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What would Gregory Maskarinec and Paul Farmer do? Gregory Maskarinec和Paul Farmer会怎么做?
Pub Date : 2024-10-07 eCollection Date: 2024-12-01 DOI: 10.1002/puh2.189
Seiji Yamada
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引用次数: 0
From Atmosphere to Health Outcomes: Analyzing Predictors of Respiratory Disease Mortality in Turkiye. 从大气到健康结果:分析土耳其呼吸系统疾病死亡率的预测因素。
Pub Date : 2024-09-18 eCollection Date: 2024-09-01 DOI: 10.1002/puh2.70003
Mehmet Kocak, Asli Nurefsan Kocak

Background: Asthma, chronic obstructive pulmonary disease (COPD), and pneumonia are significant contributors to morbidity and mortality worldwide. Identifying the predictors of mortality due to these diseases is crucial for effective public health interventions.

Methods: We conducted a longitudinal trajectory modeling using SAS TRAJ procedures on data from 81 provinces in Turkiye, categorizing death rates into two profiles for asthma and COPD and three for pneumonia. Environmental and socioeconomic factors were examined as potential predictors through logistic regression modeling.

Results: For asthma, none of the predictors met the false discovery rate (FDR) threshold for significance, suggesting the need for further research. In contrast, COPD predictors showed robust associations with mortality rates, particularly concerning environmental factors such as humidity and temperature. Pneumonia mortality was significantly associated with factors, including air pressure, humidity, temperature, alcohol use, and particulate matter.

Conclusion: The study reveals distinct mortality profiles for respiratory diseases and highlights the importance of environmental and lifestyle factors as predictors. These findings emphasize the need for targeted public health strategies and interventions to manage these diseases effectively.

背景:哮喘、慢性阻塞性肺疾病(COPD)和肺炎是全球发病率和死亡率的重要因素。确定这些疾病造成的死亡率预测因素对于有效的公共卫生干预至关重要。方法:我们使用SAS TRAJ程序对土耳其81个省的数据进行了纵向轨迹建模,将死亡率分为哮喘和慢性阻塞性肺病的两类和肺炎的三类。通过逻辑回归模型检验了环境和社会经济因素作为潜在的预测因素。结果:对于哮喘,所有预测因子均未达到显著性错误发现率(FDR)阈值,提示需要进一步研究。相比之下,COPD预测指标显示与死亡率密切相关,特别是与湿度和温度等环境因素有关。肺炎死亡率与气压、湿度、温度、酒精使用和颗粒物等因素显著相关。结论:该研究揭示了呼吸系统疾病的不同死亡率特征,并强调了环境和生活方式因素作为预测因素的重要性。这些发现强调需要有针对性的公共卫生战略和干预措施来有效地管理这些疾病。
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引用次数: 0
Oral Health in Tanzania: Unmasking Its Neglected Dimension. 坦桑尼亚的口腔健康:揭露其被忽视的方面。
Pub Date : 2024-09-13 eCollection Date: 2024-09-01 DOI: 10.1002/puh2.70000
Majani Edward, Daniel Agyapong, Innocent Kitandu Paul, Ibrahim Idris, Gbassara Koulagna Boris, Nathan Ezie Kengo, Emelia Azeyele Kpiebaya, Shuaibu Saidu Musa, Don Eliseo Lucero-Prisno

The World Health Organization's definition of oral health underscores its holistic nature encompassing physiological, psychosocial, and functional dimensions. The current estimates of oral diseases in Tanzania and around the world underscore the urgency of intervention, particularly in light of rising sugar consumption trends. The unique challenges facing Tanzania, including inadequate knowledge, limited infrastructure, and disparities in oral healthcare access, are analyzed within the broader context of sub-Saharan Africa's health priorities. This article addresses the multifaceted challenges of oral health neglect in Tanzania, emphasizing the imperative need for a comprehensive and integrated approach. The discussion offers a detailed exploration of determinants contributing to oral health neglect, spanning socioeconomic, behavioral, and commercial factors, with a focus on their implications for Tanzanian communities. Recommendations are presented as a strategic roadmap, encompassing public health education, integrated healthcare services, government intervention, educational programs, community engagement, financial accessibility, and research initiatives. By synthesizing these recommendations into a cohesive framework, a proactive and collaborative approach to mitigate the consequences of oral health neglect in Tanzania, emphasizing the need for transformative policies and cultural sensitivity, is therefore envisioned.

世界卫生组织对口腔健康的定义强调其整体性,包括生理、社会心理和功能层面。坦桑尼亚和世界各地目前对口腔疾病的估计强调了干预的紧迫性,特别是考虑到糖消费趋势的上升。坦桑尼亚面临的独特挑战,包括知识不足,基础设施有限,以及口腔保健机会的差异,在撒哈拉以南非洲卫生优先事项的更广泛背景下进行了分析。这篇文章解决了坦桑尼亚口腔健康忽视的多方面挑战,强调迫切需要一个全面和综合的方法。讨论提供了对导致口腔健康忽视的决定因素的详细探索,涉及社会经济、行为和商业因素,重点是它们对坦桑尼亚社区的影响。建议作为战略路线图提出,包括公共卫生教育、综合卫生保健服务、政府干预、教育计划、社区参与、财务可及性和研究倡议。因此,通过将这些建议综合成一个有凝聚力的框架,设想采取一种积极主动和协作的办法,减轻坦桑尼亚口腔卫生忽视的后果,同时强调有必要制定变革性政策和提高文化敏感性。
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引用次数: 0
Systems Thinking, Causal Loop Diagram, and Systems Dynamic in Public Health Challenges: Navigating Long COVID Syndrome and Sense of Smell in LGBTQIA+ Communities. 公共卫生挑战中的系统思维、因果循环图和系统动态:在LGBTQIA+社区中导航长冠状病毒综合征和嗅觉
Pub Date : 2024-09-03 eCollection Date: 2024-09-01 DOI: 10.1002/puh2.70004
Behnaz Akbari, Jessica M Wang, Namdar Baghaei-Yazdi, Hooshang Lahooti, Janet Hope Sherman

Background: The coronavirus pandemic has profoundly affected global health, economic stability, and environmental sustainability. Despite these challenges, significant gaps in data remain, particularly in effectively assessing and engaging diverse communities such as color, LGBTQIA+ individuals, and low-income groups. This shortage of comprehensive research limits our capacity to undertake sensitive studies, specifically in dealing with the complexities of long COVID, which some individuals continue to suffer from after their initial recovery.

Objective: This review delves into the ongoing repercussions of long-term COVID-19, a postinfectious syndrome marked by neurological symptoms such as cognitive deficits and sensory impairments, which may last well beyond the acute phase of the illness. These symptoms frequently overlap with mental health issues (e.g., anxiety and depression), which can aggravate the socioeconomic challenges faced by vulnerable populations, especially within the LGBTQA+ communities.

Methods: To tackle these complex interactions, we have introduced a novel public health framework: model-based systems thinking (MBST), which incorporates System Dynamics and causal loop diagrams (CLD).

Results and discussion: The articles were selected on the basis of their discussion of COVID-19-associated anosmia, exploration of olfactory dysfunction alongside neurocognitive disorders, and the challenges experienced in LGBQA+ communities. This approach offers a robust framework for dissecting the intricate ties between socioeconomic factors, health outcomes, and the extended recovery trajectories associated with long-term COVID-19, with a particular focus on olfactory dysfunction. We also explore strategies to make our models more accessible to healthcare providers and the LGBTQA+ communities, encouraging its broader adoption.

Conclusion: Long COVID's impact on public health and marginalized communities highlights the urgent need for adopting systems thinking models. Additionally, this article calls for a concerted effort from all experts to foster multidisciplinary, team-based research and implement effective support measures for COVID-19 survivors across all communities, mainly focusing on the scientific, social, and behavioral challenges LGBTQIA+ and low-income individuals face.

背景:冠状病毒大流行深刻影响了全球健康、经济稳定和环境可持续性。尽管存在这些挑战,但数据方面仍然存在重大差距,特别是在有效评估和吸引有色人种、LGBTQIA+个人和低收入群体等不同社区方面。全面研究的缺乏限制了我们进行敏感研究的能力,特别是在处理长期COVID的复杂性方面,一些人在初步康复后仍然受到影响。目的:本综述深入研究了长期COVID-19的持续影响,这是一种以认知缺陷和感觉障碍等神经系统症状为特征的感染后综合征,可能会持续到疾病的急性期之后。这些症状经常与心理健康问题(如焦虑和抑郁)重叠,这可能加剧弱势群体,特别是LGBTQA+社区所面临的社会经济挑战。方法:为了解决这些复杂的相互作用,我们引入了一个新的公共卫生框架:基于模型的系统思维(MBST),它结合了系统动力学和因果循环图(CLD)。结果和讨论:这些文章是根据他们对covid -19相关嗅觉障碍的讨论、嗅觉功能障碍与神经认知障碍的探索以及LGBQA+社区所面临的挑战而选择的。这种方法为剖析与COVID-19长期相关的社会经济因素、健康结果和长期恢复轨迹之间的复杂关系提供了一个强大的框架,特别关注嗅觉功能障碍。我们还探索了使我们的模型更容易被医疗保健提供者和LGBTQA+社区使用的策略,鼓励其更广泛的采用。结论:COVID对公共卫生和边缘化社区的长期影响凸显了采用系统思维模式的迫切需要。此外,本文呼吁所有专家共同努力,促进多学科、基于团队的研究,并为所有社区的COVID-19幸存者实施有效的支持措施,主要关注LGBTQIA+和低收入人群面临的科学、社会和行为挑战。
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引用次数: 0
Factors Associated With Satisfaction With Diabetes Care Among Patients Attending Public Diabetic Clinics in Dar es Salaam, Tanzania: A Cross-Sectional Study. 坦桑尼亚达累斯萨拉姆公立糖尿病诊所患者糖尿病护理满意度相关因素:一项横断面研究。
Pub Date : 2024-09-02 eCollection Date: 2024-09-01 DOI: 10.1002/puh2.70002
Emmanuel Z Chona, Lusajo F Kayange, Masunga K Iseselo

Background: Diabetes is a major public health problem worldwide, currently affecting more than 537 million people. The disease is associated with high morbidity and mortality rates. Modern diabetes care has evolved toward more patient-centered approaches, emphasizing individualized treatment plans and targets. This study sought to assess the level of satisfaction with diabetes care and related factors among patients attending public diabetes clinics in Dar es Salaam, Tanzania.

Methods: This descriptive cross-sectional study used a simple random sampling method to recruit 423 diabetic patients from May to October 2023. Data collection was conducted using a structured questionnaire administered by an interviewer. The collected data were coded and analyzed using Statistical Package for the Social Sciences (SPSS) version 25.

Results: The mean (±SD) age of participants was 58.7 (±11.68) years. About half (51.1%) of participants reported being satisfied with the diabetes care provided, 26.2% were very satisfied, and 22.7% were dissatisfied. Participants who usually spend 1-3 h pursuing services at the facilities had 0.40 less odds of being dissatisfied with diabetes care offered at the clinics compared to those who spend more than 3 h on each attendance (adjusted odds ratio [adjusted OR] 0.40, 95% confidence interval [CI] 0.21-0.76, p = 0.005). For each one-unit increase in the communication subscale score, the likelihood of satisfaction (as opposed to being very satisfied) increased (adjusted OR 1.23, 95% CI 1.09-1.38, p = 0.001). Each one-unit increase in the accessibility subscale score increased the probability of satisfaction (adjusted OR 1.12, 95% CI 1.02-1.24, p = 0.023) and decreased the probability of dissatisfaction (adjusted OR 0.85, 95% CI 0.76-0.95, p = 0.004).

Conclusion: These findings highlight the importance of effective communication and accessibility in improving patient satisfaction with diabetes care in public clinics. Health facilities and allied stakeholders should engage in continual capacity building among healthcare providers. Furthermore, other studies should be conducted at different levels of health facilities across the country to capture new insights on the satisfaction of homogenous sub-groups of patients.

背景:糖尿病是世界范围内的一个主要公共卫生问题,目前影响着超过5.37亿人。该病的发病率和死亡率都很高。现代糖尿病护理已经向更多以患者为中心的方法发展,强调个性化的治疗计划和目标。本研究旨在评估坦桑尼亚达累斯萨拉姆公立糖尿病诊所患者对糖尿病护理的满意度及相关因素。方法:采用简单随机抽样的描述性横断面研究方法,于2023年5 - 10月招募423例糖尿病患者。数据收集采用由采访者管理的结构化问卷进行。使用社会科学统计软件包(SPSS)第25版对收集的数据进行编码和分析。结果:参与者的平均(±SD)年龄为58.7(±11.68)岁。大约一半(51.1%)的参与者报告对所提供的糖尿病护理感到满意,26.2%的人非常满意,22.7%的人不满意。与每次就诊时间超过3小时的患者相比,通常在设施中花费1-3小时的患者对诊所提供的糖尿病护理不满意的几率低0.40(调整优势比[调整OR] 0.40, 95%可信区间[CI] 0.21-0.76, p = 0.005)。沟通子量表得分每增加一个单位,满意度(而不是非常满意)的可能性就会增加(调整OR为1.23,95% CI为1.09-1.38,p = 0.001)。可及性子量表得分每增加一个单位,满意度就增加(调整后的OR为1.12,95% CI为1.02-1.24,p = 0.023),不满意的概率就降低(调整后的OR为0.85,95% CI为0.76-0.95,p = 0.004)。结论:这些发现强调了有效的沟通和可及性对提高公立诊所糖尿病患者护理满意度的重要性。卫生设施和相关利益攸关方应参与卫生保健提供者的持续能力建设。此外,还应在全国不同级别的卫生设施中进行其他研究,以获得关于同类亚组患者满意度的新见解。
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引用次数: 0
A Situational Overview of Prenatal Screening Services in Bhutan. 产前筛查服务在不丹的情况概述。
Pub Date : 2024-08-27 eCollection Date: 2024-09-01 DOI: 10.1002/puh2.70001
Yeshey Dorjey, Tashi Gyeltshen, Thinley Dorji, Don Eliseo Lucero-Prisno, Mimi Lhamu Mynak, Sonam Gyamtsho, Tashi Tshomo, Phurb Dorji

Prenatal genetic testing is to determine the possibility of the fetus having a genetic aberration or birth defect. Prenatal screening consists of serum analytes screening with or without nuchal translucency (NT) scanning or with cell-free DNA (CfDNA) screening. Prenatal screening is recommended for all pregnant women regardless of the duration of pregnancy and maternal age or baseline risk. It is not advisable to screen with serum analytes and CfDNA concurrently to avoid discordant results. In developed countries, prenatal testing has been a part of routine antenatal care for a long time with adopting newer methods of screening and testing. In Bhutan, since the integration of the Safe Motherhood Program into primary healthcare in 1994, there has been an unprecedented improvement in obstetric care services. Almost all pregnant women attend antenatal and postnatal care, and 98.5% of deliveries are attended by trained health workers. The maternal mortality has reduced to 53 in 2023 from 770 per 100,000 live births in 1984 and the neonatal dealth has reduced to 15.2 per 1000 live births in 2023. However, despite improvements in the care of pregnant women, many babies are detected with congenital anomalies, syndromes, and birth defects during the postnatal period. Bhutan, being an underdeveloped country, could not initiate any form of prenatal testing program except for the anatomical scanning performed at 18-22 weeks of gestation. Early ultrasound dating scans, limited anomaly scanning, and growth scanning are offered to all pregnant women. There is a need to start centralized prenatal testing services in Bhutan to provide a comprehensive package of obstetric care to pregnant women. In addition, legal rights for parents to terminate severely deformed fetuses or severe genetic diseases before 24 weeks of pregnancy need to be established.

产前基因检测是为了确定胎儿是否有遗传异常或先天缺陷的可能性。产前筛查包括使用或不使用颈部半透明(NT)扫描或使用无细胞DNA (CfDNA)筛查进行血清分析。建议所有孕妇进行产前筛查,无论孕期长短、产妇年龄或基线风险如何。不建议同时使用血清分析物和CfDNA进行筛查,以免结果不一致。在发达国家,由于采用了更新的筛查和检测方法,产前检测长期以来一直是常规产前保健的一部分。在不丹,自从1994年将安全孕产方案纳入初级保健以来,产科护理服务得到了前所未有的改善。几乎所有孕妇都接受产前和产后护理,98.5%的分娩由训练有素的卫生工作者助产。产妇死亡率从1984年的每10万例活产770例降至2023年的53例,新生儿死亡率降至2023年的每1000例活产15.2例。然而,尽管对孕妇的护理有所改善,但在产后发现许多婴儿患有先天性异常、综合症和出生缺陷。不丹是一个欠发达国家,除了在妊娠18-22周进行解剖扫描外,不能启动任何形式的产前检查方案。早期超声测年扫描,有限异常扫描和生长扫描提供给所有孕妇。不丹有必要开始集中产前检测服务,为孕妇提供全面的一揽子产科护理。此外,需要确立父母在怀孕24周之前终止严重畸形胎儿或严重遗传疾病的合法权利。
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引用次数: 0
Birth Weight and Labor Market Outcomes: Findings From Tohoku Medical Megabank Data. 出生体重和劳动力市场结果:来自东北医疗银行数据的发现。
Pub Date : 2024-08-19 eCollection Date: 2024-09-01 DOI: 10.1002/puh2.221
Midori Matsushima, Taku Obara, Mami Ishikuro, Naoki Nakaya, Atsushi Hozawa, Shinichi Kuriyama

Background: Epidemiological and economic literature has revealed that low birth weight (LBW) is related to poor health conditions and a broader range of negative socio-economic outcomes, including academic achievement, income levels, and working status. However, Japanese evidence for labor outcomes is particularly lacking, as is the question of whether the impact of LBW on adulthood worsens when disasters occur. We aimed to reveal the impact on LBW on labor outcomes during the disaster recovery phase.

Methods: We used a cross-sectional data set of 4156 national health insurance holders, males aged 40-60 years, from the Miyagi and Iwate prefectures during the earthquake recovery phase. Employing a multinomial probit and logistic model, we estimated the impact of LBW on the employment status, changes in income, and the propensity to face a decline in income with a job change.

Results: The very low birth weights (VLBWs) have a disadvantage in all labor market outcomes. Compared to the non-LBWs, the VLBWs were 15.2% less likely to be full-time/self-employed and 17.1% more likely to be contingent/temporary/part-time workers. Moreover, 32.9% are more likely to face a decline in income and approximately 3.7 times more likely to change jobs leading to income decline. The LBWs were likely to face a decline in income by 8.6% and 4.6%, respectively, but no other significant effects were found on other outcomes.

Conclusions: The effects were apparent for the VLBW, but not so much for the LBW. The effects became larger during the disaster recovery phase, even though the regional economies were boosted.

背景:流行病学和经济学文献表明,低出生体重(LBW)与健康状况不佳和更广泛的负面社会经济结果有关,包括学业成绩、收入水平和工作状况。然而,日本关于劳动结果的证据尤其缺乏,就像灾难发生时LBW对成年的影响是否会恶化的问题一样。我们的目的是揭示在灾难恢复阶段LBW对劳动力产出的影响。方法:我们使用了4156名国民健康保险持有人的横断面数据集,年龄在40-60岁之间,来自宫城县和岩手县,在地震恢复阶段。采用多项probit和logistic模型,我们估计了LBW对就业状况、收入变化以及面对工作变化的收入下降倾向的影响。结果:极低出生体重(VLBWs)对所有劳动力市场结果都有不利影响。与非全职/自雇人士相比,全职/自雇人士的比例低15.2%,而兼职/临时/兼职人士的比例则高17.1%。此外,32.9%的人更有可能面临收入下降,大约3.7倍的人更有可能换工作导致收入下降。低收入人群的收入可能分别下降8.6%和4.6%,但对其他结果没有发现其他显著影响。结论:对VLBW的影响是明显的,但对LBW的影响不那么明显。尽管地区经济得到了提振,但在灾难恢复阶段,影响变得更大。
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引用次数: 0
Impact of Time and Handwashing on Infection Inference in Scenario-Based Exposures Among Adults and Children in Japan. 日本成人和儿童场景暴露中时间和洗手对感染推断的影响
Pub Date : 2024-08-13 eCollection Date: 2024-09-01 DOI: 10.1002/puh2.226
Fumikazu Furumi, Yumiko Nishio

Introduction: The COVID-19 pandemic has underscored the importance of preventive measures like handwashing and mask-wearing. However, preschoolers often struggle to comprehend disease transmission. This study examined how time and handwashing impact adults' and preschoolers' inferential processes related to infectious disease transmission.

Methods: Thirty-eight Japanese adults aged 18-23 years (8 men; 30 women) and 36 Japanese children aged 5-6 years (15 boys; 21 girls) participated in this study. Participants were presented with scenarios involving an infectious individual who was present (1) at the same time, (2) immediately before, or (3) the previous day. Scenarios were presented via PowerPoint for adults and as a picture-story for preschoolers, with questions on infection likelihood pre- and post-handwashing.

Results: Both age groups perceived a significantly higher likelihood of infection for same-time exposure than for other exposures. Preschoolers estimated a lower likelihood of infection than adults ( η p 2  = 0.25). Handwashing significantly reduced perceived infection risk, particularly for same-time ( η p 2  = 0.34) and immediately after ( η p 2  = 0.10) exposures.

Conclusion: This study highlights the critical need for age-appropriate communication about infection prevention, particularly for young children. Preschoolers exhibited a more positive perception of infectious disease transmission, which necessitates reinforcing multiple preventive measures beyond handwashing. The findings underscore the importance of considering cognitive development and the influence of contemporary experiences like the COVID-19 pandemic when educating about disease transmission. Future research should further explore the relationship between cognitive development, individual differences, and infection reasoning to enhance public health strategies for varying age groups.

导言:2019冠状病毒病大流行凸显了洗手和戴口罩等预防措施的重要性。然而,学龄前儿童往往难以理解疾病的传播。本研究考察了时间和洗手如何影响成人和学龄前儿童与传染病传播相关的推理过程。方法:38名18-23岁的日本成年人(男性8名;30名女性)和36名5-6岁的日本儿童(15名男孩;21名女孩)参加了这项研究。参与者被呈现的场景包括:(1)与此同时,(2)之前,或(3)前一天在场的传染性个体。这些场景通过ppt呈现给成年人,并以图片故事的形式呈现给学龄前儿童,其中包括洗手前后感染可能性的问题。结果:两个年龄组认为同一时间暴露的感染可能性明显高于其他暴露。学龄前儿童估计感染的可能性低于成人(η p 2 = 0.25)。洗手可显著降低感知感染风险,特别是在同一时间(η p 2 = 0.34)和暴露后立即(η p 2 = 0.10)。结论:这项研究强调了与年龄相适应的感染预防沟通的迫切需要,特别是对幼儿。学龄前儿童对传染病传播表现出更积极的认知,这需要加强洗手以外的多种预防措施。研究结果强调了在进行疾病传播教育时考虑认知发展和COVID-19大流行等当代经历的影响的重要性。未来的研究应进一步探索认知发展、个体差异和感染推理之间的关系,以加强针对不同年龄组的公共卫生策略。
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引用次数: 0
Disease Burden, Risk Factors, and Temporal Trends in Breast Cancer in Low- and Middle-Income Countries: A Global Study. 低收入和中等收入国家乳腺癌的疾病负担、危险因素和时间趋势:一项全球研究。
Pub Date : 2024-07-29 eCollection Date: 2024-09-01 DOI: 10.1002/puh2.223
Mingjun Gao, Sofia Laila Wik, QinYao Yu, FanYu Xue, Sze Chai Chan, Shui Hang Chow, Yusuff Adebayo Adebisi, Claire Chenwen Zhong, Don Eliseo Lucero-Prisno, Martin Cs Wong, Junjie Huang

Introduction: Breast cancer poses significant health risks to women and strains healthcare systems extensively. In low- and middle-income countries (LMICs), limited resources and inadequate healthcare infrastructures further exacerbate the challenges of breast cancer prevention, treatment, and awareness.

Methods: We examined the prevalence, risk factors, and trends of breast cancer in LMICs. Data on disability-adjusted life years (DALYs) and breast cancer risk factors were extracted from the Global Burden of Disease (GBD) databases for 203 countries or territories from 1990 to 2019. LMIC DALY rates were examined using joinpoint regression analysis.

Results: Among the income groups, the lower middle-income category had the highest DALYs value, with 1787 years per 100,000 people. LMICs collectively accounted for 74% of the global burden of DALYs lost due to breast cancer in 2019. However, it remained relatively consistent in lower middle income countries (LMCs). In LMCs, the risk associated with metabolic syndromes was higher compared to that with behavioral factors alone. For the past three decades, breast cancer incidences increased significantly in LMCs (average annual percent change [AAPC]: 1.212, confidence intervals [CI]: 1.51-1.87, p < 0.001), upper middle income countries (AAPC: 1.701, CI: 1.12-1.48, p < 0.001), and low-income countries (AAPC: 1.002, CI: 1.57-1.68, p < 0.001).

Conclusion: This research shows how breast cancer in LMICs is aggravated by low resources and healthcare infrastructure. To effectively combat breast cancer in these areas, future strategies must prioritize improvements in healthcare infrastructure, awareness campaigns, and early detection mechanisms.

导言:乳腺癌对妇女构成重大健康风险,并对卫生保健系统造成广泛压力。在低收入和中等收入国家(LMICs),有限的资源和不足的医疗基础设施进一步加剧了乳腺癌预防、治疗和认识方面的挑战。方法:我们检查了低收入国家乳腺癌的患病率、危险因素和趋势。从1990年至2019年203个国家或地区的全球疾病负担(GBD)数据库中提取了残疾调整生命年(DALYs)和乳腺癌风险因素的数据。LMIC DALY率采用连接点回归分析进行检验。结果:在收入群体中,中低收入阶层的DALYs值最高,为每10万人1787年。2019年,低收入和中等收入国家因乳腺癌损失的伤残调整生命年合计占全球负担的74%。然而,这在中低收入国家(LMCs)保持相对一致。在lmc中,与单独的行为因素相比,与代谢综合征相关的风险更高。近30年来,中低收入国家乳腺癌发病率显著上升(年均变化百分比[AAPC]: 1.212,可信区间[CI]: 1.51-1.87, p p p p)。结论:低资源和医疗基础设施是中低收入国家乳腺癌恶化的重要因素。为了在这些地区有效地防治乳腺癌,未来的战略必须优先考虑改善保健基础设施、提高认识运动和早期发现机制。
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引用次数: 0
Sugar‐Sweetened Beverages Taxation Plan in Indonesia: Call for Political Commitment 印度尼西亚的含糖饮料征税计划:呼吁政治承诺
Pub Date : 2024-07-15 DOI: 10.1002/puh2.217
Risyad Abiyyu Siregar, Fona Qorina, Ayers Gilberth Ivano Kalaij, Hera Afidjati, Dhani Latifani, Muhammad Faisal Putro Utomo, Louisa Patricia Sophia, Azizah Salsabila Mahmud
Indonesia is grappling with a rise in obesity and diabetes, partially driven by a high consumption of sugar‐sweetened beverages. The prevalence of obesity among adults more than doubled from 2007 to 2018, and diabetes rates have also increased. In response, the Indonesian government has proposed an excise tax on sugar‐sweetened beverages to reduce consumption. However, the implementation of this policy has repeatedly been delayed, with the latest postponement to 2024. Sugar‐sweetened beverages contribute significantly to chronic diseases, increasing the healthcare burden and reducing economic productivity. Taxation, a widely used public health strategy in the form of fiscal measures, can decrease consumption by raising prices, raising public awareness, encouraging product reformulation, and generating revenue. Despite its potential benefits, the proposed tax in Indonesia faces substantial political and commercial challenges. The president‐elect Prabowo Subanto has not explicitly supported the tax in his political manifesto, raising concerns about further delays due to industry lobbying. Successful implementation of the tax requires robust political will, public and civil society pressure, and effective cross‐sector cooperation. The government must ensure clear policy goals, equal application to domestic and foreign products, and supportive measures such as providing free drinking water alternatives. Transparent stakeholder consultations can build broad‐based support, whereas effective monitoring and evaluation frameworks are essential for compliance. To gain public support, allocating tax revenues to public health and social programs is crucial. Although initial resistance is expected, strong enforcement mechanisms can ensure adherence. With determined political commitment and public advocacy, the sugar‐sweetened beverage tax can significantly reduce obesity and diabetes rates, improving public health outcomes and economic productivity in Indonesia. This commentary provides an overview of the proposed tax, explores its challenges, and offers recommendations for successful implementation.
印度尼西亚正在努力应对肥胖症和糖尿病发病率上升的问题,其部分原因是含糖饮料消费量高。从 2007 年到 2018 年,成人肥胖症发病率增加了一倍多,糖尿病发病率也有所上升。为此,印尼政府提出对含糖饮料征收消费税,以减少消费。然而,这项政策的实施时间一再推迟,最近一次推迟到了 2024 年。含糖饮料是慢性疾病的重要诱因,不仅增加了医疗负担,还降低了经济生产力。征税是一种以财政措施形式广泛使用的公共卫生策略,可以通过提高价格、提高公众意识、鼓励产品重新配方和创造收入来减少消费。尽管征税具有潜在的好处,但印尼的征税提案面临着巨大的政治和商业挑战。当选总统普拉博沃-苏班托(Prabowo Subanto)在其政治宣言中并未明确支持征税,这引发了人们对因行业游说而进一步拖延征税的担忧。税收的成功实施需要强有力的政治意愿、公众和民间社会的压力以及有效的跨部门合作。政府必须确保政策目标明确,对国内外产品一视同仁,并采取提供免费饮用水替代品等支持措施。透明的利益相关者磋商可以建立基础广泛的支持,而有效的监测和评估框架则是遵守政策的关键。为获得公众支持,将税收用于公共卫生和社会计划至关重要。虽然最初会遇到阻力,但强有力的执行机制可以确保遵守规定。在坚定的政治承诺和公众倡导下,含糖饮料税可大幅降低肥胖症和糖尿病发病率,改善印尼的公共卫生成果和经济生产力。本评论概述了拟议的征税,探讨了其面临的挑战,并为成功实施提供了建议。
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Public health challenges
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