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Community tuberculosis screening, testing and care, Uganda. 社区结核病筛查、检测和护理,乌干达。
IF 8.4 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-04-30 DOI: 10.2471/BLT.23.290641
Stavia Turyahabwe, Muzamiru Bamuloba, Levicatus Mugenyi, Geoffrey Amanya, Raymond Byaruhanga, Joseph Fry Imoko, Mabel Nakawooya, Simon Walusimbi, Jasper Nidoi, Aldomoro Burua, Moorine Sekadde, Winters Muttamba, Moses Arinaitwe, Luzze Henry, Rose Kengonzi, Mary Mudiope, Bruce J Kirenga

Objective: To assess the effectiveness of a community-based tuberculosis and leprosy intervention in which village health teams and health workers conduct door-to-door tuberculosis screening, targeted screenings and contact tracing.

Methods: We conducted a before-and-after implementation study in Uganda to assess the effectiveness of the community tuberculosis intervention by looking at reach, outputs, adoption and effectiveness of the intervention. Campaign 1 was conducted in March 2022 and campaign 2 in September 2022. We calculated percentages of targets achieved and compared case notification rates during the intervention with corresponding quarters in the previous year. We also assessed the leprosy screening.

Findings: Over 5 days, campaign 1 screened 1 289 213 people (2.9% of the general population), of whom 179 144 (13.9%) fulfilled the presumptive tuberculosis criteria, and 4043 (2.3%) were diagnosed with bacteriologically-confirmed tuberculosis; 3710 (91.8%) individuals were linked to care. In campaign 2, 5 134 056 people (11.6% of the general population) were screened, detecting 428 444 (8.3%) presumptive tuberculosis patients and 8121 (1.9%) bacteriologically-confirmed tuberculosis patients; 5942 individuals (87.1%) were linked to care. The case notification rate increased from 48.1 to 59.5 per 100 000 population in campaign 1, with a case notification rate ratio of 1.24 (95% confidence interval, CI: 1.22-1.26). In campaign 2, the case notification rate increased from 45.0 to 71.6 per 100 000 population, with a case notification rate ratio of 1.59 (95% CI: 1.56-1.62). Of the 176 patients identified with leprosy, 137 (77.8%) initiated treatment.

Conclusion: This community tuberculosis screening initiative is effective. However, continuous monitoring and adaptations are needed to overcome context-specific implementation challenges.

目的:评估基于社区的结核病和麻风病干预措施的有效性:评估以社区为基础的结核病和麻风病干预措施的有效性。在这项干预措施中,村卫生队和卫生工作者挨家挨户进行结核病筛查、有针对性的筛查和接触者追踪:我们在乌干达开展了一项实施前后对比研究,通过考察干预措施的覆盖范围、产出、采用情况和效果,评估社区结核病干预措施的有效性。运动 1 于 2022 年 3 月开展,运动 2 于 2022 年 9 月开展。我们计算了实现目标的百分比,并将干预期间的病例通报率与上一年相应季度的病例通报率进行了比较。我们还对麻风病筛查进行了评估:在为期 5 天的活动 1 中,共筛查了 1 289 213 人(占总人口的 2.9%),其中 179 144 人(13.9%)符合推定肺结核标准,4043 人(2.3%)被诊断为细菌学确诊肺结核;3710 人(91.8%)接受了护理。在活动 2 中,对 5 134 056 人(占总人口的 11.6%)进行了筛查,发现了 428 444 名(8.3%)推定肺结核病人和 8121 名(1.9%)细菌学确诊肺结核病人;5942 人(87.1%)接受了治疗。在活动 1 中,病例通报率从每 10 万人 48.1 例增至 59.5 例,病例通报率比为 1.24(95% 置信区间:1.22-1.26)。在活动 2 中,每 10 万人的病例通报率从 45.0 上升至 71.6,病例通报率比值为 1.59(95% 置信区间:1.56-1.62)。在被确认为麻风病人的 176 人中,137 人(77.8%)开始接受治疗:结论:这一社区结核病筛查措施是有效的。结论:这一社区结核病筛查倡议是有效的,但需要持续监测和调整,以克服因地制宜的实施挑战。
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引用次数: 0
Ivanilda (Vanny) Reis: encouraging physical activity and sport for everyone. 伊万尼达-雷斯(Ivanilda (Vanny) Reis):鼓励人人参加体育锻炼和运动。
IF 11.1 2区 医学 Q1 Medicine Pub Date : 2024-06-01 DOI: 10.2471/BLT.24.030624

Vanny Reis talks to Gary Humphreys about the transformative power of sport and physical activity in improving health and well-being throughout people's lives.

Vanny Reis 与 Gary Humphreys 谈论了体育运动在改善人们一生的健康和福祉方面的变革力量。
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引用次数: 0
Outcomes of sugar reduction policies, United Kingdom of Great Britain and Northern Ireland. 减糖政策的成果,大不列颠及北爱尔兰联合王国。
IF 11.1 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-03-27 DOI: 10.2471/BLT.23.291013
Kawther M Hashem, Hattie E Burt, Mhairi K Brown, Graham A MacGregor

Poor diets are the major cause of death and disease globally, driving high levels of obesity and noncommunicable diseases. Cheap, heavily marketed, ultra-processed, energy-dense and nutrient-poor food and drinks that are high in fat, sugar and salt play a major role. The high-sugar content of these products leads to consumption levels much higher than recommended. The World Health Organization recommends that sugar intake should be reduced to just 5% of energy intake by using fiscal policies and food and drink reformulation strategies. Over the previous decade, the government of the United Kingdom of Great Britain and Northern Ireland has implemented several policies aimed at reducing sugar intake. We compare the soft drinks industry levy and the sugar reduction programme, examining how differences in policy design and process may have influenced the outcomes. Success has been mixed: the mandatory levy achieved a reduction in total sugar sales of 34.3%, and the voluntary reduction programme only achieved a 3.5% reduction in sugar levels of key contributors to sugar intake (despite a target of 20%). Both policies can be improved to enhance their impact, for example, by increasing the levy and reducing the sugar content threshold in the soft drinks industry levy, and by setting more stringent subcategory specific targets in the sugar reduction programme. We also recommend that policy-makers should consider applying a similar levy to other discretionary products that are key contributors to sugar intake. Both approaches provide valuable learnings for future policy in the United Kingdom and globally.

不良饮食是全球死亡和疾病的主要原因,导致肥胖和非传染性疾病高发。高脂肪、高糖和高盐的廉价、大量销售、超加工、高能量和低营养的食品和饮料是主要原因。这些产品的高糖含量导致消费水平远远高于建议水平。世界卫生组织建议,应通过财政政策和食品饮料改良策略,将糖的摄入量降至能量摄入的 5%。过去十年间,大不列颠及北爱尔兰联合王国政府实施了多项旨在减少糖摄入量的政策。我们比较了软饮料行业征税和减糖计划,研究了政策设计和过程中的差异可能对结果产生的影响。结果有好有坏:强制性征税使糖的总销售量减少了 34.3%,而自愿减糖计划仅使糖摄入量主要来源的糖含量减少了 3.5%(尽管目标是 20%)。这两项政策都可以加以改进,以提高其效果,例如,提高软饮料行业征税额,降低含糖量门槛,以及在减糖计划中设定更严格的具体子类别目标。我们还建议,政策制定者应考虑对其他导致糖摄入量增加的随意性产品征收类似的税费。这两种方法都为英国和全球的未来政策提供了宝贵经验。
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引用次数: 0
Overuse of antibiotics for urinary tract infections in pregnant refugees, Lebanon. 黎巴嫩怀孕难民尿路感染时过度使用抗生素。
IF 11.1 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-03-27 DOI: 10.2471/BLT.23.291235
Christine Al Kady, Krystel Moussally, Wafaa Chreif, Anna Farra, Severine Caluwaerts, Heiman Wertheim, Dounia Soukarieh, Fabiola Gordillo Gomez, Johanna Dibiasi, Annick Lenglet

Objective: To determine whether adding urine culture to urinary tract infection diagnosis in pregnant women from refugee camps in Lebanon reduced unnecessary antibiotic use.

Methods: We conducted a prospective, cross-sectional study between April and June 2022 involving pregnant women attending a Médecins Sans Frontières sexual reproductive health clinic in south Beirut. Women with two positive urine dipstick tests (i.e. a suspected urinary tract infection) provided urine samples for culture. Bacterial identification and antimicrobial sensitivity testing were conducted following European Committee on Antimicrobial Susceptibility Testing guidelines. We compared the characteristics of women with positive and negative urine culture findings and we calculated the proportion of antibiotics overprescribed or inappropriately used. We also estimated the cost of adding urine culture to the diagnostic algorithm.

Findings: The study included 449 pregnant women with suspected urinary tract infections: 18.0% (81/449) had positive urine culture findings. If antibiotics were administered following urine dipstick results alone, 368 women would have received antibiotics unnecessarily: an overprescription rate of 82% (368/449). If administration was based on urine culture findings plus urinary tract infection symptoms, 144 of 368 women with negative urine culture findings would have received antibiotics unnecessarily: an overprescription rate of 39.1% (144/368). The additional cost of urine culture was 0.48 euros per woman.

Conclusion: A high proportion of pregnant women with suspected urinary tract infections from refugee camps unnecessarily received antibiotics. Including urine culture in diagnosis, which is affordable in Lebanon, would greatly reduce antibiotic overprescription. Similar approaches could be adopted in other regions where microbiology laboratories are accessible.

目的确定在黎巴嫩难民营孕妇的尿路感染诊断中加入尿培养是否会减少不必要的抗生素使用:我们在 2022 年 4 月至 6 月间进行了一项前瞻性横断面研究,研究对象是在贝鲁特南部无国界医生组织性健康和生殖健康诊所就诊的孕妇。尿液浸量棒检测两次呈阳性(即疑似尿路感染)的妇女提供尿液样本进行培养。细菌鉴定和抗菌药敏感性测试按照欧洲抗菌药敏感性测试委员会的指南进行。我们比较了尿液培养结果呈阳性和阴性的妇女的特征,并计算了过量使用或不当使用抗生素的比例。我们还估算了在诊断算法中增加尿培养的成本:研究包括 449 名疑似尿路感染的孕妇:18.0%(81/449)的孕妇尿培养结果呈阳性。如果仅根据尿液浸量结果使用抗生素,368 名妇女将不必要地接受抗生素治疗:超量处方率为 82% (368/449)。如果根据尿液培养结果和尿路感染症状使用抗生素,则尿液培养结果为阴性的 368 名妇女中有 144 人将不必要地接受抗生素治疗:超量处方率为 39.1%(144/368)。每位孕妇尿培养的额外费用为 0.48 欧元:结论:难民营中疑似尿路感染的孕妇中有很大一部分不必要地使用了抗生素。将尿液培养纳入诊断,在黎巴嫩是负担得起的,这将大大减少抗生素的过量使用。其他有微生物实验室的地区也可采用类似方法。
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引用次数: 0
Risk negotiation: a framework for One Health risk analysis. 风险谈判:"一个健康 "风险分析框架。
IF 11.1 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-08 DOI: 10.2471/BLT.23.290672
Monika Ehling-Schulz, Matthias Filter, Jakob Zinsstag, Konstantinos Koutsoumanis, Mariem Ellouze, Josef Teichmann, Angelika Hilbeck, Mauro Tonolla, Danai Etter, Katharina Stärk, Martin Wiedmann, Sophia Johler
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引用次数: 0
Global surveillance of emerging SARS-CoV-2 variants. 对新出现的 SARS-CoV-2 变种进行全球监测。
IF 11.1 2区 医学 Q1 Medicine Pub Date : 2024-06-01 DOI: 10.2471/BLT.22.289528
Mahmut Uludağ, Roberto Incitti, Xin Gao, Jonathan L Heeney, Takashi Gojobori, Intikhab Alam
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引用次数: 0
Global, regional and national trends and impacts of natural floods, 1990-2022. 1990-2022 年全球、地区和国家自然洪水的趋势和影响。
IF 11.1 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-04-17 DOI: 10.2471/BLT.23.290243
Qiao Liu, Min Du, Yaping Wang, Jie Deng, Wenxin Yan, Chenyuan Qin, Min Liu, Jue Liu

Objective: To assess global, regional and national trends in the impact of floods from 1990 to 2022 and determine factors influencing flood-related deaths.

Methods: We used data on flood disasters from the International Disaster Database for 1990-2022 from 168 countries. We calculated the annual percentage change to estimate trends in the rates of people affected and killed by floods by study period, World Health Organization (WHO) region, country income level and flood type. We used multivariable logistic regression analysis to assess the factors associated with death from floods.

Findings: From 1990 to 2022, 4713 floods were recorded in 168 countries, which affected > 3.2 billion people, caused 218 353 deaths and were responsible for more than 1.3 trillion United States dollars of economic losses. The WHO Western Pacific Region had the most people affected by floods (> 2.0 billion), accounting for 63.19% (2 024 599 380/3 203 944 965) of all affected populations. The South-East Asia Region had the most deaths (71 713, 32.84%). The African and Eastern Mediterranean Regions had the highest number of people affected and killed by floods per 100 000 population in 2022. The odds of floods causing more than 50 deaths were significantly higher in low-income countries (adjusted odds ratio: 14.34; 95% confidence interval: 7.46 to 30.04) compared with high-income countries. Numbers of people affected and mortality due to floods declined over time.

Conclusion: Despite the decreases in populations affected and deaths, floods still have a serious impact on people and economies globally, particularly in lower-income countries. Action is needed to improve disaster risk management and flood mitigation.

目标:评估 1990 年至 2022 年全球、地区和国家洪水影响的趋势,确定洪水导致死亡的影响因素:评估 1990 年至 2022 年全球、地区和国家洪水影响的趋势,并确定影响洪水相关死亡的因素:我们使用了国际灾害数据库中 168 个国家 1990-2022 年的洪水灾害数据。我们按研究期间、世界卫生组织(WHO)地区、国家收入水平和洪水类型计算了每年的百分比变化,以估计洪水受灾和死亡人数的趋势。我们使用多变量逻辑回归分析来评估与洪灾死亡相关的因素:从 1990 年到 2022 年,168 个国家发生了 4713 次洪灾,受灾人口超过 32 亿,造成 218 353 人死亡,经济损失超过 1.3 万亿美元。世卫组织西太平洋区域受洪灾影响的人口最多(超过 20 亿),占所有受灾人口的 63.19%(2 024 599 380/3 203 944 965)。东南亚地区死亡人数最多(71713 人,占 32.84%)。2022 年,非洲和地中海东部地区每 10 万人中受洪灾影响和死亡的人数最多。与高收入国家相比,低收入国家发生洪灾造成 50 人以上死亡的几率明显更高(调整后的几率比:14.34;95% 置信区间:7.46 至 30.04)。随着时间的推移,洪灾造成的受灾人数和死亡率有所下降:结论:尽管受灾人口和死亡人数有所下降,但洪灾仍对全球人民和经济造成严重影响,尤其是在低收入国家。需要采取行动,改善灾害风险管理和洪灾减灾工作。
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引用次数: 0
Reimagining effective workplace support for health workers. 重新构想为卫生工作者提供有效的工作场所支持。
IF 11.1 2区 医学 Q1 Medicine Pub Date : 2024-06-01 DOI: 10.2471/BLT.24.291896
Jenny Jw Liu, Anthony Nazarov, Patrick Smith, Andrea Phelps, David Forbes, Nicole Sadler, Fardous Hosseiny, Sarah Dougherty, Rosilee Peto, Marion Cooper, Marc Bilodeau, Suzanne Bailey, Jodi Younger, Adam Dukelow, Sandy Jansen, Andrew Davidson, Cara Vaccarino, Karen Monaghan, Sandra Northcott, Linda Mohri, Patricia Hoffer, J Don Richardson
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引用次数: 0
Continuing a scientific dialogue between sectors on health and economics. 继续在卫生和经济部门之间开展科学对话。
IF 8.4 2区 医学 Q1 Medicine Pub Date : 2024-05-01 DOI: 10.2471/BLT.24.291722
Ritu Sadana, Rajat Khosla, Rachel Gisselquist, Kunal Sen
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引用次数: 0
Corrigendum. 更正。
IF 11.1 2区 医学 Q1 Medicine Pub Date : 2024-05-01 DOI: 10.2471/BLT.24.100524

[This corrects the article DOI: 10.2471/BLT.23.290129.].

[此处更正了文章 DOI:10.2471/BLT.23.290129]。
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引用次数: 0
期刊
Bulletin of the World Health Organization
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