• Cultural adaptation of an internet-based self-help app for grieving Syrian refugees in Switzerland

  Anaïs Aeschlimann; Eva Heim; Anna Hoxha; Valentina Triantafyllidou; Clare Killikelly; Farhad Haji; Rilana Tanja Stoeckli; Monia Aebersold; Andreas Maercker (BMC, 2024-11-01)

  Abstract Background Loss and grief pose significant challenges for victims of armed conflicts, such as Syrian refugees. Internet-based interventions (IBIs) present a promising solution to address this treatment gap and provide adequate support. However, research on grief, grief support, and IBIs remain largely limited to Western cultural contexts, and culturally adapted IBIs for grief are needed. Following the Reporting Cultural Adaptation in Psychological Trials (RECAPT) framework, this study aimed to develop and further adapt a culturally sensitive IBI for bereaved Syrian refugees in Switzerland. Methods The study employed qualitative methods. Initially, formative research was conducted to create a first version of the intervention, including semi-structured interviews with 10 experts to identify necessary cultural adaptations. The preliminary version of the intervention was then presented to six potential users and three experts to gather feedback on additional cultural adaptations through two iterative feedback rounds. The first round involved semi-structured interviews using a “paper version” of the intervention, followed by a second round with a walk-through think-aloud protocol with a beta version. Data were analyzed using framework analysis. Results The input from various key informants at different stages of development provided valuable feedback on surface and deep structure adaptation, which may enhance treatment adherence, acceptance, and motivation. Conclusions These findings provide important insights and recommendations for the cultural adaptation of interventions and may help address the treatment gap for bereaved Syrian refugees.
• Making it on the breadline – improving food security on the Anangu Pitjantjatjara Yankunytjatjara Lands, Central Australia

  Amanda J. Lee; Stephan Rainow; Liza Balmer; Rhiannon Hutchinson; Suzanne Bryce; Meron Lewis; Lisa-Maree Herron; Paul Torzillo; Robert Stevens; Margaret Kavanagh (BMC, 2024-11-01)

  Abstract Background This longitudinal case study describes the efforts and impacts of community-controlled service organisations on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in Central Australia to tackle food security since the 1980s, with a focus on the last decade, particularly during a year of concerted action from mid-2018. Methods The co-designed study comprised an interrupted time series with controls. Availability, affordability, accessibility and sales of foods in the community retail stores on the APY Lands were monitored regularly from 2014 to mid-2022, including by local research teams. Store nutrition policy was updated early 2018. For a year from mid-2018, of the eight communities with stores: (i) two were the focus for concerted intervention, including support from a locally based project officer to help implement the policy and action 105 community requests for nutrition activities (ii) three received usual support to implement the policy; and (iii) three were subject to ‘business as usual’. From mid-2019, all communities/stores received usual service, from 2020 with some restrictions related to the COVID-19 pandemic. Results were compared over time, across different community/store groups and with controls. Results In the 12 months from mid-2018, all food security metrics improved most in the two focus communities. Impacts were less marked in the communities without additional support to implement the revised nutrition policy, and even less apparent, although more varied, in the other three communities/stores. Dietary intake improved only in the two focus communities. In all communities from early 2020 most gains eroded due to impacts of the COVID-19 pandemic and other external stressors. Food security metrics, including price of healthy food, appeared more resilient in the focus communities, although diet quality worsened. At all times assessed, healthy diets were unaffordable for welfare-dependant households. Conclusions This co-designed study demonstrates the effectiveness of community-led approaches, confirming that it is possible to improve food security and diet in remote Aboriginal communities. However, sustained action and monitoring, dedicated resources and employment of local people are critical for success. Results also highlight that low incomes are a major barrier to food security.
• Development and validation of a questionnaire to evaluate the productive engagement of Chinese older adults in the community

  Yingjie Shen; Mingli Zhao; Wenya Zhao; Shuangshuang Dai; Xue Wang; Yijia Zhuo (BMC, 2024-11-01)

  Abstract Background The evaluation of productive engagement of old adults has become a challenging task because cultural, ethical, religious, and other personal values may influence perceptions of the meaning and consequences of productive engagement. Assessing the productive engagement of the older adults is crucial to promote active and productive aging. The objective of this study was to develop and validate a questionnaire concerning the productive engagement of Chinese older adults in the community. Methods A draft scale was created via a literature review and interviews with 17 older adults in the community, following the cross-cultural framework for productive engagement in later life. Content validity was assessed by seven experts. Subsequently, a preliminary questionnaire containing 33 items was developed and its psychometric properties were evaluated. Results The final version of the questionnaire was composed of 27 items distributed across five dimensions. The overall standardized Cronbach’s α for the productive engagement questionnaire was 0.904, with individual dimension values ranging from 0.759 to 0.869. Nearly all dimensions displayed satisfactory factor loadings. The correlation coefficient between each item’s score and its respective dimension ranged from 0.473 to 0.723. Conclusions The developed questionnaire exhibited good validity and reliability, showing promise for effectively evaluating the productive engagement level of Chinese older adults within the community. Trial registration Not applicable.
• Menstrual cups to reduce bacterial vaginosis and STIs through reduced harmful sexual and menstrual practices among economically vulnerable women: protocol of a single arm trial in western Kenya

  Garazi Zulaika; Fredrick O. Otieno; Linda Mason; Anna Maria van Eijk; Runa Bhaumik; Stefan J. Green; Penelope A. Phillips-Howard; Supriya D. Mehta (BMC, 2024-11-01)

  Abstract Background In western Kenya, menstrual hygiene management (MHM) is a pervasive problem. Challenges are compounded for economically constrained women who continue to engage in sex during menses and resort to practices such as vaginal insertion of tissue and cotton to maintain dryness during sex. These practices can be harmful to the vaginal microbiome (VMB) and can lead to high rates of sexually transmitted infections (STIs) and HIV. This study will evaluate whether menstrual cups that can be worn during intercourse may be beneficial to the VMB and help prevent Bacterial vaginosis (BV) and STI acquisition among these economically vulnerable women. Methods In this single-arm trial among economically vulnerable women in semi-urban western Kenya, we will evaluate the preliminary efficacy of menstrual cups on non-optimal VMB, BV, and STIs, and investigate safety, acceptability, and implementation needs. Through peer referral we aim to recruit 402 menstruating women aged 15–35 who exchange sex for money or basic needs. Women who are pregnant, have delivered in the past six months, or use an intrauterine device (IUD) will not be eligible. Participants will be seen every six months for 24 months and be asked about their sexual and MHM practices, with samples collected to assess BV and VMB. At baseline, 12-, and 24-month visits, additional samples will be collected to measure HIV and STIs (C. trachomatis, N. gonorrhoeae, and T. vaginalis). HSV-2 status will be assessed at baseline. Intervention provision will consist of one reusable disc-shaped menstrual cup per participant and a group-based training within four weeks of the 12-month visit, followed by monthly telephone surveys for the first three months to assess cup use, adverse events, and provide any assistance. Primary analyses of preliminary efficacy will compare probabilities of optimal VMB, BV, and STIs in the pre-intervention period to the post-intervention period. Primary safety analyses will compare occurrence of menstrual toxic shock syndrome and cervicovaginal laceration. Discussion If demonstrated safe and effective, this multipurpose reproductive health intervention will offer a dignified solution for the menstrual hygiene needs of women who engage in sex for livelihood and reduce their occurrence of non-optimal VMB, BV, and STIs. Trial registration Clinicaltrials.gov NCT05666778 (28th December, 2022); Pan African Clinical Trials Registry 202,305,912,778,108 (25th May, 2023).
• The association between perceive social support and post-traumatic stress disorder symptoms among medical staff in Hubei, China: a chain mediating effect of resilience and positive coping

  Junjie Cao; Yifang Liu; Shijiao Yan; Zijun Xiong; Jing Wen; Zongju Chen; Pu Zhang; Jiaxin Tao; Jun Zhang; Ying Wang (BMC, 2024-11-01)

  Abstract Background Evidence suggests that PTSD symptoms following public health emergencies are influenced by many factors. The aim of this study was to investigate the relationship between perceived social support and Post-traumatic stress disorder symptoms and to explore the chain-mediated role of resilience and positive coping style, among medical staff in Hubei Province, China, during a public health emergency. Methods Convenience sampling was used to select medical staff from two general hospitals in Hubei Province in July 2022 for this study. A total of 2,751 medical staff were included in the study. Multidimensional Scale of Perceived Social Support, 10- itemConnor- Davidson resilience scale, Simplified Coping Style Questionnaire and The Post-traumatic stress disorder Checklist for DSM-5 were used to assess the levels of perceived social support, resilience, coping style and Post-traumatic stress disorder symptoms of medical staff two years after the public health emergency. Statistical descriptions were conducted using SPSS, and a structural equation model was established using AMOS to analyze the chain-mediated roles of resilience and positive coping style between perceived social support and Post-traumatic stress disorder symptoms. Results Structural equation modeling results showed a standardized total effect of perceived social support on Post-traumatic stress disorder symptoms of -0.416 (95%CI [-0.456, -0.374], P < 0.001). Resilience mediated the effect of perceived social support and Post-traumatic stress disorder, with an indirect effect of -0.016 ( 95%CI [0.031, 0.001], P = 0.038). Positive coping mediated the effect of perceived social support and Post-traumatic stress disorder, with an indirect effect of -0.024 (95%CI [-0.035, -0.014], P < 0.001). Resilience and positive coping style chain-mediated between perceived social support and Post-traumatic stress disorder symptoms, mediating 17.1% of the total effect. Conclusion Perceived social support has significant direct and indirect effects on Post-traumatic stress disorder symptoms and resilience. In addition, positive coping style act as chain mediators between perceived social support and Post-traumatic stress disorder symptoms. We suggest that strengthening perceived social support for medical staff can enhance their resilience, encouraging them to adopt positive coping, which in turn reduces the level of post-traumatic stress symptoms among medical staff following public health emergencies.
• Cognitive disparity in online rumor perception: a group analysis during COVID-19

  Chao Shen; Pengyu He; Zhenyu Song; Yimeng Zhang (BMC, 2024-11-01)

  Abstract Background The harmonious cognitive alignment among various netizen groups is pivotal for the spread and amplification of online rumors. This alignment, characterized by shared cognitive inclinations, fosters uniformity in attitudes and perspectives, thereby precipitating synchronized engagement in the dissemination of such rumors. Notably, discernible disparities emerge in group cognition as different types of rumors pertaining to the same event propagate. This research endeavors to dissect the roles of netizen groups through the lens of cognitive variance, thereby attaining a more profound comprehension of the distinctive traits and behavioral dynamics of various netizen factions in the context of online rumor dissemination. Methods By integrating Bloom’s taxonomy and crafting a survey questionnaire, this study captured the cognitive responses of netizens to various online rumor themes across two critical dimensions: (1) Information Cognition: exploring cognitive processing levels from basic recall to application and analysis and (2) Attitude Change: evaluating higher-order cognitive processes such as evaluating and creating in response to complex rumor scenarios. The decision tree classification algorithm was meticulously applied to dissect the catalysts behind the cognitive shifts among netizens. Additionally, the K-Means clustering algorithm was effectively utilized to categorize netizen groups along thematic lines, offering a nuanced view of their cognitive engagement. Results The initial impression of a rumor significantly influences netizens’ final cognitive perceptions. Twelve characteristics were observed in netizen groups during the dissemination of rumors on different themes, and these groups were classified into four categories: knowledge-oriented, competition-oriented, social-oriented, and entertainment-oriented, based on their cognitive differences. Conclusions Throughout the lifecycle of online rumors, from inception to dissemination, diverse netizen groups assume distinct roles, each exerting a unique influence on the spread and reception of information. By implementing tailored governance strategies that are sensitive to the characteristics of these groups, it is possible to attain substantially more effective outcomes in managing the propagation of online rumors. This nuanced approach to governance recognizes the heterogeneity of the online community and leverages it to enhance the efficacy of interventions.
• The negative impact of the COVID-19 pandemic on breast cancer care in Brazil: a time series study in regions with different human development indices

  Adriano Hyeda; Élide Sbardellotto Mariano da Costa; Sérgio Candido Kowalski (BMC, 2024-11-01)

  Abstract Background The impact of the COVID-19 pandemic on breast cancer care across Brazilian regions with varying Human Development Index (HDI) levels remains unclear. This study evaluates the pandemic’s effects on screening mammograms, tumor staging at diagnosis, and treatment initiation in the Brazilian Public Health System between 2017 and 2022, focusing on regions with different HDI levels. Methods This ecological time series study uses an inflection point regression model and monthly percentage change (MPC) to analyze an open-access Brazilian Public Healthcare System dataset. The study focuses on trends and variations in these variables among women aged 50–69 in three state groups classified by HDI: Group A (very high), Group B (medium), and Group C (high). Results The average monthly rate of screening mammograms was highest in Group A (10.70) and lowest in Group B (8.38). At the onset of the COVID-19 pandemic, screening rates dropped significantly, with the most significant decline in Group B (58.6% decrease) and the smallest in Group A (45.7% decrease), lasting for three months. Subsequently, this variable recovered until December 2022 but was insufficient to restore the total series MPC to pre-pandemic levels. Group B had the lowest average rate of early-stage (0-II) diagnoses (2.88), while Group C had the highest (3.68). Early-stage diagnoses declined in the first three months of the pandemic, followed by a partial recovery that was insufficient to restore the pre-pandemic MPC levels. The proportion of advanced-stage diagnoses was highest in Group B (49.02%) and lowest in Group A (45.97%). The pandemic maintained the upward trend of advanced-stage (III-IV) diagnoses across all groups in the total time series. The average proportion of treatments initiated after 60 days of diagnosis was above 60% across all groups, with Group B at 64.50%. This variable began to rise 3 to 4 months after the pandemic and continued increasing until December 2022, with a greater intensity than the pre-pandemic period across all groups. Conclusion The COVID-19 pandemic reduced breast cancer screening and early diagnosis in Brazil, leading to more advanced cases and treatment delays across all regions, with varying impacts according to regional HDI levels.
• Mental health care-seeking and barriers: a cross-sectional study of an urban Latinx community

  Jennifer A. Newberry; Michelle A. Gimenez; Fatma Gunturkun; Erica Villa; Maritza Maldonado; Dilza Gonzalez; Gabriel Garcia; Patricia Rodriguez Espinosa; Haley Hedlin; Debra Kaysen (BMC, 2024-11-01)

  Abstract Background The Latinx community faces an increasing amount of mental health challenges and disparities in care. While the contributing factors are complex, there are likely potential barriers related to connecting with mental health support and accessing care that can be addressed. Methods To investigate barriers in connecting to mental health care, we conducted a cross-sectional survey of mental health service use and barriers in an urban community with a primarily Hispanic/Latinx ethnicity using a modified random walk approach for door-to-door data collection with a two-cluster sampling frame. Survey included questions on socio-demographic, mental health status, desire and attempt to seek care, and the Barriers to Access to Care Evaluation. Shapley additive explanation (SHAP) identified impactful barriers and demographic characteristics. Our primary outcome was the number of respondents who saw a professional in the past 12 months and the key determinants that enabled their successful connection. Secondary outcomes were people with poor mental health who had wanted or tried to seek any source of mental health support. Results Of the 1004 respondents enrolled, 70.5% were foreign born; 63.4% were women. In the past 12 months, 23.8% of respondents wanted to connect with mental health care; 15.5% tried to connect, and only 11.7% successfully connected to mental health services. The two most cited barriers had the highest SHAP values: concerns about treatments available (65%) and financial costs (62.7%). Additional barriers with high SHAP values: being seen as weak and having no one to help them find care. Of demographic characteristics, age had the highest SHAP values. Conclusion In a community with a high density of Latinx immigrants, just under half of respondents wanting mental health care successfully connected. Perceived informational, financial, and stigma-related barriers impacted the likelihood to connect with mental health care. These factors should be considered when designing programs and interventions to improve mental health care access and services in the Latinx community.
• Knowledge and practice of early gastric cancer screening among adults aged ≥ 45 years in China: a cross-sectional study

  Xiaoci He; Wei Qi; Qian Wang; Shuping Zhao (BMC, 2024-11-01)

  Abstract Background As the incidence of gastric cancer increases sharply in adults aged over 45 years, a better understanding of gastric cancer screening knowledge and practice is crucial to promote cancer-screening services. This study aimed to evaluate knowledge of early gastric cancer screening, adherence to screening, and perceived barriers hindering screening practices among adults aged ≥ 45 years in China. Methods A multi-center, face-to-face, cross-sectional study was conducted in community sites in Shijiazhuang, China, through the distribution of structured questionnaires from August to September, 2022. Results Of the 1053 respondents, only 13.4% demonstrated a good understanding of early gastric cancer screening. While 64.0% knew that gastroscopy is the gold standard for screening (“how to screen”), only 19.9% were aware of the recommended starting age (“when to screen”). Moreover, less than half could correctly identify high-risk groups (“whom to screen”), with awareness ranging from 20.5% for those infected with H. pylori to 47.8% for those with gastric diseases. Independent factors related to higher screening knowledge included female sex (OR = 1.55, 95% CI = 1.01–2.38), higher education level (OR = 4.03, 95% CI = 2.68–6.06), being with a personal/family experience of gastric diseases (OR = 1.68, 95% CI = 1.12–2.52). In addition, only 23.4% of respondents underwent GC screening. The dominant barrier to early screening was the “absence of symptoms or signs”, followed by “fearing procedural discomfort”. Conclusion This study highlights significant gaps in early gastric cancer screening knowledge and participation among middle-aged and elderly individuals in China. Addressing these gaps through culturally tailored health education campaigns is a critical strategy for increasing public awareness and participation.
• A study of the enablers and barriers to the collection of sociodemographic data by public health units in Ontario, Canada during the COVID-19 pandemic

  Menna Komeiha; Gregory Kujbida; Aideen Reynolds; Ikenna Mbagwu; Laurie Dojeiji; Joseph J. O’Rourke; Shilpa Raju; Monali Varia; Helen Stylianou; Sydnee Burgess (BMC, 2024-11-01)

  Abstract Background Collection and use of sociodemographic data (SDD), including race, ethnicity and income, are foundational to understanding health inequities. Ontario’s public health units collected SDD as part of COVID-19 case management and vaccination activities. This research aimed to identify enablers and barriers to collecting SDD during COVID-19 case management and vaccination. Methods As part of a larger mixed-method research study [1], qualitative methods were used to identify enablers and barriers to SDD collection during the COVID-19 pandemic. Purposive sampling was used to recruit participants from Ontario’s 34 public health units. Sixteen focus groups and eight interviews were conducted virtually using Zoom. Interview data were transcribed and analyzed using inductive and deductive qualitative description. Results SDD collection enablers included: legally mandating SDD collection and having dedicated data systems, technological and legal supports, senior management championing SDD collection, establishing rapport and trust between staff and clients, and gaining insight from the experiences from local communities and other jurisdictions. Identified barriers to SDD collection included: provincial data systems being perceived as lacking user-friendliness, SDD collection “was not a priority,” time and other constraints on building staff and client rapport, and perceived discomfort with asking and answering personal SDD questions. Conclusion A combination of provincial and local organizational strategies including supportive data systems, training, and frameworks for data collection and use, are needed to normalize and scale up SDD collection by local health units beyond the context of the COVID-19 pandemic.
• Sense of Community in the context of disease prevention and health promotion: A scoping review of the literature

  Nicola Spezia; Sabina De Rosis; Sabina Nuti (BMC, 2024-11-01)

  Abstract Background The centrality of community engagement in disease prevention and health promotion interventions highlights the need to understand the contextual factors that shape participation. Sense of Community (SoC), characterized by feelings of belonging, connection, and interdependence among members of a community, has emerged as a key component of community capacity and is therefore expected to influence engagement outcomes. However, empirical evidence is needed to assess its actual impact on community engagement. Additionally, the literature lacks a broader synthesis of the role and implications of SoC in this context. This study aims to review the empirical literature on SoC in disease prevention and health promotion, with a special focus on its association with community engagement. Methods A scoping review was conducted following the PRISMA guidelines, searching for empirical studies published between 1974 and 2023 via Scopus, Web of Science, and PubMed. Results Nineteen studies were included in the review, revealing three key themes: (1) the community to which SoC refers – among intervention participants, within community coalitions, and defined by the place of residence; (2) the interpretation of SoC, either as a generic, intuitive concept or as a theoretically defined construct; (3) the ways in which SoC is studied – as a predictor of engagement but also as an outcome of the interventions. Generic SoC among intervention participants emerged as a positive outcome and a factor contributing to engagement. However, as the scope expanded to encompass broader communities and SoC became more theoretically grounded, these dynamics shifted. SoC related to the place of residence did not exhibit significant improvement after interventions. Broader community-level SoC showed positive associations with engagement among members of community coalitions, but evidence was less consistent among the individuals targeted by interventions. Conclusions The review highlighted a scarcity of empirical research on SoC despite its recognition as a key component of community capacity. Contextualizing SoC is crucial, as its interpretation significantly influences its role in disease prevention and health promotion interventions. Further research is needed to clarify whether SoC can foster engagement at all community levels, especially among the general population. This is particularly relevant amid the current context of escalating health needs and strained traditional resources, where community engagement is increasingly essential to ensuring the sustainable delivery of disease prevention and health promotion efforts. If SoC can drive widespread engagement, it could play a pivotal role in building more proactive and autonomous health-promoting communities.
• Associations between various anthropometric indices and hypertension and hyperlipidaemia: a cross-sectional study in China

  Chuyao Feng; Cihang Lu; Kang Chen; Bo Song; Zhongyan Shan; Weiping Teng (BMC, 2024-11-01)

  Abstract Background This study aims to explore the association and determine the distinguished potential of anthropometric adiposity indices in screening for hypertension and hyperlipidaemia in the Chinese population. Methods A recent nationwide cross-sectional study, called the Thyroid Disorders, Iodine State, and Diabetes Epidemiological Survey (TIDE 2015–2017), provided the newest data on the relationships between anthropometric adiposity indices and hypertension and hyperlipidaemia and included 65,231 subjects. The area under the curve (AUC) was used to assess the feasibility of using these indices to distinguish hypertension and hyperlipidaemia. After age stratification, a restricted cubic spline (RCS) fitted for generalized linear regression was used to visualize the relationships of the body mass index (BMI), waist circumference (WC), the waist-to-height ratio (WHtR), the body roundness index (BRI), and the “a body shape index” (ABSI) with hypertension and hyperlipidaemia. Results The results showed that there were significant differences in the BMI, WC, the WHtR, the BRI, and the ABSI among the different age groups (P < 0.0001). After adjusting for sex, age, education, income, smoking status, urban or rural residence, and ethnicity in model, The WHtR and BRI had greater discriminatory power in identifying hypertension (AUC = 0.665, 95% confidence interval (CI) 0.660–0.671 for both), hypercholesterolaemia (AUC = 0.629, 95% CI 0.624–0.634 for both), and high low-density lipoprotein cholesterol (LDL-C; AUC = 0.659, 95% CI 0.653–0.664 for both) status in the overall population. When distinguishing hypertriglyceridaemia among the general population, the BMI (AUC = 0.711, 95% CI 0.706–0.716) and WC (AUC = 0.715, 95% CI 0.710–0.720) had greater discriminatory ability than the other anthropometric indices did. The BMI (AUC = 0.631, 95% CI 0.625–0.637) had the highest power for low high-density lipoprotein cholesterol (HDL-C) status in the general population. Conclusions Several anthropometric indices show significant correlation with hypertension and hyperlipidaemia. The WHtR and BRI were better in distinguishing hypertension, hypercholesterolaemia and high LDL-C status, while the BMI was better in hypertriglyceridaemia and low HDL-C status. The use of combined indices, such as the BMI, WC, the WHtR and the BRI, can be included in an individual’s medical history and can be used as tools for cardiovascular health screening, which may yield superior results for public health.
• The societal burden associated with adolescent idiopathic scoliosis: a cross-sectional burden-of-disease study

  Thomáy-Claire Ayala Hoelen; Silvia M. A. A. Evers; Jacobus J. Arts; Paul C. Willems; Ghislaine A. P. G. van Mastrigt (BMC, 2024-11-01)

  Abstract Background In the general population the prevalence of adolescent idiopathic scoliosis (AIS) is 2–3%. There is growing awareness of how AIS affects the quality of life of patients. However, the extent of the societal burden AIS poses remains poorly understood. Therefore, this study aimed to determine the societal burden of AIS. Methods A cross-sectional burden of disease study was conducted using a bottom-up, prevalence-based approach. Patients with AIS or guardians of a child diagnosed with AIS residing in the Netherlands were eligible for inclusion. The survey was distributed between June - December 2022 and was completed once by each participant. Costs were assessed using the institute for Medical Technology Assessment - Medical Consumption and Productivity Cost Questionnaires. The health-related quality of life (HRQoL) was assessed using the EuroQol 5D-5L/EuroQol 5D Youth and the Scoliosis Research Society-22 revised questionnaires. Costs and HRQoL were identified, measured, and valued. Results Participants (n = 229) were predominantly female (92%), on average 35 years old, and were employed (65%). The societal cost for a patient with AIS in the Netherlands was €12,275 per year. The largest costs were estimated for the healthcare and productivity losses. The mean utility score for adults was 0.7 (SD 0.20). Severe pain was experienced by 10% of the adult participants and 44% reported to experience moderate pain/discomfort. Statistically significant differences between different age groups were present for the sector costs and HRQoL. Conclusions AIS negatively impacts societal costs and the HRQoL. Reducing the burden that is posed on the productivity sector by AIS and further improving the HRQoL for AIS patients is needed.
• Vaccine equity implementation: exploring factors influencing COVID-19 vaccine delivery in the Philippines from an equity lens

  Junqiang Zhao; Shishi Wu; Renz Andrew Rafal; Helena Manguerra; Quanfang Dong; Hongyu Huang; Lincoln Lau; Xiaolin Wei (BMC, 2024-11-01)

  Abstract Background During the early phase of the COVID-19 vaccine rollout, low and middle-income countries (LMICs) were facing challenges in achieving equitable vaccine delivery. Few studies have contextualized global vaccine distributive injustice into national-specific contexts to understand its impact on vaccine delivery from an equity perspective. We aimed to investigate factors influencing equitable COVID-19 vaccine delivery in the Philippines and to provide recommendations to enhance equitable vaccine delivery in LMICs to prepare for future health emergencies. Methods The Health Equity Implementation Framework was employed to guide this qualitative study. We recruited participants using purposeful and snowballing sampling strategies. Semi-structured interviews were conducted with participants in person, online, or over the phone. A reflective thematic analysis approach was employed to analyze data. Results We recruited 38 participants including seven high-level stakeholders from the public and private sectors, 14 health workers, and 17 community members in the province of Negros Occidental, Philippines. Equitable delivery of COVID-19 vaccines was influenced by an interplay of multiple factors operating in different domains. Contextually, the rapidly evolving nature of the COVID-19 virus, ongoing scientific advancements, and international negotiations directed national-level vaccine policies. Political commitment and support were recognized as crucial drivers for successful vaccine delivery, with a strong emphasis on health information framing and communication and adherence to human rights principles. The vulnerability of the health system significantly impacted the timely and effective distribution of vaccines. Furthermore, the geographical characteristics of the Philippines presented unique logistical challenges to vaccine delivery. At the recipient domain, individual perceptions of vaccines, shaped by their socioeconomic status, exposure to (mis)information, social influence, and entrenched religious beliefs, played a major role in their vaccine decisions and thus vaccine coverage regionally. Additionally, vaccine characteristics and operational challenges related to its distribution also impacted fair allocation. Conclusions The findings highlight the urgent need for LMICs to strengthen their health system resilience and sustainability and use multilevel strategies to build public trust to improve vaccine uptake and coverage. Moreover, each LMIC must be attentive to its unique contextual factors to develop tailored implementation strategies to promote equitable vaccine distribution.
• The impact of internet medical service on rural gender inequality in health opportunity: a cross-sectional study

  Jingjing Jia; Changli Jia; Xiang Zhang; Panpan Ren; Mengyao Chen; Jinglin Xu (BMC, 2024-11-01)

  Abstract Background The increasing popularity of Internet medical service may have alleviated the gender inequality in health opportunity faced by rural women. However, research to ascertain the association between Internet medical service and gender inequality in health opportunity is scarce. This study explored the impact of Internet medical service on gender inequality in health opportunity among rural women and the underlying mechanisms involved. Methods A multistage stratified cross-sectional survey was conducted across six counties in three provinces in China, yielding 3,108 responses for a 97.13% response rate. The questionnaire was used to collect information on Internet healthcare use, health status, health behaviors, social activities and personal exercise, chronic disease status, and demographic and socio-economic characteristics of the participants. Based on Roemer's theory of equality of opportunity (EOP), we established a decomposition strategy for the fairness gap between genders, which we used for the measurement of the gender inequality in health opportunity Fixed effects models, propensity score matching (PSM), and least absolute shrinkage and selection operator (LASSO) regression were utilized to explore the impact of Internet medical service on rural gender inequality in health opportunity. Results On average, rural women experienced a gender health fairness gap of 1.63. Internet medical service significantly mitigated this inequality (β = -0.0602, P = 0.0002), and this finding remained significant across propensity score matching (PSM) and LASSO regression analyses. Mechanistic analysis revealed that human capital positively moderates this effect (β = -0.0510, P < 0.01), while income (β = 0.0370, P < 0.001) and marital status (β = 0.2039, P < 0.001) have negative moderating effects. Conclusions By focusing on gender inequality in the digital era, this study highlights the mitigating role of Internet medical service on gender inequality in health opportunity in rural areas. This study proposes and validates the mechanisms through which Internet medical service alleviates gender inequality in health opportunity, suggesting that human capital amplifies this effect, while high personal income and marital status attenuate this effect. These findings contribute to understanding how the digital age can narrow gender health opportunity equality, providing support for future interventions aimed at promoting health equity and gender equality.
• Community beliefs and practices about diabetes and their implications for the prevention and management of diabetes in Southeast Ghana

  Stanley Kofi Alor; Irene Akwo Kretchy; Franklin N. Glozah; Philip Baba Adongo (BMC, 2024-11-01)

  Abstract Background Diabetes is a major public health issue, and over half a billion people are estimated to be living with diabetes, with 6.7 million deaths reported in 2021. The global diabetes burden has been recognised and included in the United Nations Sustainable Development Goals to achieve a zero increase in diabetes cases and reduce one-third of premature diabetes deaths by 2030. However, local beliefs about the causes of diabetes have affected its prevention and management. This study examined community beliefs and practices about diabetes and how they affect the prevention and management of diabetes in the community. Methods This study was carried out in the Ho Municipality of the Volta Region of Ghana. We conducted 33 in-depth interviews with 18 patients with diabetes, 5 carers (caretakers of patients with diabetes), 3 traditional healers, 2 religious leaders, 3 community elders, and 2 assembly members who were purposefully selected from urban and rural areas across the municipality. The interviews were recorded digitally and transcribed verbatim. Thematic analysis was applied to analyse the data using QRS NVivo 20. Results Diabetes was described locally as sukli dɔ (sugar disease), which affects humans. Diabetes is believed to be caused by spiritual forces (juju, bewitchment, and punishment from gods) and physical factors (unhealthy diet, physical inactivity, eating fruits and vegetables sprayed with pesticides and insecticides, sugary and starchy foods, smoking, and abuse of alcohol). In terms of the management of diabetes, participants said traditional remedies are performed for spiritual interpretation, deliverance, fortification, and cleansing before biomedical and physical remedies are sought. Diabetes was likened to HIV/AIDS, and the sufferers were described as bringing the condition upon themselves as a result of their bad deeds. They were stigmatised, coupled with delays at the hospital, and poverty has also affected the prevention and management of diabetes. Conclusion The local belief that diabetes is caused by spiritual forces, likened to HIV/AIDS, delays at hospitals, and poverty, has affected the prevention and management of diabetes. Incorporating local beliefs and practices into the intervention design using culturally sensitive health education programmes and improving social determinants of health may help improve the prevention and management of diabetes in communities.
• Global health inequalities in the burden of interstitial lung disease and pulmonary sarcoidosis from 1990 to 2021

  Suheng Chen; Yulan Li (BMC, 2024-11-01)

  Abstract Background Interstitial lung disease and pulmonary sarcoidosis remain serious medical problems worldwide. This study aims to assess the global burden and health inequalities of interstitial lung disease and pulmonary sarcoidosis between 1990 and 2021. Methods Data on disability-adjusted life years (DALYs) due to interstitial lung disease and pulmonary sarcoidosis were obtained from the Global Burden of Diseases, Injuries and Risk Factors Study 2021. The slope index of inequality (SII) and concentration index were used to assess cross-national health inequality. Results There were 2,237,269 (95% uncertainty interval: 1,839,500 to 2,555,200) DALYs due to interstitial lung disease and pulmonary sarcoidosis in males and 1,804,881 DALYs (1,465,707 to 2,216,376) in females in 2021. The age-standardized DALY rate of interstitial lung disease and pulmonary sarcoidosis increased from 37.1 (30.6 to 45.4) per 100,000 in 1990 to 47.6 (41.3 to 53.2) per 100,000 in 2021. Countries with high socio-demographic index (SDI) showed the greatest increase in the age-standardized DALY rate of interstitial lung disease and pulmonary sarcoidosis during the past 32 years (53.4%, 45.1 to 62.2%). The SII increased from 19.6 (95% confidence interval: 11.6 to 27.5) in 1990 to 53.4 (39.7 to 67.1) in 2021. The concentration index increased from 0.15 (0.08 to 0.21) in 1990 to 0.23 (0.16 to 0.32) in 2021. Conclusion The burden of interstitial lung disease and pulmonary sarcoidosis increased and remained high in the high-SDI quintile. More attention must be given to reducing the burden of interstitial lung disease and pulmonary sarcoidosis.
• Evidence on consumers’ perceptions, understanding and uses of the Nutri-Score to improve communication about its update: a qualitative study with shopping observations in France

  Marianne Cerf; Anne-Juliette Serry; Lucile Marty; Sophie Nicklaus; Pauline Ducrot (BMC, 2024-11-01)

  Abstract Background The Nutri-Score is a front-of-pack nutrition label widely used in several European countries to improve the overall quality of consumers’ diets. In the view of the upcoming update of the Nutri-Score algorithm, this study evaluates consumers’ perceptions, understanding and uses of this label as well as their expectations or criticisms and opinions regarding the algorithm update. Methods Two complementary qualitative approaches were used in 2023. Six focus group discussions with a total of 51 participants as well as 20 individual shopping observations with real purchase conditions followed by in-depth interviews were conducted among French adults. The sessions were recorded, transcribed and then analysed using a thematic approach. Results Participants were familiar with the Nutri-Score but used it for food purchasing in a secondary way due to other more important criteria such as price or habits. They were aware that the label aimed to help them choose healthier products and to protect consumers. However, the lack of awareness about some aspects of the label such as the entity responsible for it or the calculation method of the score created a sense of mistrust about the Nutri-Score. Nevertheless, consumers did not report hearing criticism about the label in the media. Finally, they considered the updating of the label to be relevant. Conclusions Participants had a rather positive image of the Nutri-Score and its forthcoming update. Notwithstanding, to improve consumers’ trust in the label, this study recommends launching an information campaign to explain its calculation method and reassure them that the Nutri-Score is a government-endorsed scheme as part of the national public health nutrition policy.
• Correction to: Association between BMI and increased time-to-pregnancy in planned pregnancy couples: a cohort study in Guangzhou, China

  Yuxian Zhang; Dongling Gu; Yanyuan Xie; Bing Li (BMC, 2024-11-01)
• Longitudinal policy surveillance of state obesity legislation in California, 1999–2020

  Denise D. Payán; Alec M. Chan-Golston; Kesia K. Garibay; Corbin Farias (BMC, 2024-11-01)

  Abstract Background Obesity rates among children and adults continue to accelerate in the U.S., particularly among marginalized and low-income populations. Obesity prevention and reduction policies can significantly impact population health by improving environmental conditions and increasing access to health-promoting resources. Limited research has been conducted to examine state obesity policy change over time. The primary aim of this study is to examine legislative approaches used to prevent and reduce obesity in the state of California (U.S.). Methods We used quantitative policy surveillance methods to develop a state database of obesity-related legislation (bills, resolutions) introduced in California’s legislature between 1999 and 2020. Descriptive statistics were used to examine trends of introduced and enacted policy by legislative and policy characteristics. Chi-square tests were used to determine differences in characteristics between enacted and non-enacted legislation. Legislative session and policy characteristics found to be associated with enactment were used to predict adoption in a logistic regression. Results A total of 284 obesity-related bills and resolutions were introduced in California’s legislature between 1999 and 2020 with a peak of 43 in 2005–2006. On average, 25.8 bills and resolutions were introduced each 2-year legislative cycle. Findings indicate that (a) children and schools were the most frequently specified population and setting; (b) the most common policy topics were nutrition (45%) and physical activity (33%); and (c) only 15% of legislation mentioned race/ethnicity. Overall, 24.9% of bills were enacted compared to 82.1% of resolutions adopted. Legislation to raise awareness about obesity had 5.4 times the odds of being passed compared to other topics. Yet this difference was not statistically significant in a sensitivity analysis when we excluded resolutions. Conclusions This database can be leveraged to advance our knowledge of effective and equitable policy instruments to prevent and reduce obesity. Results reveal important policy elements that may impact legislative success, including policy topic, and contribute to a nascent evidence base for public health law research, legal epidemiology, and practice. Future work should investigate the role of policy effectiveness research and evidence on legislative policymaking.

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