Preventive Medicine

World Health Organization recommendations to reduce road deaths were examined to assess the potential reductions that could be realized in countries that have not adopted them. Data from 72 countries on recommended speeding laws, alcohol laws, and vehicle safety standards were analyzed, controlling statistically for differences in average temperatures and population density per square kilometer. Using regression coefficients, estimates of the reductions that would be realized if each countermeasure were adopted in countries not currently employing it were calculated. The coefficient on alcohol laws was not significant, but deaths in these countries would likely decline by about 23 percent if speeding laws were improved. The road death would have been about 55 percent lower if vehicle safety standards for imported vehicles had been adopted. New and used vehicles that did not adhere to the standards were sold in low-income countries. Better data identifying clusters of specific collision types (pedestrians in the dark, animals, fixed objects) could lead to the adoption of countermeasures known to be effective.

PurposeTo explore mens assisted reproductive technology (ART) experiences, awareness and concerns about fertility-associated health outcomes, and perceptions of using administrative health records in the United Kingdom (UK) without consent to investigate these outcomes. MethodsOver a two-year period, all adult men were eligible to complete an anonymous online survey distributed via a UK-based fertility charitys social media. Free-text responses underwent thematic analysis, and categorical responses were analysed with descriptive statistics and Fishers exact test. ResultsAmong 80 participants, most were aged [≥]40 (66.7%), completed university (70.2%), White (77.2%) and UK residents (83.0%). Older (p=0.004) and White (p=0.001) men more likely underwent ART. Most ART users received treatment privately (60%) within the past three years (71.4%). Only one-fifth of the 15 men with identified fertility problems received discussion on fertility-associated health outcomes in clinic. Regarding perceptions, most were unaware of but concerned about these outcomes across biopsychosocial aspects, with participant quotes reflecting uncertainty and vulnerability. Recency of ART was associated with awareness (p=0.015) and concerns (p=0.001). Overall, 90.3% supported using administrative health records to investigate long-term health of fertility-challenged men, and 84.2% had no concerns about doing so without individual consent under established legal frameworks. Others raised concerns about the reliability of data anonymisation. Quotes suggested participants desire to understand the wider health implications of male fertility amidst a perceived gender imbalance in fertility research. ConclusionsGaps in participant knowledge, clinician communication and research in male fertility-associated outcomes support the need for universal education and further investigations in these outcomes. Capsule SummaryMost men showed limited awareness of but notable concern about fertility-related long-term health outcomes, and most supported using administrative health records without individual consent for investigating these outcomes.

Background. Although health mediation is widely studied in the U.S. through community health worker programs, evidence on their effectiveness in promoting cancer screening in Europe is limited. Since 2022, the "13 en Sante" program has implemented a multicomponent health mediation intervention -combining educational activities, outreach strategies, and navigation support- in socioeconomically disadvantaged neighbourhoods of Marseille, France. This study evaluates the effectiveness of this program in promoting breast, colorectal, and cervical cancer screening. Methods. A controlled before-after design based on two cross-sectional surveys was conducted in 2022 and 2024 in intervention or control neighbourhoods. Individuals aged 18-74 were randomly selected and interviewed via door-to-door questionnaires. Weighting was applied to account for stratified sampling and to align age and sex distributions with census data. Weighted logistic regression models were fitted for each cancer screening to estimate the intervention's effects on uptake and awareness at both individual and population levels. Findings. Overall, 4,523 individuals were included across the two cross-sectional surveys. The program successfully reached individuals facing cumulative socioeconomic barriers to healthcare access. No significant population-level effect was observed. At the individual level, declared exposure to health mediation was associated with significantly higher uptakes of breast and colorectal cancer screenings (breast: 54% vs 74%, OR=2.3 [1.1-4.5]; colorectal: 30% vs 50%, OR=2.8 [1.3-5.8]). In addition, colorectal cancer screening awareness was significantly higher among exposed participants (83% vs 93%, OR=8.1 [2.1-31]). Interpretation. This study provides the first evidence that a multicomponent health mediation intervention could effectively promote breast and colorectal cancer screening in disadvantaged French neighbourhoods. The study highlights screening-specific mechanisms of action that should be considered to further optimize intervention effectiveness. Funding. The survey was funded by the Regional Health Agency of Provence-Alpes-Cote d'Azur and Sante publique France.

BackgroundBetween May and December 2022, the UK Health Security Agency reported 3,585 cases of mpox. The 2022 global outbreak was characterised by transmission predominantly within sexual networks of gay and bisexual men (GBMSM). UK public health responses included information and vaccination campaigns, supported by behaviour change among GBMSM. We describe community reflections on the UK mpox outbreak and the responses to it. MethodsBetween August 2023 and April 2024, we conducted five focus groups with participants (n=27) recruited through community organisations in London and Manchester. Participants were predominantly gay men from ethnically diverse backgrounds. Data were analysed thematically. ResultsComing soon after COVID-19, the mpox outbreak intensified fears of returning to lockdown. Reports of GBMSM being most affected, and its framing in the media as a gay disease, coupled with warnings within GBMSM networks echoed earlier experiences of HIV. Those who had acquired mpox reported that media coverage had intensified their experiences of stigma and discrimination. Participants perceived vaccine roll out as inequitable; Furthermore, the perceived sudden cessation of public health messaging and advice left participants uncertain about ongoing risk and the need for prevention. ConclusionsParticipant reflections two years after the 2022 mpox outbreak demonstrate how previous pandemics shape emotional responses to new outbreaks. Key challenges included stigmatising media coverage, inequitable vaccine rollout, and sudden discontinuation of public health messaging. These findings highlight the importance of targeted, non-stigmatising and unambiguous communication from trusted sources during and after an outbreak. What is already known on this topicThe media response to the 2022 UK mpox outbreak led to stigma among GBMSM and public health measures were not equitably accessible What this study addsPeople from communities affected by the outbreak sought timely information from trusted sources. Communication needs do not end with outbreaks How this study might affect research, practice or policyThere is a need for ongoing public health work to build trusted networks who can maintain inter-outbreak communications and respond rapidly to outbreaks

IntroductionElectronic nicotine delivery systems (ENDS) products continue to evolve, and so ongoing analysis of transition rates over time is important for tracking real-world associations between ENDS and cigarette use and for providing the information necessary to project future public health outcomes. MethodsUsing the Population Assessment of Tobacco and Health (PATH) Study Waves 6-7 (2021-2022), we applied a Markov multistate transition model to estimate transition rates for initiation and cessation of each product. We estimated one-year transition probabilities for each transition. These results were compared to estimated rates and probabilities in Waves 1-6 (2014- 2021). ResultsThe fraction adopting ENDS use in 2021-22 among those who had never previously established tobacco product use, those not currently using tobacco products, and those currently smoking cigarettes increased to 0.5% (95% confidence intervals [CI]: 0.4, 0.6%), 2.7% (95% CI: 2.3, 3.2%), and 6.8% (95% CI: 6.1, 7.6%), respectively. These increases were driven by young adults (ages 18-24), with respective transition fractions of 2.7% (95% CI: 2.3, 3.2%), 23.6% (95% CI: 20.2, 27.0%), and 19.2% (95% CI: 14.0, 24.5%). The fraction of adults who transitioned from dual cigarette and ENDS use to cigarette-only use remained around 25% (26.2% [95% CI: 21.7, 30.7%]), while the fraction who transitioned to ENDS-only use increased to 24.2% (95%CI: 20.5, 27.9%). The increase in the dual to ENDS-only use transition was also driven by young adults (34.4% [95% CI: 26.2, 42.6%]) and adults ages 25-34 (29.4% [95% CI: 23.1, 35.7%]). ConclusionPublic health efforts are needed to promote cigarette cessation among older adults, specifically. What this paper addsO_ST_ABSWhat is already known on this topicC_ST_ABSO_LITransitions in cigarette and ENDS use have been changing over time. Young adults have been early adopters of ENDS, with older adults less likely to try ENDS or to completely switch from cigarettes to ENDS. C_LIO_LIFrequency of product use likely impacts the likelihood of product quitting or switching. C_LI What this study addsO_LIWe found increasing adoption of ENDS among adults who have never smoked, those not currently using cigarettes or ENDS, and those using cigarettes only. These patterns were driven by young adults, with little cigarette cessation or switching to ENDS among older adults. C_LIO_LIDaily (vs non-daily) use of ENDS facilitated cigarette cessation among those using cigarettes and ENDS, but it was a barrier to ENDS cessation among those using ENDS only. C_LI How this study might affect research, practice, or policyO_LIPublic health efforts are needed to promote cigarette cessation among older adults who smoke, many of whom may already be experiencing the health effects of tobacco use. C_LIO_LIStudies are needed to develop strategies for leveraging ENDS to maximize smoking cessation while also helping those who successfully quit smoking to avoid long-term ENDS use. C_LI

Suicide is one of the worlds leading public health problems, with more than 720,000 deaths annually. Suicide has traditionally been studied from an individual perspective. However, research has increasingly highlighted the influence of community-level factors on suicide risk. This study aimed to (1) analyse the spatial distribution of suicide mortality at the provincial level in Spain (2018-2022); (2) perform stratified analyses by sex and age group; and (3) compare suicide risk across different phases of the COVID-19 pandemic. We used data from the Spanish National Institute of Statistics on 19,381 suicide deaths in 47 peninsular provinces between 2018 and 2022. Covariates included sociodemographic (e.g. aging rate, population density), economic (e.g. unemployment, GDP), and environmental (e.g. temperature) indicators. Bayesian hierarchical spatial Poisson regression models were fitted to estimate suicide risk and identify significant contextual variables. The general spatial model revealed a higher risk of suicide in provinces with lower population density, higher aging rates, and lower health expenditure. Other covariates such as gross domestic product, unemployment, or temperature were associated with specific sex or age groups. Suicide risk was highest in the northwestern provinces and lowest in the central regions. Stratified analyses showed similar patterns across gender and age groups, and between time periods, with some variations in spatial distribution. This study reveals significant spatial heterogeneity in suicide risk across Spanish regions, influenced by socio-demographic, economic, and environmental factors. These findings underline the importance of regionally tailored suicide prevention policies, especially in aging and low-density areas with low health investment. Key MessagesWe examined spatial patterns and socioeconomic and environmental determinants of suicide mortality in 50 Spanish provinces between 2018 and 2022. We found persistent geographical inequalities in suicide rates, with higher mortality in low-density provinces and those with older populations, and protective effects associated with health expenditure. These findings highlight the importance of place-based suicide prevention strategies that consider regional disparities and socioeconomic vulnerabilities.

ObjectiveExplore self-reported racial discrimination in healthcare. MethodsRepresentative population sample, Switzerland, repeated cross-sectional data 2016 to 2024 (N=15,525). ResultsContrary to expectation, respondents from the migration-related population (foreign citizens, foreign born, migration background, first/second generation) report less racial discrimination than members of the majority population. Over time, we see an increase in the non migration-related population reporting (racial) discrimination in healthcare, while the share for the migration-related population is constant. The validity of the instrument is demonstrated with reported discrimination at work and in housing and the results are reliable across specifications and statistical controls. ConclusionWe speculate that in some cases, reported racial discrimination may express unmet expectations in healthcare more generally.

ObjectivesChemsex is the use of select psychoactive drugs to enhance sexual experiences and has been described among gay, bisexual, and other men who have sex with men (GBMSM). We aimed to characterise sexual risk, wellbeing and health-seeking behaviours among GBMSM and gender-diverse people reporting chemsex-associated drug use. MethodsWe analysed data from Reducing inequalities in Sexual Health (RiiSH), an online community survey of 2,758 UK-resident men and gender-diverse people having sex with men. We compared those reporting chemsex-associated drug use with those who did not, assessing sociodemographic characteristics, well-being, sexual risk behaviours and sexual health service (SHS) engagement. ResultsOverall, 8% (218/2,758) reported chemsex-associated drug use in the last year. Participants reporting chemsex-associated drug use in the last year were more likely to report [&ge;]1 marker(s) of sexual risk (such as prior bacterial STI diagnosis, [&ge;]5 male condomless anal sex partners in the last 3-4 months) (85% vs 61%, p<0.001) and were more likely to have attended a SHS in the last year (81% vs 57%, p<0.001) compared to those who did not. Those reporting chemsex-associated drug use more frequently reported a long-term limiting mental health condition (36% vs 24%, p<0.001) and poorer personal wellbeing (e.g. reporting low life satisfaction 36% vs 20%, p<0.001). ConclusionWhile a minority of participants in this national, community-based sample reported chemsex-associated drug use, this group had higher sexual risk and poorer indicators of wellbeing. Many participants also attended SHS, reinforcing the key supporting role of SHS for referral pathways to harm reduction support for those experiencing problematic drug use.

BackgroundMotorcycles are a common mode of transport in major Cameroonian cities, contributing to a rising burden of injuries among both users and pedestrians. These groups differ in exposure, mechanisms, and vulnerability, yet both bear a disproportionately high injury burden. However, comparative data on their epidemiological patterns and outcomes remain scarce. To support targeted prevention policies, we analysed trauma registry data to describe demographic, crash, injury, clinical, and outcome characteristics across both populations. MethodsThis was a retrospective analysis of the Cameroon Trauma Registry (CTR), which collects information on injured patients presenting to 10 hospitals across seven of the 10 regions of Cameroon. Patients presenting with motorcycle-related injuries between June 1st 2022 and May 31st 2023 were assessed for demographic, crash, injury, clinical patterns of care and outcomes variables and compared using {chi}2 or Fishers exact tests for categorical data. The analysis was done using R version 4.2.1. ResultsA total of 2,757 motorcycle-related injury patients were included from the CTR database, including 2,339 (84.8%) motorcycle users and 418 (15.2%) pedestrians. Motorcycle users were mostly aged 15-34 years (59.1%) and males (83.0%), while pedestrians were frequently aged [&ge;]60 years (23.4%) and females (37.8%). Helmet use among motorcycle users was low (3.0%). Alcohol involvement was more frequent among users (14.2%) than pedestrians (7.4%, p = 0.001). Most injuries occurred during work for users (33.1%) and during leisure for pedestrians (77.5%, p < 0.001). Severe multi-region injuries (abbreviated injury severity [&ge;]3) were more common in users (21.9%) than pedestrians (16.1%, p = 0.014). Hospital admissions were high in both motorcycle users (60.2%) and pedestrians (58.4%); 6.2% required intensive care, and 2.2% underwent immediate surgery. Functional outcomes were similar: 44.8% had minor and 19.9% had major disability at discharge; 3.6% died during hospitalization. ConclusionMotorcycle-related injuries in Cameroon disproportionately affect young male motorcycle users, with low helmet use, higher rates of alcohol use and severe trauma, together with older female pedestrians. Despite differing profiles, both motorcycle users and pedestrians face high disability and hospitalization rates. Targeted safety strategies are urgently needed to address these overlapping and distinct risks.

Remote consultations, including telephone, video, text or web-based consultations, are now common in sexual and reproductive health services (SRHS) in England and Wales, offering convenience and efficiency but raising concerns about safeguarding service users compared to in-person care. Ensuring protection and support for individuals remain central to SRHS. While guidance exists, evidence on how safeguarding is enacted remotely is limited. This study explores how safeguarding is managed in remote SRHS, examining associated challenges, benefits, and perceptions of acceptability. This qualitative study, part of the CONNECT study (NIHR153151), explored safeguarding in remote delivery of SRHS across three diverse case study areas in England and Wales. Semi-structured interviews were conducted with service users and providers (March 2024-January 2025). Data were thematically analysed using inductive and deductive approaches. Eighty-nine interviews were conducted with 54 service users/potential service users and 35 professional stakeholders across three study sites. Four key themes were identified: (1) challenges of delivering remote safeguarding in practice, (2) importance of a safe space for the patient, (3) one size approach does not fit all, and (4) strategies to support remote safeguarding. Participants described difficulties identifying risks without visual cues, variable comfort with disclosure, and privacy concerns. Providers used adaptive, collaborative approaches to build trust, ensure safety, and tailor safeguarding to individual circumstances. Both service users and providers recognised the effectiveness of remote safeguarding largely depended on clinician judgement, structured questioning, and sensitive communication. While remote consultations offered flexibility, remote safeguarding relied on service users having access to safe, private space. People with language barriers or those less able to create a safe space at home, such as those experiencing housing instability or coercive control may also have greater safeguarding needs. Ensuring access to in-person options, clear safeguarding protocols, and appropriate clinician training is essential to mitigate these challenges. Author summaryDuring the COVID-19 pandemic, sexual and reproductive health services used more remote appointments, such as phone, video, or online consultations. These appointments can make it easier for some people to get care. But there are concerns about whether staff can spot safeguarding issues, such as people who may be at risk of harm, without seeing them in person. In this study, we spoke with people who use sexual and reproductive health services, people who had never used these services before, and staff who work in these settings. People described challenges with remote appointments, including not being able to see body language, feeling unsure about talking about sensitive issues, and worries about privacy at home. Staff described changing how they worked by asking careful questions, building trust, and making safeguarding fit each persons situation. Both service users and staff felt that keeping people safe during remote appointments depends on clear communication and professional judgement. It is harder when people do not have a private space, face language difficulties, or live in unsafe housing or controlling relationships. Our findings show the importance of keeping in-person appointments available and making sure staff have the right training and guidance.

IntroductionNational trends in youth suicide risk may mask significant regional variations within a country. This article attempts to account for spatio-temporal trends through a comparative analysis across South America and Europe. This paper analyzes the spatiotemporal patterns in suicide mortality among young people (10-29 years) in Argentina, Chile, Spain, and Uruguay during the period 1997-2021. MethodsOfficial data from vital statistics and population censuses of the four countries were analyzed. Spatiotemporal clusters were detected using Poisson-based scan statistics. Sociodemographic characteristics of high-and low-mortality clusters were compared with the rest of each country using Kruskal-Wallis and Wilcoxon tests. ResultsWith the exception of Chile, each country showed the emergence of spatiotemporal suicide clusters extending through 2021. Indicators of social fragmentation and lower socioeconomic status were most consistently associated with the formation of high-risk youth suicide clusters. ConclusionRecent national increases in youth suicide rates appear to be concentrated in specific sub-national regions, underscoring the need to target resources toward improving living conditions and mental healthcare access for young people in these areas.

BackgroundOral nicotine pouches (ONPs) have become the second most commonly used nicotine product among U.S. youth. However, little is known about how ONP use is distributed across population subgroups and how strongly it is patterned by use of other tobacco or nicotine products. MethodData were drawn from the 2021-2023 waves of the National Youth Tobacco Survey (NYTS), a nationally representative survey of U.S. middle and high school students (N = 66,349). We estimated the annual survey-weighted prevalence of current ONP use ([&ge;]1 day in the past 30). Using 2023 data (N = 20,174), we estimated prevalence by demographics and other tobacco/nicotine product use, and fitted survey-weighted Poisson regression models to estimate associations of current ONP use with demographics and other nicotine/tobacco product use. ResultsIn 2023, 1.6% reported current ONP use (95% confidence interval [CI] 1.0-2.1), up from 0.8% in 2021 (95% CI 0.5-1.0). Prevalence in 2023 was higher among males (2.3%, 95% CI 1.5-3.1) than females (0.8%, 95% CI 0.4-1.3), and among students who used any other tobacco or nicotine product (13.4%, 95% CI 10.3-16.5) than those who did not (0.4%, 95% CI 0.1-0.8). In fully adjusted models, use of nicotine products other than cigarettes or e-cigarettes showed the strongest association with ONP use (APR 21.1, 95% CI 13.0-34.0), followed by cigarette smoking (APR 2.0, 95% CI 1.1-3.7) and e-cigarette use (APR 1.9, 95% CI 0.8-4.5). Most current ONP users also used other tobacco/nicotine products (75.0%), though 16.6% reported no lifetime use of other products. ConclusionsOverall ONP prevalence among U.S. youth remains low but is increasing. While ONP use is largely concentrated in youth who use other nicotine/tobacco products, it is also increasing among adolescents who are otherwise nicotine-naive. These findings highlight the need for continued monitoring and targeted regulations that balance harm reduction for people who smoke against the risk of expanding nicotine dependence among youth. Key Points QuestionWhat are the prevalence, demographic patterns, and tobacco/nicotine co-use profiles of oral nicotine pouch users among US middle and high school students? FindingsIn this cross-sectional study of 66,349 students from the 2021-2023 National Youth Tobacco Survey, current oral nicotine pouch use doubled from 0.8% in 2021 to 1.6% in 2023. Most users also used other tobacco or nicotine products, but the proportion of current users with no lifetime use of other products increased from 7.4% to 16.6%. MeaningAlthough oral nicotine pouch use among US youth remains low, increasing uptake among adolescents without prior tobacco or nicotine exposure suggests a need for targeted prevention efforts alongside continued surveillance.

BackgroundRemote consultations (via telephone or video) were critical during COVID-19 restrictions for Sexual and Reproductive Health Services (SRHS) in England and Wales and continue to be implemented widely. However, there remains limited evidence on their impact on outcomes and health inequalities. This study, guided by the Framework for Digital Health Equity, explores the equity implications of remote sexual health consultations in England and Wales, examining their acceptability and appropriateness. MethodsWe conducted semi-structured interviews with 54 service users and potential service users and 35 professional stakeholders across three diverse case study areas. Participants were purposively sampled to ensure diversity in socio-demographic profile and service experience. All participants provided informed consent, and ethical approval for the study was granted by NHS Research Ethics Committee (REC: 23/NS/0128). Data were thematically analysed into narrative themes, with findings interpreted collaboratively with public and patient involvement groups. ResultsThe study found that remote consultations have reshaped care delivery, improving efficiency but also generating additional clinical workload and, for some clinicians, reduced job satisfaction. While generally acceptable, remote models were perceived to affect rapport, extend care pathways for some service users, and impact privacy and safeguarding. We found the benefits of remote consultation are unevenly distributed, with those experiencing digital exclusion, who lack access to suitable private spaces, or who experience language barriers, being less able to take advantage of their convenience. ConclusionsRemote consultations transform SRHS delivery, improving efficiency for some but introducing challenges by impacting interaction, equity, and confidentiality. Benefits and burdens are unevenly distributed, reflecting structural, social, and individual factors influencing access. SRHS must ensure equitable access to appropriate care for all populations when implementing remote consultations. The findings show that a one-size-fits-all approach is not appropriate, and that giving service users choice in how they consult, including in-person, is important.

BackgroundInjury is one of the leading causes of hospitalization among Canadians and represents a substantial public health burden. However, at the population level, the lifetime risk of injury-related hospitalization is unknown. Estimating the lifetime risk of hospitalization due to injury among Canadians provides an intuitive and policy-relevant metric to inform the development of injury prevention strategies and health system planning. MethodsThis study used the Cumulative Risk Method to estimate the lifetime risk of at least one injury-related hospitalization among Canadians. Age-specific risks were calculated and summed under assumptions of a stable population and constant injury incidence. Estimates were adjusted for an average of 1.4 hospitalizations per person, and sensitivity analyses assessed the impact of varying this assumption. ResultsThe estimated lifetime risk of experiencing at least one injury-related hospitalization among Canadians was 42.0% (95% CI: 41.9% - 42.1%), corresponding to approximately one in every 2.4 individuals over the life course. Lifetime risk was slightly higher among females (42.1%, 95% CI: 42.0% - 42.3%) than males (41.3%, 95% CI: 41.1% - 41.4%), although males exhibited higher cumulative risk before age 65. Sensitivity analyses indicated that, under different assumptions regarding repeat hospitalizations, lifetime risk estimates ranged from 31.1% to 53.5%. DiscussionA substantial proportion of Canadians will experience at least one injury-related hospitalization over their lifetime. Estimates of lifetime risk provide a clear and easily interpretable metric that can communicate the burden of injury to the general population while highlighting to healthcare providers the importance of implementing sustained, population-level injury prevention strategies. What is already known on this topicInjury is a leading cause of hospitalization and death among Canadians, especially those under 45, and imposes a substantial healthcare and economic burden. What this study addsThis study estimates that one in every 2.4 Canadians will experience one or more injury-related hospitalizations over their lifetime. It also provides sex-specific differences and examines the impact of repeated hospitalizations on risk. How might this study affect research, practice, or policyThese findings provide a clear and easily understood measure of injury burden, which can guide public health planning, inform prevention strategies, and raise public awareness of the lifetime risk of serious injury.

ObjectivesCervical cancer is a preventable disease, and a properly implemented screening programme can reduce its incidence and mortality and potentially save resources. This study aimed to evaluate the cost-effectiveness of options for potential transformation of the nationwide screening programme in the Czech Republic, especially considering recent changes in HPV DNA testing recommendations. MethodsA microsimulation model was developed to assess the cost-effectiveness and health benefits of alternative screening strategies in the Czech Republic. The model simulated annual life cycles of women from age 15, comparing combinations of cytology and HPV testing. Input parameters used were obtained from national registries in the Czech Republic and from published literature. The analysis was conducted from the perspective of healthcare payers. Costs (2025 EUR) and LYs were discounted at a rate of 3% annually. Probabilistic sensitivity analysis was conducted. ResultsThe CEA showed that, compared to the current setting (annual cytology with co-test at 35, 45, 55), only specific co-testing strategies lead to a decrease in incidence and mortality but differ in benefits and economic efficiency. The lowest ICER was reported for a strategy combining cytology at two-year intervals and co-testing at four-year intervals from ages 30 to 65. Sensitivity analysis showed that the current strategy has the highest probability of cost-effectiveness at {euro}31,000 per LY gained. At higher values, this is replaced by a strategy with a 3-year interval co-test. ConclusionsBased on the models presented, co-testing appears to be cost-effective. The actual willingness to pay threshold will facilitate selection of the most-appropriate strategy.

PurposeThe objective of this study was to identify predictors of statin adherence in the primary and secondary prevention of CVD among patients in the first two years after the date of first prescription using real-world data. MethodsThe Electronic Practice Based Research Network Linked Dataset was used in this study. Statin adherence was calculated using a modified proportion of days covered (PDC) formula. Individuals with PDC [&ge;] 80% during the two years of observation period were considered as adherent. All analyses were performed with R software. Descriptive and multivariate logistic regression analyses were performed. Sensitivity analysis was performed using the Akaike Information Criterion model selection method. ResultsOverall, 3,432 patients accounting for 57,227 visits met the selection criteria. The mean PDC was 91.6% ({+/-}22.2%), and 72.0% of the patients were adherent to statins (PDC [&ge;] 80%) in the first two years after the date of first prescription. After adjusting for all other variables, statin adherence was positively associated with age (AOR 1.7, 95% CI 1.4 - 2.0), SEIFA index (AOR 1.8, 95% CI 1.2 - 2.6), polypharmacy (AOR 1.8, 95% CI 1.3 - 2.5) and comorbidities (AOR 1.4, 95% CI 1.1 - 1.7), and negatively associated with the number of statin types (AOR 0.6, 95% CI 0.5 - 0.9) and smoking status (AOR 0.7, 95% CI 0.6 - 0.9). The sensitivity analysis showed similar results as the regression model. ConclusionsStatin adherence is influenced by an aging, multimorbid population, who are exposed to polypharmacy, multiple statin options and socioeconomic diversity. Key pointsO_LIAdherence in the first two years after the first date of statin prescription was measured as proportion of days covered (PDC) C_LIO_LIThe mean PDC was 91.6% ({+/-}22.2%) C_LIO_LI72.0% of the patients were adherent to statins, with PDC [&ge;] 80% C_LIO_LIStatin adherence was positively associated with age, area-based social advantage and disadvantage index, polypharmacy and comorbidities C_LIO_LIStatin adherence was negatively associated with the number of statin types prescribed to the patients and the smoking status of patients C_LI Plain Language SummaryThe objective of this study was to identify predictors of statin adherence among patients in the first two years after the date of first prescription using real-world data. The dataset used was the Electronic Practice Based Research Network Linked Dataset. Statin adherence was calculated using proportion of days covered (PDC). A PDC [&ge;] 80% during the two years of observation period were considered as adherent. Overall, 3,432 patients were eligible for this study, and 72.0% of them were adherent to statins in the first two years after the date of first prescription. Statin adherence was positively associated with age, area-based social advantage and disadvantage index, number of medicines taken by the patient and number of chronic conditions that the patient suffered. Moreover, statin adherence was negatively associated with the number of statin types prescribed to the patients and smoking status of patients.

Background/ObjectivesIn England, gay, bisexual and other men-who-have-sex-with-men (GBMSM) are eligible for vaccinations at NHS sexual health services, including human papillomavirus (HPV), hepatitis A virus (HAV), and hepatitis B virus (HBV). However, current research shows limited understanding of the factors influencing vaccination uptake among GBMSM. This study aimed to examine the barriers and facilitators affecting the offer and uptake of these vaccination programmes. MethodsA qualitative interview study following the Person-Based Approach (a systematic method for developing and optimising health interventions) involving GBMSM and sexual health service staff from two regions of England. Purposive sampling aimed to include GBMSM with diverse backgrounds and engagement with sexual health services. Patient and public involvement shaped the study design and interview topic guides. The interviews were recorded, transcribed, and thematically analysed to identify barriers and facilitators which were interpreted using the COM-B model of behaviour change. ResultsTwenty GBMSM and eleven staff took part. The findings showed that opportunistic delivery of HPV, HAV and HBV vaccination within sexual health services is mostly acceptable and feasible for GBMSM and staff while also highlighting areas for optimization. Despite low knowledge of these viruses and their associated risks, willingness to be vaccinated was high, with healthcare provider recommendations and the convenience of vaccine delivery during routine clinic visits acting as important facilitators. However, the reach of opportunistic models was limited, particularly for individuals underserved by sexual health services or disengaged from GBMSM social networks. System-level barriers such as complex vaccine schedules (particularly when multiple schedules are combined), inconsistent access to vaccination histories and limited system-level follow-up processes (e.g. automated invites and reminders) were also found to act as obstacles to vaccination uptake and delivery. ConclusionsTo improve equitable uptake, sexual health services should explore the feasibility of addressing both individual and structural barriers through additional strategies, including targeted and persuasive communication to increase knowledge, leveraging regular contact with GBMSM to promote uptake and implementing enhanced approaches to support vaccination completion (e.g. prompts or reminders).

BackgroundCervical screening using human papillomavirus (HPV) testing is a pillar of global cervical cancer elimination. However, different HPV assays vary in both the HPV types they detect as well as the minimum amount of virus they detect. The aim of this collaborative study was to define which HPV type-specific analytical threshold of detection provides optimal sensitivity and specificity of cervical screening. Methods100 cervical intraepithelial neoplasia grade 2 or worse (CIN2+) cases and 200 matched population-based controls were obtained at the Swedish National HPV Reference Laboratory and analyzed by 10 laboratories across 10 countries. Cumulative sensitivity (weighted according to the global HPV type distribution in invasive cervical cancer (ICC)) and specificity were estimated at varying analytical detection thresholds. ResultsConsensus results found HPV in 99/100 CIN2+ cases and 52/200 controls. HPV16 prevalence declined in HPV-vaccinated birth cohorts, among both cases and controls. Line plots of 1-specificity and ICC-weighted sensitivity found optimal analytical detection thresholds as 3 International Units (IU)/{micro}l for HPV16/18, 25 IU/{micro}l for HPV31/33/35/45/52/58 and 100 genome equivalents/{micro}l of HPV 39/51/56/59 resulting in 92.00% cumulative specificity and 90.08% ICC-weighted sensitivity. ConclusionAn international collaborative study has identified HPV analytical detection thresholds optimizing sensitivity and specificity of cervical screening.

ObjectivesUnderstanding fertility desires is one of the key components for understanding total fertility rates. The study aims to explore how attitudes towards fertility and childbearing are associated with fertility desires. MethodsA cross-sectional online survey was conducted among 822 childfree, heterosexual women aged between 18 and 35 who were involved in a romantic relationship and were not diagnosed with infertility. The relationship between attitudes to fertility and childbearing and both (1) the desire to have children and (2) the preferred timing of childbearing was analyzed. ResultsWomen who had a higher score in the Fertility and the child as an important value subscale and Personal awareness and responsibility concerning having a child subscale were more likely to (1) want to have a child and (2) want to have a child sooner (within the next 5 years). Conversely, higher scores on the A child as a barrier subscale were associated with a decreased likelihood of desiring a child and an increased likelihood of planning to have a child later than in the next five years. ConclusionThe findings highlight the role of fertility-related attitudes in shaping reproductive intentions among women of reproductive age.

Commercially available disposable products such as cell culture utensils and catheters do not necessarily possess sufficient quality for in vitro fertilization (IVF), from the perspective of pyrogen contamination. We aimed to comprehensively analyze the pyrogen contamination status, including bacterial endotoxins, of the products used for IVF in assisted reproductive technology (ART) and improve their cleanliness using a new sterilization technology. Pyrogen contamination levels were evaluated using a direct human cell-based pyrogen test that is not affected by the recovery ratio, unlike bacterial endotoxin tests. Pyrogen inactivation tests were performed using low-temperature ozone/hydrogen peroxide gas treatment. The residual hydrogen peroxide was colorimetrically quantified, and the effectiveness of its removal by drying treatment was evaluated using germ cell viability as an indicator. Significant amounts of pyrogen, from 0.014 to 1.110 EU/product, were detected in seven of the twenty products. Pyrogen contamination levels were reduced below the detection limit by ozone/hydrogen peroxide gas sterilization. Hydrogen peroxide remained on the surface of the GPS dish but was reduced to a level that did not affect human sperm viability and embryo development after drying at 80{degrees}C for 24 h following sterilization. These products may carry a potential risk of reducing ART success rates, and pyrogen contamination levels may exceed the previously reported allowable level of 0.01-0.02 EU/mL in human IVF during actual use. Our study suggests that the manufacturing of products free from pyrogens and without adverse effects on germ cells is possible using ozone/hydrogen peroxide gas sterilization and subsequent drying technologies.