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Improved water, sanitation, hygiene and waste services in health-care facilities, Ukraine. 改善保健设施的水、环境卫生、个人卫生和废物处理服务,乌克兰。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 Epub Date: 2024-12-03 DOI: 10.2471/BLT.24.291716
Maggie Montgomery, Arkadii Vodianyk, Nataliia Piven, Arabella Hayter, Ryan Schweitzer, Tetyana Skapa, Bruce Gordon, Oliver Schmoll

Problem: Water, sanitation and waste infrastructure and services in Ukrainian health-care facilities often fail to meet global and national standards, hindering the provision of safe, quality care. The war has worsened existing problems.

Approach: To incrementally improve water, sanitation, hand hygiene, environmental cleaning and health-care waste practices, the World Health Organization (WHO) is working with the health ministry, the Ukrainian Public Health Centre and regional United States Centers for Disease Prevention and Control (CDC) to implement the Water and Sanitation for Health Facility Improvement Tool (WASH FIT). In December 2022, WHO trained staff from the regional CDC, Ukrainian Public Health Centre and nine priority health-care facilities. Facility teams assessed services, and developed and implemented improvement plans in January 2023. Follow-up assessments were conducted after six months.

Local setting: About 4300 health-care facilities operate in Ukraine. Funding for new water and sanitation infrastructure, as well as operating and maintaining existing services, is likely inadequate.

Relevant changes: After implementation, the average WASH FIT score increased from 66 out of a maximum of 100 (range: 57-73) to 83 (range: 69-93). Facilities more effectively managed water-related risks, replaced broken taps, improved waste management practices and installed backup water supply and storage sources.

Lessons learnt: WASH FIT can be used to identify gaps in water, sanitation, hygiene and waste services and track progress towards addressing these gaps. Engaged local leaders, health-based national water, sanitation, hygiene standards, regular on-site training and mentoring drive these improvements. Strengthening public health entities is critical to institutionalize the process.

问题:乌克兰保健设施的水、卫生和废物基础设施和服务往往达不到全球和国家标准,妨碍了提供安全、高质量的护理。战争使现有的问题更加恶化。方法:为了逐步改善用水、环境卫生、手部卫生、环境清洁和保健废物处理做法,世界卫生组织(世卫组织)正在与卫生部、乌克兰公共卫生中心和美国疾病预防和控制区域中心合作,实施卫生设施改善用水和环境卫生工具(WASH FIT)。2022年12月,世卫组织培训了来自区域疾控中心、乌克兰公共卫生中心和9个重点卫生保健设施的工作人员。2023年1月,设施团队评估了服务,并制定和实施了改进计划。六个月后进行随访评估。当地环境:乌克兰约有4300个保健设施。新的供水和卫生基础设施以及运营和维护现有服务的资金可能不足。相关变化:实施后,WASH FIT的平均得分从最高100分(范围:57-73)中的66分增加到83分(范围:69-93)。设施更有效地管理了与水有关的风险,更换了损坏的水龙头,改进了废物管理做法,并安装了备用供水和储存水源。经验教训:WASH FIT可用于确定水、环境卫生、个人卫生和废物处理服务方面的差距,并跟踪解决这些差距的进展情况。积极参与的地方领导人、以健康为基础的国家水、环境卫生和个人卫生标准、定期现场培训和指导推动了这些改进。加强公共卫生实体对于使这一进程制度化至关重要。
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引用次数: 0
Policy coherence of price controls on food and noncommunicable disease prevention, WHO South-East Asia and Western Pacific regions. 粮食价格控制与非传染性疾病预防的政策一致性,世卫组织东南亚和西太平洋区域。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 Epub Date: 2024-11-06 DOI: 10.2471/BLT.24.291812
Bella Sträuli, Anne Marie Thow, Erica Reeve

Noncommunicable diseases are the leading cause of death and disability globally, with suboptimal diet being a significant risk factor. Fiscal policies that promote nutritious foods have been identified as part of a best-practice package of interventions and are a focus for governments in the current context of rising food prices. Price controls are a strategy that governments commonly apply to limit mark-up on prices of specific foods, with the aim of protecting consumers and promoting food security. To date, which specific foods are being placed under price controls is unclear. This paper aimed to provide an overview of the use of food price controls in 10 Member States of the World Health Organization South-East Asia and Western Pacific regions, which have price controls on specific food commodities. The types of foods and beverages under price controls differed considerably. Many of these foods and beverages (for example, sugar-sweetened beverages and instant noodles) were not aligned with global recommendations for healthy diets and the prevention of noncommunicable diseases. Price controls are being implemented by government agencies for finance or commerce, which are generally separate from the agencies overseeing the prevention of noncommunicable diseases. Therefore, an opportunity exists for policy-makers to strengthen policy coherence of price controls on food and the prevention of diet-related noncommunicable diseases.

非传染性疾病是全球死亡和残疾的主要原因,不理想的饮食是一个重要的风险因素。促进营养食品的财政政策已被确定为一揽子最佳做法干预措施的一部分,也是当前粮食价格上涨背景下各国政府的重点。价格管制是政府通常用来限制特定食品价格上涨的一种策略,目的是保护消费者和促进食品安全。到目前为止,还不清楚具体哪些食品受到了价格控制。本文旨在概述世界卫生组织东南亚和西太平洋区域的10个会员国对特定粮食商品实行价格管制的情况。受价格管制的食品和饮料种类差别很大。其中许多食品和饮料(例如,含糖饮料和方便面)不符合关于健康饮食和预防非传染性疾病的全球建议。价格控制由政府金融或商业机构实施,这些机构通常与监督非传染性疾病预防的机构分开。因此,决策者有机会加强粮食价格控制和预防与饮食有关的非传染性疾病的政策一致性。
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引用次数: 0
Establishing links between drug registers and essential medicines lists. 在药品登记和基本药物清单之间建立联系。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 Epub Date: 2024-10-29 DOI: 10.2471/BLT.24.291512
Petra Brhlikova, Zaheer-Ud-Din Babar, Allyson M Pollock

Access to essential medicines is still suboptimal in many countries. Recent studies examining the registration of medicines at the country level show that a considerable proportion of essential medicines do not have any corresponding products registered for use at the country level and therefore cannot be available at all times. Conversely, many non-essential medicines are registered by regulatory authorities for local markets, potentially facilitating inappropriate drug use and antimicrobial resistance. Addressing this public health gap requires linking the data on national drug registers with national essential medicines lists. Achieving this linkage will necessitate the development of common data variables and standards for both drug registers and essential medicines lists. This linkage would provide medicines regulators and health policy-makers with information on the gaps in the registration of essential medicines and allow them to take steps to prioritize registration of these medicines. This approach would improve availability of essential medicines for public health priorities and prevent over-registration of unnecessary medicines.

在许多国家,获得基本药物的情况仍然不够理想。最近审查国家一级药品注册情况的研究表明,相当大比例的基本药物没有在国家一级注册使用的任何相应产品,因此不能随时提供。相反,许多非基本药物已由监管机构在当地市场注册,这可能助长不适当的药物使用和抗微生物药物耐药性。要解决这一公共卫生差距,就需要将国家药物登记册的数据与国家基本药物清单联系起来。要实现这种联系,就必须为药物登记和基本药物清单制定共同的数据变量和标准。这种联系将为药品监管机构和卫生政策制定者提供关于基本药物注册差距的信息,并使他们能够采取步骤,优先考虑这些药物的注册。这一做法将改善公共卫生重点的基本药物供应,并防止不必要的药物过度注册。
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引用次数: 0
Air quality standards and WHO's guidance on particulate matter measuring 2.5 μm (PM2.5). 空气质量标准和世界卫生组织关于2.5 μm (PM2.5)颗粒物的指南。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-01-01 Epub Date: 2024-12-03 DOI: 10.2471/BLT.23.290522
Yevgen Nazarenko, Devendra Pal, Sanjeev Dwivedi, Parisa A Ariya
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引用次数: 0
Associations between sexual health and well-being: a systematic review. 性健康与幸福之间的关系:一项系统综述。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-01 Epub Date: 2024-11-04 DOI: 10.2471/BLT.24.291565
Priscila Vasconcelos, Mariana L Carrito, Ana Luísa Quinta-Gomes, Ana Luísa Patrão, Catarina Ap Nóbrega, Pedro A Costa, Pedro J Nobre

Objective: To investigate the associations between sexual health dimensions, and overall health and well-being.

Methods: In February 2024, we systematically searched Scopus, PsyArticles, PsycINFO®, PubMed®, Web of Science and LILACS for articles reporting on associations between sexual health, health and well-being indicators. We applied no language restrictions and followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. To assess the risk of bias in the included studies, we used the Risk Of Bias In Non-randomized Studies - of Exposures tool.

Findings: Of 23 930 unique titles identified, 63 studies met the inclusion criteria. We grouped the results into two categories: (i) sexual and physical health; and (ii) sexual and psychological health. The results consistently showed strong correlations between sexual health, overall health and well-being. Almost all studies found significant associations between positive sexual health indicators and lower depression and anxiety, higher quality of life, and greater life satisfaction among men and women, including older adults, pregnant women, and same-sex and mixed-sex couples.

Conclusion: Findings indicate that emphasizing a positive perspective on sexual health and highlighting its benefits should be regarded as an important component of the effort to improve overall health and well-being for everyone.

目的:探讨性健康各维度与整体健康和幸福感之间的关系。方法:我们于2024年2月系统检索Scopus、PsyArticles、PsycINFO®、PubMed®、Web of Science和LILACS,检索有关性健康、健康和幸福指标之间关系的文章。我们没有使用语言限制,并遵循2020年系统评价和荟萃分析指南的首选报告项目。为了评估纳入研究的偏倚风险,我们使用了非随机研究的偏倚风险-暴露工具。结果:23 930篇文献中,63篇文献符合纳入标准。我们将结果分为两类:(i)性健康和身体健康;(二)性健康和心理健康。结果一致表明,性健康、整体健康和幸福感之间存在很强的相关性。几乎所有的研究都发现,积极的性健康指标与男性和女性(包括老年人、孕妇、同性和异性伴侣)较低的抑郁和焦虑程度、较高的生活质量和较高的生活满意度之间存在显著关联。结论:研究结果表明,强调对性健康的积极看法并强调其益处应被视为改善每个人整体健康和福祉的重要组成部分。
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引用次数: 0
Sexual exploitation, abuse and harassment in humanitarian contexts. 人道主义环境中的性剥削、性虐待和骚扰。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-01 Epub Date: 2024-09-25 DOI: 10.2471/BLT.24.291655
Jasmine-Kim Westendorf, Junru Bian, Megan Daigle, Alina Potts, Kathleen Jennings, Moira Reddick, Carl Cecil Massonneau, Gaya Gamhewage, Mohamed Esam Mahmoud

Considerable investment has been made in recent years to address sexual exploitation, abuse and harassment by aid workers in the humanitarian sector. However, such sexual misconduct remains a persistent, complex challenge with wide-ranging impacts, including on sexual health, for individuals and communities hosting humanitarian responses. This article considers the state of research regarding sexual exploitation, abuse and harassment in humanitarian contexts, and identifies gaps in the evidence base necessary for reinforcing prevention and response efforts. We first report what we know about sexual exploitation, abuse and harassment, including its impacts on sexual health, risk factors and the permissive enabling organizational cultures. We then identify several critical knowledge gaps that must be addressed for more effective future strategies and approaches to prevent and respond to sexual exploitation, abuse and harassment. We discuss system-wide knowledge gaps, such as lack of evidence on programming approaches and effectiveness of prevention and accountability mechanisms. We explore potential options that health-care programming provides for preventing and responding to sexual exploitation, abuse and harassment. We also describe population-level knowledge gaps, including in patterns of perpetration and specific challenges faced by marginalized groups. We conclude with reflections for a future integrated research and policy agenda.

近年来,为解决人道主义部门援助工作人员的性剥削、性虐待和性骚扰问题进行了大量投资。然而,这种性行为不端仍然是一个持续的、复杂的挑战,对开展人道主义反应的个人和社区具有广泛的影响,包括性健康。本文考虑了人道主义背景下关于性剥削、性虐待和性骚扰的研究现状,并指出了加强预防和应对工作所需的证据基础中的差距。我们首先报告我们所了解的关于性剥削、性虐待和性骚扰的情况,包括其对性健康的影响、风险因素和纵容性的组织文化。然后,我们确定了几个关键的知识空白,这些空白必须得到解决,以便更有效地预防和应对性剥削、性虐待和性骚扰的未来战略和方法。我们讨论了全系统的知识差距,例如缺乏关于规划方法和预防和问责机制有效性的证据。我们探讨保健方案为预防和应对性剥削、性虐待和性骚扰提供的可能选择。我们还描述了人口层面的知识差距,包括犯罪模式和边缘化群体面临的具体挑战。最后,我们对未来的综合研究和政策议程进行了反思。
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引用次数: 0
Trial of an mHealth intervention to improve HIV prophylaxis for female sex workers, United Republic of Tanzania. 坦桑尼亚联合共和国改善女性性工作者艾滋病毒预防的移动医疗干预试验。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-01 Epub Date: 2024-10-29 DOI: 10.2471/BLT.24.291516
Christopher H Mbotwa, Method R Kazaura, Kåre Moen, Christopher R Sudfeld, Emmy Metta, Melkizedeck T Leshabari, Muhammad Bakari, Elia J Mmbaga

Objective: To evaluate the effect of a mobile health (mHealth) intervention on early retention of female sex workers in human immunodeficiency virus (HIV) pre-exposure prophylaxis services in the United Republic of Tanzania.

Methods: The study involved 783 female sex workers: 470 from Dar es Salaam who were given the Jichunge mHealth application (app) in addition to standard HIV pre-exposure prophylaxis (intervention arm), and 313 from Tanga who received pre-exposure prophylaxis alone (control arm). Participants were recruited using respondent-driven sampling and followed up for 12 months. Early retention was defined as attending a pre-exposure prophylaxis follow-up clinic within 28 days of an appointment scheduled for 1 month after starting treatment. To assess if the Jichunge app led to higher retention, we conducted intention-to-treat and per-protocol analyses using a regression model adjusted by inverse probability weighting.

Findings: Early retention in HIV pre-exposure prophylaxis care was observed in 27.6% (130/470) of participants in the intervention arm and 20.1% (63/313) in the control arm. In the adjusted, intention-to-treat analysis, early retention was observed in 29.4% in the intervention arm and 17.7% in the control arm (risk difference: 11.8 percentage points; 95% confidence interval: 5.3-18.3).

Conclusion: Early retention in HIV pre-exposure prophylaxis care was significantly greater among female sex workers in the United Republic of Tanzania who used the Jichunge app than in those who did not. Nevertheless, more than two thirds of sex workers using the application did not attend follow-up services after 1 month, suggesting that additional interventions are needed.

目的:评估坦桑尼亚联合共和国移动保健(mHealth)干预措施对女性性工作者早期保留人类免疫缺陷病毒(HIV)暴露前预防服务的影响。方法:该研究涉及783名女性性工作者:470名来自达累斯萨拉姆,除了标准的艾滋病毒暴露前预防外,还给予Jichunge移动健康应用程序(app)(干预组),313名来自坦噶,仅接受暴露前预防(对照组)。参与者采用受访者驱动的抽样方式招募,并随访12个月。早期保留被定义为在开始治疗后1个月的预约后28天内参加暴露前预防随访诊所。为了评估“积城”应用程序是否会带来更高的保留率,我们使用逆概率加权调整的回归模型进行了意向治疗和协议分析。结果:干预组中27.6%(130/470)的参与者和对照组中20.1%(63/313)的参与者早期保留了HIV暴露前预防护理。在调整后的意向治疗分析中,干预组的早期保留率为29.4%,对照组为17.7%(风险差异:11.8个百分点;95%置信区间:5.3-18.3)。结论:在坦桑尼亚联合共和国,使用Jichunge应用程序的女性性工作者中,HIV暴露前预防护理的早期保留率明显高于未使用该应用程序的女性。然而,使用该应用程序的性工作者中,超过三分之二的人在1个月后没有参加后续服务,这表明需要额外的干预措施。
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引用次数: 0
Public health round-up. 公共卫生综述。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-01 DOI: 10.2471/BLT.24.011224
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引用次数: 0
Progress towards sustainable development goals related to sexual health. 实现与性健康有关的可持续发展目标的进展情况。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-01 Epub Date: 2024-10-29 DOI: 10.2471/BLT.23.291163
Onikepe O Owolabi, Jonathan Hopkins, Akinrinola Bankole, Jonathan Bearak

Achieving the sexual health components of sexual and reproductive health and rights as outlined in the sustainable development goals (SDGs) is integral to overall physical and mental well-being and a core part of universal health coverage. However, tracking national and global progress towards advancing the sexual health and rights of people is challenging because of the paucity of indicators to examine many of its components. To assess the state of sexual health in populations, determine service provision needs, evaluate the effectiveness of health system interventions and monitor progress in optimizing health, a comprehensive set of indicators is needed to cover every component of sexual health. Without comparable global indicators for each component of sexual health across the individual, health systems and policy levels, and disaggregated across subgroups including all genders, there is a considerable lack of insight into people's sexual health needs and progress towards meeting those needs. This article explores the availability of global indicators for the different components of sexual health by analysing two key sources: the global indicator framework of the SDGs and the indicator index of the Global Health Observatory. We summarize the indicators for each component of sexual health using the Guttmacher-Lancet Commission framework, highlighting gaps in current indicators, and recommend areas where additional indicators are needed along with strategies on how to improve data availability, quality and inclusiveness.

实现可持续发展目标所概述的性健康和生殖健康及权利的性健康组成部分,是整体身心福祉的组成部分,也是全民健康覆盖的核心部分。然而,跟踪国家和全球在促进人民性健康和性权利方面的进展具有挑战性,因为缺乏审查其许多组成部分的指标。为了评估人群的性健康状况,确定提供服务的需求,评价卫生系统干预措施的有效性和监测优化健康方面的进展,需要一套全面的指标来涵盖性健康的每一个组成部分。在个人、卫生系统和政策层面上,性健康的每个组成部分都没有可比较的全球指标,也没有包括所有性别在内的各个子群体的分类指标,因此对人们的性健康需求以及在满足这些需求方面取得的进展缺乏深入了解。本文通过分析两个关键来源:可持续发展目标的全球指标框架和全球卫生观察站的指标指数,探讨了性健康不同组成部分的全球指标的可用性。我们使用Guttmacher-Lancet委员会的框架总结了性健康的每个组成部分的指标,突出了当前指标的差距,并建议了需要增加指标的领域,以及如何改善数据的可用性、质量和包容性的战略。
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引用次数: 0
In this month's Bulletin. 在这个月的公报中。
IF 8.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-01 DOI: 10.2471/BLT.24.001224
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引用次数: 0
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