BMC Public Health最新文献

Background: Health inequity: defined as systematic and avoidable difference in health outcome, remain entrenched across high-income countries, with socioeconomic gaps in life expectancy exceeding 7-10 years. Upstream interventions addressing the social determinants of health are critical. This umbrella review evaluates which macro-level policies and public health interventions most effectively reduce health inequity.

Methods: We conducted an umbrella review of systematic reviews. Four databases (Embase, Medline, Scopus, Cochrane) were searched from May 2017, the date of the last umbrella review on the subject, to September 2024. Eligible reviews reported population-level interventions in OECD countries, with outcomes stratified by socioeconomic status or related disadvantage. Included systematic reviews were appraised using AMSTAR II. We devised a conceptual Health Equity Pyramid that classified interventions by their agentic demand and population reach.

Results: Thirty-five systematic reviews were included. This review evaluated evidence across six policy domains. Redistributive and welfare interventions, including cash transfers, basic income and food subsidies, consistently improved food security, household financial stability and maternal-child health outcomes. Legislative and regulatory measures, such as smoke-free policies and pharmaceutical subsidy reforms, demonstrated robust population-level gains, particularly in disadvantaged groups. Community and housing interventions improved psychological health, reduced morbidity and mortality in targeted populations, and enhanced housing stability. Health system interventions, notably tailored smoking cessation and hospital discharge coordination for people experiencing homelessness, were effective in narrowing disparities. By contrast, educational and behavioural programmes and telehealth interventions often demanded high individual agency; without contextual tailoring, may exacerbate intervention-generated inequality.

Conclusions: This umbrella review demonstrates that interventions characterised by low agentic demand: welfare reform, housing support, and legislative measures; yield the most consistent reductions in inequity. High agentic interventions can be effective when carefully tailored to disadvantaged populations but may otherwise exacerbate disparities. Future policy should prioritise structural, population-level strategies to achieve sustainable equity in health outcomes.

Trial registration: CRD42024529176.

Background: In China, the HIV prevalence among men who have sex with men (MSM) is still rising, with a large proportion of people never tested for HIV in this group. HIV self-testing (HIVST) offers a user-empowered approach in expanding testing coverage. Peer navigation, recognized for its effectiveness in supporting MSM in HIV care, is proposed here as a potential enhancement to HIVST. This study aims to evaluate peer navigation in promoting digital secondary distribution of HIVST among MSM in China.

Methods: We plan to recruit 400 participants (indexes) identified as key nodes in the network using our previously developed algorithm, RiskRank, via the BlueD platform. RiskRank is a method to prioritize nodes for targeted interventions by incorporating their topological features on the multilayer complex networks and considering the underlying epidemic dynamics. The eligible participants will be randomized into the intervention group (peer navigation) and the control group in a 1:1 allocation ratio. In the intervention group, 20 peer navigators will be recruited and trained. Each peer navigator will provide the peer navigated intervention to 10 participants (indexes). The peer navigation process consists of three modules ([BHSD], [SSDE], and [CFPS]). In the control group, we will implement the standard HIVST secondary distribution we have developed before. The index will distribute the HIVST kits to the alters, leveraging their existing social connections to try to make the kits reach those who may not have access to traditional testing services. All index participants will be requested to complete a baseline survey and a 3-month follow-up survey. Both indexes and alters will complete a survey upon returning the results, by taking a photo of the used kits with the unique identification number.

Discussion: HIV testing rate remains to be below the desired levels among MSM in China. Creative approaches like peer navigation are essential to enhance HIV testing uptake among key populations. The findings of the trial can offer valuable scientific evidence and insights into promoting the secondary distribution of HIV self-testing (HIVST) to reach key populations not yet reached by current testing services.

Trial registration: The study has been registered with the Chinese Clinical Trial Registry ChiCTR2400093985; Date of Registration: 16 December, 2024; Protocol Version: R3.

Background: Vaccine hesitancy is a major public health problem on a global scale, where individual choices directly affect public health and increase the risk of re-spread of infectious diseases. In particular, parental indecision about childhood vaccinations leads to weakened community immunity, placing a serious burden on health systems. Today, the ease of access to digital information has led to increased health concerns and individuals develop cyberchondria behaviors in the process of online information seeking. At the same time, individuals' fatalistic beliefs about health may also affect their vaccination decisions. This study evaluates the effects of religious health fatalism and cyberchondria on parents' hesitancy regarding childhood vaccinations.

Methods: This descriptive and cross-sectional study was conducted with 535 parents of children aged 0-5 who visited a healthcare institution in Turkey between March and August 2024. Data were collected using a Personal Information Form, the Religious Health Fatalism Scale, the Vaccine Hesitancy Scale, and the Cyberchondria Severity Scale Short Form. Data analysis was performed using SPSS 27.0 and the Hayes PROCESS program.

Results: In this study, a significant positive relationship was found between vaccine hesitancy and religious health fatalism (β = 0.274, p < .001) and cyberchondria (β = 0.193, p < .001). In hierarchical regression, religious health fatalism (β = 0.298) and cyberchondria (β = 0.200) significantly predicted vaccine hesitancy and together explained 12.7% of the variance. Demographic variables did not contribute significantly to the model (p > .05). In the moderation analysis, cyberchondria was found to play a role in strengthening the relationship between religious health fatalism and vaccine hesitancy (β = 0.088, p = .011).

Conclusions: This study has revealed that health-related fatalistic beliefs and levels of cyberchondria may be associated with parents' vaccine hesitancy. The findings suggest that vaccine hesitancy may be influenced not only by a lack of information but also by individuals' belief systems and health-related concerns in the digital environment.

Background: Despite the crucial distinction between insomnia symptoms and a diagnosed disorder, population-level studies based on contemporary criteria and clinical interviews are scarce. This study therefore examined the insomnia spectrum by assessing the prevalence, identifying subtypes, and exploring associations with sociodemographic factors and comorbid mental disorders for both conditions.

Methods: This large-scale, community-based cross-sectional study was conducted in Beijing from October to December 2021. A sample of 10,778 adults was recruited via multistage stratified random sampling. Trained psychiatrists conducted standardized diagnostic interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to collect data on insomnia disorder and mental disorders. Descriptive analysis and weighted Rao-Scott chi-square tests, were performed using the Statistical Analysis System (SAS, version 9.4).

Results: The weighted prevalence rates were 17.7% for subjective sleep problems, 10.7% for clinically assessed insomnia symptoms, and 3.0% for DSM-5-diagnosed insomnia disorder. Among insomnia subtypes, initial insomnia was most prevalent, both as a symptom (8.1%) and a disorder (2.6%). Furthermore, insomnia disorder prevalence varied by sociodemographics, being higher in females, older adults (≥ 60 years), and those with lower education. Among individuals with insomnia disorder, 31.3% had comorbid other mental disorders, particularly alcohol-related disorders (13.4%). Conversely, insomnia disorder was observed in 14.4% of individuals with other mental disorders, with the highest prevalence in depressive (21.4%) and anxiety disorders (19.2%).

Conclusions: The marked disparity between prevalent insomnia symptoms and formal diagnoses, compounded by significant psychiatric comorbidity, mandates a public health shift toward population-level screening and early intervention. This imperative includes adopting standardized diagnostics and implementing integrated, transdiagnostic treatment models as a pivotal preventive strategy.