Public Health [JOURNAL]
Sun
200 papers
Prevalence and severity of premenstrual tension syndrome and its impact on academic performance among female university students in Bangladesh: a cross-sectional study.
Lemon MMH, Ahmed S, Khatun MK … +1 more , Rana MS
BMC Public Health · 2026 Jul · PMID 42387460 · Full text
BACKGROUND: Premenstrual tension (PMT) syndrome is an important condition that affects women's psychological, physical, and behavioral well-being, as well as their academic performance. This study investigates the associ...
BACKGROUND: Premenstrual tension (PMT) syndrome is an important condition that affects women's psychological, physical, and behavioral well-being, as well as their academic performance. This study investigates the association between premenstrual tension (PMT) symptom severity and academic performance among female university students. METHODS: A cross-sectional study was conducted over an 8-month from January to August 2025 among 273 female students of Islamic University, Bangladesh. A reliable, self-administered, bilingual questionnaire was developed based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5) criteria to collect the primary data. It was used to assess the prevalence and severity of psychological, behavioral, and physical symptoms as well as their impact on academic performance. Data were analyzed using SPSS (version 25.0) and Python (Pandas, NumPy, SciPy, and Matplotlib). The Chi-square test was used to examine the association between PMT and academic outcomes. RESULTS: A total of 273 participants were selected from 976 eligible female students. The age of the participants ranged from 17 to ≥ 25 years, with a median age category of 23-24 years. The prevalence of premenstrual tension (PMT) symptoms was 65.2%, while 8.1% of participants met the criteria for premenstrual dysphoric disorder (PMDD). Severe mood swings (39.6%) and irritability (37.0%) were identified as the most frequently reported symptoms. A statistically significant association was observed between PMT and academic performance indicators, including difficulty concentrating in class (69.6%, p = 0.013), negative impact on examination performance (64.4%, p = 0.012), and difficulty participating in extracurricular activities (60.0%, p = 0.009). Overall, 54.9% of the female university students reported that their academic performance was negatively affected by premenstrual symptoms. CONCLUSION: Our study revealed a high prevalence of premenstrual tension (PMT) and premenstrual dysphoric disorder (PMDD) among female university students, with severe psychological symptoms such as mood swings and irritability negatively affecting concentration, examination performance, and participation in extracurricular activities. The findings underscore the importance of raising awareness, implementing targeted mental health support, and providing appropriate interventions to improve academic performance and overall well-being.
Association of musculoskeletal pain with incidence and recurrence of cardiovascular disease: a longitudinal cohort in China.
Chen Y, Sun S, Guo H … +5 more , Yan L, Peng C, Deng Y, Cai Y, Zhu M
BMC Public Health · 2026 Jul · PMID 42387455 · Full text
BACKGROUND: Globally, cardiovascular disease remains the leading cause of death and disability. Musculoskeletal pain, affecting nearly 30% of the global population, is increasingly recognized as a potential contributor t...
BACKGROUND: Globally, cardiovascular disease remains the leading cause of death and disability. Musculoskeletal pain, affecting nearly 30% of the global population, is increasingly recognized as a potential contributor to cardiovascular disease (CVD). However, its links to CVD persistence and recurrence in low- and middle-income regions remain unstudied. This study examines the association of musculoskeletal pain with both incident and recurrent CVD in a prospective cohort. METHODS: A prospective cohort analysis was performed using a nationally representative dataset of middle-aged and older population in China during 2011-2020. In the final analysis, 8,716 participants were evaluated for incident CVD, and 1,151 were examined for recurrent CVD events. The associations between musculoskeletal pain and both incident and recurrent CVD were examined using Cox proportional hazards regression and restricted cubic spline models. RESULTS: Participants with musculoskeletal pain showed a significantly higher CVD incidence rate than pain-free individuals throughout follow-up (3.45 vs. 2.43 per 100 person-years). Individuals with musculoskeletal pain had a 54% increased risk of recurrence (HR = 1.54, 95% CI: 1.28-1.85). Participants with multisite pain demonstrated progressively greater CVD risks, with significant trend for both incident and recurrent events (P trend < 0.001). All pain dynamics (generated, disappeared, intermittent, continuous) were significantly associated with both incident and recurrent CVD. CONCLUSIONS: Musculoskeletal pain is independently associated with both incident and recurrent CVD; prolonged pain duration and an increasing number of pain sites further amplify these risks.
Cross-border food reformulation: changes in nutrient content in Uruguay following the implementation of front-of-package policies in neighbouring countries.
Ares G, Alcaire F, Allegue G … +4 more , Antúnez L, Gitz E, Rincon Gallardo S, Natero V
BMC Public Health · 2026 Jul · PMID 42387448 · Full text
BACKGROUND: Food reformulation is frequently discussed as a potential strategy to address obesity and diet-related non-communicable diseases. However, evidence regarding its effectiveness and broader implications within...
BACKGROUND: Food reformulation is frequently discussed as a potential strategy to address obesity and diet-related non-communicable diseases. However, evidence regarding its effectiveness and broader implications within globalised food systems remains limited. This study examined changes in the nutrient content of packaged foods commercialised in Uruguay between 2021 and 2025, a period characterised by limited domestic regulatory action but during which front-of-package (FOP) warning label policies were implemented in Argentina and Brazil, Uruguay's main trading partners. METHODS: Nutrient information was obtained through systematic in-store data collection and compiled into an online database. Linear mixed-effects models were used to estimate changes in nutrient content, accounting for repeated product-level observations and testing interactions between year and country of origin. RESULTS: At the aggregate level, modest but statistically significant reductions were observed in total fat, saturated fat, and sodium, alongside a small increase in fibre content. However, significant interactions between year and country of origin revealed substantial heterogeneity in reformulation patterns. Products imported from Argentina showed the most pronounced reformulation, with significant reductions in total fat, saturated fat, and sodium, and increases in fibre content. In contrast, domestically produced products in Uruguay exhibited limited reformulation, with statistically significant changes observed only for saturated fat and of smaller magnitude. Products from Brazil and other countries showed minimal changes, with statistically significant increases limited to fibre content. Category-level analyses further indicated that reformulation effects were uneven across the packaged food supply. CONCLUSIONS: These findings are consistent with the possibility that the implementation of FOP warning labels in Argentina was associated with reformulation with spillover effects into the Uruguayan market. Differences in policy design, particularly the stringency of the underlying nutrient profile model, may help explain the divergent industry responses. The limited changes observed among domestic products in the period highlight the need for complementary policy instruments to promote more substantial reformulation.
Changes in household food purchases in Iran: income and urban-rural inequality.
Jafarvand E, kianiRad A, Pouraram H
BMC Public Health · 2026 Jul · PMID 42387445 · Full text
BACKGROUND: Regular monitoring of nutritional indicators serves as an early warning system for policymakers and is essential for the effective governance of food security. This study presents the first 18-year trend anal...
BACKGROUND: Regular monitoring of nutritional indicators serves as an early warning system for policymakers and is essential for the effective governance of food security. This study presents the first 18-year trend analysis of changes in Iranian household food purchases, with a specific focus on inequalities across income deciles and between urban and rural areas in Iran. METHODS: Data from the Statistical Center of Iran (2005-2022) were analyzed. Six major food groups, calories, and macronutrients derived from household purchases were examined. Linear regression, with year as a continuous predictor, was performed using SPSS (p < 0.05 considered significant). Data processing and figure generation were conducted using Microsoft Access 2016 and Excel 2016, respectively. RESULTS: Over the 18-year study period, per capita purchases of all major food groups declined in both urban and rural areas. Urban-rural disparities in household food purchases, as well as the associated estimated calorie and macronutrient quantities, narrowed. Furthermore, although higher-income households consistently purchased more of most food groups (except cereals) than lower-income households, these income-based inequalities also diminished over time. CONCLUSION: Although nutritional inequalities in Iran have decreased in recent years, the simultaneous decline in overall household food purchases calls for more rigorous research on the subject. Analyzing long-term trends in household food purchase-based nutritional indicators is a critical scientific and policy priority for evaluating programs and designing evidence-based policies.
Type 2 diabetes prevention programs at the community and municipal level: a scoping review of controlled intervention studies.
Michels D, Walter C, Grathwohl-Karl A … +4 more , Pfau J, Haumann H, Joos S, Fröhlich D
BMC Public Health · 2026 Jul · PMID 42387346 · Full text
BACKGROUND: Type 2 diabetes mellitus poses a major challenge to public health globally due to its rising prevalence and high proportion of patients who are undiagnosed, untreated and/or uncontrolled. Lifestyle interventi...
BACKGROUND: Type 2 diabetes mellitus poses a major challenge to public health globally due to its rising prevalence and high proportion of patients who are undiagnosed, untreated and/or uncontrolled. Lifestyle interventions targeting nutrition, physical activity, and further health-related behaviors such as weight and stress management can prevent the onset of type 2 diabetes mellitus or delay progression from prediabetes to manifest disease. Although lifestyle interventions are widely used in clinical trials and national programs, there is limited evidence on how such interventions are designed, adapted, and reported in community, municipal, and public health settings. METHODS: A scoping review was conducted using the Population Concept Context framework. Systematic searches were performed in PubMed, Web of Science Core Collection, CINAHL, and CENTRAL. The CDSR was used for citation tracking to identify relevant primary studies. Additional searches included grey literature, organizational websites, and an AI-assisted search (undermind.ai). Searches covered studies published in English or German between January 2014 and May 2025 and were conducted on 28 May 2025. Eligible studies examined lifestyle-based interventions targeting physical activity, nutrition, or broader behavioral change among healthy adults and adults at increased risk of developing type 2 diabetes, including individuals with prediabetes or metabolic syndrome, delivered in community, municipal, or public health settings. Inclusion was restricted to controlled study designs ((cluster-)randomized controlled trials, non-randomized controlled studies, or controlled clinical trials). Feasibility studies, pilot studies, uncontrolled implementation studies, and process evaluations were excluded. Pharmacological interventions were not considered. Data were charted and synthesized descriptively. RESULTS: Of 464 records identified, 26 studies were included. Interventions were largely adapted from established prevention programs and delivered through group-based education, with limited reporting of theoretical frameworks. Definitions and operationalization of "community-based" delivery varied across studies, and intervention duration and maintenance components were heterogeneous. The evidence base was dominated by studies conducted in high-income countries, with limited representation from lower-resource settings. CONCLUSIONS: This scoping review highlights the need for greater representation of studies from lower-resource settings and theoretically grounded and methodologically rigorous prevention approaches in the community setting. The potential of community-based initiatives offers valuable guidance for further development and scaling future diabetes prevention efforts. TRIAL REGISTRATION: Open Science Framework (osf.io/zafg5).
Evaluation of the quality and reliability of infertility information on Chinese social media platforms Bilibili and TikTok : a cross-sectional study.
Zhang J, He J, Wei Q … +1 more , Rao M
BMC Public Health · 2026 Jul · PMID 42387332 · Full text
BACKGROUND: Infertility has become a major global health issue, affecting approximately one in six couples worldwide; this problem is particularly pronounced in China. With the advent of the digital age, an increasing nu...
BACKGROUND: Infertility has become a major global health issue, affecting approximately one in six couples worldwide; this problem is particularly pronounced in China. With the advent of the digital age, an increasing number of people struggling with infertility are turning to social media platforms for health information. However, the quality and reliability of such video content remain unclear. Therefore, this study aims to assess the overall quality and reliability of infertility-related information on mainstream social media platforms in China. METHOD: This study used the Chinese term "Infertility" as a search term to retrieve the top 100 videos on Bilibili and TikTok. Video quality was assessed using the DISCERN tool and the Global Quality Scale (GQS), and statistical analysis was conducted to explore the relationships among various variables. RESULTS: This study ultimately included 163 videos in the analysis, comprising 72 videos from Bilibili and 91 from TikTok. The results showed that the average daily engagement metrics on Bilibili were significantly higher than those on TikTok (P < 0.05). The proportion of medical personnel on the TikTok platform was as high as 90.1%, significantly higher than the 27.8% on Bilibili (P < 0.001). Videos on the TikTok platform were more concentrated in the medium-quality category, while the Bilibili platform had a higher proportion of low-quality videos (GQS low quality: 41.7% vs. 21.1%, adjusted P = 0.024). Multivariate regression analysis showed that the DISCERN score was significantly positively correlated with the number of shares (β = 0.045, 95% CI: 0.002-0.088, P = 0.040). Both the number of likes and the number of comments were negatively correlated with video duration (β = -0.001, P = 0.040; β = -0.001, P = 0.022). CONCLUSION: The overall quality of videos on infertility-related topics on TikTok needs improvement. Bilibili has a significant gap in this content, suggesting that high-quality content creators-such as medical professionals-should not limit their science communication efforts to a single platform. Creators of science communication videos may consider adopting narrative techniques or focusing on specific topics for in-depth explanations to enhance the accessibility of their content.
Using Ripple Effects Mapping to translate an innovative service model for children with disabilities in Lusaka, Zambia.
Hearst MO, Lunda E, Mwandileya W … +1 more , Rabaey P
Public Health · 2026 Jul · PMID 42385292 · Publisher ↗
OBJECTIVES: Describe the use and output from Ripple Effects Mapping, a participatory process to evaluate the impact of a program to decrease stigma toward children with disabilities (CWD) living with families in low-inco...
OBJECTIVES: Describe the use and output from Ripple Effects Mapping, a participatory process to evaluate the impact of a program to decrease stigma toward children with disabilities (CWD) living with families in low-income compounds in Zambia. STUDY DESIGN: Participatory, group-based process that occurs at one time with retrospective reflection. METHODS: In Dec. 2024, health facility staff, community partner staff, community outreach workers, women with CWD, and a pastor participated in Ripple Effects Mapping in Lusaka, Zambia. Participants interviewed each other using four open-ended questions, such as "Share a story or highlight a success that you had based on your involvement with Kusamala+. What did this lead to? How did it happen?" Real-time mind mapping was done while participants shared their interviews and additional written notes were added. Inductive analysis created preliminary themes that were validated by the participants. Using the Social Model of Disability and deductive analysis, the mind-maps were quantified across domains. RESULTS: Briefly, 50% of the participant responses indicated improved access to education, 30% of the responses were related to decreased social isolation, 48% of responses indicated more services were available, and 19% indicated that there were improved policies and practices at the institutional level. The Ripple Effects Mind Map and the application to the Social Model of Disability revealed strong positive impacts due to Kusamala+. CONCLUSIONS: Kusamala + had substantial positive impacts in the community and for families. Ripple Effects Mapping is an effective and adaptable tool to evaluate program impacts.
Phenotyping population-level chronic condition prevalence: The importance of forcing factors from the ecological framework.
Wang S, Arena R, Woodard C … +1 more , Pronk NP
Public Health · 2026 Jul · PMID 42385291 · Publisher ↗
OBJECTIVE: The primary health challenges currently facing the United States (U.S.) and many other countries around the world are largely due to patients with chronic conditions, which act either independently or synergis...
OBJECTIVE: The primary health challenges currently facing the United States (U.S.) and many other countries around the world are largely due to patients with chronic conditions, which act either independently or synergistically. The current study assesses the ability of the Ecological Framework of Population Health to predict U.S. county-level prevalences of eight common chronic conditions. STUDY DESIGN: Analytic analysis of population-level surveillance data METHODS: This study utilizes several U.S. county-level datasets representing over 30 predictive variables of the ecological framework, a model that includes measures of culture, politics, policy, socioeconomics, lifestyle behaviors, and both chronic condition risk factors and diagnoses. A non-linear artificial intelligence statistical approach was used to assess the ability of these variables (i.e., features) to predict the prevalence of eight leading chronic conditions at the U.S. county-level. RESULTS: Artificial intelligence models demonstrated good to excellent performances in the independent test set (0.73 < R < 0.96) in predicting U.S. county-level prevalence of chronic conditions. Findings indicate that upstream domains (culture, politics, policy and environment) explain substantial variance in the prevalence of chronic conditions before downstream domains (behavior and risk) are introduced. CONCLUSIONS: Despite a significant amount of attention given to the health challenges associated with chronic conditions, little progress has been made in reversing trends. The findings presented here propose a new approach to this complex issue that focuses on the forcing factors that lie upstream from health behaviors to improve downstream health outcomes.
Multifactorial predictive model for nurses' intention to correct online health misinformation: A machine-learning and SHAP analysis.
Duan P, Liu Z, Chen S … +5 more , Liang W, Hou P, Qian L, Wang W, Liu Y
Public Health · 2026 Jul · PMID 42385290 · Publisher ↗
OBJECTIVES: To develop and interpret a predictive model that detects key factors associated with nurses' intention to rectify online health misinformation, and to offer an evidence foundation for targeted interventions t...
OBJECTIVES: To develop and interpret a predictive model that detects key factors associated with nurses' intention to rectify online health misinformation, and to offer an evidence foundation for targeted interventions that strengthen frontline responses to misinformation. STUDY DESIGN: A nationwide cross-sectional survey that incorporated machine-learning modelling and explainable artificial intelligence. METHODS: Convenience sampling was used to conduct this cross-sectional online survey among registered nurses employed in Chinese healthcare facilities between May and June 2025. A dichotomous item was used to measure the intention to rectify online health misinformation. Thirty-nine predictors were collected, including sociodemographic traits, psychological constructs, health information attitudes, eHealth literacy, and work environment factors. Stratified data splitting, the Synthetic Minority Over-sampling Technique, and grid-search-based hyperparameter tuning were used to train seven machine-learning algorithms (i.e., logistic regression, random forest, AdaBoost, CatBoost, ExtraTrees, XGBoost, and LightGBM). Accuracy, recall, precision, F1 score, and the area under the receiver operating characteristic curve (AUC) were used to assess the model's discrimination ability. The best-performing model was interpreted with SHapley Additive exPlanations (SHAP). Structural equation modelling (SEM) was subsequently conducted to test theoretically hypothesized relationships among the key predictors identified by SHAP, providing theory-driven validation of the findings. RESULTS: Data analyses from 1120 nurses suggested that 80.2% of them intended to actively rectify online health misinformation. On the test set, the ExtraTrees model performed the best (AUC = 0.919; accuracy = 0.827). The model demonstrated a balance between sensitivity (recall = 0.827) and precision (0.791), indicating reasonable performance despite class imbalance. SHAP analysis identified perception of information-related harm, working in general wards, education level, perceived information trustworthiness, years of clinical experience, and eHealth literacy skills as the most influential predictors. These variables clustered into three overarching domains, namely risk perception, professional competence, and clinical practice context. Higher values of these features were consistently associated with positive SHAP values, indicating an increased likelihood of correction intention. Notably, perception of information harm exhibited a clear monotonic positive relationship with the outcome. Visual inspection of SHAP dependence plots suggested that interaction effects among key predictors were limited, with most variables demonstrating consistent monotonic relationships with the outcome. Structural equation modelling further supported these findings, showing that capability factors (eHealth literacy) exerted a strong positive effect on psychological factors (risk perception and information attitudes) (β = 0.761, p < 0.001), a direct effect on intention (β = 0.336, p < 0.001), and an indirect effect mediated by psychological factors (β = 0.124, 95% CI [0.065, 0.188]), accounting for 27.0% of the total effect. The model explained 22.4% of the variance in intention (R = 0.224) with acceptable fit (SRMR = 0.056). CONCLUSIONS: This study provides novel machine-learning-based and explainable evidence on the determinants of nurses' intention to correct online health misinformation, offering a comprehensive framework that integrates predictive modelling and theory-driven analysis. The ability of nurses to recognise harm caused by misinformation, critically appraise data, and mobilise digital health competencies within supportive practice settings influences their intention to rectify online health information. Enhancing eHealth literacy and risk communication skills may increase frontline capacity to reduce the negative effects of misinformation on public health, particularly in high-interaction ward settings.
The effect of boarding on students' noncognitive skills: evidence from rural education in Northwest China.
Tang B, Xiao S, Lin X … +4 more , Cheng Z, Qin Y, Shi Y, Chang F
BMC Public Health · 2026 Jun · PMID 42381010 · Full text
BACKGROUND: A significant proliferation of boarding schools and boarding students has been observed in rural areas of China due to the challenges associated with "school consolidation" policies and parental migration fro...
BACKGROUND: A significant proliferation of boarding schools and boarding students has been observed in rural areas of China due to the challenges associated with "school consolidation" policies and parental migration from rural to urban areas for employment purposes. Hence, boarding has emerged as a prominent characteristic within the present-day rural student community. However, there remains a lack of consensus regarding the impact of boarding on noncognitive development among rural students. This study investigates the impact of boarding on students' noncognitive development using a two-period panel dataset collected during the research conducted on rural elementary schools in 2019 and 2020. METHODS: Using a two-period panel dataset comprising 10,923 students from 195 rural elementary schools in 21 counties, we employ both the propensity score matching method and instrumental variable approach to establish a causal relationship between boarding arrangements and students' noncognitive development. RESULTS: This study finds that boarding has detrimental effects on students' noncognitive skills, negatively impacting certain aspects such as openness and grit, and affinity for schools. The study also reveals that the impact of boarding varies across different student subgroups, with girls, younger students, those from affluent families, and students with more educated mothers benefiting more from the boarding experience. The study also examines pathways through which boarding influences students' noncognitive development. CONCLUSIONS: This paper proposes the following policy recommendations: (1) At the familial level, parents should allocate additional time and effort towards nurturing their children's emotional well-being and academic performance. (2) Schools ought to incorporate curriculum training programs aimed at enhancing students' noncognitive skills, including self-care, resilience, and interpersonal abilities. (3) The government should ensure the cultivation of students' non-cognitive skills by implementing policies, allocating funds, as well as promoting and raising awareness about the significance of these skills.
Examining inclusive research practices to engage communities: a qualitative inquiry.
Chan SWC, Diaz K, Lin N … +6 more , Chakraborty T, Ali SH, Ðoàn LN, Kwon SC, Hade EM, Yi SS
BMC Public Health · 2026 Jun · PMID 42380985 · Full text
BACKGROUND: Efforts to improve representation of diverse communities in clinical research have progressed, yet suboptimal reach due to lack of language support, mistrust, and cultural misalignment, persist. While researc...
BACKGROUND: Efforts to improve representation of diverse communities in clinical research have progressed, yet suboptimal reach due to lack of language support, mistrust, and cultural misalignment, persist. While research often prioritizes generalizability or recruiting a specific community, a tailored approach is essential to recruit and retain diverse communities. This study aims to illustrate the depth and breadth of existing community-engaged research methods that have been used to increase recruitment and retention of diverse communities. METHODS: Semi-structured interviews were conducted to identify common themes and best practices of inclusive research with 48 principal investigators and their study staff who had successfully engaged with different diverse communities from research institutions in the United States. Data were analyzed using a rapid qualitative analysis approach and organized thematically. FINDINGS: Six key themes related to conducting community-engaged research emerged: research team as community health advocate, community-academic partnership characteristics, best practices for conducting research with diverse communities, incurred financial costs, sustainability of inclusive research efforts, and system-related challenges. Participants emphasized the role of research teams to uplift community voices, build authentic and collaborative partnerships, prioritize cultural practices of the community, and use data to inform policy. Best practices included providing incentives, offering bilingual materials and having bilingual staff, and using multi-pronged recruitment and retention strategies. Financial costs included both tangible costs such as transportation and honoraria, while intangible costs such as time and trust-building were also highlighted. Sustainability required early planning, capacity-building, and continuous fiscal support. Challenges included insufficient institutional support, burnout, and staff turnover, stressing the need for multi-level strategies and solutions integrated into the research environment to support inclusive research practices. CONCLUSIONS: A general research approach that tailors to specific communities' preferences and fosters collaborative partnerships will better enhance representation in research. However, the research environment requires attention to multi-level strategies to minimize challenges to conducting community-engaged research.
Associations of cumulative exposure and two-time-point clustering of the triglyceride-cholesterol-body weight index with incident cardiovascular disease in middle-aged and older Chinese adults: a nationwide cohort study.
Liu J, Fu Q, Zhang D … +8 more , Fu Y, Li S, Zhou L, Lyu Y, Wang P, Ao Q, Sun H, Liang N
BMC Public Health · 2026 Jun · PMID 42380976 · Full text
AIMS: The triglyceride-cholesterol-body weight index (TCBI) has been proposed as a biomarker of the prognosis of stroke. However, the relationship between cumulative exposure and dynamic trajectories of the TCBI (cuTCBI/...
AIMS: The triglyceride-cholesterol-body weight index (TCBI) has been proposed as a biomarker of the prognosis of stroke. However, the relationship between cumulative exposure and dynamic trajectories of the TCBI (cuTCBI/TCBI changes) and the risk of cardiovascular disease (CVD) remains unclear. The aim of this study is to examine the association between cuTCBI/TCBI changes and the risk of CVD. METHODS AND RESULTS: The participants were from the China Health and Retirement Longitudinal Study (CHARLS). Partitioning Around Medoids (PAM) algorithm, Cox regression model, restricted cubic spline (RCS), Kaplan-Meier analysis and subgroup analysis were employed to evaluate the association between cuTCBI/TCBI changes and CVD risk. In model 3, compared to Q1, the risk of CVD increased by 83% for Q4 (HR:1.83, 95%CI: 1.49,2.24) (P for trend < 0.001). RCS analysis revealed a significant nonlinear relationship between cuTCBI and CVD risk. The results of PAM clustering demonstrated that the participants in moderate increase cluster (HR:1.35, 95%CI: 1.17,1.56, P < 0.001) and persistently high level cluster (HR:1.49, 95%CI: 1.22,1.83, P < 0.001) demonstrated a significantly elevated risk of CVD compared with the stable low risk cluster, with a significant trend towards increased risk across clusters (P for trend < 0.001). In the gender-stratified analysis, significant associations were observed in males, whereas the female TCBI change clusters did not reach statistical significance in the fully adjusted model. CONCLUSION: Our research demonstrated a significant association between cuTCBI/TCBI changes and the increased risk of CVD. And the relationship between cuTCBI and CVD risk is nonlinear. The association between TCBI change clusters and outcomes may differ by gender, with statistical significance observed only in males. Our results indicated that regular monitoring of cuTCBI levels and maintaining relatively low levels may be crucial for CVD prevention.
Prevalence and trends of gestational diabetes in a large university hospital in Lebanon before and during the COVID-19 pandemic.
Yazbek N, Bou Absi M, Abi Tayeh G … +2 more , Gannagé-Yared MH, El Ghorayeb N
BMC Public Health · 2026 Jun · PMID 42380925 · Full text
BACKGROUND: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide in parallel with obesity, maternal age, improved screening methods and wider screening coverage. The objective of our study was to...
BACKGROUND: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide in parallel with obesity, maternal age, improved screening methods and wider screening coverage. The objective of our study was to determine the prevalence of GDM in Lebanon and to evaluate its risk factors before and during the COVID-19 pandemic. METHODS: Records of 2595 pregnant women who gave birth at the Hôtel-Dieu de France Hospital in Beirut, were collected retrospectively from 2018 to 2022. GDM was determined by documentation in the maternity fileward. A univariate analysis was performed to assess the factors affecting GDM. The χ² test, Fisher's exact test, independent samples T-test, and ANOVA were used for this purpose. RESULTS: The mean age was 32.03 years (± 4.75). The mean BMI at the beginning of pregnancy was 24.86 kg/m² (± 8.99), and the mean gestational weight gain (GWG) was 12.17 kg (± 5.06). The overall prevalence of GDM was 4.1%, increasing significantly from 2.9% to 6.4% between 2018 and 2022 (p value = 0.007). The peak in 2020 was temporally associated with the onset of the COVID-19 pandemic and the compounding socioeconomic crises. The risk factors associated with GDM included older age (p = 0.003) and obesity (p = 0.004). CONCLUSION: The increasing trend of GDM incidence emphasizes the importance of implementing evidence-based prevention, diagnostic, and treatment strategies.
Global suicide trends across major religions from 2000 to 2021.
Ito A, Mori H, Yano Y … +1 more , Naito T
BMC Public Health · 2026 Jul · PMID 42380917 · Full text
BACKGROUND: Suicide claims over 700,000 lives annually. Religious beliefs may influence suicide risk, yet large-scale, cross-national comparisons remain limited. METHODS: This retrospective, ecological study analyzed age...
BACKGROUND: Suicide claims over 700,000 lives annually. Religious beliefs may influence suicide risk, yet large-scale, cross-national comparisons remain limited. METHODS: This retrospective, ecological study analyzed age-standardized suicide rates of 185 countries over a 22-year period (2000-2021) using World Health Organization (WHO) mortality data. Countries were classified by dominant religion, including Buddhism, Christianity, Hinduism, Islam, and Others, per Pew Research Center data, and by income level (World Bank) and region (WHO). Suicide numbers were estimated by multiplying suicide rates and UN population data. Poisson regression models, controlling for income, region, and year, examined the association between religion and suicide rates. RESULTS: Islam showed the lowest suicide rates across total, male, and female populations. Poisson analysis confirmed significantly lower risk for Muslims (total population RR = 0·37, 95% CI: 0·33-0·42) than Buddhists as a base. Hindu populations, particularly females, exhibited the highest suicide rates (total population RR = 2·02, 95%CI:1·82-2·24), (female population RR = 4·74, 95%CI: 4·26-5·28). Christianity showed high male suicide rates descriptively, but adjusted risk decreased after accounting for region. (total population RR = 0·65, 95%CI: 0·57-0·75). CONCLUSIONS: Our findings indicate a statistical association between a country's dominant religion and its suicide rates. The lower rates observed in Islamic-majority countries might be related to factors such as religious prohibitions and community cohesion, while the high rates among females in Hindu-majority nations could be linked to specific socio-cultural pressures. Given the study's cross-sectional ecological design, these results merely highlight associations and cannot establish causality. Further research is necessary to elucidate the complex mechanisms underlying these observations.
Determinants of female genital mutilation among daughters in Ethiopia: a negative binomial regression approach.
Tsegaye TG, Azeze GA, Kena SS … +1 more , Negash BT
BMC Public Health · 2026 Jun · PMID 42380912 · Full text
BACKGROUND: Female genital mutilation is a major issue that has considerable effect on millions of girls in Africa, including Ethiopia. Despite the state initiatives to eliminate the practice by making it illegal, many m...
BACKGROUND: Female genital mutilation is a major issue that has considerable effect on millions of girls in Africa, including Ethiopia. Despite the state initiatives to eliminate the practice by making it illegal, many mothers continue think that it should be continued for their daughters. Therefore, we aimed determinants of the number undergoing female genital mutilation of daughters in Ethiopia. METHODS: Data for this study were obtained from the 2016 EDHS. The weighted sample included in this study was 3754 adolescent girls and young women aged 15-24 years. Descriptive data were summarized using descriptive statistics and tables. A negative binomial regression model was fitted. The strength of association was assessed using AIR with a 95% confidence interval (CI) and a p-value < 0.05 was reported. The deviance test was used to check the goodness of fit. RESULTS: Of the 3754 women, 1728 (46%) were aged from 25 to 34 years and 2503(66.7%) women were uneducated. Maternal age between 25 and 34 years (AIRR = 0.25, 95% CI: 0.16-0.37), as well as between 35 and 44 years (AIRR = 0.57, 95% CI: 0.44-0.739), living in urban areas (AIRR = 0.343, 95% CI: 0.222-0.532), having no employment (AIRR = 1.4, 95% CI: 1.1,1.6), not listening to the radio at all (AIRR = 2.68, 95% CI: 1.96-3.7) or listen to it less than once per weeks (AIRR = 2.39, 95% CI:2.391.68-3.38), and watching television less than once per week (AIRR = 2.1, 95% CI: 1.24-3.6), along with having one to five household members(AIRR = 0.64, 95% CI: 0.54,0.76), were significant predictors of daughter's FGM. CONCLUSION: In this study, factors that help protect a daughter from female genital mutilation include older maternal age, residing in urban areas, and having a smaller household size. Conversely, maternal unemployment and limited exposure to TV and radio are associated with a higher risk of female genital mutilation. Address these issue, efforts should be made to empower mothers through employment opportunities, and addressing the female genital concerns in targeted media campaigns is crucial.
Predicting abnormal birth weight and identifying associated factors using machine learning in the Hararghe Health and Demographic Surveillance System, Ethiopia.
Abdeta S, Diop O, Cygu S … +14 more , Drame A, Momanyi R, Endalamaw Dejene B, Tadele M, Sintayehu Y, Barasa M, Woldie M, Girma T, Tsegaye R, Kiragga A, Adnew B, Howe R, Dheresa M, Abdisa A
BMC Public Health · 2026 Jun · PMID 42380910 · Full text
BACKGROUND: Birth weight is a reliable indicator of intrauterine growth and an important predictor of neonatal survival, growth, and long-term development. Globally, approximately 15.5% of live births are low birth weigh...
BACKGROUND: Birth weight is a reliable indicator of intrauterine growth and an important predictor of neonatal survival, growth, and long-term development. Globally, approximately 15.5% of live births are low birth weight, and nearly 10% are macrosomic (high birth weight), with a substantial proportion of these cases occurring in sub-Saharan Africa. Birth weights outside the normal range of 2,500-4,000 g are considered abnormal and are associated with increased risks of neonatal and maternal complications. Ethiopia is similarly affected by the growing burden of abnormal birth weight. METHODS: A retrospective cross-sectional study design using secondary HDSS data collected from 2015 to 2022 was employed. This design was considered appropriate because the study aimed to develop machine learning models using routinely collected surveillance data to predict abnormal birth weight and identify associated factors, rather than to establish causal relationships. All singleton births were included, and those with missing birth weight data were excluded. Six machine learning algorithms identified from the literature were built and compared to identify the best-performing model for predicting abnormal birth weight. Prior observational studies and expert opinion were used to select the candidate features for all models. The synthetic minority oversampling technique (SMOTE) was used to manage the imbalance in the dataset. The dataset was split into training (80%, n = 9,242) and testing (20%, n = 2,311) subsets for model development and evaluation. Hyper-parametric tuning was performed using grid search combined with 10-fold cross-validation to optimize model performance and reduce over-fitting. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), accuracy, precision, F1-score, and Kappa. Feature importance analysis was done using Shapley Additive explanation (SHAP) values. RESULTS: The Descriptive analysis of 11,553 singleton births showed that 10.78% of the newborns had high birth weight (HBW) and 9.28% had low birth weight (LBW). The eXtreme Gradient Boosting (XGBoost) model performed best by achieving an AUC of 0.835, an accuracy of 0.72, a precision of 0.67, an F1-score of 0.63, a recall of 0.54, and a kappa of 0.52 for abnormal birth weight prediction. The feature importance analysis showed that the top predictors for the low birth weight (LBW) include maternal educational status, age at first delivery, and antenatal care (ANC) visit, while high birth weight (HBW) was strongly predicted by antenatal care (ANC) visit, maternal literacy status, age at first delivery, and maternal education. CONCLUSION: Machine learning models showed moderate performance in predicting abnormal birth weight using HDSS surveillance data. Maternal educational characteristics, age at first delivery, and ANC utilization were identified as important predictive features. However, the findings should be interpreted cautiously because the model identified predictive associations rather than causal relationships. Further studies incorporating additional maternal clinical and nutritional variables, as well as external validation datasets, are recommended to improve predictive performance and generalizability.
Associations between physical activity and sociodemographic and migration-related correlates among adults with a history of migration in Germany: results of a nationwide cross-sectional survey.
Zhang H, Koschollek C, Hövener C … +2 more , Loss J, Manz K
BMC Public Health · 2026 Jun · PMID 42380899 · Full text
BACKGROUND: Promoting physical activity among the general population as well as among people with a history of migration is a crucial aspect of health promotion. However, we still lack a general understanding of physical...
BACKGROUND: Promoting physical activity among the general population as well as among people with a history of migration is a crucial aspect of health promotion. However, we still lack a general understanding of physical activity levels and their potential correlates among adults with a history of migration living in Germany. METHODS: The GEDA Fokus study, conducted by the Robert Koch Institute from 11/2021 to 05/2022, is a nationwide cross-sectional health interview survey of adults (18-79 years) with Croatian, Italian, Polish, Syrian or Turkish citizenship living throughout Germany (n = 6,038). The Aims of this study were (1) to assess the physical activity levels of adults with selected citizenships in Germany, specifically, adherence to World Health Organization (WHO) recommendations for aerobic activity and muscle strengthening, and in addition, cycling as a means of transport and (2) to identify sociodemographic, migration-related and psychosocial correlates of their physical activity behaviour. RESULTS: Approximately 70% of the participants reported not achieving the WHO recommendations for aerobic physical activity and 75% did not achieve the recommendation for muscle strengthening. The physical activity levels among the participants were associated with a number of sociodemographic, migration-related and psychosocial factors. Multivariable regression analyses showed that men compared to women, adults with higher educational levels, higher subjective social status, better German language proficiency and a higher level of social support were more likely to achieve the WHO recommendations for physical activity. In addition, men compared to women and adults with higher educational levels were more likely to cycle as a means of transport. CONCLUSIONS: Overall, the study found that physical activity levels among adults of Croatian, Italian, Polish, Syrian or Turkish citizenship living in Germany were low in comparison to the general population, and there were significant associations between their physical activity behaviour and a range of sociodemographic, migration-related and psychosocial factors. Further in-depth research is needed, both from a public health and health sociology perspective, to identify barriers to physical activity among people with a history of migration and to derive appropriate measures for intervention planning.
Systematic review of sexual violence against sex workers: implications for mental and sexual health.
Püffel M, Orbay İ, Salo I … +5 more , Berg H, Hasanagic L, Ruiz Burga E, Bernier T, Heinrichs N
BMC Public Health · 2026 Jun · PMID 42380886 · Full text
BACKGROUND: Sex workers worldwide experience different forms of violence and stigma that increase the risk of adverse health outcomes. It is assumed that a discriminatory, criminalizing context as well as intersectional...
BACKGROUND: Sex workers worldwide experience different forms of violence and stigma that increase the risk of adverse health outcomes. It is assumed that a discriminatory, criminalizing context as well as intersectional stigma increases the risk of sexual violence for sex workers. We aim to answer the following questions: (1) What types of sexual violence do sex workers experience and (2) how frequently do they encounter it? (3) To what extent are these types of sexual violence associated with mental and sexual health conditions? (4) Are these associations moderated by legislative models? METHODS: In a preregistered systematic review (PROSPERO: CRD42024503922), scientific databases, references from meta-analyses, and publications from sex work organizations were searched. A total k = 207 quantitative and qualitative studies (N = 157,991) published since 2013 were summarized meta-analytically and narratively. RESULTS: Sex workers experience sexual violence across various contexts, with quantitative records identifying rape as the most prevalent form. Qualitative findings document varied forms of sexual violence including non-penetrative acts, sexual harassment, technology-facilitated sexual violence, and sexual neglect. The lifetime prevalence of sexual violence is 26.3% (95% Confidence Interval [CI] 22.0-31.0). Mental health conditions (depressive, post-traumatic stress symptoms, and suicidality) were associated with sexual violence: OR [95% CI] = 1.85 [1.58-2.16], p < .001, as were alcohol and other recreational drugs: OR [95% CI] = 1.95 [1.59-2.38], p < .001. Both sexually transmitted infections, including HIV (OR [95% CI] = 1.36 [1.11-1.66], p = .003) and reproductive health related outcomes (OR [95% CI] = 1.76 [1.18-2.63], p = .013) were significantly associated with sexual violence. Potential moderation by legislative model could not be detected due to insufficient data. CONCLUSION: This systematic review suggests sexual violence against sex workers as a critical human rights issue. However, the generalisability of these findings is constrained by substantial statistical heterogeneity and limited representativeness within the current literature, which remains focused predominantly on cisgender women in in-person sex work. This calls for redefining sexual violence with input by sex workers and addressing structural inequities to aid in destigmatizing sex work and reducing social inequities.
Community-based abdominal ultrasound survey of cystic echinococcosis in Bhutan: prevalence and risk factors.
Wangchuk P, Hattendorf J, Zinsstag J
BMC Public Health · 2026 Jun · PMID 42380884 · Full text
BACKGROUND: Cystic echinococcosis (CE) is a neglected parasitic zoonosis, caused by larvae of the Echinococcus granulosus sensu lato (s.l.) complex. The parasitic transmission cycle is maintained between dog and livestoc...
BACKGROUND: Cystic echinococcosis (CE) is a neglected parasitic zoonosis, caused by larvae of the Echinococcus granulosus sensu lato (s.l.) complex. The parasitic transmission cycle is maintained between dog and livestock (ungulates), with humans involved as dead-end hosts. In Bhutan, CE is a recognized public health and veterinary problem; however, the true burden of CE in high-risk communities remains unknown. This study assessed the community-level prevalence, potential risk factors, and awareness of CE in Bumthang District to inform CE control strategies. METHODS: We conducted a cross-sectional, community-based abdominal ultrasound survey (April-July 2025) in four gewogs of Bumthang district using cluster sampling design. We invited all individuals aged ≥ 12 years from the selected villages. The WHO-IWGE ultrasound staging criteria were used to classify the cysts. RESULTS: Among the 3,058 participants with complete data (of 3,077 screened), the cluster-adjusted prevalence of confirmed CE (ultrasound-pathognomonic findings) was 2.58% (95% CI: 1.93-3.44). When cystic lesions (CL) were included, the estimate was 3.66% (95% CI: 2.92-4.59). The liver was the most commonly affected organ (93%), and cyst stages ranged from CE1 to CE5, indicating the presence of both active and inactive infections. Only intermittent dog contact ("sometimes") was independently associated with higher odds of prevalent CE (aOR 1.73, 95% CI 1.04-2.82). Other commonly hypothesized individual-level factors (sex, education, occupation and place of birth) were not independently associated with infection. All participants with CE and other clinically significant ultrasound findings received counselling, stage-appropriate management for CE cases, and appropriate referral and treatment within Bhutan's state-funded free healthcare system. CONCLUSION: CE is prevalent in Bumthang district. Currently, it remains under-recognized, under-reported and a huge detection gap exists between hospital-based passive detection and true community prevalence. The weak discrimination by individual-level risk factors and the pattern of modest village-level clustering are consistent with the environmentally mediated transmission hypothesis. These findings support the need of One Health control strategies including integrated surveillance rather than targeted approaches for high-risk groups.
Health literacy and vaccination attitudes among parents from different ethnic groups: a health belief model approach.
Deger VB, Butun A
BMC Public Health · 2026 Jun · PMID 42380835 · Full text
INTRODUCTION: Health literacy is a key determinant of health behaviours, including vaccination. Despite the proven benefits of immunization, vaccine hesitancy remains a global challenge, shaped by cultural, social, and i...
INTRODUCTION: Health literacy is a key determinant of health behaviours, including vaccination. Despite the proven benefits of immunization, vaccine hesitancy remains a global challenge, shaped by cultural, social, and individual factors. The aim of this study was to investigate the relationship between parents' health literacy and vaccine attitudes according to the health belief model among different ethnic groups. This study is expected to highlight the role of cultural differences in achieving public health objectives, while also contributing to improved health literacy and the development of more inclusive policies in child health and immunization. METHODS: This descriptive cross-sectional study was conducted with 908 parents (Turkish: 249; Kurdish: 217; Arab: 245; Assyrian: 197) living in Mardin, Turkey, between January and July 2025. Data were collected through face-to-face interviews using a sociodemographic form, the Public Attitude Towards Vaccination Scale-Health Belief Model, and the Turkey Health Literacy Scale-32. Data were analysed using descriptive statistics, chi-square tests, one-way ANOVA, and generalized linear model analyses. RESULTS: Health literacy and vaccination attitudes differed significantly according to ethnic group (p< .001). Arab parents had the lowest general health literacy scores and the most negative vaccination attitudes, including the highest perceived barriers to vaccination (24.04 ± 3.98). In contrast, Assyrian parents had the highest scores for sensitivity and severity, awareness of importance, belief in vaccine benefits, and health responsibility. Higher health literacy was positively associated with more favourable vaccination attitudes among Turkish, Kurdish, and Assyrian parents. However, among Arab parents, higher health literacy was associated with lower awareness of importance, lower belief in vaccine benefits, lower health responsibility, and greater perceived barriers. Significant interaction effects between ethnicity and health literacy were found for awareness of importance, belief in vaccine benefits, and health responsibility. CONCLUSION: Health literacy is an important factor influencing vaccination attitudes, but its effect varies according to ethnic background and cultural context. In some groups, higher health literacy supports more positive vaccination attitudes, whereas in others it may not lead to greater vaccine acceptance. Public health interventions should therefore use culturally sensitive and trust-based approaches to improve vaccination attitudes among diverse populations.
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