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

Background: The increasing prevalence of caesarian section (C-section) births in South and Southeast Asia poses potential public health challenges by influencing maternal and child nutrition. These changes may contribute to the growing double burden of malnutrition (DBM), where maternal overweight/obesity coexists with child undernutrition. This study explores how C-section deliveries are linked to household-level DBM in three countries in this region. Understanding this link is key for developing effective interventions to improve maternal and child nutrition and reduce health burdens.

Methods: We analysed 2022 Demographic and Health Survey (DHS) data from Bangladesh, Cambodia, and Nepal, including women aged 15-49 with at least one child, with available nutritional and delivery mode data. Chi-square tests, analysis of variance, and two-level logistic regression were used to assess the association between C-sections and DBM.

Results: C-section deliveries were linked to a significantly higher risk of DBM in Bangladesh and Nepal. Delayed breastfeeding initiation after C-section further increased this risk. Urban households showed higher DBM rates, while longer breastfeeding duration was protective.

Conclusion: To reduce DBM, policies should focus on limiting unnecessary C-sections, promoting early and sustained breastfeeding, and supporting maternal postpartum health-especially in urban areas where risks are higher. Understanding local factors is crucial for effective interventions.

Background: There is a demand for population level research on the potential genetic-basis of mesothelioma (e.g. BRCA1-associated protein-1 [BAP1]) independent of other risk factors, such as amphibole asbestos exposure. By surrogate, another primary cancer history can be used to explore this issue, including in the USA, where the incidence rates (IRs) in men, but not women, are temporally aligned with historical asbestos consumption.

Methods: We computed age-adjusted IRs of mesothelioma in females and males stratified by other primary cancer history using publicly available U.S. cancer data from 1975 to 2021. To facilitate comparison with other cancers associated with BAP1, we calculated age-adjusted IRs for female breast cancer and melanoma.

Results: Similar to breast cancer and melanoma, ~ 25% of females with mesothelioma had a history of at least one other primary cancer. While IRs of mesothelioma in males without a history of other primary cancers were temporally aligned with historical asbestos consumption trends in the USA, IRs of mesothelioma among males with other primary cancer histories showed no relationship with asbestos consumption trends.

Conclusions: Our findings suggest that a genetic predisposition for malignancy contributes to U.S. mesothelioma rates and is a distinct risk factor independent of asbestos exposure.

Objective: To evaluate the impact of socioeconomic variables on access to cardiology assistance through referrals from primary care (PC).

Methodology: We analysed all referrals from PC to the Cardiology Department between 2010 and 2019 in our healthcare area (n = 41 332). Income levels were categorized into quartiles based on the sample's distribution by municipality of origin. The association between each variable and accessibility was analysed using logistic regression (LR).

Results: Accessibility to e-consultation was lower in lower income groups (OR: 0.68, P = 0.0001, for Q1; and OR: 0.72, P = 0.001, for Q2) and higher for the follow-up consultations (OR: 8.66, for Q2 and 4.88, for Q1; P < 0,001 for both quartiles), but related with cardiovascular complexity associated with higher prevalence of cardiovascular risk factors and cardiovascular disease in lower income levels. Emergency department attendance and hospital admissions were independent of any economic parameter (OR: 0.01; P < 0.001).

Conclusions: Our public health system attends the patients independently of income level, and the differences observed were associated with complexity of the patients. Income levels did not have a negative influence on referrals to hospital care resources in our healthcare system, whether it is for consultations (initial or follow-up), emergencies, or hospital admissions.

Background: Osteoporotic fractures are a major public concern as a serious, fatal condition. We aimed to investigate the differences in the incidence and types of osteoporotic fractures between people with and without disabilities, including both mental and physical disabilities.

Methods: This is a serial cross-sectional study using the National Disability Registration and National Health Insurance claims data. After excluding individual with Paget's disease and cancer that damages bone, we analyzed trends and associated factors of osteoporotic fractures between 2008 and 2017.

Results: The age-standardized incidence rate (ASIR) of osteoporotic fractures was higher in the disabled than in the non-disabled for 10 years (41.3 and 24.0 per 10 000 persons, respectively, in 2017). Vertebral fractures were the most common. However, the incidence of non-vertebral fractures was about twice as high in the disabled as in the non-disabled. In multivariate analysis, the highest odds ratios were observed for epilepsy (OR = 3.80; 95% confidence intervals = 2.40-5.99), liver disease (OR = 2.38), and intellectual disability (OR = 1.95) in men and for epilepsy (OR = 3.19), liver (OR = 1.64), and respiratory (OR = 1.49) disease in women.

Conclusion: Given the preventability and high incidence of fracture in disabled people, health systems should be designed to ensure timely and appropriate prevention and intervention for disabled people.

Background: Co-design is increasingly used in residential aged care research. However, there is limited literature on how these co-design processes are evaluated, particularly in the absence of co-design evaluation frameworks developed specifically for this setting. We examined how co-design processes used with residents and informal carers to develop healthcare interventions in residential aged care are evaluated.

Methods: Six electronic databases were searched, and 4594 studies reporting co-design of healthcare interventions with older adults and/or informal carers in residential aged care were screened. Data extraction included study characteristics and co-design evaluation practices.

Results: Of 22 included studies, six evaluated their co-design process. Narrative reflection was the most common approach (n = 4). Evaluation was predominantly retrospective and based on researchers' reflections, drawing on data collected during the process. No studies used pre-defined evaluation criteria to measure the impact or effectiveness of the co-design process, or if the process meaningfully involved residents or their informal carers.

Conclusion: Co-design is increasingly used in residential aged care research, although evaluation of these processes is uncommon. As a result, little is known about how effectively co-design is being applied in this setting, or whether it is achieving its core aim of meaningfully involving end-users in research.

Introduction: Accumulating evidence suggests that early-onset and late-onset cancers may be etiologically heterogeneous. Thus, we examined the global distribution of incidence rates of early-onset and late-onset cancers by sex.

Methods: The GLOBOCAN database provides age-standardized incidence rates (ASIRs) of cancers by age and sex across countries worldwide. By defining early-onset and late-onset cancers using the age cut-off of 50 years, we examined global trends in ASIRs of early-onset and late-onset cancers by visualizing data with various graphs.

Results: The top five countries with the highest ASIRs of early-onset and late-onset cancers were concentrated in Europe in men, whereas the rates were scattered across the continents in women. While ASIRs of early-onset cancers had increased steadily over time, the rates were considerably lower than ASIRs of late-onset cancers in both men and women. By cancer type, thyroid cancer and lung cancer ranked first in ASIRs of early-onset and late-onset cancers, respectively, in men. In women, breast cancer ranked first for both early-onset and late-onset cancers. Colorectal cancer appeared among the top five for both early-onset and late-onset cancers across all sexes.

Conclusions: Global ASIRs trends of early-onset and late-onset cancers were heterogeneous with respect to sex, geographic distribution, time-trend, and cancer types.

Background: The World Health Organization's convention, agreement or other international instrument on pandemic prevention, preparedness, and response, often referred to as the 'pandemic treaty', was established with principles to guide implementation. The treaty's underlying ethic was cosmopolitan in intent, emphasizing equal value of all people with obligations stemming from shared humanity.

Methods: The principles of the working draft of 13 July 2022 and the proposed agreement of 22 April 2024 were compared by textual analysis for content and sequence. Changes were analysed using the ethical framework of cosmopolitanism and associated public health implications identified.

Results: Compared with the working draft, the proposed agreement consolidated principles such as solidarity and reduced specific obligations, weakening ethical demands. Sovereignty was elevated to the cardinal principle, while obligations tied to equity and human rights were less specific, reflecting a shift from cosmopolitan intentions and a reduced emphasis on cooperation for shared public health goals.

Conclusions: Changes made through the pandemic treaty negotiation process suggest ethical amnesia, undermining global equity, justice, and solidarity with consequences for public health and pandemic preparedness. Strengthening obligations in the treaty text is essential to embed a collective motivation for cooperation necessary for effective public health before the next pandemic.

Objective: We compared non-laboratory models' efficacy with standard laboratory-based model in identifying high-risk populations for cardiovascular disease (CVD) in resource-limited settings.

Methods: A national sample of 121 672 individuals aged 40-70 from the PERSIAN cohort was analyzed. Non-laboratory models, including the World Health Organization (WHO) and Iranian pooled-cohort CVD mortality models, were compared with the WHO laboratory-based model. Intra-class correlation coefficient (ICC) and concordance correlation coefficient (CCC) were utilized. Sensitivity and specificity of non-laboratory models were evaluated against the laboratory-based one at various risk thresholds. The number of reduced tests in the stepwise approach was calculated considering the Iranian census.

Results: Both non-laboratory and laboratory-based models showed similar trends in predicting CVD risks across age groups. Strong correlations and concordance were observed in both men (ICC: 94.4%, CCC:0.893) and women (ICC: 93.8%, CCC:0.883). Utilizing a 5% risk threshold for WHO non-laboratory and 2% for the Iranian pooled-cohort CVD mortality model as the initial step achieved high sensitivity (99.6%) and moderate specificity (52%) for identifying candidates for the second-step laboratory test. This approach effectively reduced the number of tests by 16 807 982.

Conclusion: Non-laboratory models, in a stepwise approach, offer a promising strategy to alleviate strain on financial resources and enhance healthcare system efficiency in resource-limited countries.

Background: Tobacco smoke exposure was associated with inflammation and adverse health outcomes. However, the impact of early-life tobacco exposure on rheumatic diseases, including rheumatoid arthritis, osteoarthritis, gout, and spondyloarthritis, and the potential modifying role of inflammation are unclear.

Methods: A prospective analysis of over 200 000 participants without rheumatic diseases at baseline in the UK Biobank was conducted. Cox proportional hazards regression models were employed to assess the associations between early-life tobacco exposure with rheumatic diseases. Furthermore, we evaluated whether inflammation status modified these associations.

Results: Among participants, 77,825 (29.0%) experienced in utero tobacco exposure, and 14,216 (5.4%) initiated smoking during childhood. In utero tobacco exposure was associated with increased rheumatic disease incidence, with hazard ratios of 1.18 (1.08, 1.28) for rheumatoid arthritis, 1.10 (1.08, 1.13) for osteoarthritis, 1.12 (1.05, 1.19) for gout, and 1.24 (1.13, 1.35) for spondyloarthritis. Earlier smoking initiation significantly increased the incidence of rheumatic diseases (P < .001), with remarkable trends (Ptrend < .001). Combined associations and interactions were observed between in utero tobacco exposure, smoking initiation age, and inflammation. Participants with high inflammation, in utero tobacco exposure, and earlier smoking initiation had the highest rheumatic disease risk.

Conclusions: In utero tobacco exposure and earlier smoking initiation were associated with an increased risk of rheumatic diseases, especially in those with high inflammation status.