Public Health [JOURNAL]
Sun
200 papers
Behavioral and psychosocial factors associated with coadministration of COVID-19 and influenza vaccines among the elderly.
Seo S, Jo S, Kim H … +7 more , Lee S, Jeong HS, Lee JW, Kim AR, Kang MJ, You M, Kim DH
BMC Public Health · 2026 Jul · PMID 42399847 · Full text
BACKGROUND: Health authorities recommend adults aged 65 years and older receive COVID-19 and influenza vaccines at the same visit to improve vaccine uptake in this high-risk group. However, it remains unclear how widely...
BACKGROUND: Health authorities recommend adults aged 65 years and older receive COVID-19 and influenza vaccines at the same visit to improve vaccine uptake in this high-risk group. However, it remains unclear how widely older adults have accepted this recommendation in practice. METHODS: Using data from the Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission, we examined coadministration uptake and factors associated with its acceptance among 2,860 community-dwelling Korean adults aged 65 years or older who received the 2023-2024 influenza vaccine. Verified vaccination and infection records from the Korea Disease Control and Prevention Agency were linked with survey responses on psychological antecedents of COVID-19 vaccination. Vaccination behavior was categorized as coadministration, separate visit vaccination, or influenza-only vaccination. RESULTS: Overall, 15.0% received both vaccines at the same visit, while 43.3% received them on separate days. Prior receipt of both vaccines was the strongest predictor of coadministration (OR, 2.59; 95% CI, 1.70-3.95). Higher confidence in COVID-19 vaccination (OR, 1.30; 1.12-1.50) and lower complacency (OR, 0.81; 0.73-0.91) were associated with coadministration uptake. CONCLUSIONS: These findings highlight the need for targeted efforts to build trust and communicate the safety and convenience of coadministration to improve uptake among older adults.
Provider perspectives on barriers to medico-legal service provision for sexual violence survivors in Kenya: a qualitative interview study.
Rockowitz S, Sidhar E, Kanja W … +1 more , Flowe HD
BMC Public Health · 2026 Jul · PMID 42399843 · Full text
BACKGROUND: Medico-legal services are essential for supporting survivors of sexual violence and facilitating access to justice. Unfortunately, their provision remains a challenge in many low-resource settings. In Kenya,...
BACKGROUND: Medico-legal services are essential for supporting survivors of sexual violence and facilitating access to justice. Unfortunately, their provision remains a challenge in many low-resource settings. In Kenya, high prevalence of sexual violence contrasts sharply with low rates of case progression and conviction, yet much of the existing evidence is drawn from intervention studies or specific health facilities, limiting understanding of routine medical practice for the general population. This study aimed to explore the perspectives of medico-legal professionals on barriers to delivering effective medico-legal services to sexual violence survivors in both urban and rural Kenya. METHODS: A qualitative descriptive study was conducted using either semi-structured or small group interviews with 21 medico-legal professionals, including clinicians, lawyers, and police officers. Participants were recruited through professional networks and a non-governmental organisation, known as the Wangu Kanja Foundation (WKF). Interviews were conducted in English either online or in person, audio-recorded, transcribed verbatim, and analysed using the Framework Method with an inductive thematic approach. RESULTS: Five key themes emerged: professional journey, operating outside of the norm, case details and procedure, limiting factors, and personal reflections. Participants reported inadequate formal training in sexual violence response, reliance on informal or NGO-led training, and significant shortages of forensic and psychosocial resources. Service provision was constrained by weak inter-sectoral collaboration, investigation and prosecution delays within the justice system, and public misconceptions about evidence preservation. Provider bias, including victim-blaming attitudes, and substantial emotional burden among professionals were also evident. CONCLUSIONS: Medico-legal professionals in Kenya face multiple interrelated barriers, including inadequate training, limited resources, and systemic constraints that hinder effective handling for sexual violence survivors and contribute to case attrition. Integrating sexual violence training into formal professional education, strengthening multisectoral collaboration, and improving resource allocation may enhance survivor-centred handling and improve medico-legal outcomes.
Association between residential physical environmental exposures and multidimensional successful ageing in the UK biobank.
Zhou J, He L, Wei H … +6 more , Zhao H, Yang Z, Chen H, Afzal S, Liu C, Luo B
BMC Public Health · 2026 Jul · PMID 42399841 · Full text
BACKGROUND: Successful ageing is a global priority, yet the impact of the physical environment on this multidimensional process is not fully understood. Previous research has predominantly focused on isolated exposures o...
BACKGROUND: Successful ageing is a global priority, yet the impact of the physical environment on this multidimensional process is not fully understood. Previous research has predominantly focused on isolated exposures or specific diseases, overlooking the complex physical "exposome." We aimed to evaluate the associations between a comprehensive array of environmental exposures and a holistic Successful Ageing Index (SAI). METHODS: In this cross-sectional study of 28,090 UK Biobank participants aged ≥ 60 years, we constructed a continuous SAI integrating 11 indicators across cognitive, physical, psychosocial, and disease domains. Fourteen residential environmental exposures-including air pollutants, noise, and natural environments-were assessed. We used multivariable linear regression, restricted cubic splines, and mediation analyses to evaluate independent associations, non-linearity, and biological pathways. RESULTS: In crude models, most air pollutants were negatively associated, and natural environments positively associated, with the SAI. However, after extensive adjustment for sociodemographic and lifestyle factors, associations with natural environments were largely attenuated. Conversely, PM (β = -0.15; 95% CI: -0.27, -0.04; P = 0.010, per 1-SD increase), No (β = -0.14; 95% CI: -0.26, -0.02; P = 0.022, per 1-SD increase) and NO (β = -0.16; 95% CI: -0.28, -0.05; P = 0.005, per 1-SD increase) remained significantly and independently associated with a lower SAI. These adverse effects were most pronounced in the physical and psychosocial domains and were stronger among males and individuals with lower socioeconomic status. Non-linear dose-response relationships were observed for NO and greenspace. Mediation analysis identified chronic inflammation and metabolic dysfunction as significant biological pathways linking air pollution to reduced successful ageing. CONCLUSION: Higher baseline residential traffic-related air pollution indicators were associated with lower multidimensional SAI in this cross-sectional analysis, after adjustment for sociodemographic and lifestyle factors. These findings suggest that reducing traffic-related air pollution may be relevant to population healthy ageing, although longitudinal studies are needed to determine whether such interventions can extend healthy lifespan or reduce late-life morbidity.
Assessment of hepatitis B and tetanus toxoid vaccination coverage and associated factors among healthcare workers at Kabul University of Medical Sciences affiliated hospitals in Afghanistan.
Golzareh P, Shahim S, Usmani N … +3 more , Mann EM, Sabawoon A, Yousofzai MS
BMC Public Health · 2026 Jul · PMID 42399840 · Full text
OBJECTIVE: Hepatitis B and tetanus remain significant public health challenges in Afghanistan, a developing country where vaccination coverage is suboptimal. Healthcare workers are particularly at risk due to their expos...
OBJECTIVE: Hepatitis B and tetanus remain significant public health challenges in Afghanistan, a developing country where vaccination coverage is suboptimal. Healthcare workers are particularly at risk due to their exposure to infected blood and bodily fluids, and they play a vital role as health role models; however, their vaccination rates for hepatitis B and tetanus are often inadequate, risking both their health and potential transmission to patients. This study aimed to assess the vaccination coverage and associated factors among health personnel in teaching hospitals affiliated with Kabul University of Medical Sciences, providing insights to inform strategies for improving immunization practices and occupational safety. METHODS: A cross-sectional study was conducted at three teaching hospitals affiliated with Kabul University of Medical Sciences. The study sample included medical personnel (physicians, nurses, midwives, laboratory technicians, and other clinical staff) actively engaged in patient care with direct exposure to blood or bodily secretions. Demographic and vaccination information were gathered from them using questionnaires. Descriptive statistics and logistic regression were performed using Stata version 18.0. RESULTS: A total of 284 professional staff members from the three teaching hospitals of Kabul University of Medical Sciences participated in this study from 20 December 2024 to 20 March 2025. The majority were male (52.8%), with ages ranging from 19 to 62 years. Hepatitis B vaccination coverage was 57.8% (full) and 67.3% (partial or full); tetanus toxoid vaccination coverage was 45.5% (full) and 49.3% (partial or full). Factors associated with hepatitis B vaccination included profession and work experience. Tetanus vaccination was strongly associated with gender and profession, with a trend toward higher odds among those with higher income. The most commonly cited reason for non-vaccination was lack of access (48.4%), including geographical barriers, unavailability of vaccines at health facilities, and cost. CONCLUSION: Hepatitis B and tetanus vaccination coverage among healthcare workers in Kabul was suboptimal but comparable to that reported in other developing countries, with distinct factors driving uptake for each vaccine. Despite near-universal positive attitudes toward vaccination, the primary barrier was lack of access, highlighting systemic gaps in occupational health services. Institutional vaccination programs with free, on-site access are needed to protect healthcare workers and their patients. Further studies with larger samples across diverse settings are needed to confirm these findings.
Barriers to the behavioral conversion of dementia screening intentions among high-risk individuals: a qualitative study in an urban Chinese setting.
Wu Y, Fu N, Wu Q … +2 more , Tang L, Lyu Q
BMC Public Health · 2026 Jul · PMID 42399838 · Full text
BACKGROUND: As dementia prevention increasingly shifts toward community settings, early screening can help identify individuals who may benefit from timely assessment, referral, and support. Although many individuals at...
BACKGROUND: As dementia prevention increasingly shifts toward community settings, early screening can help identify individuals who may benefit from timely assessment, referral, and support. Although many individuals at high risk of dementia express willingness to undergo screening, actual participation remains low, indicating an intention-behavior gap. This study explored barriers that prevented individuals with documented screening willingness from completing dementia screening. METHODS: This descriptive phenomenological qualitative study drew on a preliminary survey conducted in two urban communities in Guangzhou, China, from November 16, 2021, to April 2, 2022. Among 439 individuals at high risk of dementia, 272 expressed willingness to undergo dementia screening. At the six-month follow-up, 156 individuals were successfully contacted; 19 had completed screening. Fifteen individuals with documented screening willingness but no subsequent screening behavior were purposively selected for semi-structured interviews between June and December 2022. Data were analyzed using Colaizzi's seven-step method. RESULTS: Three themes and nine sub-themes were identified. Theme 1, post-intentional hesitation in initiating screening, included low perceived urgency after initial willingness, fear- and stigma-driven postponement, and delayed self-initiation pending trusted confirmation. Theme 2, individual and familial constraints to intention enactment, included limited understanding of dementia screening, economic constraints and competing responsibilities, and insufficient instrumental support for screening attendance. Theme 3, service-level barriers to intention enactment, included fragmented and restricted access to screening services, perceived low credibility of community-based screening, and lack of follow-up or continuity of care. Overall, screening willingness was often postponed or remained unacted upon when screening was perceived as non-urgent, emotionally threatening, difficult to arrange, or insufficiently connected to a trustworthy care pathway. CONCLUSION: Among individuals at high risk of dementia who were willing to be screened, non-participation was shaped by delayed action, limited screening knowledge, fear and stigma, practical constraints, and service-level barriers. Community-based services should help willing older adults move from intention to action through clear information, emotional reassurance, practical assistance, credible screening procedures, and visible referral and follow-up support.
The role of health institutions in the epidemiological surveillance of arboviral diseases in Rio Grande do Sul, Brazil: notification, hospitalization, and regional differences.
Kist LF, Wolf JM, Rocha MLG … +3 more , da Silva AD, Pereira RB, da Veiga ABG
BMC Public Health · 2026 Jul · PMID 42399836 · Full text
BACKGROUND: Arboviral diseases represent a growing public health challenge worldwide, with Brazil reporting the highest number of dengue cases and recent expansion into southern regions. Effective epidemiological surveil...
BACKGROUND: Arboviral diseases represent a growing public health challenge worldwide, with Brazil reporting the highest number of dengue cases and recent expansion into southern regions. Effective epidemiological surveillance relies on the capacity of health institutions to identify, notify, and manage cases. This study evaluated the role of healthcare facilities of different administrative spheres in arboviral disease surveillance, based on their participation in case notification and hospitalization, in Rio Grande do Sul (RS), the southernmost Brazilian state. The influence of meteorological factors was also assessed. METHODS: A retrospective ecological study was conducted using data from the National Notifiable Diseases Information System (SINAN) from January 2020 to June 2024 along with healthcare facility data from the National Registry of Healthcare Facilities (CNES). Institutions were classified as public administration, philanthropic organizations, business entities, or individuals. Notification and hospitalization rates were analyzed in absolute and relative numbers (per 100 institutions and per 100,000 inhabitants). Spatial analysis was performed based on intermediate geographic regions, and seasonality of cases was analyzed together with meteorological data (temperature, humidity, and precipitation). RESULTS: A total of 414,569 suspected arboviral cases were reported, including 277,878 confirmed dengue cases. Public administration institutions, although representing only 14.66% of facilities, accounted for 80.35% of notifications and 82.19% of confirmed cases. Philanthropic organizations (1.98% of institutions) contributed disproportionately (11.67%) and showed the highest notification rates per facility. Hospitalizations totaled 14,196, with similar contributions from public (45.79%) and philanthropic (43.78%) sectors. Spatial analysis revealed concentration of cases in major regional hubs, while population-adjusted rates indicated higher burdens in less populous regions. In addition, increases in case numbers were observed following periods of high temperature. CONCLUSIONS: Public and philanthropic health institutions play a central role in arboviral disease surveillance and care in RS, despite representing a minority of facilities. Limited participation of private entities underscores the need for improved integration across the healthcare system. Regional disparities and climatic influences further emphasize the importance of targeted, data-driven public health strategies to strengthen surveillance and control efforts.
Heterogeneity in blood pressure and weight trajectories and associated mortality risk among hypertensive patients in rural South Africa: findings from cluster analysis of longitudinal clinical record linkage data.
Bashingwa JJH, Gómez-Olivé FX, Dzomba A … +4 more , Kahn K, Tollman S, Chirwa T, Kabudula CW
BMC Public Health · 2026 Jul · PMID 42399830 · Full text
BACKGROUND: Hypertension and obesity are the leading risk factors for cardiovascular disease (CVD), causing over ten million annual preventable deaths globally. Understanding individual differences in how blood pressure...
BACKGROUND: Hypertension and obesity are the leading risk factors for cardiovascular disease (CVD), causing over ten million annual preventable deaths globally. Understanding individual differences in how blood pressure (BP) and weight changes over time can inform tailored prevention and treatment strategies. METHODS: We used data from a longitudinal database of clinical and treatment records collected between 2015 and 2018 and linked to the Agincourt Health and Demographic Surveillance System (Agincourt HDSS-Clinic-Hospital link) in Mpumalanga Province, South Africa, to characterize long-term trends in BP and weight among hypertensive patients and assess the risk of death associated with homogenous group trajectories. K-means clustering was used to cluster the BP and weight trajectories. Multinomial logistic regression model was used to identify factors associated with emerging group trajectories. Finally, Cox Proportional hazard regression models were used to assess the mortality risk associated with each BP and weight group trajectory. RESULTS: Three groups were identified among 1640 hypertensive patients and labelled according to the slopes of their BP and weight measurements. The first group was labelled as the steady BP and weight group (n = 760, 46% of patients) and consisted predominantly of patients from high socioeconomic status (SES) households, with a high level of education (secondary or higher education), and mostly women. The second group, labelled as the decreasing BP group (n = 264, 16% of patients), consisted predominantly of individuals from lower SES households and mostly older people of Mozambican ethnicity. The third group was labeled as the increasing BP and weight group (n = 616, 38% of patients) comprised of elderly men mostly from the middle and lower levels of household SES. The risk of dying was 1.82 times (95% CI [1.17-2.84]) higher for patients with increasing BP and weight as compared to patients with steady BP and weight. CONCLUSION: Cluster-based characterization of hypertensive patients by BP and weight trajectory can facilitate personalized hypertension interventions and treatments.
Association between health care insurance type and rates of visceral surgical procedures in Switzerland. A population-based weighted retrospective cohort study.
Rafaisz K, Suter F, Rohrmann S … +5 more , Mueller B, Schuetz P, Nebiker CA, Kutz A, Struja T
BMC Public Health · 2026 Jul · PMID 42399821 · Full text
BACKGROUND: Indication for visceral surgical procedures should be based on clinical reasoning only and independent of financial incentives. Yet, there is a lack of studies investigating whether insurance type (basic vs....
BACKGROUND: Indication for visceral surgical procedures should be based on clinical reasoning only and independent of financial incentives. Yet, there is a lack of studies investigating whether insurance type (basic vs. supplementary private) is associated with surgical procedure rates. METHODS: In this study we assessed whether incidence rates in adults with supplementary private insurance undergoing visceral surgical, non-emergency, in-patient procedures from 2012 to 2020 are higher compared to those with basic insurance only in Switzerland. We assessed incidence rates (IR) for basic only and supplementary private insurance stratified over time and by different age groups, and we fitted negative binomial regression models adjusted by inverse probability weights for specific visceral surgical procedures. We used primary or secondary discharge procedure codes for one of the following procedures: cholecystectomy, fundoplication, sigmoidectomy, rectopexy, haemorrhoidectomy, inguinal, femoral, and umbilical hernia repair. RESULTS: Of 1,954,119 surgical admissions (median age 63, 53.3% male, 15.3% non-Swiss nationality), 70.5% had basic insurance only. People with supplementary private insurance had a 7% higher probability (IRR, 1.07, 99% CI 1.06-1.07) to have a visceral surgical procedure done compared to people with basic insurance only-a result consistent across different types of procedures including cholecystectomy (IRR, 1.06, 99% CI 1.06-1.06), fundoplication (IRR, 1.09, 99% CI 1.09-1.10), sigmoidectomy (IRR, 1.10, 99% CI 1.10-1.10), rectopexy (IRR, 1.05, 99% CI 1.04-1.06), haemorrhoidectomy (IRR, 1.04, 99% CI 1.03-1.04), and hernia repair (IRR, 1.07, 99% CI 1.07-1.07). Sensitivity analyses, including side procedures, stratification by length of stay, and propensity score matching, suggested robustness of the results. CONCLUSION: In this cohort study, supplementary private insurance was independently associated with a higher probability of undergoing a visceral surgical procedure. The role of financial incentives in surgical procedures is still unclear.
Factors influencing health-promoting lifestyle among medical personnel: A mixed-methods systematic review.
Huang P, Abang Abai DSB, Latip MB … +4 more , Xiao H, Zhang Q, Yang L, Abdullah KB
Public Health · 2026 Jul · PMID 42398369 · Publisher ↗
OBJECTIVES: Medical personnel have high health literacy; however, research suggests they experience barriers to engaging in health-promoting practices, and limited systematic research on influencing factors exists. This...
OBJECTIVES: Medical personnel have high health literacy; however, research suggests they experience barriers to engaging in health-promoting practices, and limited systematic research on influencing factors exists. This study aims to identify the factors influencing health-promoting lifestyle among medical personnel to inform targeted multi-level interventions. STUDY DESIGN: A mixed-methods systematic review. METHODS: PubMed, Scopus and Web of Science were searched from inception to 21 January 2025, using keywords and Medical Subject Headings (MeSH) terms related to health-promoting lifestyle and medical personnel. English-language, peer-reviewed original studies were eligible. Two reviewers independently screened records, extracted data, and appraised study quality with the Mixed Methods Appraisal Tool (MMAT). Findings were synthesized narratively, with candidate factors organised using the Ecological Model of Health Behaviour (EMHB). Quantitative, qualitative and mixed-methods designs were included. RESULTS: Twenty-seven studies (21 quantitative, 4 qualitative, 2 mixed-methods) were included. Most focused on nurses (18/27) and were cross-sectional. Studies spanned multiple countries (e.g. five from the USA, four from South Korea, four from Iran). Influencing factors emerged at intrapersonal, interpersonal, organizational, and community levels, with few policy-level factors reported. Intrapersonal factors included demographics (gender, age, tenure, income), health attitudes, and self-efficacy. Interpersonal support (e.g. encouragement by family or colleagues) was important. Major organizational barriers were shift work, heavy workload, and lack of workplace wellness resources. Few studies examined community or policy influences. CONCLUSIONS: Health-promoting lifestyles among medical personnel are shaped by multi-level determinants, with organisational factors (shift work, work stress, lack of support) being most frequently reported. Interventions should target these barriers: institutions can reduce job stress and improve resources (wellness programs, healthy food, exercise opportunities), while training and education can improve staff knowledge and motivation. Future research should diversify samples beyond nurses, use longitudinal or experimental designs, and explore policy-level influences.
Impacts of hepatitis B and C prevention programmes on long-term outcomes of advanced liver disease and hepatocellular carcinoma: A systematic review.
Cai S, Dharmayani PNA, Lewandowska M … +10 more , Wijekulasuriya S, Varghese G, Carrigan A, Vizheh M, Boutros R, Goodall S, George J, Zekry A, Zurynski Y, Accelerated translational research in PRImary Liver Cancer Program Group
Public Health · 2026 Jul · PMID 42398368 · Publisher ↗
OBJECTIVES: To synthesise evidence on hepatitis B/C (HBV/HCV) prevention programmes that reduce long-term liver disease and hepatocellular carcinoma (HCC) in high-income countries with opioid misuse, high immigration fro...
OBJECTIVES: To synthesise evidence on hepatitis B/C (HBV/HCV) prevention programmes that reduce long-term liver disease and hepatocellular carcinoma (HCC) in high-income countries with opioid misuse, high immigration from endemic regions, and risk-based prevention strategies. STUDY DESIGN: Mixed-methods systematic review. METHODS: MEDLINE, Embase, CINAHL, and Scopus were searched for peer-reviewed English-language studies (January 2013-November 2025). Eligible studies evaluated tailored or enhanced HBV/HCV prevention programmes in high-income countries and reported improvements in liver-related outcomes. Evidence on disease burden, risk factors, programme effectiveness, cost-effectiveness, and facilitators and barriers was synthesised. Study quality was assessed using ROBINS-I and CHEERS. RESULTS: Twenty-three studies assessed prevention strategies including screening, vaccination, early treatment, ongoing liver disease monitoring, and HCC surveillance. Locally targeted community screening identified 15.3%-34.3% of undiagnosed HBV/HCV infections. Integrated care pathways and monitoring programmes enabled detection of advanced fibrosis (5.3%-46.2%) and HCC (3.5%-39.2%). Early treatment reduced long-term disease burden and economic costs. Cross-sector collaboration, community engagement, and integrated care models were notable enablers. CONCLUSIONS: Prevention strategies were shown to improve case finding, early detection of chronic infection and liver damage, linkage to care, treatment uptake, and surveillance adherence. Population-level modelling also demonstrated reductions in long-term disease burden and costs. However, direct evidence that implemented programmes reduce HCC incidence and mortality remains limited, and methodological heterogeneity constrains synthesis. Strengthening evidence on programme effectiveness in preventing advanced liver disease and HCC is needed. Co-designed, patient-centred, integrated programmes spanning the hepatitis-HCC care continuum may enhance equity and maximise prevention benefits when implemented at scale.
Network analysis of anxiety, depression, self-affirmation, and sleep disturbances in general hospital patients: a cross-sectional study.
Li Y, Yao Y, Deng X … +6 more , Tan R, Qing Y, Xie J, Yang D, Song X, Zhang W
BMC Public Health · 2026 Jul · PMID 42393643 · Full text
Sleep disorders are prevalent among general hospital patients, significantly impairing quality of life and exacerbating existing medical conditions, leading to prolonged hospital stays and increased costs. Current treatm...
Sleep disorders are prevalent among general hospital patients, significantly impairing quality of life and exacerbating existing medical conditions, leading to prolonged hospital stays and increased costs. Current treatments primarily rely on pharmacological and psychological interventions, often neglecting the complex interactions between sleep disorders and emotional disturbances such as anxiety and depression, as well as psychological traits like self-affirmation. This study aims to address this gap by systematically exploring the multidimensional factors influencing sleep disorders and elucidating their interrelations. Utilizing a cross-sectional design, the research involved 5,523 hospital patients, employing standardized scales (PHQ-9, GAD-7, SA-9, and AIS-8) alongside multiple linear regression and network analysis methods to assess the impact of psychological factors on sleep disturbances. The results demonstrated that anxiety, depression, and self-affirmation are significantly associated with sleep disorders, with depression emerging as the strongest correlate. The network analysis revealed core symptoms and bridging pathways, notably highlighting the strong statistical associations of depressive symptoms with sleep disturbances. Additionally, no significant differences were observed in network structures across gender and marital status subgroups, suggesting that intervention strategies may maintain broad applicability. This research not only enriches the theoretical framework surrounding the comorbidity of sleep disorders and psychological symptoms but also provides critical insight for the development of targeted psychological health management strategies in hospital settings, emphasizing the need for comprehensive approaches that address both psychological and sleep health. The findings present innovative implications for future research and clinical practice, advocating for a nuanced understanding of psychological factors in sleep disorder interventions.
Effectiveness of WHO mhGAP-IG in identification and management of depression by primary level non-specialist health workers - protocol of a cluster randomized controlled trial from India.
Siddaiah A, Sathe H, Chari U … +16 more , Manivannan MM, Rathod R, Kudlekar A, Urkude A, Kalidindi B, Devadass D, Parthasarathy R, Paradkar R, John S, Raut A, Raj JM, Bhatia T, Beniwal RP, Praharaj SK, Ruben JP, Deshpande S
BMC Public Health · 2026 Jul · PMID 42393641 · Full text
BACKGROUND: Reports suggest that > 90% of the cases go undetected in low- and middle-income countries (LMICs) leading to a huge treatment gap. Evidence shows that task-sharing interventions such as training HWs, screenin...
BACKGROUND: Reports suggest that > 90% of the cases go undetected in low- and middle-income countries (LMICs) leading to a huge treatment gap. Evidence shows that task-sharing interventions such as training HWs, screening led to improved detection of depression at the primary level. In this regard, the World Health Organization (WHO) developed the mhGAP-IG to aid non-specialist HWs to detect and manage common mental health disorders such as depression to bridge the gap. The present study aims to design and test the effectiveness of a digital mental health intervention designed by contextualizing e-mhGAP in improving the detection and management of depression at the primary care level. METHODS: Formative phase will involve qualitative interviews, literature review aimed at co-developing a mobile application with the district mental health program. This will be followed by a cRCT. The trial will be conducted in eight PHCs, located in Tumkur district, Karnataka, and Wardha district, Maharashtra. Randomisation will be done at the PHC level. We plan to enrol non-specialist HWs working in these PHCs and a sample of 2400 adults who are availing the PHC services. Intervention PHC will receive training for HWs and a mobile application. Control PHCs will follow usual care. Both the groups will be encouraged to identify, manage, and follow-up people with mild depression. Study tools include PHQ-2, PHQ-9, acceptability of intervention measure, and Eq. 5D5L instrument. Change in the detection rates of depression between intervention and control arms will be the primary outcome. Cost effectiveness analysis will be done. DISCUSSION: This trial advocates for integrating mental health services into primary healthcare, which aligns with the Comprehensive Mental Health action plan that seeks to enhance the capacity of non-specialist HWs in mental healthcare delivery. Co-development with the district mental health program, features of app such as offline functionality, multimedia visuals, and follow-up tracking are some of the strengths. If this intervention is found effective, then it could significantly impact the treatment gap for depression by integrating mental health within the ambit of primary care model across India. TRIAL REGISTRATION: Prospectively registered with the Clinical Trials Registry of India on 23/04/2024 (Reference number- CTRI/2024/04/066142).
Multivariate decomposition analysis of factors influencing successful quitting of smoking in global adult tobacco survey of India, waves one and two.
Mathur MR, Arora M, Rawal T … +2 more , Bassi S, Golkari A
BMC Public Health · 2026 Jul · PMID 42393636 · Full text
BACKGROUND: Understanding the factors that support sustained smoking cessation is essential for evaluating the effectiveness of tobacco control measures and improving quit outcomes at the population level. This study inv...
BACKGROUND: Understanding the factors that support sustained smoking cessation is essential for evaluating the effectiveness of tobacco control measures and improving quit outcomes at the population level. This study investigates successful quitting smoking (SQS), defined as abstinence for at least six months, using two waves of the Global Adult Tobacco Survey (GATS), and explores the factors associated with and contributing to changes in SQS over time. METHODS: We conducted a secondary analysis of GATS India Wave 1 (2009-2010) and Wave 2 (2016-2017). Adults who smoked either currently or in the past 12 months were included, and SQS was assessed among those who reported quitting and remaining abstinent for six months or more. Chi-squares and z-tests were used to examine the difference in characteristics of included participants between two waves and the change in prevalence of SQS among them. Multivariate logistic regression was used to examine associations between SQS and explanatory or tobacco control-related factors within each wave. Multivariate decomposition analysis was conducted to quantify the contribution of each factor to the change in SQS between waves. RESULTS: While the prevalence of smoking decreased significantly from 17.18% in Wave 1 to 13.18% in Wave 2, the prevalence of SQS remained unchanged at 0.70%. Higher education and the presence of indoor smoking restrictions at home were consistently associated with greater odds of SQS. Receiving cessation support other than physician advice was associated with higher SQS in Wave 2. However, no significant change in SQS was observed among individuals who received advice from healthcare professionals. The decomposition analysis revealed no statistically significant contribution of individual factors to the overall change in SQS, although smoke-free home rules showed a high positive contribution within the sample. CONCLUSION: The findings suggest that while India has made strong policy gains in reducing smoking, these have not translated into improvements in sustained quitting. Strengthening evidence-based cessation support, particularly beyond routine provider advice, and leveraging digital platforms and household-level interventions could be key to improving SQS rates. Continued monitoring and targeted policies are essential to ensure quit attempts result in lasting success.
Implementation, coverage and impact of a programmatic mass drug administration campaign for malaria in southern Mozambique.
Tusell M, Fuente-Soro L, Nhacolo A … +19 more , Martí-Soler H, Vecchio J, Nhangave A, Bapu K, Amone F, Riley C, Chivite O, Catorze N, Novele V, Simone W, Chiposse I, Moiane A, Gomo A, Chissico O, Dimene M, Sibindy S, Candrinho B, Aide P, Guinovart C
BMC Public Health · 2026 Jul · PMID 42393634 · Full text
BACKGROUND: Between 2022 and 2023, the Mozambican National Malaria Control Programme developed a locally-tailored implementation strategy for programmatic mass drug administration (pMDA), which was piloted in Chidenguele...
BACKGROUND: Between 2022 and 2023, the Mozambican National Malaria Control Programme developed a locally-tailored implementation strategy for programmatic mass drug administration (pMDA), which was piloted in Chidenguele (Manjacaze District), southern Mozambique. Two rounds of door-to-door pMDA with dihydroartemisinin-piperaquine were conducted, targeting 59,271 individuals in 14,818 households, according to administrative data. Satellite imagery was used to support household enumeration and field navigation. METHODS: An evaluation of the pMDA was conducted. Coverage was assessed using programmatic data and a community household survey (n = 770 individuals). A quasi-experimental design, using neighboring areas not receiving pMDA as a comparison group, was used to evaluate the impact of the pMDA on clinical malaria incidence during the ensuing 22 months through a controlled interrupted time-series analysis of routine surveillance data, adjusting for covariates. RESULTS: According to programmatic data, household availability coverage (households reached/target households) increased from 59.4% (8,796/14,818) in the first round to 94.3% (13,972/14,818) in the second, following optimization of the implementation strategy. Programmatic or contact coverage (individuals treated/target population) increased from 41.2% (24,437/59,271) to 69.7% (41,320/59,271). In the second round, 8% of the target population was not reached, 8.7% were absent during visits, 6.9% were ineligible, and 6.7% refused participation. The household survey showed similar coverages and estimated that 81.6% of respondents (628/770, 95% CI 78.6-84.2) were treated in at least one of the rounds. We found weak evidence of a larger decrease in malaria incidence immediately following the pMDA implementation in the pMDA group versus the comparison group (level change incidence risk ratio [IRR] = 0.66, p = 0.074), and no evidence of a difference in the malaria trend over time between the two groups (trend change IRR = 0.96, p = 0.104). CONCLUSIONS: Although more than 90% of target households and individuals were reached in the second round, achieving the recommended 80% programmatic coverage remained challenging. This target was reached only when considering participation in either of the two rounds, highlighting the importance of conducting multiple rounds. High coverage requires strong community engagement, household revisits and/or fixed points, and substantial human and logistical resources. Using satellite imagery and triangulating with census data allowed us to estimate denominators, though challenges remain in this process. We found weak evidence of an impact on malaria incidence immediately following the pMDA and no evidence of a difference in the incidence trend over time. Overall, pMDA can be implemented under programmatic conditions, but is resource-intensive and should be reserved for specific contexts alongside other core malaria interventions.
Mapping the landscape of mathematical models for antimicrobial resistance: a scoping review.
Schardong F, Struchiner CJ, Carvalho LM
BMC Public Health · 2026 Jul · PMID 42393630 · Full text
BACKGROUND: Antimicrobial resistance (AMR) is a serious global public health problem, that contributed to an estimated 4.95 million deaths in 2019 and with approximately 10 million annual deaths and up to US$100 trillion...
BACKGROUND: Antimicrobial resistance (AMR) is a serious global public health problem, that contributed to an estimated 4.95 million deaths in 2019 and with approximately 10 million annual deaths and up to US$100 trillion in cumulative economic losses projected by 2050. Its emergence and spread result from complex interactions between biological, ecological, and socioeconomic factors. Mathematical modelling has been recognized as a crucial tool for clarifying the dynamics of AMR emergence and transmission. However, the dominant literature is fragmented and characterized by notable methodological and contextual limitations. This scoping review aims to synthesize and analyse recent mathematical modelling studies on AMR to identify prevalent trends, methodological biases, and key research gaps. METHODS: We conducted a scoping review following the PRISMA-ScR statement. We systematically searched three databases (PubMed, Web of Science, and Scopus) from 2019 - 2024 for published papers that created or used dynamic mathematical models of AMR. After removing duplicates and screening, 36 studies were considered eligible for inclusion. Data were extracted via a structured form that was divided into three categories: model type and context, model construction and correlated parameters, and model outputs and validation. In each category, the information considered most relevant for further analysis was extracted. RESULTS: Our analysis demonstrated a predominance of deterministic models using ordinary differential equations (ODEs), which were mostly focused on bacterial pathogens such as Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus. The vast majority of models focused on the human host, with only one study adopting a One Health approach. The most commonly modelled resistance mechanisms are horizontal transfer by conjugation and mutation, and the rarely modelled mechanisms include transduction, transformation, host immunity, and spatial heterogeneity. Furthermore, only two have considered economic impact. There was apparent consistency in geographic inequality, with the vast majority of studies originating from high-income countries. CONCLUSION: Mathematical modelling of AMR is an active field, but is characterized marked by low methodological diversity and is limited in scope to a few contexts. Given these limitations, there is a need to develop mathematical models of AMR that are capable of capturing the complex dynamics among hosts, environments, transmission, and intervention dynamics. The use of deterministic models based on ODEs contributes significantly to advancements in the study of AMR dynamics, but future work requires the integration of stochasticity, spatial structure, and ecological interactions to more realistically represent the complexity of the real world. Furthermore, the introduction of a One Health framework and the incorporation of economic and social variables will be essential for the development of models that not only explain the observed patterns but also guide effective global strategies to mitigate the impact of AMR.
Cost-effectiveness analysis of implementing a medication monitor and differentiated care approach among people with TB in South Africa.
Mukora R, Pelusa R, Maraba N … +8 more , Orrell C, Jennings L, Naidoo P, Velen K, Fielding KL, Dowdy D, Sweeney S, Charalambous S
BMC Public Health · 2026 Jul · PMID 42393627 · Full text
BACKGROUND: Digital Adherence Technologies (DATs) are being investigated for use in many countries. In this study we evaluated the cost-effectiveness of a technology-enabled Differentiated Care Approach (DCA), where a me...
BACKGROUND: Digital Adherence Technologies (DATs) are being investigated for use in many countries. In this study we evaluated the cost-effectiveness of a technology-enabled Differentiated Care Approach (DCA), where a medication monitor (Wisepill evriMED 1000 device) provided daily reminders and identified missed doses to guide SMS, phone call, and home visit interventions within the TB Monitoring Adherence to Treatment Endpoints (TB MATE) cluster-randomised trial in South Africa. METHODS: We conducted a cost-effectiveness analysis from a societal perspective in one intervention clinic and one standard-of-care (SoC) clinic in each of three selected provinces between June 2019 and August 2020. Health system costs were collected using a bottom-up activity-based costing approach involving time and motion studies. People with Tuberculosis (PWTB) were interviewed on costs related to accessing the intervention. The primary efficacy outcome used in the trial was proportion of patients with ≥ 80% adherence, measured using medication monitor opening as a proxy for adherence. Unit costs were calculated as cost per patient treated for TB while incremental cost-effectiveness ratio (ICER) was calculated as cost per additional adherent PWTB. RESULTS: From a total of 2757 enrolled (62% male, median age 36 years IQR (27-45 years), adherence data was available for 1306 PWTB in the intervention arm and 1278 PWTB in the SoC arm, where effectiveness was 81% and 50.8% in the intervention and SoC arms respectively. The total cost per patient treated for TB was $103.93-$199.87 (intervention) and $44.89 - $131.22 (SoC), resulting in a societal incremental cost of $49.73 (mean). Patient costs were $38.98 - $117.94 (intervention) and $35.92-$91.94 (SoC) per patient with indirect costs (foregone income) contributing to a large proportion of total costs at three intervention (56.7% - 69.8%) and two SoC (69% and 77.4%) clinics. The ICER of achieving an additional adherent PWTB was $166.33. CONCLUSION: Medication monitors and DCA can be considered a cost-effective option for investment and scale-up if we reduce health systems costs.
Short-term effects of ambient air pollutants on neurological hospital admissions: a time-series analysis in a northern Chinese city.
Cao Y, Ma Q, Chen L … +3 more , Liu J, Lang L, Zhang Q
BMC Public Health · 2026 Jul · PMID 42393626 · Full text
BACKGROUND: Air pollution is an important environmental factor influencing respiratory and cardiovascular diseases, and growing experimental evidence suggests that exposure to air pollutants can also cause neuroinflammat...
BACKGROUND: Air pollution is an important environmental factor influencing respiratory and cardiovascular diseases, and growing experimental evidence suggests that exposure to air pollutants can also cause neuroinflammation and neuronal damage. However, epidemiological evidence on the impact of air pollution exposure on neurological disorders remains limited. This study aims to evaluate the impact of short-term air pollution exposure on hospital admissions for neurological disorders. METHODS: A total of 249,717 hospital admissions for neurological disorders in Harbin, China, from 2014 to 2023, were collected in this registry-based cohort study. Distributed lag nonlinear model (DLNM) was used to evaluate the effects of PM, PM, NO, CO, and a composite pollution index on overall neurological disorders, specific ICD disease modules and categories. Stratified analyses by sex, age, pandemic period, and season were further performed to identify high-risk subpopulations and examine variations in susceptibility to air pollution. Attributable risk estimations were further performed to assess the disease burden attributable to air pollution. RESULTS: Exposure to PM (RR = 1.23, 95% CI: 1.14-1.32), NO (RR = 1.18, 95% CI: 1.10-1.27), PM (RR = 1.12, 95% CI: 1.06-1.19), and CO (RR = 1.10, 95% CI: 1.03-1.19) was associated with increased hospital admissions for overall neurological disorders. These associations were stronger in the cold season than in the warm season. Attributable risk analysis suggested that PM contributed the largest burden, accounting for 8.46% (95% CI: 5.46%-10.76%) of admissions. Different ICD disease modules and categories exhibited varying associations with different air pollutants. CONCLUSIONS: Short-term exposure to air pollution increases the risk of hospital admissions for neurological disorders, particularly during the cold season, with PM contributing the largest disease burden.
Posttraumatic stress in German volunteer lifeguards: evidence for the building block effect.
Stucke KM, Nehler KJ, Schultze M
BMC Public Health · 2026 Jul · PMID 42393622 · Full text
BACKGROUND: Emergency responders are regularly exposed to potentially traumatic events, placing them at risk of developing posttraumatic stress symptoms (PTSS). Within this group, lifeguards remain an understudied popula...
BACKGROUND: Emergency responders are regularly exposed to potentially traumatic events, placing them at risk of developing posttraumatic stress symptoms (PTSS). Within this group, lifeguards remain an understudied population. The present study examined the building block effect in volunteer emergency responders of the German Lifesaving Association (DLRG), hypothesizing that a higher number of stressful events would be associated with greater PTSS. In addition, potential influencing factors on symptom severity and on the relationship between event exposure and PTSS, including gender, age, perceived social support, and peer support measures, were investigated. METHOD: Data were collected via a web-based self-report survey, resulting in a final analysis sample of 365 lifeguards from the DLRG. Participants were nested within 198 local subgroups. Generalized linear mixed models were constructed, with predictors entered in a stepwise manner. RESULTS: The findings support the building block effect of stressful experiences, indicating that greater exposure is associated with higher PTSS among lifeguards in Germany. Hypothesis testing further revealed protective effects of higher age, male gender, greater perceived social support, and stronger peer support measures in reducing symptom severity. Interaction effects of these protective factors on the relationship between the number of traumatic events and PTSS were non-significant. Exploratory analyses also suggested that higher rank within the organization may be associated with lower symptom severity. CONCLUSION: The study highlights the importance of addressing mental health challenges among volunteer lifeguards, acknowledging that PTSS do not necessarily stem from a single worst traumatic event but can develop cumulatively. The findings also indicate target groups for additional training efforts, particularly younger women, and underscore the value of fostering support networks.
Ambient air pollution and risk of respiratory tract infections in low- and middle-income countries: a systematic review and meta-analysis.
Bbuye M, Kasasa S, Nampogo AM … +9 more , Muttamba W, Muyanja SZ, Sekalala S, Kirenga BJ, Okoboi S, Sabiiti W, Atuyambe LM, Buregyeya E, Uthman OA
BMC Public Health · 2026 Jul · PMID 42393621 · Full text
BACKGROUND: Exposure to ambient air pollution increases the risk of respiratory tract infections (RTIs). This systematic review and meta-analysis quantified the association between ambient air pollution and RTIs in low-...
BACKGROUND: Exposure to ambient air pollution increases the risk of respiratory tract infections (RTIs). This systematic review and meta-analysis quantified the association between ambient air pollution and RTIs in low- and middle-income countries (LMICs). METHODS: We searched Ovid Medline, Embase, and related databases for studies published between January 2000 and December 2024 reporting on ambient air pollution and RTIs in LMICs. Two reviewers independently screened studies, assessed risk of bias using the RoBANS tool, and conducted a random-effects meta-analysis. Studies reporting odds ratios (ORs) were included in a random-effects meta-analysis, and separately for each pollutant-outcome combination for studies reporting multiple pollutants. RESULTS: Of 2,201 records identified, 111 full texts were assessed, 17 studies were included in the systematic review and 7 in the meta-analysis. Exposure to ambient air pollution was associated with increased odds of respiratory tract infections (pooled OR: 1.25, 95% CI: 1.04-1.49), with substantial heterogeneity (I² = 65.2%). Subgroup analyses suggested stronger associations in studies conducted in Africa (OR: 1.94, 95% CI: 1.46-2.58) compared to Asia (OR: 1.16, 95% CI: 0.92-1.45), and for pneumonia (OR: 1.74, 95% CI: 1.38-2.18) compared to other respiratory tract infections; though based on few studies. Among pollutants, PM2.5 showed the most consistent association with respiratory tract infections (OR: 1.05, 95% CI: 1.03-1.08), while associations for NO₂ and NOx were not statistically significant. Evidence of publication bias was suggested by funnel plot asymmetry. Meta-regression indicated a declining trend in effect estimates over time from 2018 to 2024. CONCLUSION: Ambient air pollution, particularly PM2.5, is significantly associated with increased RTI risk, with stronger effects in African settings and for pneumonia. The association appears to weaken in more recent studies, potentially reflecting changing exposure patterns or research methodological advancements. TRIAL REGISTRATION: PROSPERO Registration: CRD42024586784.
Exposure to air pollutants is associated with adverse changes in hemoglobin trajectories and an increased risk of anemia in children and adolescents.
Zheng K, Zhang F, Chu L … +8 more , Yang Y, Sun L, Huang Y, Qu S, Huang S, Qi W, Yang D, Luo C
BMC Public Health · 2026 Jul · PMID 42393619 · Full text
BACKGROUND: Air pollution is associated with anemia in children, however, longitudinal data supporting this association are insufficient. METHODS: From 2019 to 2023, we conducted a dynamic cohort study involving 33,900 p...
BACKGROUND: Air pollution is associated with anemia in children, however, longitudinal data supporting this association are insufficient. METHODS: From 2019 to 2023, we conducted a dynamic cohort study involving 33,900 participants from 119 primary and secondary schools across 16 districts in Shanghai. We obtained the daily average concentrations of five air pollutants (PM, O₃, NO₂, SO₂, and CO) based on school addresses using the China High Air Pollutants (CHAP) dataset to assess the exposure levels of the study subjects. We used latent class mixed models to determine the longitudinal trajectories of hemoglobin (Hb) and multinomial logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between trajectory categories. Linear and logistic regression models were used to evaluate the associations between air pollutant exposure level and Hb and anemia risk, respectively, and Cox regression models was used for longitudinal validation. Interaction terms for gender, age, and body mass index (BMI) were used to explore the modifying effects of these factors. RESULTS: At the baseline survey, 3,213 students (9.48%) were identified as anemic, with a higher proportion of girls (63.8%). During an average follow-up period of 3.16 years, 1,685 participants (4.9%) were observed to develop anemia. Children's hemoglobin levels showed three different trajectory patterns throughout the study period. Exposure to PM [OR (95% CI) = 2.124(1.853, 2.433)] was associated with adverse trajectory changes characterized by "low hemoglobin". Longitudinal analysis shows that exposure to PM [HR = 1.213, 95% CI: (1.068, 1.376)], NO [HR = 1.409, 95% CI: (1.254, 1.584)], and SO [HR = 1.268, 95% CI: (1.172, 1.372)] is associated with an increased risk of anemia. Stratified analysis showed that the adverse effects of PM exposure on anemia were more pronounced in younger or underweight children. The adverse effects of NO exposure on anemia were more significant in older or obese children. The association between SO exposure and the impact on anemia mainly appeared in male or younger children. CONCLUSIONS: Long-term exposure to air pollutants is associated with an increased burden of anemia in children and adolescents, and attention should be focused on vulnerable groups such as girls and underweight children.
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