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

Background: There is a significant gap in understanding which strategies effectively enhance vaccination rates for recommended adult vaccines in primary care settings. This review aimed to identify interventions in outpatient clinics that increase vaccination rates for commonly recommended adult vaccines and describe the change in vaccination rate associated with each intervention aimed at increasing vaccination rates in adults.

Methods: Systematic searches identified randomized, controlled trials aiming to increase the rate of vaccination in adults in outpatient clinics. Following PRISMA guidelines, PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Two reviewers independently extracted relevant data and assessed risk of bias. Meta-analysis was not done due to heterogeneity of data.

Results: Forty-four RCTs met inclusion criteria. Clinician reminders to order vaccine increased vaccination 4%-32%. Electronic health record (EHR) prompts to patients or physicians increased vaccination 1%-16%. Bundled interventions increased vaccination 4%-42%, with more intensive interventions associated with higher increases. RCT of interventions involving face-to-face contact with patients increased vaccinations 6%-17%. Group outpatient visits increased vaccination 13%-17%, home visits 6%-17%, and physician or nurse recommendation 15%.

Conclusions: Clinics may increase vaccination rates by reminding doctors to order vaccine, promoting face-to-face conversations about vaccination, and instituting bundled clinic process improvements. EHR prompts may be less effective.

Background: This study aimed to identify hospital trusts in England most consistently reporting higher-than-average rates of extended perinatal mortality (EPM), including stillbirths and neonatal deaths.

Methods: We conducted a retrospective study of MBRRACE-UK Perinatal Mortality Surveillance Reports (2015-21) comparing EPM rates for births occurring in 124 hospital trusts in England between 2013 and 2019. Utilizing MBRRACE-UK definitions and designations, including coloured bands (red and amber indicate higher death rates), we devised a scoring method to determine which trusts most consistently reported higher-than-average rates of EPM throughout seven years.

Results: We identified 23 (18.5% of 124) 'red flag' trusts most consistently falling into MBRRACE-UK red and amber bands. They included Shrewsbury and Telford Hospitals NHS Trust (SaTH) and East Kent Hospitals University Trust, both under investigation during the parliamentary Health and Social Care Committee's inquiry into the safety of maternity services in England. Seven trusts, including SaTH, reported higher-than-average deaths in all seven years. Indications of regional patterns were evident.

Conclusions: By examining maternity services mortality data over an extended period, patterns of clinical significance may emerge. We found evidence of a minority of trusts in England consistently reporting higher-than-average rates of EPM. These red flags may warrant further attention.

Objective: To investigate the likelihood of attributing colorectal cancer (CRC) symptoms to medications for chronic conditions.

Methods: The online vignette survey included 1287 participants aged ≥50 years, with quota sampling to recruit sufficient participants with type 2 diabetes. Participants self-reported chronic conditions and answered questions on symptom attribution and help-seeking, after reading vignettes describing new-onset rectal bleeding or change in bowel habit. Using multivariable logistic regression, we analyzed the association between specific conditions and attributing new-onset CRC symptoms to medications, controlling for demographics.

Results: Among participants, 25% reported type 2 diabetes, 31% being overweight, 25% hypertension and 22% arthritis. Participants with diabetes, versus those without, had a higher likelihood of attributing change in bowel habit to medications [7% vs 3%; adjusted Odds Ratio (aOR) 2.55, Confidence Interval (95% CI) 1.30-5.00]. This was also the case for participants reporting being overweight (7% vs 2%; aOR 2.36, 95% CI 1.25-4.44), arthritis (8% vs 3%; aOR 2.27, 95% CI 1.19-4.35), but not for hypertension. No significant association was found regarding attribution of rectal bleeding to medications.

Conclusions: Patients with common chronic conditions have a higher likelihood of attributing change in bowel habit to medications. Tailored information is needed for these patients, encouraging them to discuss any new symptom with their doctor.

Background: The COVID-19 pandemic had widespread impact, with evidence indicating lasting effects on wellbeing. This study aims to examine enduring impacts through individual narratives, using Conservation of Resources (COR) theory that serves for studying crises.

Methods: Analysis of narratives from 1148 responses to an open-ended question about pandemic's lasting effects, using qualitative and quantitative methods within COR theory framework including thematic analysis, Elastic Net Regression, word cloud visualization and sociodemographic analysis.

Results: About 42% of respondents reported lasting effects, with almost equal distribution between 'Loss' and 'Gain' groups, and 7% reporting mixed experiences. COR resources manifested as: work-finance and social bonds showed both disruption and strengthening; mental health, physical health and protective habits characterized loss narratives. Gain narratives were predominantly characterized by renewed perspective and personalized time investment. Women reported more physical health impacts. Resource combinations exemplified resource caravans. 'Mixed' group revealed complex balance of loss-gain dynamics. Work-life balance emerged as a sustained valued asset. The findings align with COR theory principles.

Conclusion: Three years post-pandemic onset, while lasting losses persist, narratives indicate shifting dynamics toward gains, predominantly reflecting transformed perspectives. Findings enhance COR theory in pandemic context and inform policy by highlighting emotional toll management and work-life balance preservation.

Background: The coronavirus pandemic was a major event that severely disrupted the health care system in the USA. Understanding the impact, especially among socioeconomically disadvantaged individuals, is necessary for informing health care and public health policy. This study evaluates changes in adequate prenatal care (PNC) across education levels after the 2020 pandemic.

Methods: The key outcome was adequate PNC utilization using the Kotelchuck index. A repeated cross-sectional study of before and after the COVID pandemic among individuals with low educational attainment compared to those with a college degree or above was used to estimate changes in adequate PNC use.

Results: A decrease in adequate PNC use after 2020 was greater (-4.4%) for less than high school graduation, compared to higher education levels (-2.0% to -0.8%). The difference in adjusted changes reaffirmed that having less than high school graduation was associated with a greater decrease in adequate PNC by -3.7 percentage points (95%CI -5.8, -1.5) compared to obtaining college degrees after 2020.

Conclusion: Disparities in access to care are persistent and further deteriorate among individuals of low educational attainment after the 2020 pandemic. An innovative, robust healthcare model is vital to reduce barriers to and disparities in access to care.

Background: Storm Daniel, characterized as the most severe 21st century flood event in Greece, struck the Regions of Thessaly and Central Greece in early September 2023, resulting in 17 reported direct fatalities.

Methods: This study evaluated all-cause excess mortality in the prefectures of Fthiotida, Karditsa/Trikala and Magnesia affected by Storm Daniel. We compared weekly deaths during the first week and the 90 days following the flood, to expected deaths based on historical trends 2015-2019.

Results: During the week of the flooding event, Fthiotida, Karditsa/Trikala and Magnesia prefectures experienced mortality increases of 57% (95%CI: 19%-95%), 40% (95%CI: 13%-66%) and 39% (95%CI: 7%-70%) over expected levels, respectively. A total of 54 (95% CI: 31-77) excess deaths were recorded during the week of Storm Daniel's landfall, with the cumulative number of excess deaths reaching to 335 (95% CI: 250-420) over subsequent 90 days.

Conclusion: Conventional approaches that focus solely on immediate and direct flood fatalities underestimate the overall and actual health risks faced by flood-affected communities. Floods have complex and long-term health effects, necessitating continuous monitoring of the affected communities.

Background: Although a few studies have found that healthy lifestyle is linked to a range of non-communicable chronic diseases (NCDs), its association with the onset, progression, and prognosis of multimorbidity of NCDs (MNCDs) has never been studied.

Method: A total of 332 444 adults aged 39-73 years who were free of heart disease, stroke, diabetes, and cancer at baseline were selected. Then we used multi-state model to analyze the associations between healthy lifestyle and transition trajectory were analyzed with results expressed as hazard ratio (HR) and 95% confidence interval.

Results: A total of 62 994 participants developed first NCDs (FNCDs). After adjustment for potential confounders, healthy lifestyle was negatively associated with the transition trajectory from baseline to FNCD (HR = 0.38), from FNCDs to MNCDs (HR = 0.30), etc. Further, the transition trajectory from FNCDs to MNCDs became more pronounced among the offspring who aged ˂60 (HRFNCDs → MNCDs = 0.29), who never took medicine(HRFNCDs → MNCDs = 0.25). Besides, possessing all five healthy lifestyle factors could extend the life expectancy of MNCD participants.

Conclusion: This study suggests that healthy lifestyle is associated with almost all transition phases of MNCDs development and decreases the mortality risk of MNCDs.

Background: During the COVID-19 pandemic, data collection activities largely became tele-remote, excluding those who did not have the required technology or digital literacy.

Methods: Between June and September 2020, we collected data in-person from people who use opioids in New York City. Participants were recruited via street intercept and outside four syringe service programs in the city. Surveys were conducted outdoors, with researchers and participants wearing masks and maintaining physical distance.

Results: A total of 329 people participated in the survey. Participants reported an average age of 45.8 years, 69.6% identified as male, 32.6% identified as Hispanic/Latino/a and 22.3% identified as Black. Many experienced unstable housing/street homelessness (65.9%) and half did not have regular smartphone access (51.1%).

Conclusion: Many participants were struggling to meet their basic needs and did not have the resources to participate in tele-remote research or surveillance. In-person engagement may help researchers build trust, explain data security measures, and decrease technology and comprehension barriers. As data inform policies and programs, researchers must center equity by including under-engaged groups in data collection activities.

Background and objectives: Multiple sclerosis (MS) is a chronic autoimmune disorder that significantly impacts individuals' quality of life and imposes a substantial social burden on patients and society. Despite its global socioeconomic implications, limited research has focused on the social burden of MS. This study aimed to assess the social burden of MS in Georgia by evaluating the health-related quality of life of MS patients and exploring the correlation between disease burden and quality of life.

Methodology: This cross-sectional study was performed to assess the social burden of the disease by evaluating the impact of the disease on the quality of life of 384 patients with MS. The Multiple Sclerosis Quality of Life-54 questionnaire was administered to assess quality of life.

Results: The Expanded Disability Status Scale score was significantly negatively correlated with the physical health composite score (r = -0.249, P < .001) and the general quality of life score (r = -0.220, P < .001). The quality of life was highly associated with gender, employment status, living/residence place, and moderately with age.

Conclusions and implications: This study revealed the intricate interplay between disability, quality of life, and sociodemographic factors among Georgian MS patients. The results of the study highlight the need for specialized therapies, networks of support, and public health initiatives to lessen the societal cost of MS.