Tag: pubmed

Psychooncology. 2024 Dec;33(12):e70045. doi: 10.1002/pon.70045.

ABSTRACT

OBJECTIVE: To identify the feasibility, acceptability, and effectiveness of web-based acceptance and commitment therapy (ACT) on health-related outcomes in patients with lung cancer.

METHODS: A feasibility, prospective, parallel, individual-based, assessor-blinded randomized controlled trial was designed. This study was conducted at a third-level hospital in Sichuan Province, China. A total of 101 participants were enrolled and randomly assigned to usual care group or 7-weekly web-based acceptance and commitment therapy group. The primary outcome was feasibility and acceptability of the intervention, and the secondary outcomes including quality of life, psychological flexibility, anxiety, depression, fatigue, and sleep disturbance. Generalized estimating equations were used to evaluate the group differences. All analyses followed the principle of intention-to-treat.

RESULTS: Web-based ACT presented good feasibility and acceptability in this study, with an attrition rate of 13.86%, a median compliance rate of 71.43%, and a satisfaction rate of 65.9%. Compared with control group, participants in intervention group reported statistically significant increases in quality of life (MD = 15.10, 95% CI: [10.09, 20.11], d = 0.37), psychological flexibility (MD = -8.42, 95% CI: [-10.81, -6.03], d = -1.47), anxiety (MD = -1.27, 95% CI: [-2.50, -0.05], d = -0.44), depression (MD = -2.11, 95% CI: [-3.28, -0.95], d = -0.76), and sleep disturbance (MD = -1.85, 95% CI: [-3.10, -0.59], d = 0.13) at postintervention, however, the improvement in fatigue was not statistically significant (MD = -2.02, 95% CI: [-9.02, 4.98], d = -0.12).

CONCLUSIONS: Web-based ACT was an approach with good feasibility and acceptability, and it could effectively improve quality of life, psychological flexibility, anxiety, depression, and sleep disturbance in patients with lung cancer. In order to achieve better results, there is a need to design a more tailored intervention plan and a more operational platform.

PMID:39681977 | DOI:10.1002/pon.70045

BMC Glob Public Health. 2024 Dec 10;2(1):83. doi: 10.1186/s44263-024-00105-x.

ABSTRACT

BACKGROUND: Despite a wealth of data from high-income countries, there is limited information on the distinct epidemiological patterns observed in diverse, densely populated regions within Latin America. This retrospective analysis of COVID-19’s four major waves in Bogotá, Colombia, evaluates 1.77 million cases in detail.

METHODS: A comprehensive suite of statistical methods was employed. Transmission dynamics were assessed by estimating the instantaneous reproduction number $R\left(t\right)$ , while variant-specific transmission advantages were estimated using multinomial logistic regression models. Disease severity was assessed through a suite of indicators: Hospitalisation Case Ratio (HCR), intensive care unit case ratio (ICU-CR), case fatality ratio (CFR), hospitalisation fatality ratio (HFR), and ICU fatality ratio (ICU-FR). Additionally, we analysed the distribution of hospitalisations, ICU admissions, and fatalities by age group and wave. We employed a Bayesian hierarchical model to capture epidemiological delays-such as onset-to-death, hospitalisation, and ICU admission durations to estimate hospital and ICU stay durations.

RESULTS: Our findings reveal substantial variation in $R\left(t\right)$ , with peaks exceeding 2.5 during the ancestral and Omicron waves. Over the course of the pandemic, we observed a 78% reduction in CFR, underscoring shifts in clinical severity. The third wave, associated with the Mu variant, recorded the highest case and death counts, alongside a decreased CFR, an elevated HFR, and a shift in the most affected age group towards younger populations. In contrast, the fourth wave, driven by the Omicron variant, exhibited the highest reproduction number and the lowest overall severity. This wave was characterised by a significant increase in pediatric hospitalisations. The study reveals a continued decline in the mean durations of hospital and ICU stays across the four waves, with hospital stays decreasing from 10.84 to 7.85 days and ICU stays dropping from 16.2 to 12.4 days.

CONCLUSIONS: This study reveals significant shifts in transmission and severity metrics-including mortality, hospitalisation, and ICU rates and stays-across age groups during Bogotá’s four COVID-19 waves. These insights underscore the value of retrospective analyses to understand the pandemic’s varied impact and inform public health strategies in diverse urban settings.

PMID:39681974 | DOI:10.1186/s44263-024-00105-x

BMC Glob Public Health. 2024 Sep 3;2(1):58. doi: 10.1186/s44263-024-00087-w.

ABSTRACT

New, first-in-class oral antibiotics like zoliflodacin, developed in a public-private partnership, require an optimal introduction strategy while ensuring antibiotic stewardship. Zoliflodacin, given as a single dose for uncomplicated urogenital gonorrhoea, recently demonstrated non-inferiority to ceftriaxone plus azithromycin and safety in a phase 3 randomised controlled trial. Following regulatory approval, zoliflodacin could improve sexually transmitted infection (STI) management and help address the threat of untreatable gonorrhoea, as levels of resistance to current first-line treatments increase. The Global Antibiotic Research & Development Partnership (GARDP) convened an expert meeting during the 2023 STI and HIV World Congress to discuss key questions about the introduction of zoliflodacin in low- and middle-income countries (LMICs). The questions included: which patients to treat in which situations, the timing of introduction, and what additional evidence is needed to change policy for the use of new antibiotics for gonorrhoea. Recommendations from the expert group included: the generation of evidence for the role of a drug like zoliflodacin in clinical treatment failures; the need for additional antimicrobial resistance surveillance; investigation of the role of novel diagnostic approaches, such as point-of-care tests, to improve stewardship; study of preferences and values among the population in need; and modelling of the emergence of N. gonorrhoeae resistance and transmission in different scenarios. Forthcoming World Health Organization (WHO) global guidelines could outline recommendations for a new oral antibiotic like zoliflodacin based on existing evidence, and rational approaches for certain populations or use cases, while the evidence base is further strengthened.

PMID:39681965 | DOI:10.1186/s44263-024-00087-w

Health Serv Res. 2024 Dec 16:e14420. doi: 10.1111/1475-6773.14420. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the impact of the Massachusetts Medicaid program’s reimbursement policy change for perinatal depression screening on utilization rates.

STUDY SETTING AND DESIGN: This study employed a difference-in-differences design to compare insurance-paid prenatal and postpartum depression screening rates as well as postpartum antidepressant receipt rates between Medicaid and privately insured individuals before and after policy implementation in May 2016.

DATA SOURCES AND ANALYTIC SAMPLE: Data are from the 2014-2020 Massachusetts All-Payer Claims Database. The study included individuals with a live birth from October 10, 2014, to December 31, 2019, who were continuously insured either by Medicaid or private insurance.

PRINCIPAL FINDINGS: Among 141,085 births, 42.6% were covered by Medicaid. Among those with Medicaid, 1.9% had a paid postpartum depression screening prior to the policy and 16.9% after (1.5% vs. 12.3% for prenatal screening); among privately insured, 3.8% had a paid postpartum screening prior to the policy and 10.6% after (0.9% vs. 6.7% for prenatal screening). Antidepressant receipt rose from 6.9% to 8.3% among Medicaid enrollees and from 3.3% to 4.9% among privately insured individuals after the policy. After regression adjustment, implementation of the Massachusetts Medicaid reimbursement policy was positively associated with perinatal depression screening rates with a differential increase of 10.0 percentage points (p < 0.001) for postpartum screening and 3.5 percentage points (p < 0.001) for prenatal screening among Medicaid enrollees versus privately insured. Despite increased depression screening, the policy was not associated with a statistically significant change in antidepressant receipt among Medicaid enrollees compared to privately insured individuals.

CONCLUSIONS: Separate payment for perinatal depression screening significantly improved screening rates among Medicaid beneficiaries, highlighting Medicaid’s critical role in identifying mental health needs for vulnerable populations. However, the persistence of sub-optimal screening rates among perinatal individuals underscores the need for a comprehensive approach to ensure universal screening and effective treatment for perinatal depression.

PMID:39681957 | DOI:10.1111/1475-6773.14420

BMC Glob Public Health. 2024 Apr 17;2(1):25. doi: 10.1186/s44263-024-00056-3.

ABSTRACT

BACKGROUND: Intimate partner violence (IPV) against women has harmful effects on their psychological and physical health. However, help-seeking for IPV is significantly low among women in the Indian context. This study examines the different factors that influence help-seeking behaviour among women in India. It also studies associations of the type of IPV with the source of help.

METHODS: The study analyses data from the fifth round of the National Family Health Survey that was conducted in India (2019-2021). Independent variables were categorized at individual, relationship-household and community levels. The Stata 14.2 software was used to calculate the prevalence ratios and their corresponding 95% confidence intervals. Variables with p-values less than 0.05 were considered statistically significant. Poisson regression helped identify factors associated with help-seeking.

RESULTS: Results indicate that among 72,320 women aged 18-49 years, 17,765 women ever-faced IPV. Of them, 14.2% of women who faced either physical and/or sexual IPV sought any help. Husband’s consumption of alcohol almost doubled the likelihood of help-seeking among women (19.91%), compared to women whose husbands did not drink alcohol (10.19%). Witnessing parental IPV also increased the odds (17.26%) of help-seeking. Women who were not empowered were more likely to seek help (14.11%) compared to women who were empowered (12.56%). The police were the predominant source where women went for formal help (6.94 to 8.43%), followed by doctors (1.84 to 2.71%). Close to 1 in 4 women (22.5%) sought help for sexual IPV, while 14.4% of women sought help for physical IPV. Around 95% of all women who faced IPV sought informal help, with 3 in 5 of them approaching their own families, and 3 in 10 approaching their in-laws or marital families.

CONCLUSIONS: Two significant factors that associate positively with help-seeking by women facing IPV are husbands’ alcohol consumption and witnessing parental IPV. Most women preferred informal help from the natal family, while among formal providers, the police were the foremost choice. Programmes and initiatives to build capacities of communities, and of police to respond to women seeking help for IPV, would enable more women to reach out for help.

PMID:39681945 | DOI:10.1186/s44263-024-00056-3

BMC Glob Public Health. 2024 May 6;2(1):28. doi: 10.1186/s44263-024-00061-6.

ABSTRACT

BACKGROUND: Colorectal cancer (CRC) poses a significant public health challenge in Canada, with the Atlantic provinces bearing a particularly high burden. The implementation of population-based colon screening programs is aimed to address this concern. However, limited research exists on the effect of these programs especially in Canada. This study aimed to examine the impact of the first few years of the CRC screening programs in the Atlantic provinces of Canada by assessing changes in screening uptake, barriers, and predictors of screening among eligible populations.

METHODS: Employing a repeated cross-sectional design, this study analyzed data from a representative sample of 7614 respondents in 2010 and 6850 in 2017 from the Atlantic provinces aged 50-74 years, extracted from the Canadian Community Health Survey (CCHS). The outcomes measured were CRC screening rates, changes in predictors of screening uptake, and barriers to participation. Potential predictors examined included age, sex, income, education, smoking, and health status.

RESULTS: The proportion of adults aged 50-74 years who meet CRC screening requirements increased from 42% in 2010 to 54% in 2017 yet below the national target of 60%. New Brunswick reported the most significant increase in screening prevalence (18%, p < 0.05). Participation in fecal tests increased from 19.6 to 32.4%. Despite these improvements, disparities in screening participation remained, with lower uptake observed among individuals with lower income and education levels. Age (> 60 years, OR = 2.09, p < 0.01), the presence of multiple chronic health conditions (OR = 2.11, p < 0. 01), being female (OR = 1.21, p < 0.01), married status (OR = 1.21, p < 0.05), access to regular healthcare (OR = 1.91, p < 0.01), and nonsmoking status (OR = 2.55, p < 0.01) were identified as significant predictors of CRC screening uptake.

CONCLUSIONS: This study shows that while CRC screening uptake increased across the Atlantic provinces between 2010 and 2017, barriers to and disparities in screening participation persist. This highlights the need for targeted interventions to improve awareness, access, and screening uptake, particularly among disadvantaged groups, to promote equitable healthcare outcomes. Continued efforts should focus on reducing barriers to screening and leveraging available evidence to inform interventions aimed at mitigating the CRC burden in the region.

PMID:39681936 | DOI:10.1186/s44263-024-00061-6

BMC Glob Public Health. 2024 May 3;2(1):27. doi: 10.1186/s44263-024-00057-2.

ABSTRACT

BACKGROUND: Travel restrictions and border controls were used extensively during the COVID-19 pandemic. However, the processes for making robust evidence-based risk assessments of source countries to inform border control policies was in many cases very limited.

METHODS: Between April 2020 and February 2022, all international arrivals to New Zealand were required to spend 14 days in government-managed quarantine facilities and were tested at least twice. The infection rates among arrivals in the years 2020, 2021 and 2022 were respectively 6.3, 9.4 and 90.0 cases per thousand arrivals (487, 1064 and 1496 cases). Test results for all arrivals were linked with travel history, providing a large and comprehensive dataset on the number of SARS-CoV-2-positive and negative travellers from different countries over time. We developed a statistical model to predict the country-level infection risk based on infection rates among recent arrivals and reported cases in the country of origin. The model incorporates a country-level random effect to allow for the differences between the infection risk of the population of each country and that of travellers to New Zealand. A time dependent auto-regressive component of the model allows for short term correlation in infection rates.

RESULTS: A model selection and checking exercise found that the model was robust and reliable for forecasting arrival risk for 2 weeks ahead. We used the model to forecast the number of infected arrivals in future weeks and categorised countries according to their risk level. The model was implemented in R and was used by the New Zealand Ministry of Health to help inform border control policy during 2021.

CONCLUSIONS: A robust and practical forecasting tool was developed for forecasting infection risk among arriving passengers during a period of controlled borders during the COVID-19 pandemic. The model uses historical infection rates among arrivals and current infection rates in the source country to make separate risk predictions for arrivals from each country.

PMID:39681931 | DOI:10.1186/s44263-024-00057-2

BMC Glob Public Health. 2024 Jun 17;2(1):38. doi: 10.1186/s44263-024-00069-y.

ABSTRACT

BACKGROUND: Understanding how the COVID-19 pandemic evolved under control measures is crucial to tackle the SARS-CoV-2 virus spread. Laos, a country bordering China but with late occurrence and low burden of COVID-19 compared to its neighbouring countries, was used for a case study.

METHODS: A transmission model with disease reporting was proposed to investigate the impact of control measures on the SARS-CoV-2 virus spread in Laos from April 2021 to May 2022. It was assumed that the transmission rate changed with people’s behaviours, control measures and emerging variants; susceptibility decreased with vaccination and infection. Bayesian inference was used for model calibration to data of confirmed cases, deaths, and recoveries, and the deviance information criterion was used to select the best model variant.

RESULTS: Our model including Non-pharmaceutical interventions (NPIs), behaviour change, vaccination, and changing variants well explained the three waves in Laos. The Alpha variant was estimated to have a basic reproduction number of 1.55 (95% CrI: 1.47-1.64) and was replaced by the Delta variant from September 2021 which was 1.88 (95% CrI: 1.77-2.01) times more transmissible; the Delta variant was replaced by Omicron variant from March 2022 which was 3.33 (95% CrI: 2.84-3.74) times more transmissible. The Delta variant was the most severe with a case fatality rate of 1.05% (95% CrI: 0.96-1.15%) while the Alpha variant and Omicron variant were much milder. The ascertainment rate was low and variable: first decreasing from 13.2 to 1.8% by 23 May 2021, and then increasing to 23.4% by 15 March 2022. Counterfactual simulations indicated that vaccination played strong roles in reducing infections even under the emergence of immune escape variants while behaviour change delayed but might not flatten the peak of outbreaks.

CONCLUSIONS: The three waves of Laos’ epidemics were due to the invasion of more transmissible and immune escape variants that affected the herd immunity built via vaccination and infection. Even with immunity waning and the escape of new variants, vaccination was still the major contributor to control COVID-19 and combining behaviour changes and vaccination would best suppress future outbreaks of COVID-19.

PMID:39681927 | DOI:10.1186/s44263-024-00069-y

BMC Glob Public Health. 2024 Apr 12;2(1):24. doi: 10.1186/s44263-024-00055-4.

ABSTRACT

BACKGROUND: Prior research has reaffirmed lifestyle risk behaviors to cluster among adolescents. However, the lifestyle cluster effect on suicidal thoughts and behaviors (STBs) was unclear among adolescents in low- and middle-income countries (LMICs). No comparison of such associations was conducted across nations.

METHODS: Data from 45 LMICs were obtained from the Global School-based Student Health Survey (GSHS) between 2009 and 2019. Lifestyle behavior factors were collected through a structured questionnaire. Suicidal ideation, plan, and attempt were ascertained by three single-item questions. Lifestyle risk scores were calculated via a sufficient dimension reduction technique, and lifestyle risk clusters were constructed using a latent class analysis. Generalized linear mixed models with odds ratio (OR) and 95% confidence interval (CI) were used to estimate the lifestyle-STB associations.

RESULTS: A total of 229,041 adolescents were included in the final analysis. The weighted prevalence of suicidal ideation, plan, and attempt was 7.37%, 5.81%, and 4.59%, respectively. Compared with the favorable lifestyle group, the unfavorable group had 1.48-, 1.53-, and 3.11-fold greater odds of suicidal ideation (OR = 1.48, 95%CI: 1.30-1.69), plan (OR = 1.53, 95%CI 1.34-1.75), and attempt (OR = 3.11, 95%CI 2.64-3.65). Four clusters of lifestyle risk behaviors were identified, namely healthy lifestyles (H-L), insufficient intake of vegetables and fruit (V-F), frequent consumption of soft drinks and fast food (D-F), and tobacco smoking and alcohol drinking (S-A) clusters. Compared with H-L cluster, V-F cluster was associated with 43% and 42% higher odds of suicidal ideation and plan, followed by S-A cluster (26% for ideation and 20% for plan), but not significant in D-F cluster (P > 0.05). D-F cluster was associated with 2.85-fold increased odds of suicidal attempt, followed by V-F cluster (2.43-fold) and S-A cluster (1.18-fold).

CONCLUSIONS: Clustering of lifestyle risk behaviors is informative for risk stratification of STBs in resource-poor settings. Lifestyle-oriented suicide prevention efforts should be initiated among school-attending adolescents in LMICs.

PMID:39681898 | DOI:10.1186/s44263-024-00055-4

BMC Glob Public Health. 2024 Oct 3;2(1):67. doi: 10.1186/s44263-024-00098-7.

ABSTRACT

BACKGROUND: COVID-19 will not be the last pandemic of the twenty-first century. To better prepare for the next one, it is essential that we make honest appraisals of the utility of different responses to COVID. In this paper, we focus specifically on epidemiologic forecasting. Characterizing forecast efficacy over the history of the pandemic is challenging, especially given its significant spatial, temporal, and contextual variability. In this light, we introduce the Weighted Contextual Interval Score (WCIS), a new method for retrospective interval forecast evaluation.

METHODS: The central tenet of the WCIS is a direct incorporation of contextual utility into the evaluation. This necessitates a specific characterization of forecast efficacy depending on the use case for predictions, accomplished via defining a utility threshold parameter. This idea is generalized to probabilistic interval-form forecasts, which are the preferred prediction format for epidemiological modeling, as an extension of the existing Weighted Interval Score (WIS).

RESULTS: We apply the WCIS to two forecasting scenarios: facility-level hospitalizations for a single state, and state-level hospitalizations for the whole of the United States. We observe that an appropriately parameterized application of the WCIS captures both the relative quality and the overall frequency of useful forecasts. Since the WCIS represents the utility of predictions using contextual normalization, it is easily comparable across highly variable pandemic scenarios while remaining intuitively representative of the in-situ quality of individual forecasts.

CONCLUSIONS: The WCIS provides a pragmatic utility-based characterization of probabilistic predictions. This method is expressly intended to enable practitioners and policymakers who may not have expertise in forecasting but are nevertheless essential partners in epidemic response to use and provide insightful analysis of predictions. We note that the WCIS is intended specifically for retrospective forecast evaluation and should not be used as a minimized penalty in a competitive context as it lacks statistical propriety. Code and data used for our analysis are available at https://github.com/maximilian-marshall/wcis .

PMID:39681892 | DOI:10.1186/s44263-024-00098-7