Journal of public health (Oxford, England)最新文献

Introduction: Green spaces are increasingly recognized as critical to public health. This study examines English local planning authorities' green infrastructure strategies, evaluating how health improvement and inequality reduction goals are integrated.

Methods: A quantitative content analysis was conducted on publicly accessible green infrastructure strategy documents. Of 305 potential authorities, 133 (44%) were included based on eligibility criteria. Only strategies published from 2012 onwards were included. Data were coded across themes: health policy and actors, health outcomes, demographics and inequalities, environmental change and health. A scoring system quantified consideration of health and inequality, with descriptive statistics summarizing thematic presence, frequency, regional variation, and temporal trends.

Results: The integration of health and inequality varied substantially. Most strategies referenced general health outcomes, but fewer detailed actions targeting health inequalities or specific demographic groups. Regional differences were observed, and methods for monitoring health impacts were limited.

Conclusion: Local green infrastructure strategies in England increasingly recognize their health improvement potential, but inconsistent integration of health and inequality may limit impact. Stronger collaboration between planning and public health is needed to create equitable, accessible, health-promoting environments. Future research should explore longitudinal health impacts and identify best practices for integrating health equity in spatial planning.

Background: Overweight and obesity rates have skyrocketed over the last three decades, particularly in developing countries. This study examines the prevalent trends, and spatial and temporal patterns of overweight/obesity among India's adult women.

Methods: Using unit-level data from the National Family Health Surveys (NFHSs), this study examines the extent of overweight/obesity among adult women. Majority of the extant studies in the Indian context focus on a single metric, i.e. headcount ratio. This approach only considers a single cut-off point and ignores the differences beyond this threshold. However, the obesity burden is unlikely to be evenly distributed. To address this, I incorporate measures that explicitly take this into consideration and resort to a distribution-sensitive metric, i.e. the Foster-Greer-Thorbecke index (FGT), to identify the underlying changes in the body mass index (BMI) distribution.

Results: The analysis reveals a consistent increase in most FGT index measures, particularly among urban women. The results suggest that interventions should preferably be group-specific and targeted in nature.

Conclusions: The findings highlight that a distribution-sensitive metric provides a more nuanced understanding of the prevalent inequalities in the BMI distribution. It helps to capture the non-linear health and economic dimensions of the growing overweight or obesity burden in India.

Background: Multi-cancer detection tests (MCDs) have the potential to reduce cancer-related deaths by identifying cancers early when they can be more effectively treated. While initial studies show promise in detecting multiple cancer types, there is a lack of large-scale, prospective trials evaluating their clinical utility and real-world impact.

Methods: We conducted 23 focus groups with 158 participants to identify and describe key stakeholders' perspectives on the benefits and risks of MCD tests. Participants included clinicians (n = 58), patients (n = 17), and community members recruited from partner community advisory boards (n = 83).

Results: Participants recognized the benefits of early cancer detection and the convenience of a single blood test in reducing barriers to cancer screening. However, they shared concerns about insufficient clinical validation for MCD tests and the potential physical and psychological harm that false positives, overdiagnosis, and overtreatment may cause. They also expressed concerns about the financial costs and time burden associated with follow-up care, as well as potential inequities in access and outcomes in underserved communities.

Conclusions: Patients and clinicians want better evidence before routine use of MCD testing for cancer screening. Future research should prioritize rigorous randomized controlled trials that evaluate cancer-mortality, quality of life, diagnostic workup, and potential harms.

Background: The associations and mediation pathways between child maltreatment and incident irritable bowel syndrome (IBS) remain unclear.

Methods: We carried out the Cox proportional hazard models to explore the associations of child maltreatment and its five subtypes with hazard ratios (HRs) of IBS, and mediation analyses were conducted to assess the roles of obesity, lifestyles, and mental disorders in such associations among participants with different genetic susceptibilities.

Results: Participants who reported two or more subtypes of child maltreatment exhibited the greatest risk of IBS with HR of 1.63 (95% CI: 1.56, 1.70), compared to those who did not suffer child maltreatment. All five subtypes of child maltreatment were associated with elevated incident IBS, particularly emotional abuse with HR of 1.56 (95% CI: 1.49, 1.63). Also, such associations were more evident in those with high genetic risk score (GRS) than the low GRS. Further, obesity, lifestyles (such as smoking, sedentary behavior, sleep duration, and physical activity), and mental disorders mediated the associations of child maltreatment with the incident IBS. Anxiety and depression showed larger mediated proportions, ranging from 10.79% to 22.21% than the mediation of lifestyles.

Conclusion: Child maltreatment and its five subtypes were associated with increased incident IBS, particularly in those with higher genetic predisposition. Obesity, lifestyles and mental disorders played mediated role in such association.

Background: This systematic review and meta-regression analysis assessed the impact of human papillomavirus 16/18 (HPV16/18)-AS04 vaccine (Cervarix®) on advanced cervical lesions, including grade 3 cervical intraepithelial neoplasia or worse (CIN3, CIN3+), or cervical cancer, highlighting age-at-vaccination-dependent vaccine efficacy and effectiveness.

Methods: Studies reporting HPV16/18-AS04 vaccine efficacy or effectiveness were included with an intervention group receiving HPV16/18-AS04 vaccine and comparator group receiving placebo, another vaccine or being unvaccinated. Of 53 articles identified, nine were selected. Meta-analysis and meta-regression models with random effects and data-driven model selection determined vaccine effects (VEs) and impactful covariates.

Results: HPV16/18-AS04 vaccine effectively prevented advanced cervical premalignant lesions and cancer in adolescent girls and women vaccinated at 12-25 years. Combined randomized controlled trials and observational studies VEs on CIN3+ ranged between 76.78% (95% CI 28.15-92.49) for HPV16/18 and 56.19% (95% CI 24.76-74.49) irrespective of HPV type. Vaccine effectiveness was greatest in those vaccinated at the youngest ages.

Conclusions: HPV16/18-AS04 vaccine provides long-term protection against cervical premalignant lesions and cervical cancer in both controlled and real-world settings, particularly when administered at younger ages. The evidence urges policymakers and the community to ensure HPV vaccination begins at the youngest recommended ages.

Background: This study aimed to identify maternity services in England that most consistently reported both higher-than-average and lower-than-average rates of extended perinatal mortality (EPM), including stillbirths and neonatal deaths, throughout the government's decade-long National Maternity Safety Ambition to halve the rate of stillbirths and neonatal deaths.

Methods: We conducted a retrospective study of MBRRACE-UK Perinatal Mortality Surveillance Reports (2015-2024) to compare EPM rates for births occurring in 121 organizations providing maternity services in England between 2013 and 2022. Utilizing MBRRACE-UK definitions and designations, we devised a scoring method to determine which organizations most consistently reported higher-than-average and lower-than-average deaths.

Results: We identified 10 organisations providing maternity services (8.3%) with the five highest scores and 15 (12.4%) with the five lowest scores. A total of 20 organisations (16.5%) reported higher-than-average deaths in ≥80% of MBRRACE-UK reports and/or each of the past five years, and 22 (18.2%) reported lower-than-average deaths. Strong indications of a North-South divide for EPM were evident.

Conclusions: We provide evidence of regional EPM variation over the past decade, building on previous study findings of a North-South mortality divide in England. We propose that shared learning between outlier maternity services has the potential to ameliorate avoidable harm.

Background: Public health messaging during infectious disease outbreaks can influence healthcare demand. The winter 2022 surge in Group A Streptococcus (GAS) in England provided an opportunity to examine the relationship between communications and National Health Service (NHS) activity, informing future strategies for resilience and risk communication.

Methods: This observational study analysed UK Health Security Agency (UKHSA) invasive GAS (iGAS) notifications, NHS 111, General Practice (GP), and emergency department (ED) surveillance data, prescription records, internet searches, and media reports. Temporal associations were assessed descriptively, with weekly differences from winter averages calculated.

Results: Following initial media reports and UKHSA messaging, internet search interest rose sharply (4%-63%). In the subsequent week, there were increases in NHS 111 contacts (fevers +256%, sore throats +953%), acute respiratory infection ED visits (+155%), GP pharyngitis consultations (+356%), and community penicillin prescriptions (+134%) compared to winter averages. Compared to the previous week, consultations for scarlet fever declined.

Conclusions: This is the first study to link outbreak communications with system-wide NHS activity in real time. Messaging likely prompted appropriate care-seeking, but the rapid return to baseline and the low predictive value of consultations for iGAS suggest that many were for self-limiting illness. Findings highlight the need for tailored messaging, interdisciplinary collaboration, and scalable healthcare capacity during outbreaks.