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Temperature-related mortality burden and projected change in 1368 European regions: a modelling study. 欧洲 1368 个地区与气温有关的死亡率负担和预计变化:一项模拟研究。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 Epub Date: 2024-08-21 DOI: 10.1016/S2468-2667(24)00179-8
David García-León, Pierre Masselot, Malcolm N Mistry, Antonio Gasparrini, Corrado Motta, Luc Feyen, Juan-Carlos Ciscar
<p><strong>Background: </strong>Excessively high and low temperatures substantially affect human health. Climate change is expected to exacerbate heat-related morbidity and mortality, presenting unprecedented challenges to public health systems. Since localised assessments of temperature-related mortality risk are essential to formulate effective public health responses and adaptation strategies, we aimed to estimate the current and future temperature-related mortality risk under four climate change scenarios across all European regions.</p><p><strong>Methods: </strong>We modelled current and future mortality due to non-optimal temperatures across 1368 European regions, considering age-specific characteristics and local socioeconomic vulnerabilities. Overseas territories were excluded from the analysis. We applied a three-stage method to estimate temperature-related risk continuously across age and spatial dimensions. Age and city-specific exposure-response functions were obtained for a comprehensive list of 854 European cities from the Urban Audit dataset of Eurostat. Regional aggregates were calculated using an aggregation and extrapolation method that incorporates the risk incidence in neighbouring cities. Mortality was projected for present conditions observed in 1991-2020 and for four different levels of global warming (1·5°C, 2°C, 3°C, and 4°C increase) by regions, and subregions using an ensemble of 11 climate models produced by the Coordinated Regional Climate Downscaling Experiment-CMIP5 over Europe, and population projection data from EUROPOP2019.</p><p><strong>Findings: </strong>Our results highlight regional disparities in temperature-related mortality across Europe. Between 1991 and 2020, the number of cold-related deaths was 2·5 times higher in eastern Europe than western Europe, and heat-related deaths were 6 times higher in southern Europe than in northern Europe. During the same time period, there were a median of 363 809 cold-related deaths (empirical 95% CI 362 493-365 310) and 43 729 heat-related deaths (39 880-45 921), with a cold-to-heat-related death ratio of 8·3:1. Under current climate policies, aligned with 3°C increase in global warming, it is estimated that temperature-related deaths could increase by 54 974 additional deaths (24 112-80 676) by 2100, driven by rising heat-related deaths and an ageing population, resulting in a cold-to-heat-related death ratio of 2·6:1. Climate change is also expected to widen disparities in regional mortality, particularly impacting southern regions of Europe as a result of a marked increase in heat-related deaths.</p><p><strong>Interpretation: </strong>This study shows that regional disparities in temperature-related mortality risk in Europe are substantial and will continue to increase due to the effects of climate change and an ageing population. The data presented can assist policy makers and health authorities in mitigating increasing health inequalities by prioritising the protec
背景:过高和过低的温度严重影响人类健康。预计气候变化将加剧与高温相关的发病率和死亡率,给公共卫生系统带来前所未有的挑战。由于与气温相关的局部死亡风险评估对于制定有效的公共卫生对策和适应战略至关重要,因此我们旨在估算欧洲所有地区在四种气候变化情景下当前和未来与气温相关的死亡风险:我们对欧洲 1368 个地区当前和未来因非最佳气温导致的死亡率进行了模拟,同时考虑了年龄特征和当地的社会经济脆弱性。海外地区不在分析之列。我们采用了一种三阶段法来估算与气温相关的跨年龄和空间维度的连续风险。我们从欧盟统计局的城市审计数据集中获得了一份包含 854 个欧洲城市的综合清单,其中包括特定年龄和城市的暴露-反应函数。区域总量的计算采用了综合和外推法,将邻近城市的风险发生率纳入其中。利用欧洲协调区域气候降尺度实验--CMIP5 生成的 11 个气候模型的集合以及 EUROPOP2019 的人口预测数据,按地区和次地区对 1991-2020 年观测到的当前条件和四种不同的全球变暖水平(1-5°C、2°C、3°C 和 4°C)下的死亡率进行了预测:我们的研究结果凸显了整个欧洲与气温有关的死亡率的地区差异。1991 至 2020 年间,东欧与寒冷相关的死亡人数是西欧的 2-5 倍,南欧与高温相关的死亡人数是北欧的 6 倍。在同一时期,与寒冷相关的死亡中位数为 363 809 例(经验值 95% CI 362 493-365 310),与高温相关的死亡中位数为 43 729 例(39 880-45 921),寒冷与高温相关的死亡比例为 8-3:1。根据目前的气候政策,按照全球升温 3°C 的情况,估计到 2100 年,与气温相关的死亡人数会增加 54 974 人(24 112-80 676),原因是与高温相关的死亡人数增加和人口老龄化,导致与寒冷相关的死亡人数与与高温相关的死亡人数之比为 2-6:1。预计气候变化还将扩大地区死亡率的差距,尤其是对欧洲南部地区的影响,因为与热有关的死亡人数将显著增加:这项研究表明,由于气候变化和人口老龄化的影响,欧洲与气温相关的死亡风险的地区差异很大,并将继续扩大。所提供的数据可以帮助政策制定者和卫生部门优先保护更易受影响的地区和老年人群,从而缓解日益加剧的健康不平等现象。我们确定了预计风险较高的地区(南欧),在这些地区应优先采取旨在建立适应性和提高复原力的政策干预措施:欧盟委员会。
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引用次数: 0
Mental health and lower adolescent HPV vaccine coverage. 心理健康与青少年 HPV 疫苗接种率较低。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 DOI: 10.1016/S2468-2667(24)00190-7
Mallory K Ellingson, Noel T Brewer
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引用次数: 0
New insights into the incidence and prevalence of food allergy in England. 对英格兰食物过敏症发病率和流行率的新认识。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 DOI: 10.1016/S2468-2667(24)00186-5
R C Knibb
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引用次数: 0
Interventions to reduce harms related to drug use among people who experience incarceration: systematic review and meta-analysis. 减少被监禁者吸毒危害的干预措施:系统回顾和荟萃分析。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 DOI: 10.1016/S2468-2667(24)00160-9
Christel Macdonald, Georgina Macpherson, Oscar Leppan, Lucy Thi Tran, Evan B Cunningham, Behzad Hajarizadeh, Jason Grebely, Michael Farrell, Frederick L Altice, Louisa Degenhardt

Background: Mortality, suicide, self-harm, and substance use are elevated among people who are incarcerated. There is a wide range of heterogeneous interventions aimed at reducing these harms in this population. Previous reviews have focused on specific interventions or limited their findings to drug use and recidivism and have not explored interventions delivered after release from prison. Our aim is to examine the effect of interventions delivered to people who use drugs during incarceration or after release from incarceration, on a wide range of outcomes.

Methods: In this systematic review and meta-analysis, we searched Embase, MEDLINE, and PsycINFO databases up until Sept 12, 2023 for studies published from Jan 1, 1980 onwards. All studies evaluating the effectiveness of any intervention on drug use, recidivism outcomes, sexual or injecting risk behaviours, or mortality among people who use psychoactive drugs and who were currently or recently incarcerated were included. Studies without a comparator or measuring only alcohol use were excluded. Data extracted from each study included demographic characteristics, interventions, and comparisons. Pooled odds ratios and risk ratios were calculated using random-effects meta-analyses.

Findings: We identified 126 eligible studies (47 randomised controlled trials and 79 observational studies) encompassing 18 interventions; receiving opioid-agonist treatment (OAT) in prison reduced the risk of death in prison (one study; hazard ratio 0·25; 95% CI 0·13-0·48), whereas receiving OAT in the first 4 weeks following release reduced risk of death in the community (two studies; relative risk 0·24; 95% CI 0·15-0·37). Therapeutic community interventions reduced re-arrest at 6-12 months (six studies; odds ratio [OR] 0·72; 95% CI 0·55-0·95) and reincarceration at 24 months (two studies; OR 0·66; 95% CI 0·48-0·96). There was scarce evidence that OAT and syringe service provision are effective in reducing injecting risk behaviours and needle and syringe sharing.

Interpretation: There are effective interventions to reduce mortality and recidivism for people who use drugs who have been incarcerated. Nonetheless, there are also substantial gaps in the research examining the effect of interventions on risk behaviours and mortality during incarceration and a need for randomised designs examining outcomes for people who use drugs after release.

Funding: Australian National Health and Medical Research Council.

背景:被监禁者的死亡率、自杀率、自残率和药物使用率都很高。目前有多种不同的干预措施,旨在减少这些危害。以往的综述侧重于特定的干预措施,或将其研究结果局限于药物使用和累犯问题,并未对刑满释放后提供的干预措施进行探讨。我们的目的是研究针对服刑期间或刑满释放后吸毒人员的干预措施对一系列结果的影响:在本系统综述和荟萃分析中,我们检索了 Embase、MEDLINE 和 PsycINFO 数据库中自 1980 年 1 月 1 日起至 2023 年 9 月 12 日发表的研究。所有评估任何干预措施对目前或近期被监禁的精神活性药物使用者的药物使用、累犯结果、性行为或注射风险行为或死亡率的有效性的研究均被纳入。没有比较对象或仅测量酒精使用情况的研究被排除在外。从每项研究中提取的数据包括人口统计学特征、干预措施和比较。采用随机效应荟萃分析法计算汇总的几率比和风险比:我们确定了126项符合条件的研究(47项随机对照试验和79项观察性研究),其中包括18项干预措施;在狱中接受阿片类受体激动剂治疗(OAT)可降低在狱中的死亡风险(一项研究;危险比为0-25;95% CI为0-13-0-48),而在获释后的前4周接受OAT可降低在社区的死亡风险(两项研究;相对风险为0-24;95% CI为0-15-0-37)。治疗性社区干预减少了 6-12 个月时的再次逮捕(六项研究;几率比 [OR] 0-72;95% CI 0-55-0-95)和 24 个月时的再次监禁(两项研究;几率比 0-66;95% CI 0-48-0-96)。很少有证据表明提供 OAT 和注射器服务能有效减少注射风险行为以及共用针头和注射器:有一些有效的干预措施可以降低被监禁的吸毒者的死亡率和再犯率。尽管如此,在研究干预措施对监禁期间的危险行为和死亡率的影响方面还存在很大差距,需要采用随机设计来研究吸毒者获释后的结果:澳大利亚国家健康与医学研究委员会。
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引用次数: 0
Public health interventions to address digital determinants of children's health and wellbeing. 采取公共卫生干预措施,解决影响儿童健康和福祉的数字决定因素。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 Epub Date: 2024-08-16 DOI: 10.1016/S2468-2667(24)00180-4
Louise Holly, Sandro Demaio, Ilona Kickbusch

The increasing use of digital media and devices by children has led to growing concerns that spending time online without sufficient guarding is having negative effects on their health and wellbeing. In this Viewpoint, we argue that children's use of digital technologies and engagement in digital environments should be recognised as important determinants of their health and that a public health approach is required to protect children from digital harms. Drawing on lessons from well-established approaches to address other public health challenges, we summarise three groups of public health interventions that can help delay media use among very young children, reduce digital media use among children of all ages, and mitigate any harmful consequences of children's digital media use. To build healthy digital environments for children now and future generations, we recommend a precautionary approach to governance that prioritises children's health and wellbeing, recognises their desire to enjoy the benefits of the digital world, and allows children to have a role in shaping their digital futures.

儿童越来越多地使用数字媒体和设备,这让人们越来越担心,在没有充分保护的情况下长时间上网会对儿童的健康和幸福产生负面影响。在本观点中,我们认为儿童使用数字技术和参与数字环境应被视为其健康的重要决定因素,需要采取公共卫生方法来保护儿童免受数字伤害。借鉴应对其他公共卫生挑战的成熟方法,我们总结了三类公共卫生干预措施,这些措施可以帮助推迟年幼儿童使用媒体的时间,减少所有年龄段儿童使用数字媒体的时间,并减轻儿童使用数字媒体造成的任何有害后果。为了给现在和后代的儿童营造健康的数字环境,我们建议采取预防性的治理方法,优先考虑儿童的健康和福祉,承认他们享受数字世界带来的好处的愿望,并允许儿童在塑造自己的数字未来方面发挥作用。
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引用次数: 0
The role of mental illness and neurodevelopmental conditions in human papillomavirus vaccination uptake within the Swedish school-based vaccination programme: a population-based cohort study. 瑞典学校疫苗接种计划中精神疾病和神经发育状况对人类乳头瘤病毒疫苗接种率的影响:一项基于人群的队列研究。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 DOI: 10.1016/S2468-2667(24)00182-8
Kejia Hu, Mary M Barker, Eva Herweijer, Jiangrong Wang, Adina L Feldman, Donghao Lu, Unnur Valdimarsdóttir, Karin Sundström, Fang Fang

Background: Despite documented mental illness-related disparities in cervical cancer screening and incidence, insufficient data exist on differences in cervical cancer prevention strategies, such as human papillomavirus (HPV) vaccination. We aimed to investigate the association of mental illness and neurodevelopmental conditions among girls and their parents with uptake of HPV vaccination in Sweden.

Methods: This population-based cohort study was based on the Swedish school-based HPV vaccination programme, which offers the first vaccine dose to girls aged 10-13 years, with a second dose offered within 12 months. We identified all girls born between Jan 1, 2002, and March 1, 2004, using the Swedish Total Population Register-ie, those eligible for two vaccine doses in the vaccination programme from its initiation in autumn 2012, to March, 2019. Nationwide Swedish register data (National Patient Register, Prescribed Drug Register, HPV Vaccination Register, National Vaccination Register, Total Population Register, Multi-Generation Register, Longitudinal Integrated Database for Health Insurance and Labour Market Studies, Education Register, National Cervical Screening Registry, and Cancer Register) were used to define individual and parental mental health conditions, including mental illness and neurodevelopmental conditions (defined by a clinical diagnosis and prescribed psychotropic medication use), HPV vaccine uptake (first and second dose), and sociodemographic and clinical characteristics. The two outcomes were uptake of the first HPV vaccine dose by the girl's 14th birthday and uptake of the second dose by the 15th birthday in relation to individual and parental mental health conditions, calculated using multivariable Poisson regression models.

Findings: 115 104 girls were included in the study population. 2211 girls (1·9%) had a specialist diagnosis of any mental health condition. Uptake of the first HPV vaccine dose was 80·7% (92 912 of 115 104) and was lower among girls with versus without any mental health condition (adjusted relative risk 0·89 [95% CI 0·87-0·91]). The diagnosis of autism (0·79 [0·75-0·85]) or intellectual disability (0·78 [0·73-0·83]) were most strongly associated with lower HPV vaccine uptake. Vaccine uptake was also lower among girls with versus those without prescribed use of psychotropic medication (0·93 [0·92-0·95]), with the strongest association observed for antipsychotics (0·68 [0·56-0·82]). Uptake of the second dose was 95·0% (88 308 of 92 912), with no strong associations between uptake and mental health conditions in girls or their parents.

Interpretation: Our findings suggest disparities in cervical cancer prevention among girls with mental health conditions, and call for further research to ensure equitable protection.

Funding: Swedish Cancer Society.

背景:尽管在宫颈癌筛查和发病率方面存在与精神疾病相关的差异,但有关宫颈癌预防策略(如人类乳头瘤病毒(HPV)疫苗接种)差异的数据却不足。我们的目的是调查瑞典女孩及其父母的精神疾病和神经发育状况与 HPV 疫苗接种率的关系:这项基于人群的队列研究以瑞典学校的 HPV 疫苗接种计划为基础,该计划为 10-13 岁的女孩接种第一剂疫苗,并在 12 个月内接种第二剂疫苗。我们通过瑞典总人口登记册确定了 2002 年 1 月 1 日至 2004 年 3 月 1 日期间出生的所有女孩,即从 2012 年秋季启动至 2019 年 3 月期间有资格接种两剂疫苗的女孩。瑞典全国范围内的登记数据(全国患者登记册、处方药登记册、HPV疫苗接种登记册、全国疫苗接种登记册、总人口登记册、多代人登记册、医疗保险和劳动力市场研究纵向综合数据库、教育登记册、全国宫颈筛查登记册和癌症登记册)被用来定义个人和父母的精神健康状况,包括精神疾病和神经发育状况(根据临床诊断和处方精神药物使用情况定义)、HPV疫苗接种情况(第一剂和第二剂)以及社会人口和临床特征。两个结果是女孩在14岁生日前接种第一剂HPV疫苗和在15岁生日前接种第二剂HPV疫苗与个人和父母心理健康状况的关系,采用多变量泊松回归模型进行计算:研究对象包括 115 104 名女童。2211名女孩(1-9%)被专家诊断患有任何精神疾病。第一剂HPV疫苗的接种率为80-7%(115 104人中有92 912人接种),接种率较低(调整后相对风险为0-89 [95% CI 0-87-0-91])。自闭症(0-79 [0-75-0-85])或智力障碍(0-78 [0-73-0-83])诊断与 HPV 疫苗接种率较低的关系最为密切。接种疫苗的女孩中,服用精神药物和未服用精神药物的女孩接种率也较低(0-93 [0-92-0-95]),其中与抗精神病药物的关联性最强(0-68 [0-56-0-82])。第二次服药率为 95%-0%(92 912 人中有 88 308 人),服药率与女孩或其父母的精神健康状况之间没有很强的关联:我们的研究结果表明,有精神健康问题的女孩在宫颈癌预防方面存在差异,因此需要进一步研究,以确保提供公平的保护:瑞典癌症协会。
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引用次数: 0
Time trends in the epidemiology of food allergy in England: an observational analysis of Clinical Practice Research Datalink data. 英格兰食物过敏流行病学的时间趋势:临床实践研究数据链数据的观察分析。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 DOI: 10.1016/S2468-2667(24)00163-4
Paul J Turner, Alessia Baseggio Conrado, Constantinos Kallis, Eimear O'Rourke, Sadia Haider, Anhar Ullah, Darije Custovic, Adnan Custovic, Jennifer K Quint

Background: Estimates for the prevalence of food allergy vary widely, with a paucity of data for adults. The aim of this analysis was to report trends in the incidence and prevalence of food allergy in England, using a national primary care dataset.

Methods: We analysed data from Clinical Practice Research Datalink between 1998 and 2018, with linked data to relevant hospital encounters in England. The main outcomes were incidence and prevalence of food allergy, according to three definitions of food allergy: possible food allergy, probable food allergy, and probable food allergy with adrenaline autoinjectors prescription. We also evaluated the difference in proportion of patients prescribed adrenaline autoinjectors by English Index of Multiple Deprivation (IMD), age, and by previous food anaphylaxis, and explored differences in patient encounters (general practice vs emergency department setting).

Findings: 7 627 607 individuals in the dataset were eligible for inclusion, of whom 150 018 (median age 19 years [IQR 4-34]; 82 614 [55·1%] female and 67 404 [44·9%] male) had a possible food allergy. 121 706 met diagnostic criteria for probable food allergy, of whom 38 288 were prescribed adrenaline autoinjectors. Estimated incidence of probable food allergy doubled between 2008 and 2018, from 75·8 individuals per 100 000 person-years (95% CI 73·7-77·9) in 2008 to 159·5 (156·6-162·3) individuals per 100 000 person-years in 2018. Prevalence increased from 0·4% (23 399 of 6 432 383) to 1·1% (82 262 of 7 627 607) over the same period and was highest in children under 5 years (11 951 [4·0%] of 296 406 in 2018) with lower prevalence in school-aged children (from 11 353 [2·4%] of 473 597 in 2018 for children aged 5-9 years to 6896 [1·7%] of 404 525 for those aged 15-19 years) and adults (42 848 [0·7%] of 5 992 454 in 2018). In those with previous food anaphylaxis, only 2321 (58·3%) of 3980 (975 [64·0%] of 1524 children and young people and 1346 [54·8%] of 2456 adults) had a prescription for adrenaline autoinjector. Adrenaline autoinjectors prescription was less common in those resident in more deprived areas (according to IMD). In the analysis of health-care encounters, 488 604 (97·1%) of 503 198 visits recorded for food allergy occurred in primary care, with 115 655 (88·4%) of 130 832 patients managed exclusively in primary care.

Interpretation: These estimates indicate an important and increasing burden of food allergy in England. Our findings that most patients with food allergy are managed outside the hospital system, with low rates of adrenaline autoinjector prescription in those with previous anaphylaxis, highlight a need to better support those working in primary care to ensure optimal management of patients with food allergy.

Funding: UK Food Standards Agency and UK Medical Research Council.

背景:对食物过敏患病率的估计差异很大,成人的数据更是少之又少。本分析旨在利用全国初级保健数据集报告英格兰食物过敏发病率和流行率的趋势:我们分析了 1998 年至 2018 年期间临床实践研究数据链(Clinical Practice Research Datalink)中的数据,这些数据与英格兰相关医院的就诊情况相关联。主要结果是食物过敏的发生率和患病率,根据食物过敏的三种定义:可能的食物过敏、可能的食物过敏以及可能的食物过敏并伴有肾上腺素自动注射器处方。我们还根据英国多重贫困指数(IMD)、年龄和既往食物过敏性休克情况评估了开具肾上腺素自动注射器处方的患者比例差异,并探讨了患者就诊环境(全科诊所与急诊科)的差异:数据集中有 7 627 607 人符合纳入条件,其中 150 018 人(中位年龄 19 岁 [IQR:4-34];82 614 [55-1%] 女性和 67 404 [44-9%] 男性)可能患有食物过敏。121 706 人符合可能食物过敏的诊断标准,其中 38 288 人被处方肾上腺素自动注射器。2008 年至 2018 年期间,可能食物过敏的估计发病率翻了一番,从 2008 年的每 10 万人年 75-8 人(95% CI 73-7-77-9)增至 2018 年的每 10 万人年 159-5 人(156-6-162-3)。同期,患病率从 0-4%(6 432 383 例中的 23 399 例)上升至 1-1%(7 627 607 例中的 82 262 例),5 岁以下儿童患病率最高(2018 年为 296 406 例中的 11 951 例 [4-0%]),学龄儿童患病率较低(从 2008 年的 11 353 例 [95% CI 73-7-77-9] 上升至 2018 年的 296 406 例 [4-0%])。学龄儿童(从 2018 年 5-9 岁儿童的 473 597 例中的 11 353 例[2-4%]到 15-19 岁儿童的 404 525 例中的 6896 例[1-7%])和成人(2018 年 5 992 454 例中的 42 848 例[0-7%])的发病率较低。在曾发生食物过敏性休克的人群中,3980 人中只有 2321 人(58-3%)(1524 名儿童和青少年中的 975 人[64-0%]和 2456 名成人中的 1346 人[54-8%])有肾上腺素自动注射器处方。肾上腺素自动注射器处方在居住在较贫困地区(根据 IMD)的居民中较少见。在对就诊情况的分析中,503 198 例因食物过敏而就诊的记录中,有 488 604 例(97-1%)发生在初级医疗机构,130 832 例患者中有 115 655 例(88-4%)完全由初级医疗机构管理:这些估计数字表明,在英格兰,食物过敏是一个重要且日益加重的负担。我们的研究结果表明,大多数食物过敏患者都是在医院系统外接受治疗的,曾发生过敏性休克的患者使用肾上腺素自动注射器的比例很低,这突出表明有必要更好地支持基层医疗机构的工作,以确保对食物过敏患者进行最佳治疗:资金来源:英国食品标准局和英国医学研究委员会。
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引用次数: 0
The future of the temperature-mortality relationship. 温度与死亡率关系的未来。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 Epub Date: 2024-08-21 DOI: 10.1016/S2468-2667(24)00184-1
Matteo Pinna Pintor
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引用次数: 0
New-generation pneumococcal vaccines for children. 新一代儿童肺炎球菌疫苗。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 Epub Date: 2024-08-14 DOI: 10.1016/S2468-2667(24)00189-0
Philippe De Wals
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引用次数: 0
Financialisation: a 21st century commercial determinant of health equity. 金融化:21 世纪健康公平的商业决定因素。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 DOI: 10.1016/S2468-2667(24)00187-7
Sharon Friel, Ashley Schram, Nick Frank, Megan Arthur, Bel Townsend, Hridesh Gajurel

In 21st century capitalism, financial markets reign supreme. The elevation of investing, trading, and speculating as a way of making profit has shifted economic power towards institutional investors and enhanced the power of financial capital. Financialisation has introduced uncertainty in the commitment to public provision of goods and services. The behaviours of corporations focus more on profit for shareholders and senior executives to the detriment of wages, worker protections, livelihoods, and impact on prices and the environment. The practices of this financial system pose major challenges to public health and planetary health equity through the influence on social inequality, climate change, and health outcomes. The aim of this Viewpoint is to expand the understanding of the commercial determinants of health to explicitly include the financial system and present key plausible pathways via which the financialisation of advanced economies influences public health and planetary health equity. The global public health community must pay close attention to these key commercial determinants of health. It is now crucial to reduce the power of financial actors and hold financial actors accountable. Civil society groups can highlight their practices, articulate alternative visions, and hold financial actors and governments to account. Interdisciplinary research must provide a diagnosis of the financial and public health issues, and, importantly, illuminate effective pathways forward. Financial and commercial worlds must return to stakeholder primacy rather than that of the shareholder.

在 21 世纪的资本主义中,金融市场至高无上。将投资、交易和投机提升为一种盈利方式,使经济权力向机构投资者转移,增强了金融资本的力量。金融化为公共产品和服务的承诺带来了不确定性。企业的行为更加注重股东和高级管理人员的利润,而忽视了工资、工人保护、生计以及对价格和环境的影响。这种金融体系的做法通过对社会不平等、气候变化和健康结果的影响,对公共卫生和地球健康公平构成了重大挑战。本观点旨在扩大对健康的商业决定因素的理解,将金融体系明确纳入其中,并提出发达经济体的金融化影响公共健康和地球健康公平的主要合理途径。全球公共卫生界必须密切关注这些关键的健康商业决定因素。现在,至关重要的是削弱金融行为体的权力,并追究金融行为体的责任。民间社会团体可以强调他们的做法,阐明替代愿景,并让金融参与者和政府承担责任。跨学科研究必须对金融和公共卫生问题做出诊断,重要的是,要指明有效的前进道路。金融和商业界必须回归利益相关者至上,而不是股东至上。
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Lancet Public Health
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