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AnteayerBMJ Open

Prevalence and factors associated with pre-diabetes and undiagnosed diabetes in Cambodia: cross-sectional study based on the World Health Survey Plus 2023

Por: Chhim · S. · Ku · G. V. · Kowal · P. · Te · V. · Sorithisey · M. · Ngor · C. · Walton · P. · Maung · K. T. · Ng · N. · Naidoo · N. · Por · I. · Klipstein-Grobusch · K. · Chhea · C. · Sopheab · H.
Objective

This study aimed to determine the prevalence and factors associated with pre-diabetes and undiagnosed type 2 diabetes (UDD) in Cambodia.

Design

This analysis used data from the WHO World Health Survey Plus, which was collected using a cross-sectional design with a GIS-based, three-stage sampling approach. Multiple logistic regression was used to identify key associated factors, based on a significance level of p

Setting

Data were collected from all 25 provinces in Cambodia between 12 March 2023 and 31 May 2023.

Participants

4427 individuals aged 18 years or older, residing in the selected household for at least 6 months in the past year.

Primary outcome measures

Pre-diabetes (Haemoglobin A1c (HbA1c) 5.7%–6.4%) and UDD (HbA1c≥6.5%), without prior knowledge of having type 2 diabetes (T2D).

Results

The weighted prevalences of pre-diabetes and UDD were 26.4% (95% CI 24.0% to 29.0%) and 9.3% (95% CI 7.9% to 11.0%). Pre-diabetes prevalence was higher in urban areas compared with rural areas (adjusted OR, aOR=1.2, 95% CI 1.0 to 1.4), males (aOR=1.7, 95% CI 1.3 to 2.3), individuals aged 40–49 (aOR=1.8, 95% CI 1.4 to 2.4), individuals aged 50+ years group (aOR=2.9, 95% CI 2.3 to 3.6) compared with the 18–39 years group, overweight individuals (aOR=1.7, 95% CI 1.4 to 2.0), obese (aOR=2.1, 95% CI 1.5 to 3.0) and those with elevated total triglycerides (aOR=1.3, 95% CI 1.1 to 1.5). Similar risk factors were identified for UDD, with the addition of hypertension (aOR=1.6, 95% CI 1.3 to 2.0) and high waist circumference (aOR=2.0, 95% CI 1.5 to 2.7).

Conclusions

The high prevalence of pre-diabetes and UDD in Cambodia is a pressing public health concern. Urgent and intensive interventions are needed to effectively prevent and manage T2D, particularly among urban residents, older persons and individuals with metabolic risk factors.

Assessment of dietary practices and nutritional status of children aged 5 to 72 months: study protocol of a nationwide Polish cross-sectional study (PITNUTS 2024)

Por: Sawicki · M. · Kowalkowska · J. · Kułaga · Z. · Socha · P. · Swiader-Lesniak · A. · Swiecicka-Ambroziak · A. · Szajewska · H. · Wadołowska · L. · Weker · H.
Introduction

Optimal nutrition during early childhood is crucial for psychosomatic development and for preventing diet-related diseases. However, evidence from Poland highlights significant deviations from recommended dietary practices. The previous Polish Infants and Toddler Nutritional Study conducted in 2016 (PITNUTS 2016) revealed imbalances in nutrient intake among children aged 5–36 months. The aim of this study (PITNUTS 2024) is to assess the diet and nutritional status of infants and children aged 5–72 months, providing a broader understanding of eating behaviours across critical stages of growth and development and allowing evaluation of how dietary practices changed in recent years.

Methods and analysis

This cross-sectional study will recruit a nationally representative sample of Polish infants and children aged 5 to 72 months using stratified random sampling. Survey interviews will be conducted with parents or legal guardians as proxy reporters for the children. Dietary practices will be evaluated through validated qualitative and quantitative dietary assessments, ensuring a comprehensive evaluation of food consumption and energy and nutrient intake. Dietary data will be collected using the 3 day food record and the survey questionnaire, including a food frequency questionnaire (FFQ). Daily energy and nutrient intake will be compared with national dietary standards and WHO guidelines. Dietary patterns will be derived based on the FFQ data. Nutritional status will be assessed based on measured anthropometric parameters. Energy, macro- and micronutrient intake as well as dietary patterns identified among children will be associated with nutritional status, including body mass index z-score and body weight status.

Ethics and dissemination

The study has been approved by the ethics board of the Institute of Mother and Child. Written informed consent was obtained from all participants’ parents or legal guardians before the interviews began. The results from this study will be presented at scientific conferences and published in peer-reviewed journals, contributing to nutrition policies in Poland and informing educational materials and dietary consultation services.

Trial registration number

NCT06417151, results.

Skill mix changes in healthcare professions during the COVID-19 pandemic: a scoping review

Por: Petka-Nosal · N. · Bielska · I. A. · Badora-Musiał · K. · Nowak-Zajac · K. · Domagała · A. · Gałazka-Sobotka · M. · Kowalska-Bobko · I.
Objectives

The objective of the scoping review was to systematise the existing knowledge about skill mix changes among the healthcare workforce during the COVID-19 pandemic.

Design

Scoping review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review.

Data sources

Five databases including CINAHL Ultimate, Web of Science, Medline, Embase and Scopus were searched in August 2024.

Eligibility criteria

The review encompassed original research studies published from January 2020 to August 2024, on the skill mix of healthcare workers during the COVID-19 pandemic. Quantitative and qualitative studies were included without geographical or linguistic restrictions.

Data extraction and synthesis

Data were independently extracted by two researchers, capturing details such as publication year, study title, country, target population, study purpose and methodology, sample size, analysed variables, results and recommendations.

Results

A total of 13 563 records were identified in the databases of which 3962 remained for abstract review. 32 articles were included in the final analysis. 17 of the 32 papers were from Western and Southern Europe. The healthcare professions which were described in the studies were physicians, nurses, midwives, paramedics, pharmacists, physiotherapists, occupational therapists and medical assistants, of which the majority of the studies were conducted among nurses (n=16), pharmacists (n=11) and physicians (n=6). Most studies (n=9) concerned the adding of new tasks/roles and reallocating tasks in combination with teamwork (n=8). Research covered a range of topics, including psychological aspects of work, patient safety, work reorganisation, training and collaboration. Many studies focused on the challenges related to skill mix, such as the blurring of responsibilities and role ambiguity.

Conclusions

The research summarised in this review demonstrates the impact of implementing skill mix changes on healthcare workers during the COVID-19 pandemic, particularly in the area of mental health. The research highlights the importance of adaptation in response to pressures among healthcare professions and the entire system. Further research is needed to examine the long-term impact of skill mix on healthcare workers across regions and professions in crisis situations.

Modelling US health equity impacts of emicizumab for severe haemophilia A: aggregate distributional cost-effectiveness analysis

Por: Majda · T. · Lee · J. S. · Curtis · R. · Kowal · S. L.
Objectives

Emicizumab is the first bispecific antibody approved for prophylaxis in people with haemophilia A with or without factor VIII inhibitors. Aggregate distributional cost-effectiveness analysis assesses health equity impacts by evaluating how health effects and costs from funding an intervention are distributed among population subgroups. The objective was to evaluate how funding emicizumab for people with severe haemophilia A (PwSHA) impacts population health and health disparities in the USA.

Design

Population-level model of PwSHA from the perspective of the US healthcare system, using published sources and considering a lifetime time horizon.

Intervention

Emicizumab versus other haemophilia A prophylaxis treatments.

Primary outcome measures

Quality-adjusted life-years (QALYs) gained and change in Atkinson index of inequality in quality-adjusted life expectancy.

Results

When an estimated 6512 PwSHA in the USA were treated with emicizumab, the US healthcare system would save US$160 billion over those individuals’ lifetimes. If these cost savings fund additional healthcare interventions in the overall population, funding emicizumab would improve overall US population health (1 068 903 QALYs gained, using a threshold of US$150 000/QALY) and reduce existing overall US inequities (–0.01% on the Atkinson index).

In all scenarios tested for sensitivity, increased emicizumab and prophylaxis utilisation led to further reductions in health disparities and greater increases in population health. Results were robust to deterministic variations in the allocation of cost savings due to emicizumab use.

Conclusion

Funding emicizumab treatments for PwSHA improves overall population health and reduces overall health inequities in the USA. Cost savings from the use of emicizumab free up important resources that can be leveraged to support other healthcare interventions, but decisions on how these funds are used have large consequences for equity.

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