% CI (3.98–12.66)), access to media (AOR: 2.8, 95% CI (1.4–5.7)), and having a positive attitude (AOR: 8.6, 95% CI (2.43–31.0)) were significant predictors of maternal hygienic complementary feeding practice .The magnitude of good maternal hygienic complementary feeding practice was low. Hence, the district health office, education office, communication office and water and energy office should work hard jointly on maternal education, pipe water supply, awareness creation and information dissemination.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"32 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140404381","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 : 2024-03-01DOI: 10.1136/bmjph-2023-000437
Adam Mitchell, Malin Inghammar, Louise Bennet, P. Östergren, M. Moghaddassi, Jonas Björk
Better understanding of societal factors associated with COVID-19 vaccination can have important implications for public health policy to increase uptake.This study investigated sociodemographic determinants of COVID-19 vaccine uptake with ≥2 doses vs 0 doses, and ≥3 doses vs 2 doses, among adults (≥18 years) in a general population from Sweden followed from 27 December 2020 (n=1 064 548 at the present cross-section—12 June 12 2022). Associations between individual-level and area-level sociodemographic factors and vaccine uptake were modelled with logistic regression, with average marginal effects and estimated proportion vaccinated subsequently estimated.Being vaccinated with ≥2 doses vs 0 doses was positively associated with education (tertiary vs primary, OR 1.5, 95% CI 1.3 to 1.7), household disposable income (Q5 vs Q1, OR 2.3; 95% CI 1.9 to 2.7), comorbidities (≥2 doses vs none, OR 1.9, 95% CI 1.8 to 1.9) and residential area type (affluent socioeconomic conditions vs poor, OR 2.0, 95% CI 1.6 to 2.4). Whereas, being born outside Sweden was associated with a lower uptake (low and middle-income countries vs Swedish born, OR 0.6, 95% CI 0.5 to 0.7). The associations were generally similar when comparing booster vs remaining on only two doses. From these ORs, there were consistent differences in the estimated proportion vaccinated both for ≥2 doses and booster vaccination. Absolute changes in percentage vaccinated between affluent and poor areas were largely similar across individual country of birth, income and education, both for at least two doses and for the booster doses.COVID-19 vaccine uptake was associated with higher sociodemographic classifications both at the individual level and area level. The predicted proportion vaccinated increased with more affluent socioeconomic conditions and concurrent increases in individual household income were the strongest indicators. This sociodemographic selection showed consistency with respect to entering (obtaining ≥2 doses) and remaining (obtaining at least one booster dose) in the vaccination programme.
本研究调查了自 2020 年 12 月 27 日起跟踪调查的瑞典普通人群中成人（≥18 岁）COVID-19 疫苗接种≥2 剂与 0 剂、≥3 剂与 2 剂的社会人口学决定因素（本横断面的样本数=1 064 548，2022 年 6 月 12 日）。个人层面和地区层面的社会人口因素与疫苗接种率之间的关系采用逻辑回归建模，随后估算平均边际效应和接种疫苗的估计比例。接种≥2剂与0剂疫苗与受教育程度（大专与小学，OR 1.5，95% CI 1.3至1.7）、家庭可支配收入（Q5与Q1，OR 2.3；95% CI 1.9至2.7）、合并症（≥2剂与无，OR 1.9，95% CI 1.8至1.9）和居住地区类型（富裕社会经济条件与贫穷，OR 2.0，95% CI 1.6至2.4）呈正相关。而在瑞典以外出生的人接受率较低（中低收入国家与瑞典出生的人相比，OR值为0.6，95% CI为0.5至0.7）。在比较强化免疫与只接受两剂免疫时，两者之间的关系大致相似。根据这些 OR，≥2 剂和加强接种的估计接种比例存在一致的差异。富裕地区和贫困地区之间接种疫苗比例的绝对变化在很大程度上与个人的出生国、收入和教育程度相似，在至少接种两剂疫苗和加强接种两剂疫苗方面都是如此。社会经济条件越富裕，预测的疫苗接种比例就越高，个人家庭收入的同步增长是最有力的指标。这种社会人口学选择在疫苗接种计划的进入（接种≥2剂）和保持（至少接种1剂加强剂）方面表现出一致性。
{"title":"COVID-19 vaccine uptake in Skåne county, Sweden, in relation to individual-level and area-level sociodemographic factors: a register-based cross-sectional analysis","authors":"Adam Mitchell, Malin Inghammar, Louise Bennet, P. Östergren, M. Moghaddassi, Jonas Björk","doi":"10.1136/bmjph-2023-000437","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000437","url":null,"abstract":"Better understanding of societal factors associated with COVID-19 vaccination can have important implications for public health policy to increase uptake.This study investigated sociodemographic determinants of COVID-19 vaccine uptake with ≥2 doses vs 0 doses, and ≥3 doses vs 2 doses, among adults (≥18 years) in a general population from Sweden followed from 27 December 2020 (n=1 064 548 at the present cross-section—12 June 12 2022). Associations between individual-level and area-level sociodemographic factors and vaccine uptake were modelled with logistic regression, with average marginal effects and estimated proportion vaccinated subsequently estimated.Being vaccinated with ≥2 doses vs 0 doses was positively associated with education (tertiary vs primary, OR 1.5, 95% CI 1.3 to 1.7), household disposable income (Q5 vs Q1, OR 2.3; 95% CI 1.9 to 2.7), comorbidities (≥2 doses vs none, OR 1.9, 95% CI 1.8 to 1.9) and residential area type (affluent socioeconomic conditions vs poor, OR 2.0, 95% CI 1.6 to 2.4). Whereas, being born outside Sweden was associated with a lower uptake (low and middle-income countries vs Swedish born, OR 0.6, 95% CI 0.5 to 0.7). The associations were generally similar when comparing booster vs remaining on only two doses. From these ORs, there were consistent differences in the estimated proportion vaccinated both for ≥2 doses and booster vaccination. Absolute changes in percentage vaccinated between affluent and poor areas were largely similar across individual country of birth, income and education, both for at least two doses and for the booster doses.COVID-19 vaccine uptake was associated with higher sociodemographic classifications both at the individual level and area level. The predicted proportion vaccinated increased with more affluent socioeconomic conditions and concurrent increases in individual household income were the strongest indicators. This sociodemographic selection showed consistency with respect to entering (obtaining ≥2 doses) and remaining (obtaining at least one booster dose) in the vaccination programme.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"113 S8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140407053","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 : 2024-03-01DOI: 10.1136/bmjph-2023-000095
J. W. Long, S. J. Maksi, Francisco Javier López Frías, Robin Ireland, Travis D Masterson
Food marketing has been implicated as a driving force of the obesity epidemic. Electronic sports, or ‘esports’, garners billions of viewership hours and is a consolidation of two major marketing outlets, online social media and sporting events, making it a focal point for food marketers and policy-makers.The top 10 esports events and leagues were identified using data scraped between 1 January 2021 and 15 December 2021. The 10 teams within each league (90 total teams) and up to 10 players from each team (451 total players) were identified. Of the top 10 events and leagues, 6 events and 2 leagues were held or located outside the USA, reflecting the global popularity of esports. Food and beverage brands associated with each event, league, team or player were systematically identified and extracted via official websites and social media accounts. The number of sponsorships was totalled for each brand. Brands were then categorised based on product type into the following categories: energy drinks, sugar-sweetened beverages, alcohol, candy/snacks, restaurants, food delivery and stores, and supplements. The total number of brand sponsorships was then calculated for each product category.90 unique food and beverage brands were identified. Across all brands, a total of 497 food brand sponsorships were identified. For product categories, energy drink brands had the most sponsorships (181 sponsorships, 36.4%), followed by restaurants (86 sponsorships, 17.3%) and candy/snacks (64 sponsorships, 12.8%). The individual brand with the most sponsorships was Monster Energy (47 sponsorships, 9.4%), followed by Jack Links (44 sponsorships, 8.8%) and Red Bull (42 sponsorships, 8.4%).Despite its nascent character, the esports industry is already heavily saturated by food and beverage marketing. There is a need to consider policies to appropriately regulate food and beverage marketing within esports communities to safeguard the health of viewers.
{"title":"Content analysis of food and beverage marketing in global esports: sponsorships of the premier events, leagues, teams and players","authors":"J. W. Long, S. J. Maksi, Francisco Javier López Frías, Robin Ireland, Travis D Masterson","doi":"10.1136/bmjph-2023-000095","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000095","url":null,"abstract":"Food marketing has been implicated as a driving force of the obesity epidemic. Electronic sports, or ‘esports’, garners billions of viewership hours and is a consolidation of two major marketing outlets, online social media and sporting events, making it a focal point for food marketers and policy-makers.The top 10 esports events and leagues were identified using data scraped between 1 January 2021 and 15 December 2021. The 10 teams within each league (90 total teams) and up to 10 players from each team (451 total players) were identified. Of the top 10 events and leagues, 6 events and 2 leagues were held or located outside the USA, reflecting the global popularity of esports. Food and beverage brands associated with each event, league, team or player were systematically identified and extracted via official websites and social media accounts. The number of sponsorships was totalled for each brand. Brands were then categorised based on product type into the following categories: energy drinks, sugar-sweetened beverages, alcohol, candy/snacks, restaurants, food delivery and stores, and supplements. The total number of brand sponsorships was then calculated for each product category.90 unique food and beverage brands were identified. Across all brands, a total of 497 food brand sponsorships were identified. For product categories, energy drink brands had the most sponsorships (181 sponsorships, 36.4%), followed by restaurants (86 sponsorships, 17.3%) and candy/snacks (64 sponsorships, 12.8%). The individual brand with the most sponsorships was Monster Energy (47 sponsorships, 9.4%), followed by Jack Links (44 sponsorships, 8.8%) and Red Bull (42 sponsorships, 8.4%).Despite its nascent character, the esports industry is already heavily saturated by food and beverage marketing. There is a need to consider policies to appropriately regulate food and beverage marketing within esports communities to safeguard the health of viewers.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140407462","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 : 2024-03-01DOI: 10.1136/bmjph-2023-000627
Sara Shayegi-Nik, William G. Honer, F. Vila-Rodriguez, Ni Gusti Ayu Nanditha, Thomas L. Patterson, S. Guillemi, Hasan Nathani, J. Trigg, Weijia Yin, Alejandra Fonseca, Bronhilda T Takeh, Rolando Barrios, Julio S. G. Montaner, Viviane D. Lima
Dementia is a progressive and debilitating disease, and people living with HIV (PLWH) often develop dementia much earlier than those not living with HIV. We estimated the incidence and prevalence of dementia and identified its key risk factors in a cohort of PLWH in British Columbia, Canada.This retrospective cohort study used data from the Seek and Treat for Optimal Prevention of HIV/AIDS study. Eligible individuals were diagnosed with HIV, ≥40 years of age, naïve to antiretroviral therapy (ART), had no dementia at the index date and were followed for ≥1 year during 2002–2016. Our main outcome was incident dementia. We examined the effect of sociodemographic and clinical covariates on the incidence of dementia using a cause-specific hazard (CSH) model, with all-cause mortality as a competing risk event.Among 5121 eligible PLWH, 108 (2%) developed dementia. The crude 15-year prevalence of dementia was 2.1%, and the age–sex standardised incidence rate of dementia was 4.3 (95% CI: 4.2 to 4.4) per 1000 person-years. Among the adjusted covariates, CD4 cell count<50 cells/mm3(adjusted CSH (aCSH) 8.61, 95% CI: 4.75 to 15.60), uncontrolled viremia (aCSH 1.95, 95% CI: 1.20 to 3.17), 10-year increase in age (aCSH 2.41, 95% CI: 1.89 to 3.07), schizophrenia (aCSH 2.85, 95% CI: 1.69 to 4.80), traumatic brain injury (aCSH 2.43, 95% CI: 1.59 to 3.71), delirium (aCSH 2.27, 95% CI: 1.45 to 3.55), substance use disorder (SUD) (aCSH 1.94, 95% CI: 1.18 to 3.21) and mood/anxiety disorders (aCSH 1.80, 95% CI: 1.13 to 2.86) were associated with an increased hazard for dementia. Initiating ART in 2005–2010 (versus<2000) produced an aCSH of 0.51 (95% CI: 0.30 to 0.89).We demonstrated the negative role of immunosuppression and inflammation on the incidence of dementia among PLWH. Our study also calls for the enhanced integration of care services provided for HIV, mental health, SUD and other risk-inducing comorbidities as a means of lowering the risk of dementia within this population.
{"title":"Incidence and contributing factors of dementia among people living with HIV in British Columbia, Canada, from 2002 to 2016: a retrospective cohort study","authors":"Sara Shayegi-Nik, William G. Honer, F. Vila-Rodriguez, Ni Gusti Ayu Nanditha, Thomas L. Patterson, S. Guillemi, Hasan Nathani, J. Trigg, Weijia Yin, Alejandra Fonseca, Bronhilda T Takeh, Rolando Barrios, Julio S. G. Montaner, Viviane D. Lima","doi":"10.1136/bmjph-2023-000627","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000627","url":null,"abstract":"Dementia is a progressive and debilitating disease, and people living with HIV (PLWH) often develop dementia much earlier than those not living with HIV. We estimated the incidence and prevalence of dementia and identified its key risk factors in a cohort of PLWH in British Columbia, Canada.This retrospective cohort study used data from the Seek and Treat for Optimal Prevention of HIV/AIDS study. Eligible individuals were diagnosed with HIV, ≥40 years of age, naïve to antiretroviral therapy (ART), had no dementia at the index date and were followed for ≥1 year during 2002–2016. Our main outcome was incident dementia. We examined the effect of sociodemographic and clinical covariates on the incidence of dementia using a cause-specific hazard (CSH) model, with all-cause mortality as a competing risk event.Among 5121 eligible PLWH, 108 (2%) developed dementia. The crude 15-year prevalence of dementia was 2.1%, and the age–sex standardised incidence rate of dementia was 4.3 (95% CI: 4.2 to 4.4) per 1000 person-years. Among the adjusted covariates, CD4 cell count<50 cells/mm3(adjusted CSH (aCSH) 8.61, 95% CI: 4.75 to 15.60), uncontrolled viremia (aCSH 1.95, 95% CI: 1.20 to 3.17), 10-year increase in age (aCSH 2.41, 95% CI: 1.89 to 3.07), schizophrenia (aCSH 2.85, 95% CI: 1.69 to 4.80), traumatic brain injury (aCSH 2.43, 95% CI: 1.59 to 3.71), delirium (aCSH 2.27, 95% CI: 1.45 to 3.55), substance use disorder (SUD) (aCSH 1.94, 95% CI: 1.18 to 3.21) and mood/anxiety disorders (aCSH 1.80, 95% CI: 1.13 to 2.86) were associated with an increased hazard for dementia. Initiating ART in 2005–2010 (versus<2000) produced an aCSH of 0.51 (95% CI: 0.30 to 0.89).We demonstrated the negative role of immunosuppression and inflammation on the incidence of dementia among PLWH. Our study also calls for the enhanced integration of care services provided for HIV, mental health, SUD and other risk-inducing comorbidities as a means of lowering the risk of dementia within this population.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"36 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140270306","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 : 2024-03-01DOI: 10.1136/bmjph-2023-000315
Daniel Ohene-Kwofie, Carlos Riumallo-Herl, C. Kabudula, F. Gómez-Olivé
The prevalence of chronic diseases is high among the older population. Awareness of these conditions is a crucial prerequisite to initiate treatment, control and prevent further complications. This study evaluates sociodemographic disparities in awareness of chronic diseases among people 40 years and over in rural South Africa.Data from the baseline survey of the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa were analysed to estimate the level of awareness of chronic conditions such as HIV, hypertension, diabetes and dyslipidaemia among the population 40+ years. We compare self-reported awareness with objective measurements and conduct logistic regressions to evaluate sociodemographic determinants of awareness of chronic conditions.We find that 80% of individuals have at least one chronic condition—HIV, diabetes, hypertension and/or dyslipidaemia. Awareness rates were relatively high among those with at least one chronic condition but varied across conditions and genders: HIV (83% for women, 84% for men), hypertension (88% of women, 81% of men); diabetes (76% for women, 75% for men); dyslipidaemia (10% for both women and men). We observe differences across individual, household and community factors. Generally, women are more aware of their condition; awareness increases with age except for HIV; persons from high consumption per capita households, living with one or more persons and living closer to a health facility are more likely to be aware of their conditions.Older adults in rural South Africa are generally aware of their chronic conditions, though there are important differences by age, gender and socioeconomic status. However, there is still a fraction unaware of their conditions and, therefore, lacking the necessary information to initiate treatment and implement behavioural changes to control them. Our findings may guide policy-makers directing the required efforts to promote targeted awareness campaigns by sociodemographic/socioeconomic subgroups.
{"title":"Sociodemographic disparities in awareness of chronic conditions: an observational study among older persons in rural north-east of South Africa","authors":"Daniel Ohene-Kwofie, Carlos Riumallo-Herl, C. Kabudula, F. Gómez-Olivé","doi":"10.1136/bmjph-2023-000315","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000315","url":null,"abstract":"The prevalence of chronic diseases is high among the older population. Awareness of these conditions is a crucial prerequisite to initiate treatment, control and prevent further complications. This study evaluates sociodemographic disparities in awareness of chronic diseases among people 40 years and over in rural South Africa.Data from the baseline survey of the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa were analysed to estimate the level of awareness of chronic conditions such as HIV, hypertension, diabetes and dyslipidaemia among the population 40+ years. We compare self-reported awareness with objective measurements and conduct logistic regressions to evaluate sociodemographic determinants of awareness of chronic conditions.We find that 80% of individuals have at least one chronic condition—HIV, diabetes, hypertension and/or dyslipidaemia. Awareness rates were relatively high among those with at least one chronic condition but varied across conditions and genders: HIV (83% for women, 84% for men), hypertension (88% of women, 81% of men); diabetes (76% for women, 75% for men); dyslipidaemia (10% for both women and men). We observe differences across individual, household and community factors. Generally, women are more aware of their condition; awareness increases with age except for HIV; persons from high consumption per capita households, living with one or more persons and living closer to a health facility are more likely to be aware of their conditions.Older adults in rural South Africa are generally aware of their chronic conditions, though there are important differences by age, gender and socioeconomic status. However, there is still a fraction unaware of their conditions and, therefore, lacking the necessary information to initiate treatment and implement behavioural changes to control them. Our findings may guide policy-makers directing the required efforts to promote targeted awareness campaigns by sociodemographic/socioeconomic subgroups.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140283278","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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