International Journal for Equity in Health最新文献

Background:  Marginalized populations experience persistent health disparities that may be exacerbated by exposure to health misinformation. This systematic review aimed to identify interventions designed to address health misinformation in marginalized populations and characterize their effectiveness for changing health beliefs, intentions or behaviors.

Methods: Medline, Embase, PsycINFO and Web of Science Core Collection were searched from inception to January 2025, with additional hand-searching of journals and citations. All studies were assessed for eligibility by two reviewers. Quantitative, qualitative, or mixed-method studies were eligible if they aimed to address health misinformation in a marginalized population and reported an outcome relating to health beliefs, intentions or behaviors. Studies that focused only on program design or engagement, and those lacking outcome data, were excluded. The Effective Public Health Practice Project Quality Assessment Tool and the National Institute for Health and Care Excellence Quality Appraisal Checklist were used to assess study quality and risk of bias. Findings were described through narrative synthesis.

Results: Thirty-two studies met eligibility criteria; seven were assessed as moderate quality, 25 as weak. Studies were classified based on intervention components: message-focused (n = 17); capacity- or trust-building (n = 6); or both (n = 9). Studies of message-focused interventions provided moderate-to-low quality evidence for use of pre/debunking to change misinformation beliefs and to increase intentions to comply with recommended health behaviors. Sixteen studies included community engagement in design, and 14 were delivered by community members; early community participation in ideation, design or delivery was reported to improve engagement and trust in health information, contributing to intervention efficacy. However, most studies had limitations in randomization, blinding, and outcome measurement.

Conclusion:  Evidence on interventions to overcome health misinformation in marginalized populations remains limited and generally weak. Debunking and prebunking approaches show promise in changing health beliefs and intentions in some marginalized groups. Representatives from marginalized populations should be routinely involved in design, delivery and evaluation of such interventions.

Registration:  The protocol and search strategy were registered and published in the PROSPERO International Prospective Register of Systematic Reviews (CRD42024550534).

Nitrogen dioxide (NO₂), a significant air pollutant from transport-related fossil fuel combustion, presents a critical environmental health challenge. This study analyses NO₂ trends in Ireland from 2010 to 2020, leveraging the country's low-pollution baseline as a unique case study to analyse inequalities in NO₂ concentrations across the country. Data at a small area level from Census 2022 were integrated with measurements of NO₂ concentrations to assess environmental inequalities across novel indicators such as housing tenancy and self-rated health alongside conventional socioeconomic measures. The research uncovers clear evidence of environmental inequalities in NO₂ concentrations, with higher levels found in neighbourhoods with larger proportions of non-white populations and non-owner-occupied housing. A stratified urban-rural analysis shows these disparities were most pronounced in urban areas. A U-shaped relationship between NO₂ levels and deprivation, educational attainment, and skills, suggests that while the most and least deprived may experience similar NO₂ concentrations, the health burden on disadvantaged groups may be amplified by co-occurring vulnerabilities. These findings underscore an urgent need for targeted interventions to mitigate the disproportionate burden of NO₂ air pollution on vulnerable communities in Ireland.

Background: Maternal and child undernutrition remains a major global health concern despite modest progress. Accelerating reductions in stunting and wasting will require increased investments in nutrition-sensitive interventions, which target nutrition impacts outside of the healthcare setting. This review examines the effects of four types of nutrition-sensitive interventions -cash/food transfers, nutrition-sensitive agriculture, water/sanitation/hygiene, and school nutrition- on maternal and child nutrition outcomes and dietary diversity.

Methods: We synthesized the evidence using an initial broad search and synthesis for nutrition-sensitive interventions, followed by targeted searches and syntheses for specific interventions and nutrition outcomes. Meta-analyses were performed to evaluate the impacts of cash transfers and agricultural interventions, while a narrative synthesis was produced for additional nutrition-sensitive interventions. Additionally, qualitative synthesis was incorporated to provide insights into the relationship between implementation context and program effectiveness.

Results: Our initial evidence synthesis included 260 quantitative studies, and additional targeted searches produced 72 eligible articles. Meta-analyses reveal positive impacts on dietary diversity for cash transfers without nutrition-specific components (0.14 SMD; 95% CI: 0.06-0.22), and some nutrition-sensitive agricultural interventions (0.24 SMD; 95% CI: 0.11-0.37). Cash transfers have larger effects on dietary diversity when they include behavior change communication or other nutrition-specific elements (0.41 SMD; 95% CI; 0.15-0.66), whereas agriculture programs with nutrition-specific elements do not show larger effects on dietary diversity than those without. Narrative syntheses indicate that homestead food production interventions may reduce anemia, school feeding interventions may improve anthropometric outcomes, and WASH interventions are most effective when combined with other nutrition initiatives.

Conclusions: We find consistent evidence that nutrition-sensitive programs contribute to dietary diversity and may have small but positive effects on nutrition outcomes, such as anthropometric outcomes and anemia. Integrating nutrition into social protection, agriculture, and education sectors is essential for addressing the underlying causes of malnutrition, such as dietary diversity.

Registration: Our review protocols were pre-registered at AIR.org [ https://www.air.org/sites/default/files/2024-01/Synthesis-of-evidence-nutrition-sensitive-interventions-maternal-childrens-nutrition-outcomes-research-protocol-Nov-2023.pdf ] and PROSPERO [ https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024552449 ].

Background: Anorectal malformations (ARMs) are common congenital anomalies in low-and middle-income countries (LMICs), and they are often repaired in a staged manner. High out-of-pocket (OOP) payment for surgical care in many LMICs makes households vulnerable to catastrophic health expenditures (CHE). ARM patients often require multiple operations and hospitalizations, which may make them vulnerable to CHE. In this study, we sought to determine the prevalence of CHE and the factors driving these costs among families of children with ARMs in southwestern Uganda.

Methods: This was a combined retrospective and prospective cohort study of the OOP and CHE among families of children with ARMs at a Regional Referral Hospital between June 2021 and July 2023. CHE was defined as a cost exceeding 10% of annual income. Patient characteristics were compared, and multivariable modeling with best subset analysis was used to determine which factors were significantly associated with CHE and total OOP expenditure.

Results: There were 236 study participants with a median age at diagnosis of 6 days, 51% were male, 71% lived in rural areas, and the median distance traveled was 175 km. 64% of patients experienced CHE, with almost all families incurring travel costs (99%). Following best subset analysis, distance traveled (OR 1.06, 95% CI: 1.03-1.08) and rurality (OR 1.83, 95% CI: 0.96-3.48) were significantly associated with CHE, suggesting that for every additional 10 km, a patient traveled for care, there were 6% higher odds of incurring CHE. In examining total cost, patients who had a two-stage repair incurred more than twice the costs compared to those who had a single-stage repair, and education level and repair type were also significantly associated.

Conclusion: Identifying methods to provide financial protection from CHE is essential for all children. ARM patients are at particularly high risk for CHE and high OPP expenditures, especially those living far from healthcare services and in rural areas.

Background: Ethnic inequities in lung cancer in New Zealand are stark, with Māori (New Zealand's indigenous population) rates more than three times higher than European rates. New Zealand has a broad range of data that can be used to understand and monitor health inequities but limited understanding of how the use of different datasets and methods affects reported rates of health indicators. This study examined whether measured ethnic differences in lung cancer registration rates change depending on the population used and the source of ethnicity data.

Methods: We used data from the Integrated Data Infrastructure (IDI), a collection of linked, deidentified, New Zealand whole-population administrative and survey datasets. Lung cancer registrations were identified through the New Zealand Cancer Registry. We calculated age-standardised lung cancer registration rates (for Māori and sole European ethnic groups) and relative risks (Māori compared to sole European). These were compared for: six population selection methods (holding the source of ethnicity data constant); four sources of ethnicity data (holding the population constant); and ten combinations of population selection method and ethnicity data source.

Results: Population selection method and source of ethnicity data each had independent impacts on lung cancer registration rates and the Māori: sole European relative risk. Changing the population selection method had a larger impact than changing the source of ethnicity data. Different combinations of population selection method and ethnicity data source resulted in different age-standardised lung cancer registration rates, with 24.4% difference between the lowest and highest Māori rates and 11.7% between the lowest and highest sole European rates. The Māori: sole European relative risk varied by13.4% between the lowest and highest estimates.

Conclusions: Population selection method and source of ethnicity data have a measurable impact on lung cancer rates, especially for Māori, and on measures of inequity. Changes to these methods may disrupt the time series, obscure trends in inequities, and disrupt Māori rights to monitor the Crown. It is therefore critical that any methodological changes are undertaken with guidance from Māori. Transparency and consistency in IDI methods, and collecting high quality ethnicity data, are also priorities.