International Journal of Public Health最新文献

Objectives: Poor hypertension prevention among people living with HIV (PLHIV) in sub-Saharan Africa may undermine progress in HIV prevention achieved within this population. This review synthesizes data on the prevalence, diagnosis, treatment, control, and challenges related to hypertension prevention among PLHIV in SSA.

Methods: A mixed-method systematic review with meta-analysis was conducted from January to December 2024. Data analysis was performed using random-effects modeling stratified by age and sex, along with thematic analysis. The JBI critical appraisal tool was used to assess study quality.

Results: A total of 31 studies, including 32286 PLHIV (±37 years old), were included. Hypertension affected 25% [95% CI, 21%-28%] of PLHIV, yet only 34% [95% CI, 11%-64%] of cases received treatment, and 19% [95% CI, 3%-34%] had controlled blood pressure, despite BP measurement in 95% [95% CI, 89%-100%] of them.

Conclusion: Hypertension prevention challenges stem from patient-related factors, healthcare providers, and health system gaps. Despite the high prevalence of hypertension among PLHIV, treatment initiation and blood pressure control rates remain low. Strengthening the integration of HIV and hypertension care services is urgently needed.

Objectives: Community engagement (CE) is vital for Primary Health Care (PHC) and for achieving the UN Sustainable Development Goals (SDGs) by 2030. However, large public health programs often prioritize measuring outcomes and impact over assessing CE itself. This paper proposes a comprehensive, community-centered Monitoring and Evaluation (M&E) framework with relevant indicators to strengthen CE assessment.

Methods: We reviewed international M&E frameworks and their applications from both public health and community perspectives. Our analysis drew on guidelines from international organizations and 10 years of project data from seven countries.

Results: Findings underscore the need to bridge program-level and community-level indicators while aligning recent M&E guidance with CE frameworks from international agencies. Accordingly, we present a revised, comprehensive, community-centered M&E framework, along with supporting actions for its implementation-such as contextual adaptation, research, digital innovation, resource mobilization, and recommended policy measures.

Conclusion: As the 2030 targets approach, strengthening normative and policy guidance on CE is essential to accelerate progress toward the SDGs. This publication reinforces CE's central role in PHC, Universal Health Coverage, and sustainable development strategies.

Objectives: The study examined the impact of varying prescription requirements for phosphodiesterase-5 inhibitors (PDE-5is) on the management of erectile dysfunction (ED) in men.

Methods: A survey involving 10,000 men from Germany, Norway, Poland, and Switzerland was conducted using the International Index of Erectile Function Questionnaire to identify men with ED and interview them regarding their treatment and experiences. The use of PDE-5is by men without ED was also investigated.

Results: The proportion of PDE-5i users with ED was higher in Norway and Poland (over-the-counter availability) and Switzerland (prescribed by pharmacist) than that in Germany (doctor's prescription required). Across all countries, men seeking to buy PDE-5is from pharmacies were advised to consult a doctor. The use of black market channels for purchasing PDE-5is was minimal in regions allowing non-prescription availability. The non-medical use was uncommon in all regions.

Conclusion: The need for a prescription for PDE-5is may hinder seeking treatment for ED and detecting underlying conditions. Therefore, PDE-5is should be approved as prescription-free medicines to improve the management of ED and to encourage men's engagement with the healthcare system.

Objective: This randomised controlled trial examined whether individuals with severe mental disorders (SMD) in a high-unemployment context benefit in mental health, functional and vocational outcomes when receiving the Individual Placement and Support (IPS) model, compared to vocational rehabilitation (VR).

Methods: A total of 557 individuals (ICD-10 F20-F29 or F31-F32.3) were screened. 63 met inclusion criteria and voluntarily participated. They were randomly assigned to IPS or VR groups. Assessments were conducted at baseline and six months. The study was ethically approved, registered and conducted with blinded evaluations.

Results: IPS participants achieved significantly higher rates of competitive employment and showed greater improvements in global functioning compared with VR. Other mental health and functional outcomes showed no significant group differences. However, participants who obtained employment reported greater improvements in quality of life. No adverse events, such as hospitalizations, were reported.

Conclusion: These findings suggest that IPS may be effective beyond employment outcomes, with some benefits in mental health and functional domains. Despite limitations such as short follow-up and modest sample size, the study supports the feasibility of IPS in challenging labor markets.

Objective: In Côte d'Ivoire, prevalence of hypertension was 39.9% in 2017. This study aimed to determine the prevalence, associate health conditions and evolution of chronic hypertension among pregnant women in Abidjan's neighborhood.

Methods: This was a prospective multicenter cohort study. Bivariate and multivariate analysis was performed.

Results: Prevalence of chronic hypertension was 8.6% [6.11-11.09]. Age (p = 0.001; 95% CI: 2.2-14.5); hyperglycemia (p = 0.04; 95% CI: 1.1-33.5); total cholesterol level (p = 0.02; 95% CI: 1.2-7.3); LDL cholesterol level (p = 0.01; 95% CI: 1.2-5.0); left ventricular hypertrophy (p = 0.03; 95% CI: 1.1-6.6) were significantly associated with chronic hypertension. After multivariate analysis, age ≥35 years (OR = 3.9; 95% CI: 1.4-11.8; p = 0.01) was the only variable statistically associated with chronic hypertension. During the follow-up to full-term pregnancy, systolic and diastolic blood pressures were significantly lower than those collected at inclusion. No complication such as preeclampsia was observed.

Conclusion: The prevalence of chronic hypertension was relatively high. Women aged 35 and over were most at risk of developing the disease. Blood pressure gradually fell and stabilized in the women. No complication was observed.

Objectives: To explore the causal association of metabolic syndrome (MetS) and its components [systolic blood pressure (SBP), fasting blood glucose (FG), waist circumference (WC), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG)] with seven infectious diseases (COVID-19 infection, hospitalized COVID-19, very severe COVID-19, bacterial pneumonia, influenza, intestinal infection, and sepsis) using Mendelian randomization (MR) analysis.

Methods: Causal estimates were primarily obtained using the inverse-variance weighted method, with multiple sensitivity analyses conducted to assess heterogeneity and horizontal pleiotropy.

Results: MetS was causally associated with higher risks of COVID-19 infection (OR = 1.09), hospitalized COVID-19 (OR = 1.27), very severe COVID-19 (OR = 1.40), and sepsis (OR = 1.50). Among MetS components, WC increased risks of COVID-19 infection (OR = 1.10), hospitalized COVID-19 (OR = 1.39), very severe COVID-19 (OR = 1.56), bacterial pneumonia (OR = 1.11), and sepsis (OR = 1.42), while HDL-C reduced risks of intestinal infection (OR = 0.96) and sepsis (OR = 0.92).

Conclusion: This MR study supports a causal link between MetS traits and several infectious diseases, emphasizing the importance of metabolic management in reducing infection susceptibility.

Objectives: This cluster randomized controlled trial assessed the effect of a two-day in-person pesticide safety training with or without text messages grounded in behavioral change theory on knowledge, attitude, and practice scores, exposure intensity scores (EIS) during application, and self-reported signs and symptoms of pesticide poisoning among 539 Ugandan smallholder farmers.

Methods: Twelve subcounties were randomized into three groups: educational (n = 180), educational + text messages (n = 179), or control (n = 180). Intervention effects were estimated with mixed-effects regression models using baseline (2021) and follow-up (2022) data.

Results: Knowledge scores increased by 4.4% (95% CI: 0.9, 7.8) and 6.1% (95% CI: 2.7, 9.6) in the educational and in the education + text messages groups, respectively. Attitudes increased by 6.6% (95% CI: 1.8, 11.4) with text messages. Practice scores showed no significant change. Both interventions reduced pesticide exposure, and text messages reduced signs and symptoms of pesticide poisoning by 1.1% (95% CI: -1.7, -0.3).

Conclusion: The limited changes in general practices suggest that generic and content-heavy training programs may hinder implementation. Tailored behavior change approaches, identifying and addressing locally relevant practices and psychosocial drivers, may enhance farmer safety.

Objectives: In the context of the COVID-19 epidemic, adopting preventive behavior could be defined as complying with recommendations issued by public health authorities. The aim of this study was to investigate heterogeneity of preventive behavior changes over time among cancer patients (CPs) during outbreak.

Methods: The PAPESCO-19 study is a multicenter prospective cohort including 893 CPs from French comprehensive cancer centers (June 2020- June 2021). During the 1-year follow-up, CPs completed questionnaires on socio-demographics, lifestyle and COVID-19-related history. Biological and clinical data were collected from medical records. We used the R package lcmm to determine the different classes of preventive behavior trajectories in CPs.

Results: Between June 2020 and April 2022, over two-thirds of CPs reported wearing a mask during all outings. Only one class of preventive behavior was identified. Female CPs, those on sick leave, CPs unable to work due to health reasons and those spending most of the day at home, showed more preventive behavior. CPs with two or more children were less likely to adopt preventive behavior.

Conclusion: No patient clinical characteristics were associated with preventive behavior.

Objectives: Despite compulsory universal health coverage, rising health insurance premiums in Geneva, Switzerland may present financial barriers to care. This study evaluates trends in forgoing healthcare for financial reasons from 2011 to 2025, with associations with insurance premiums, socioeconomic and health-related factors.

Methods: We conducted an annual cross-sectional study with 1,000 randomly selected participants every year (2011-2025), (n = 10,169). The primary outcome was self-reported forgoing of healthcare for financial reasons. Temporal trends and associations with premiums were analyzed using Locally Estimated Scatterplot Smoothing LOESS regression. Logistic regression assessed associations with individual-level determinants.

Results: Overall, 18.1% reported forgoing care, increasing from 15.8% in 2011 to 25.8% in 2025 (+64.6%), corresponding to a 61.9% rise in premiums. Although low income remained a strong predictor (aOR 2.33 [1.76-3.09]), increases were also seen among higher-income groups. Strong correlations were found between premiums and forgoing care, especially in women (0.813) and young adults (0.805).

Conclusion: Additional reforms are needed to reduce growing inequities in access to care despite compulsory universal coverage.

Objectives: This article analyzes the factors associated with neonatal mortality in Burkina Faso, as well as the communal inequalities in this mortality.

Methods: The analysis is based on data from the 2021 Demographic and Health Survey (DHS). It draws on a representative sample of 7,225 children. The determinants of mortality were examined using a log-binomial regression model. For the analysis of geospatial inequalities, the Richardson method was applied to classify communes according to their probability of achieving SDG target 3.2.2 by 2030, distinguishing areas with low, medium, and high likelihoods of attainment.

Results: The analysis reveals an excess risk of neonatal mortality linked to male sex, multiple births, short birth intervals, low maternal education, and limited access to health services. According to the Richardson classification, all communes are on track to meet SDG target 3.2.2 (12‰ by 2030). However, 37 communes show higher residual risks requiring close monitoring.

Conclusion: These results underline the importance of implementing multi-sectoral interventions adapted to territorial specificities in order to effectively maintain the reduction of neonatal mortality in Burkina Faso.