BMC Public Health最新文献

Background: The risk of HIV acquisition is heightened during pregnancy and early parenthood with the additional risk of vertical HIV transmission. While recent studies have improved our understanding of PrEP use among pregnant and breastfeeding women, further evidence is needed to inform the design of interventions that support sustained use, especially among young women who are pregnant or parenting.

Methods: We analysed data from young women aged 15-29 years who initiated PrEP in an implementation study (FastPrEP) in Cape Town, South Africa. Logistic regression was used to examine the association between pregnancy or parenting status (≥ 1 living child) and PrEP discontinuation at 1- and 4-months post-initiation, based on pharmacy refill data. The primary exposure was currently pregnant or having a child (vs. not); secondary analyses stratified by age (15-24 vs. 25-29 years) among women who were pregnant/parenting. Models were adjusted for age and hypothesised explanatory factors were included in sensitivity analysis: service delivery location, contraceptive use, HIV risk perception, and relationship status.

Results: Between August 2022 and June 2024 n = 4,876 young women initiated PrEP; 44% were pregnant/parenting (of which 10% were pregnant), and the median age was 21.6 years (IQR:18-25). At 1-month, women who were pregnant/parenting had higher odds of PrEP discontinuation (aOR:1.30, 95% CI:1.14-1.49). At 4-months this relationship persisted (aOR:1.41, 95% CI:1.12-1.78) compared with non-pregnant/parenting women. Among those pregnant/parenting, younger women (15-24 years) had higher odds of discontinuation at 1-month (aOR:1.31, 95% CI:1.08-1.58) and 4-months (aOR:1.41, 95%CI:1.02-1.96) compared to women aged 25-29. In the fully adjusted multivariable model, receiving PrEP in mobile clinics (aOR:0.71, 95% CI:0.61-0.82) vs. government clinics was associated with lower odds of early discontinuation.

Conclusion: Young women who are pregnant/parenting face elevated risk of early PrEP discontinuation. Differentiated, life-stage and youth-responsive interventions, such as counselling, partner involvement, and integration with maternal and child health, or sexual and reproductive health services, are critical to improving PrEP persistence among this priority population. This population should be prioritised in the rollout of long-acting PrEP formulations, which may better align with their needs and reduce the burden of daily adherence.

Background: The prevalence of raised blood pressure (RBP) in Cambodia has nearly doubled over the past decade. This study aimed to examine the associated factors and quantify the magnitude of educational and economic inequalities in relation to the prevalence of RBP among Cambodian adults.

Methods: Data were obtained from the 2023 STEPwise approach to noncommunicable disease risk factor surveillance. The study included 3,186 adults aged 18-69 years. Multilevel logistic regression models were used to identify potential associated factors for RBP. The magnitude of educational and economic inequalities was assessed using the regression-based slope index of inequality (SII) and relative index of inequality (RII).

Results: Overall, the prevalence of RBP was 16.2% (95% confidence interval [CI]: 14.5%-18.1%). The main associated factors for RBP were age 40-49 years (odds ratio [OR]: 4.97, 95% CI: 2.51-9.85), 50-59 years (OR:10.67, 95%CI: 5.52-20.62), and 60-69 years (OR:12.92, 95%CI: 6.55-25.48), overweight (OR:1.66, 95%CI:1.19-2.33), obesity (OR: 3.52, 95% CI: 2.38-5.21), and comorbid diabetes (OR: 2.53, 95% CI:1.81-3.54). Female sex (OR: 0.39, 95% CI: 0.25-0.63), current usage of smoking tobacco products (OR: 0.47, 95% CI: 0.27-0.83), adequate consumption of fruits and vegetables (OR: 0.63, 95%CI: 0.46-0.85), and underweight (OR:0.33, 95%CI:0.18-0.61) were associated with reduced risk of RBP. Substantial educational inequality was observed in relation to the prevalence of RBP, with RBP disproportionately affecting individuals without formal schooling at the national (SII: -18.9, 95% CI: -24.80 to -12.90, p < 0.001), rural-urban, and regional levels. Nationally, individuals with higher education levels were 67% less likely to have RBP than those without formal schooling (RII: 0.33, 95% CI: 0.17-0.66). Significant absolute economic inequalities in RBP prevalence, to the disadvantage of poor households, were also observed among urban residents (SII: -10.8, 95% CI: -20.10 to -1.50, p < 0.05) as well as those living in the plateau and mountain regions (SII: -13.8, 95% CI: -26.10 to -1.40, p < 0.05).

Conclusion: RBP remains a major public health challenge in Cambodia, with substantial educational and context-specific economic inequalities. Addressing these social determinants through equity-oriented, context-sensitive interventions is essential to reduce the burden of RBP and prevent cardiovascular diseases in the Cambodian population.

Background: Childhood myopia has emerged as a growing public health concern, adversely affecting both visual function and vision-related quality of life (VR-QoL). This study examined the relationships among parent engagement, primary school children's eye care behaviors, and vision-related quality of life based on the Health Belief Model (HBM).

Methods: In 2022, a total of 2,139 parent-child dyads were recruited from six primary schools in Hangzhou City, China, using stratified cluster sampling. Both children and their parents completed validated, self-administered questionnaires assessing eye care behaviors, engagement efficacy, and HBM variables. Multiple regression analyses were conducted to examine the associations among parent and child health beliefs, parent engagement practices, children's eye care behaviors, and VR-QoL.

Results: The participated children were aged from 9.24 to 10.19 years old. After adjusting for sociodemographic factors, parents with greater eye care knowledge, fewer perceived barriers, and stronger engagement efficacy were more likely to support their children's eye care behaviors. Among children, higher levels of eye care knowledge, perceived severity of myopia, and perceived benefits of protective practices were significantly associated with more frequent engagement in eye care behaviors. Children with stronger perceptions of severity and benefits, lower susceptibility, fewer barriers, and better eye care behavior reported higher VR-QoL.

Conclusions: Health belief variables were significantly associated with parent engagement, children's eye care behaviors, and VR-QoL. These findings highlight the importance of considering both parent- and child-level cognitive and behavioral factors when examining childhood eye health. Theory-informed assessments can inform the development of contextually appropriate vision health promotion strategies.

Objectives: Vitamin D deficiency remains a major global public health concern. This study aimed to assess vitamin D levels measured in individuals aged 18 years and older between 2016 and 2025 in a tertiary care hospital and to examine the association of these levels with seasonal, annual, and demographic variables.

Patients and methods: This retrospective observational study included patients who presented to Duzce University Hospital for any reason between 2016 and 2025 and had serum 25(OH)D levels measured. In total, data from 85,892 individuals were analyzed. Vitamin D status was categorized as sufficient (> 30 ng/mL), insufficient (20-30 ng/mL), or deficient (< 20 ng/mL).

Results: Among the participants, 70.2% (n = 60,309) were women and 29.8% (n = 25,583) were men. The mean age was 47.16 ± 17.62 years. The overall mean serum 25(OH)D level was 17.90 ± 12.08 ng/mL. Vitamin D deficiency (< 20 ng/mL) was identified in 68.6% of women and 61.3% of men. Overall, 66.4% (n = 57,051) of participants had Vitamin D deficiency (< 20 ng/mL), 21.7% (n = 18,635) had Vitamin D insufficiency (20-30 ng/mL), and 11.9% (n = 10,206) had sufficient Vitamin D levels (> 30 ng/mL). The mean 25(OH)D level was 19.16 ± 10.74 ng/mL in men and 17.37 ± 12.56 ng/mL in women, with significantly higher levels observed in men (p < 0.001). Participants aged 65 years and older had significantly higher vitamin D levels compared with those under 65 years (p < 0.001). Seasonally, the highest mean vitamin D levels were recorded in summer, whereas the lowest levels were found in winter.

Conclusion: Vitamin D deficiency continues to pose a substantial public health challenge in Turkey. Addressing this issue should be considered a priority, and further comprehensive studies are urgently needed to support the development of effective strategies aimed at reducing deficiency rates.