Public Health最新文献_第9页

The distribution of healthcare workforces relative to population ill health in England: Repeated cross-sectional analysis of Census data 2001–2021 英格兰医疗保健工作人员相对于健康不良人口的分布：2001-2021年人口普查数据的重复横断面分析。

IF 3.2 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2025-12-15 DOI: 10.1016/j.puhe.2025.106090

A. Clarke , L. Quinn , G.M. Peat

Objectives

To investigate inverse and positive care laws for the geographic distribution of different healthcare workforces in England between 2001 and 2021.

Study design

Repeated, cross-sectional, ecologic study at the level of Local Authorities (2001, 2011, 2021) and Integrated Care Boards (2021).

Methods

Using national Census survey data for England from 2001, 2011, and 2021 we correlated the prevalence of ill health in the resident population with the proportion of different health professional groups employed in the resident working-age population. To explore the previously described Positive Care Law for informal care, we correlated with the prevalence of ill health with the proportion of the resident population providing 50+ hours of unpaid care per week.

Results

Across 2001, 2011, and 2021, the distributions of medical professionals and ‘health associates and therapy professionals’ were consistently inversely distributed relative to population ill health. Nursing professionals and informal caregiving were consistently positively correlated. Data available in 2021 on detailed professional groups revealed wide variation in the distribution of different professional groups relative to population ill health: speech and language therapists (r=−0.456), complementary health associate professionals (r=−0.478), and psychotherapists/cognitive behaviour therapists (r=−0.558) showed the strongest inverse correlation with population ill health. Pharmaceutical technicians (0.774), nursing auxiliaries/assistants (0.764), and care workers/home carers (0.746) were among the most positively correlated.

Conclusions

Inverse and positive care laws for healthcare workforce distribution in England appear largely unchanged over the past 20 years. Marked variation between different health professions suggests the need for targeted actions to improve equitable distribution.

目的：调查2001年至2021年间英格兰不同医疗保健劳动力地理分布的逆保健和正保健规律。研究设计：在地方政府（2001年、2011年、2021年）和综合护理委员会（2021年）层面进行重复的、横断面的生态研究。方法：利用英国2001年、2011年和2021年的全国人口普查数据，将常住人口中健康状况不佳的患病率与常住工作年龄人口中不同卫生专业群体的比例联系起来。为了探索之前描述的非正式护理的积极护理法，我们将健康状况不健康的患病率与每周提供50小时以上无偿护理的常住人口比例联系起来。结果：在2001年、2011年和2021年，医疗专业人员和“健康助理和治疗专业人员”的分布相对于人口健康状况一直呈负分布。专业护理人员与非正式护理持续呈正相关。2021年关于详细专业群体的现有数据显示，相对于人口健康状况不佳，不同专业群体的分布差异很大：语言和语言治疗师（r=-0.456）、辅助健康助理专业人员（r=-0.478）和心理治疗师/认知行为治疗师（r=-0.558）与人口健康状况不佳表现出最强的负相关。药学技术人员（0.774）、护理辅助人员/助理（0.764）和护理人员/家庭护理人员（0.746）呈正相关。结论：在过去的20年里，英格兰医疗保健劳动力分布的逆和正护理法律似乎基本没有变化。不同卫生专业之间的显著差异表明，需要采取有针对性的行动来改善公平分配。

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引用次数: 0

Epidemiology and control of human immunodeficiency and hepatitis C virus in Spanish prisons over the last 30 years: Towards the achievement of sustainable development goals 过去30年来西班牙监狱中人体免疫缺陷和丙型肝炎病毒的流行病学和控制：实现可持续发展目标。

IF 3.2 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2025-12-13 DOI: 10.1016/j.puhe.2025.106097

Victoria Hernando , Catarina Filipe Santos , Natalia Cuenca , Julia del Amo , Asuncion Diaz , Enrique Acín , Carmen Martinez-Aznar

Objectives

Our aims were to describe the public health interventions for the prevention and control of HIV and HCV infections in penitentiary institutions in Spain from 1989 until 2023 and to describe the epidemiological trends of HIV and HCV among inmates from 1993 until 2023.

Study design

Ecological and retrospective observational study.

Methods

All prevention programs and control measures for HIV and HCV infections implemented in Spanish prisons were reviewed. Aggregate data were extracted from central registries, reports, official documents (grey literature) and epidemiological bulletins issued by the Public Health division of the General Subdirectorate of Prison Health.

Results

Various control measures, such as harm reduction programs, including syringe exchange and methadone maintenance programs, have been implemented in Spanish prisons since 1989. These measures have been modified and adapted in response to changes in the prison population. The prevalence of HIV and HCV infection among inmates in Spanish prisons has decreased markedly over the study period: from 23.5 % in 1993 to 3.2 % in 2023 for HIV, and from 48.6 % in 1998 to 9.6 % in 2023 for HCV. In the past three years, fewer than 1 % of inmates had a detectable HCV viral load. No HIV or HCV seroconversions have been reported in Spanish prisons since 2015 and 2020, respectively.

Conclusions

This ecological study found a correlation between interventions designed and implemented in Spanish prisons for the prevention, diagnosis and treatment of HIV and HCV, and a reduction in the prevalence of these infections among the prison population.

目的：我们的目的是描述1989年至2023年西班牙监狱机构预防和控制艾滋病毒和丙型肝炎病毒感染的公共卫生干预措施，并描述1993年至2023年囚犯中艾滋病毒和丙型肝炎病毒的流行病学趋势。研究设计：生态学和回顾性观察性研究。方法：对西班牙监狱实施的所有HIV和HCV感染预防规划和控制措施进行回顾。汇总数据摘自中央登记处、报告、官方文件（灰色文献）和监狱卫生总局公共卫生司发布的流行病学公报。结果：自1989年以来，西班牙监狱实施了各种控制措施，如减少危害方案，包括注射器交换和美沙酮维持方案。根据监狱人口的变化，对这些措施进行了修改和调整。在研究期间，西班牙监狱囚犯中艾滋病毒和丙型肝炎病毒感染率显著下降：艾滋病毒感染率从1993年的23.5%降至2023年的3.2%，丙型肝炎病毒感染率从1998年的48.6%降至2023年的9.6%。在过去的三年里，只有不到1%的囚犯有可检测到的HCV病毒载量。自2015年和2020年以来，西班牙监狱分别没有HIV或HCV转换的报告。结论：这项生态学研究发现，在西班牙监狱中设计和实施的预防、诊断和治疗艾滋病毒和丙型肝炎病毒的干预措施与监狱人口中这些感染的患病率降低之间存在相关性。

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引用次数: 0

The effect of Tai Chi exercise on physical and psychological health of college students with persistent fatigue after COVID-19 infection: A randomized controlled trial 太极拳运动对新型冠状病毒感染后持续性疲劳大学生身心健康的影响：一项随机对照试验

IF 3.2 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2025-12-13 DOI: 10.1016/j.puhe.2025.106105

Jingyu Sun, Ke Yao, Hang Chu, Jiajia Chen, Changhong Du, Bin Li, Zhijie Yu, Ziqi Zhang, Tao Chen

Objectives

This study aims to examine the impact of a 16-week Tai Chi program on the physical and mental health of college students (ages 18–20 years) with post-COVID-19 fatigue symptoms.

Study design

A randomized controlled trial.

Methods

Seventy students were randomly assigned to either a Tai Chi group (n = 35), participating in a 16-week Tai Chi exercise program (3 × 90 min/week), or a control group (n = 35), maintaining their usual routines. Physical and mental health were assessed before and after using various scales, including the Fatigue Scale 14, Pittsburgh Sleep Quality Index, Hamilton Anxiety Scale, the 10-item Kessler Psychological Distress Scale, Perceived Stress Scale, Self-Rating Depression Scale, the 36-Item Short Form Health Survey questionnaire (SF-36), International Physical Activity Questionnaire, and physical fitness data.

Results

The Tai Chi group showed significant improvements in fatigue, physical functioning (SF-36), balance (one foot with eyes closed), and squat performance compared to the control group (p < 0.05). Sleep quality, habitual sleep efficiency, physical and social functioning, total physical activity, high-intensity activity, flexibility, and core strength (e.g., sit-ups) also improved significantly (p < 0.05).

Conclusion

Tai Chi effectively reduces fatigue and enhances physical fitness, balance, and sleep in college students with post-COVID-19 fatigue symptoms.

目的：本研究旨在探讨为期16周的太极拳运动对新冠肺炎后疲劳症状大学生（18-20岁）身心健康的影响。研究设计：随机对照试验。方法：70名学生被随机分配到太极拳组（n = 35），参加为期16周的太极拳锻炼计划（3 × 90分钟/周），或对照组（n = 35），保持他们的日常活动。采用疲劳量表14、匹兹堡睡眠质量指数、汉密尔顿焦虑量表、10项Kessler心理困扰量表、感知压力量表、抑郁自评量表、36项简短健康调查问卷（SF-36）、国际体育活动问卷和体能数据，对前后的身心健康状况进行评估。结果：与对照组相比，太极拳组在疲劳、身体功能（SF-36）、平衡（单脚闭眼）和深蹲表现方面均有显著改善(p)。结论：太极拳能有效减轻疲劳，增强新冠肺炎后疲劳症状大学生的体质、平衡和睡眠。

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引用次数: 0

Characterising online gamblers exceeding financial risk thresholds in the UK: A retrospective analysis using open banking data 表征在线赌徒超过金融风险阈值在英国：回顾性分析使用开放银行数据

IF 3.2 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2025-12-11 DOI: 10.1016/j.puhe.2025.106080

Kasra Ghaharian , Mana Azizsoltani , Charles Cohen , Piyush Puranik , Bernardo Chagas

Objectives

In February 2025, the UK Gambling Commission mandated that online gambling operators must conduct financial risk checks for customers incurring a net loss of over £150 in any rolling 30-day period. This policy aims to mitigate gambling-related harm by identifying potentially vulnerable individuals. This study provides a pre-policy baseline profile of individuals who would have triggered these newly mandated thresholds, using large-scale open banking data.

Study design

Retrospective cross-sectional analysis.

Methods

We used a 12-month period of bank transaction data from 243,478 UK-based gamblers to characterize individuals who would have exceeded the threshold. We examined demographic and behavioural characteristics of this group and used cluster analysis to identify subgroups with distinct financial and gambling profiles.

Results

Nearly a quarter of gamblers triggered the threshold and accounted for the vast majority of total gambling expenditure (∼92%). These Exceeding Threshold Gamblers (ETGs) were disproportionately male, younger, and exhibited significantly greater gambling involvement. Cluster analysis revealed three ETG subgroups, with approximately half classified as diversified spenders whose gambling appeared proportionate to income and part of broader discretionary spending, while others exhibited patterns more consistent with potential financial vulnerability.

Conclusions

While the policy may effectively flag at-risk individuals, it also captures a heterogeneous population.

2025年2月，英国赌博委员会规定，在线赌博运营商必须对任何30天内净损失超过150英镑的客户进行财务风险检查。这项政策旨在通过识别潜在的弱势群体来减轻与赌博相关的伤害。本研究使用大规模开放银行数据，提供了可能触发这些新规定阈值的个人政策前基线概况。研究设计：回顾性横断面分析。方法：我们使用了来自243478名英国赌徒的12个月的银行交易数据来描述可能超过阈值的个人。我们检查了这一群体的人口统计和行为特征，并使用聚类分析来确定具有不同金融和赌博概况的子群体。结果近四分之一的赌徒触发了阈值，占赌博总支出的绝大部分（约92%）。这些超过阈值的赌徒（etg）不成比例地是男性，年轻，并表现出更大的赌博参与。聚类分析揭示了三个ETG子组，其中大约一半被归类为多元化消费者，他们的赌博似乎与收入成比例，是更广泛的可自由支配支出的一部分，而其他人则表现出与潜在的财务脆弱性更一致的模式。结论：虽然该政策可能有效地标记出高危人群，但它也捕获了异质人群。

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引用次数: 0

Humiliation and sexual violence in medical students: Results from two nationwide studies 医学生的羞辱和性暴力：两项全国性研究的结果

IF 3.2 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2025-12-11 DOI: 10.1016/j.puhe.2025.106089

Agnès Trouche , Nicolas Doudeau , François Vilain , Kahina Sadat , Yannick Morvan , Ariel Frajerman

Objectives

Sexual and gender-based violence (SGBV) affects an important part of the population, and medical trainees are no exception. A 2014 meta-analysis on medical students found that 59 % experienced at least one form of harassment or discrimination during their studies. This study aimed to gather data on SGBV among French medical students in 2024 and to compare its evolution since 2021.

Study design

Two national online surveys on mental health in medical school students and residents of all specialities were conducted in 2021 and 2024.

Methods

In both surveys, the questionnaire included a section on humiliation and sexual violence, using 5 questions from a nationwide survey on Students in France.

Results

We included 17,225 subjects: 9960 in 2021 and 7265 in 2024. The prevalence of violence during the medical studies was 27 % and 17 % for humiliation, 29 % and 22 % for sexual harassment, and 5 % and 6 % for sexual assault in 2021 and 2024, respectively. Women were five times more likely to experience sexual harassment than men. Among the victims, 76 % reported experiencing violence in the hospital, 28 % at student parties, and 10 % at the university. Since 2021, there has been a 26 % increase in reported incidents of violence compared to the previous year (19 %).

Conclusions

Despite policies implemented following previous surveys, the rate of sexual harassment remains high. The majority of these violent occurrences in hospital settings highlighting the importance of taking specific actions tailored to the structure of medical studies and the healthcare and caregiving system.

性暴力和基于性别的暴力（SGBV）影响到人口的重要组成部分，医务学员也不例外。2014年一项针对医学生的荟萃分析发现，59%的医学生在学习期间至少经历过一种形式的骚扰或歧视。本研究旨在收集2024年法国医学生中SGBV的数据，并比较其自2021年以来的演变。研究设计于2021年和2024年进行了两次全国医学院学生和各专业住院医师心理健康在线调查。方法在这两项调查中，问卷都包含了关于羞辱和性暴力的部分，使用了来自法国全国学生调查的5个问题。结果共纳入受试者17225例，其中2021年9960例，2024年7265例。在2021年和2024年，医学研究期间的暴力发生率分别为羞辱27%和17%，性骚扰29%和22%，性侵犯5%和6%。女性遭受性骚扰的可能性是男性的五倍。在受害者中，76%的人报告在医院遭受暴力，28%在学生聚会上，10%在大学。自2021年以来，报告的暴力事件比前一年（19%）增加了26%。尽管根据之前的调查实施了相关政策，但性骚扰的发生率仍然很高。这些暴力事件大多数发生在医院环境中，突出了针对医学研究结构和医疗保健和护理系统采取具体行动的重要性。

{"title":"Humiliation and sexual violence in medical students: Results from two nationwide studies","authors":"Agnès Trouche , Nicolas Doudeau , François Vilain , Kahina Sadat , Yannick Morvan , Ariel Frajerman","doi":"10.1016/j.puhe.2025.106089","DOIUrl":"10.1016/j.puhe.2025.106089","url":null,"abstract":"<div><h3>Objectives</h3><div>Sexual and gender-based violence (SGBV) affects an important part of the population, and medical trainees are no exception. A 2014 meta-analysis on medical students found that 59 % experienced at least one form of harassment or discrimination during their studies. This study aimed to gather data on SGBV among French medical students in 2024 and to compare its evolution since 2021.</div></div><div><h3>Study design</h3><div>Two national online surveys on mental health in medical school students and residents of all specialities were conducted in 2021 and 2024.</div></div><div><h3>Methods</h3><div>In both surveys, the questionnaire included a section on humiliation and sexual violence, using 5 questions from a nationwide survey on Students in France.</div></div><div><h3>Results</h3><div>We included 17,225 subjects: 9960 in 2021 and 7265 in 2024. The prevalence of violence during the medical studies was 27 % and 17 % for humiliation, 29 % and 22 % for sexual harassment, and 5 % and 6 % for sexual assault in 2021 and 2024, respectively. Women were five times more likely to experience sexual harassment than men. Among the victims, 76 % reported experiencing violence in the hospital, 28 % at student parties, and 10 % at the university. Since 2021, there has been a 26 % increase in reported incidents of violence compared to the previous year (19 %).</div></div><div><h3>Conclusions</h3><div>Despite policies implemented following previous surveys, the rate of sexual harassment remains high. The majority of these violent occurrences in hospital settings highlighting the importance of taking specific actions tailored to the structure of medical studies and the healthcare and caregiving system.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"251 ","pages":"Article 106089"},"PeriodicalIF":3.2,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exploring the association between supportive school policy and youth tobacco use 探索支持性学校政策与青少年烟草使用之间的关系

IF 3.2 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2025-12-10 DOI: 10.1016/j.puhe.2025.106083

Lina S. Modjarrad , Jaclyn M. Hall , Frederick R. Kates , Christopher R. Cogle , Robert Ostbye , Nicole M. Marlow , Jennifer H. LeLaurin

Objectives

To examine the association between supportive, evidence-based school tobacco policies and youth tobacco use across Florida counties.

Study design

Cross-sectional exploratory study.

Methods

This study was conducted across 66 counties and their respective school districts in the state of Florida. Using 2021 school district policy data and 2022 youth tobacco use data, we conducted a linear regression analysis to assess the county-level correlation between supportive tobacco policies and self-reported youth tobacco use. We also examined changes in school tobacco policy from 2021 to 2022.

Results

Policy data was available for 66 of the 67 total Florida counties. Results of the primary analysis indicate that counties with evidence-based tobacco policies experienced a 15.7 % relative reduction in self-reported youth tobacco product use in the subsequent year. Counties with in-school support services had the strongest association with lower youth tobacco product use, followed by referral to cessation resources. The number of counties with any supportive policy increased from 51 (77.3 %) in 2021 to 61 (92.4 %) in 2022. The proportion of counties with exclusionary policies remained unchanged.

Conclusions

We found a small but significant association of lower tobacco use rates among youth in counties with supportive tobacco policies. This study concurs with evidence that supportive tobacco policies are protective against youth tobacco use. However, given the exploratory nature of this study, these findings should be considered preliminary, and additional research is warranted to confirm the observed associations. Further research is needed to understand the barriers and facilitators of policy reform and implementation in these areas.

目的研究支持性的、基于证据的学校烟草政策与佛罗里达州各县青少年烟草使用之间的关系。研究设计横断面探索性研究。方法本研究在佛罗里达州66个县及其各自的学区进行。利用2021年学区政策数据和2022年青少年烟草使用数据，我们进行了线性回归分析，以评估县级支持烟草政策与青少年自我报告烟草使用之间的相关性。我们还研究了2021年至2022年学校烟草政策的变化。结果佛罗里达67个县中有66个县的政策数据可用。初步分析结果表明，实施循证烟草政策的县在随后一年自我报告的青少年烟草制品使用情况相对减少了15.7%。有校内支持服务的县与青少年烟草制品使用率较低的相关性最强，其次是转介到戒烟资源。有扶持政策的县从2021年的51个（77.3%）增加到2022年的61个（92.4%）。实行排斥政策的县的比例保持不变。结论：我们发现，在支持烟草政策的县，青少年的烟草使用率较低，相关性虽小，但意义重大。这项研究与支持性烟草政策可防止青少年使用烟草的证据相一致。然而，考虑到本研究的探索性，这些发现应该被认为是初步的，需要进一步的研究来证实观察到的关联。需要进一步研究以了解这些领域政策改革和实施的障碍和促进因素。

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引用次数: 0

Adaptation, acceptability and preliminary impacts of a sexual health and financial literacy intervention for indigenous adolescents in Ecuador: A mixed-methods pilot study 厄瓜多尔土著青少年性健康和金融知识干预措施的适应、可接受性和初步影响：一项混合方法试点研究

IF 3.2 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2025-12-08 DOI: 10.1016/j.puhe.2025.106088

Allpa Tituaña , Marta Wilson-Barthes , Alethea Desrosiers , Shari J. Jardine , Megna Srinivasan , Iván Palacios , Omar Galárraga

Objectives

To assess the acceptability, feasibility and preliminary impacts of a group-based financial literacy and reproductive health intervention adapted for indigenous youth in Ecuador.

Study design

Mixed-methods quasi-experimental pilot study.

Methods

This study (November 2023–June 2024) enrolled 47 adolescents, ages 15–19, from Cotacachi, Ecuador. Using the ADAPT-ITT framework, we adapted an existing entrepreneurship curriculum to the local context, and integrated curriculum with an existing reproductive health education platform. Twenty-nine adolescents received the school-based group intervention over 4 months, with 18 control participants. Qualitatively, focus groups elicited intervention acceptability from 11 youth. Quantitatively, Wilcoxon rank-sum tests and MANOVA compared empowerment and health outcomes between intervention participants and controls. Adjusted linear and logistic regression estimated intention-to-treat effects of the intervention on outcomes.

Results

The study recruited 96.7 % and 60.0 % of the target sample for the intervention (29/30) and control (18/30) conditions, respectively. Regression results showed positive associations between the intervention and financial literacy (β = 1.33, p < 0.01) and sexual health knowledge (β = 1.52, p < 0.01), and modest positive associations (p > 0.10) with entrepreneurial self-efficacy, engagement in income-generating activities, gender empowerment, and less-frequent penetrative sex. All focus group participants valued the financial management and entrepreneurship components of the intervention; most stated that the curriculum improved their decision-making around sex and relationships.

Conclusions

This pilot evidence supports acceptability and potential benefits of an economic empowerment and reproductive health intervention for indigenous youth at high risk of pregnancy in Ecuador. A randomized trial is needed to test the effectiveness of the intervention on longer-term income generation and pregnancy reduction.

目的评估厄瓜多尔土著青年基于群体的金融知识和生殖健康干预的可接受性、可行性和初步影响。研究设计混合方法准实验先导研究。方法本研究（2023年11月- 2024年6月）从厄瓜多尔科塔卡奇市招募了47名15-19岁的青少年。利用ADAPT-ITT框架，我们根据当地情况调整了现有的创业课程，并将课程与现有的生殖健康教育平台相结合。29名青少年接受了为期4个月的以学校为基础的小组干预，对照组为18名。从质量上讲，焦点小组从11名青年中引出了干预的可接受性。定量地，Wilcoxon秩和检验和方差分析比较了干预参与者和对照组之间的赋权和健康结果。调整后的线性和逻辑回归估计了干预对结果的意向治疗效应。结果干预组（29/30）和对照组（18/30）分别招募了96.7%和60.0%的目标样本。回归结果显示，干预与金融知识（β = 1.33, p < 0.01）和性健康知识（β = 1.52, p < 0.01）呈正相关，与创业自我效能感、创收活动参与、性别赋权和较少的插入性行为呈正相关（p > 0.10）。所有焦点小组参与者都重视干预措施的财务管理和企业家精神组成部分；大多数人表示，该课程提高了他们在性和人际关系方面的决策能力。这一试点证据支持了经济赋权和生殖健康干预对厄瓜多尔高危怀孕土著青年的可接受性和潜在效益。需要一项随机试验来测试干预对长期创收和减少怀孕的有效性。

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引用次数: 0

Regional differences in type 2 diabetes prevention priorities for women with previous gestational diabetes: A multi-methods consensus study 既往妊娠期糖尿病妇女2型糖尿病预防重点的地区差异：一项多方法共识研究

IF 3.2 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2025-12-08 DOI: 10.1016/j.puhe.2025.106011

Gebresilasea Gendisha Ukke , Maureen Makama , Elysa Ioannou , Helen Skouteris , Cynthia Montanaro , Melaku Taye Amogne , Bhagiaswari Kodapally , Lisa J. Moran , CHIRP, Ahmed Reja , Sharleen L. O'Reilly , Leanne M. Redman , Elezebeth Mathews , Jacqueline A. Boyle , Siew Lim

Objectives

To identify values, principles, and research priorities for type 2 diabetes mellitus (T2DM) prevention in women with previous gestational diabetes mellitus (GDM) across five regions, and evaluate the appropriateness of modified Delphi and nominal group consensus methods in diverse cultural settings.

Study design

Mixed-methods.

Methods

Health professionals and women with previous GDM from five regions were invited to participate in the priority-setting activities according to a modified Delphi process and nominal group technique. The Child Health and Nutrition Research Initiative was used to develop the assessment criteria, which included answerability, effectiveness, deliverability, the maximum potential for improving the health and well-being of postpartum mothers, and the effect on equity. Participants ranked items in three rounds of the Delphi process. Evaluation surveys and semi-structured interviews were conducted to understand participants' experiences of the process.

Results

Fifty health professionals and 50 women with previous GDM participated in the priority-setting process and evaluation survey, with 11 individuals also taking part in interviews. Regional differences emerged in priority rankings for values and principles. Africa emphasised cost-effectiveness and capacity building; the Americas prioritised people-centred approaches and continuity of care; Asia focused on equity-driven services and family support; Europe highlighted combating misinformation; Oceania emphasised planning skills. Consensus methods were feasible and acceptable across the regions.

Conclusion

T2DM prevention priorities for women with a history of GDM vary across geographical regions, suggesting a need for local and tailored approaches for effective implementation. Consensus approaches involving the community in implementation efforts are acceptable across diverse geographical contexts.

目的：确定五个地区既往妊娠期糖尿病（GDM）妇女预防2型糖尿病（T2DM）的价值、原则和研究重点，并评估改进的德尔菲法和名义群体共识法在不同文化背景下的适用性。研究设计：混合方法。方法：根据改进的德尔菲法和名义小组技术，邀请来自五个地区的卫生专业人员和既往患有GDM的妇女参与重点确定活动。儿童健康和营养研究倡议用于制定评估标准，其中包括责任、有效性、可交付性、改善产后母亲健康和福祉的最大潜力以及对公平的影响。参与者在三轮德尔菲过程中对项目进行排名。通过评估调查和半结构化访谈来了解参与者在这一过程中的经历。结果：50名保健专业人员和50名既往患有GDM的妇女参加了确定优先事项的过程和评估调查，11人也参加了访谈。在价值观和原则的优先排序上，出现了地区差异。非洲强调成本效益和能力建设；美洲优先考虑以人为本的办法和持续的护理；亚洲侧重于股票驱动型服务和家庭支持；欧洲强调打击错误信息；大洋洲强调规划技能。协商一致的方法在各区域都是可行和可接受的。结论：对于有GDM病史的女性，预防T2DM的重点在不同的地理区域有所不同，这表明需要采取因地制宜的方法来有效实施。让社区参与执行工作的协商一致办法在不同的地理环境中都是可以接受的。

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引用次数: 0

Spatial and temporal patterns and determinants of chronic disease multimorbidity among middle-aged and older adults in China: Evidence from two longitudinal cohort studies 中国中老年人慢性病多发病的时空格局和决定因素：来自两项纵向队列研究的证据

IF 3.2 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2025-12-06 DOI: 10.1016/j.puhe.2025.106084

Jiaojiao Lv , Yanran Huang , Fan Du, Jiaxuan Wang, Mingxia Jing

Objectives

This study aims to investigate the spatial and temporal heterogeneity in the evolution and determinants of multimorbidity among middle-aged and elderly populations, thereby providing data support for formulating regionalized prevention and control measures for multimorbidity.

Study design

Retrospective analysis of two longitudinal cohort studies.

Methods

We utilized longitudinal data from five waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020) and the China Family Panel Study (CFPS, 2012–2020), focusing on individuals aged 45 years and older. Sociodemographic information and chronic disease prevalence were extracted and analyzed using geographic information system (GIS) technology to identify spatial and temporal patterns in the development of multimorbidity and the identification of determinants influencing multimorbidity across different provinces.

Results

Between 2011 and 2020, the prevalence of chronic diseases among middle-aged and elderly individuals showed a fluctuating but overall upward trend at both the national level and within the regions of China. A spatial pattern of stepwise increase from east to west emerged, with Henan Province consistently serving as the epicenter of multimorbidity prevalence. Significant spatial autocorrelation was detected in the distribution of multimorbidity. Moreover, the determinants behind multimorbidity exhibited marked spatial heterogeneity, indicating region-specific influences. Alcohol consumption leads to increased risk of multimorbidity, especially in the East China regions. The Northwest region is the primary location where smoking has a negative effect.

Conclusions

Multimorbidity among middle-aged and elderly adults in China is not only highly prevalent but also increasing at a rapid pace. The spatial distribution highlights the need for geographically differentiated public health strategies. Particular attention should be paid to the higher prevalence among women, and targeted tobacco and alcohol control policies are especially warranted in northwestern regions of the country.

目的研究中老年人群多重发病的时空异质性及其影响因素，为制定区域化的多重发病防治措施提供数据支持。研究设计对两项纵向队列研究进行回顾性分析。方法利用中国健康与退休纵向研究（CHARLS, 2011-2020）和中国家庭面板研究（CFPS, 2012-2020）的五波纵向数据，重点关注45岁及以上的个体。利用地理信息系统（GIS）技术提取和分析社会人口统计信息和慢性病患病率，以确定不同省份多病发展的时空格局，并确定影响多病的因素。结果2011 - 2020年，中国中老年人群慢性病患病率在全国和区域范围内均呈波动上升趋势。呈现自东向西逐步增加的空间格局，河南省始终是多病流行的中心。多病分布存在显著的空间自相关性。此外，多病背后的决定因素表现出明显的空间异质性，表明区域特异性影响。饮酒导致多病风险增加，特别是在华东地区。西北地区是吸烟产生负面影响的主要地区。结论中国中老年人群多种疾病发病率高，且呈快速增长趋势。这种空间分布突出表明，需要有地域差别的公共卫生战略。应特别注意妇女吸烟率较高的问题，并特别有必要在该国西北地区制定有针对性的烟草和酒精控制政策。

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引用次数: 0

Cancer deaths attributable to lifestyle risk factors in five Latin American countries 五个拉丁美洲国家中由生活方式风险因素导致的癌症死亡

IF 3.2 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health

Pub Date : 2025-12-05 DOI: 10.1016/j.puhe.2025.106079

Paloma Ferrero-Hernández , Claudio Farías-Valenzuela , Leandro F.M. Rezende , Eduardo Augusto Fernandes Nilson , Jacqueline Wahrhaftig , Luis Felipe Castelli Correia de Campos , Gerson Ferrari

Objectives

Cancer is the leading cause of premature death in Latin America, driven largely by modifiable lifestyle factors such as poor diet, physical inactivity, alcohol intake and tobacco use. In this study, we estimated the burden of cancer deaths attributable to lifestyle risk factors in five Latin American countries.

Study design

Comparative risks assessment modeling study.

Methods

Data were obtained from national surveys Argentina, Brazil, Chile, Colombia, and El Salvador, comprising 259,327 adults aged 15 to ≥85 years. Lifestyle risk factors included fruit and vegetable consumption, physical activity, alcohol use, and tobacco. The Preventable Risk Integrated ModEl (PRIME) was applied to estimate the impact of these factors on cancer mortality under 75 years by sex. The model compared baseline distributions with counterfactual scenarios based on World Health Organization (WHO) recommendations to assess potential reduction in annual cancer deaths.

Results

Women reported higher fruit and vegetable intake, whereas men were more physically active and had higher levels of alcohol consumption and tobacco use. Following WHO recommendations could prevent or postpone 103,217 deaths under 75 years (95 % uncertainty interval [95 % UI]: 92,577 to 113,659), with Brazil contributing to nearly half and Argentina over a quarter of them. Most averted deaths were among women, except in Colombia and El Salvador, where a higher proportion was observed among men. Lung cancer accounted for the largest share of preventable deaths (28,596, 95 % UI: 20,804 to 35,326), followed by stomach, esophageal, and pancreatic cancers.

Conclusion

Promoting healthy lifestyle could significantly reduce or delay cancer deaths in individuals under 75 in Latin American countries.

癌症是拉丁美洲过早死亡的主要原因，主要由可改变的生活方式因素驱动，如不良饮食、缺乏身体活动、饮酒和吸烟。在这项研究中，我们估计了五个拉丁美洲国家因生活方式风险因素导致的癌症死亡负担。研究设计比较风险评估模型研究。方法数据来自阿根廷、巴西、智利、哥伦比亚和萨尔瓦多的国家调查，包括259,327名年龄在15岁至≥85岁的成年人。生活方式的风险因素包括水果和蔬菜的消费、身体活动、饮酒和吸烟。应用可预防风险综合模型（PRIME）按性别估计这些因素对75岁以下癌症死亡率的影响。该模型将基线分布与基于世界卫生组织（世卫组织）建议的反事实情景进行比较，以评估每年癌症死亡的潜在减少。结果女性报告了更多的水果和蔬菜摄入量，而男性则更活跃，饮酒和吸烟的水平更高。按照世卫组织的建议可预防或推迟103217例75岁以下死亡（95%不确定区间[95% UI]: 92577至113659），其中巴西占近一半，阿根廷占四分之一以上。避免死亡的大多数是妇女，但哥伦比亚和萨尔瓦多除外，这两个国家的男性比例较高。肺癌占可预防死亡的最大份额（28,596,95%,UI: 20,804至35,326），其次是胃癌，食道癌和胰腺癌。结论在拉美国家，提倡健康的生活方式可显著降低或延缓75岁以下人群的癌症死亡。

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引用次数: 0