BMC Public Health [JOURNAL]
Sun
200 papers
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.
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.
Self-management of long COVID symptoms with over-the-counter medicines and other non-prescribed therapies: a cross-sectional survey.
Guan N, Turner G, Hotham R … +15 more , Lange D, Brown KR, McMullan C, Hughes SE, Aiyegbusi OL, Matthews K, Jackson L, Yahyouche A, Alder Y, Jeyes F, Buckland L, Chong A, Stanton D, Calvert M, Haroon S
BMC Public Health · 2026 Jul · PMID 42393618 · Full text
BACKGROUND: The high prevalence of long COVID globally necessitates investigation into its self-management, especially given the absence of definitive and effective treatments and uneven access to healthcare services. ME...
BACKGROUND: The high prevalence of long COVID globally necessitates investigation into its self-management, especially given the absence of definitive and effective treatments and uneven access to healthcare services. METHODS: This study surveyed the use of over-the-counter (OTC) medicines, supplements, remedies, and other non-prescription therapies for managing long COVID symptoms in the UK. It aimed to identify the range of treatments used for self-management, explore the sources of these treatments, factors influencing treatment choices, and associated out-of-pocket expenses. A cross-sectional electronic survey was provided to individuals experiencing long COVID. It included questions on the use of OTC medications, supplements, and other therapies, where they were sourced, decision-making influences, and financial costs. Descriptive statistics and thematic analysis were applied to analyse the data. RESULTS: Among the 193 surveyed participants, significant use of vitamins, minerals, and herbal treatments (88.8%), and analgesics (73.6%) was reported, with 42% exceeding recommended dosages. Some participants sought relief through alternative therapies such as physiotherapy and acupuncture, often incurring significant personal expenses. Choices about self-management were influenced by medical professionals, family, friends, and online sources, including support groups and social media. CONCLUSIONS: People with long COVID may access a wide range of OTC medicines, dietary supplements, herbal remedies, and non-pharmacological therapies to self-manage symptoms. Healthcare providers should be aware of the use of non-prescribed therapies among long COVID sufferers and consider these in their treatment plans. Public health policies should focus on providing accurate information and guidance for patients self-managing long COVID symptoms.
Identifying predictor factors for asthma using machine learning: evidence from the English Longitudinal Study of Ageing.
Yang ZC, Xiao Z
BMC Public Health · 2026 Jul · PMID 42393616 · Full text
BACKGROUND: Asthma is a common chronic inflammatory airway disease. Accumulating evidence highlights the roles of demographic, lifestyle, and comorbidity factors in the risk of asthma. This study aimed to identify predic...
BACKGROUND: Asthma is a common chronic inflammatory airway disease. Accumulating evidence highlights the roles of demographic, lifestyle, and comorbidity factors in the risk of asthma. This study aimed to identify predictor factors of asthma using machine learning approaches. METHODS: Data were obtained from the 10th wave (2021-2023) of the English Longitudinal Study of Ageing (ELSA). Participants aged ≥ 50 years with complete information on asthma status and relevant variables were included. Baseline characteristics were compared between asthma and control groups. Subsequently, Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to identify candidate variables. Eight machine learning algorithms were developed and compared to evaluate diagnostic performance. The optimal model was selected and used to determine key variables. Additionally, SHapley Additive exPlanations (SHAP) analysis was applied to interpret variable contributions. Finally, a nomogram was constructed based on the key variables. RESULTS: A total of 3429 participants (535 asthma cases) were analyzed. Asthma was significantly associated with 19 baseline variables. LASSO regression retained 14 candidate variables. Among eight machine learning models, the Bagging Tree (BT) model achieved the highest diagnostic performance (micro-averaged area under the curve (AUC) = 0.856; macro-averaged AUC = 0.881). SHAP analysis identified alcohol consumption, marital status, and disease lung as the most influential variables. A total of 11 key variables were identified by the BT model, including marital status, vigorous physical activity, moderate physical activity, alcohol consumption, frequency of feeling isolated, depression, headache, activity limitations, disease lung, arthritis, and psychiatric disease. The nomogram showed good calibration (Hosmer-Lemeshow test p = 0.0857), but its discriminatory ability was moderate (AUC = 0.662). CONCLUSIONS: This study demonstrated that socio-behavioral factors, psychological distress, and respiratory comorbidities played important roles in asthma risk stratification. Machine learning with multidimensional variables offers a useful exploratory framework for identifying potential predictor factors and generating hypotheses for asthma prevention, although its predictive accuracy remains moderate.
Retention and attrition of community health volunteers in rural Malawi; a mixed-methods study.
Kaunda-Khangamwa BN, Msuku H, Kamiza CT … +5 more , Chimala AA, Stanley CC, Chinkhumba J, Mwapasa V, Mathanga DP
BMC Public Health · 2026 Jul · PMID 42393611 · Full text
BACKGROUND: Community health volunteers (CHVs) are an important resource for supporting health service delivery, surveillance, and social programmes. However, retention and attrition of CHVs remain a big challenge. This...
BACKGROUND: Community health volunteers (CHVs) are an important resource for supporting health service delivery, surveillance, and social programmes. However, retention and attrition of CHVs remain a big challenge. This study explored factors affecting the retention and attrition of CHVs working as village reporters (VRs) responsible for community-based death notification in the Malaria Vaccine Implementation Program (MVIP) in Malawi. METHODS: This mixed-methods exploratory study, which intersected with the case studies, was conducted from November 2022 to March 2023 in nine rural districts in southern and central Malawi. Purposive sampling was used to select 64 study participants for qualitative interviews. Using case studies, we conducted six in-depth interviews (IDIs) with CHVs who had dropped out, were reachable, and agreed to be interviewed-many were dispersed, hesitant to attend meetings, or unreachable for focus group discussions (FGDs). We held five FGDs (n = 50) with CHVs who remained in the MVIP for shared norms and experiences and eight key informant interviews (KIIs) with health workers, opinion leaders, and program staff to provide insights into health workers motivation, supervisory and program perspectives. Thematic analysis and the social capital framework (roles, relationships, and empowerment) were used to analyse and interpret the qualitative data. The qualitative study was complemented by a cross-sectional survey involving 696 randomly selected participants from a pool of 2,861 CVHs to demonstrate the trends of retention over time. Descriptive statistics were computed from quantitative survey data, with retention as a primary outcome (defined as whether a CHVs was willing to stay in the program). RESULTS: At the start of the program in 2019, a total of 2,861 CHVs were recruited by March 2023; only 295 (10.3%) had dropped out. Among 696 CHVs surveyed, the most commonly reported factors associated with retention were incentives (643; 92%), participation in exchange visits (377; 54%), and managing a small geographical area (275; 40%). Qualitative data from FGDs and KIIs corroborated these findings and identified compassion for serving others, financial and non‑financial incentives, and flexibility to work across multiple programmes as key motivators for continued participation. Factors associated with attrition included experiences of ridicule or disrespect, lack of opportunities for personal development, and limited career progression. IDIs with CHVs who left the programme provided in‑depth accounts of these individual‑level drivers, which helped explain patterns observed in the survey. CONCLUSION: Engagement of CHVs in community-based programs can be promoted by offering opportunities to serve others, incentives, and flexibility to work on multiple programmes. However, it is also important to address ridicule-making fun or rude comments and limited personal and career development, which act as barriers to the continued engagement of lay health workers.
Defining quality of healthcare in Dutch police custody: the development of a conceptual framework for monitoring care quality through a scoping review and expert consultations.
Zinger ND, Slev VVN, Verheij RA … +3 more , Ramerman L, Bos I, Kringos DS
BMC Public Health · 2026 Jul · PMID 42393609 · Full text
BACKGROUND: Individuals in police custody may require medical attention, yet little is known about the quality of care in police custody. Research is lacking on appropriate standards and indicators for measuring care qua...
BACKGROUND: Individuals in police custody may require medical attention, yet little is known about the quality of care in police custody. Research is lacking on appropriate standards and indicators for measuring care quality. This study aimed to develop a conceptual framework to identify key aspects for measuring the quality of care in police custody in the Netherlands. METHODS: A scoping review supplemented by expert consultations was conducted to gather information on health needs and quality of care in short-term police custody settings. Searches were performed across seven electronic databases (Embase, Medline, PsycInfo, CINAHL, Criminal Justice Abstracts, PiCarta, and Cochrane) for articles published in English or Dutch between 2008 and February 2023, and were supplemented with Dutch documents of medical guidelines, protocols, work instructions, and additional grey literature. An initial conceptual framework was developed from the literature review and author expertise, which was subsequently discussed and validated by field experts through two expert consultation group meetings. RESULTS: This study included 69 scientific articles, 17 medical guidelines, protocols and work instructions, and 12 reports, alongside consultation with 27 experts. The resulting conceptual framework applies a structure-process-outcome model to evaluate the care quality in police custody, organized into 14 domains. At the structure level, it includes the scope and nature of care demand, (healthcare) staff, the legal framework, quality assurance, infrastructure and (medical) resources, and funding. The process level covers triage and access to healthcare, detection of care needs, continuity of healthcare information, coordination of care, general healthcare provision, and healthcare provision for common needs. The outcome level addresses effectiveness and health outcomes, and satisfaction. These domains are further classified into 48 subdomains. There were no existing indicators identified in the literature to populate the framework. CONCLUSIONS: The conceptual framework outlines key domains for measuring quality of care in Dutch police custody. Future research will be necessary to populate the framework with indicators to monitor quality of care and support improvement efforts tailored to the needs of specific stakeholders. The operationalization and implementation of the framework will be vital for improving the care provided within police custody.
Private garden exposure and public park access in relation to type-2 diabetes incidence: a UK Biobank cohort study.
Odebeatu CC, Darssan D, Roscoe C … +2 more , Reid S, Osborne NJ
BMC Public Health · 2026 Jul · PMID 42393608 · Full text
BACKGROUND: Existing longitudinal studies examining the relationship between greenspace exposure and incidence of type-2 diabetes (T2D) have primarily operationalized greenspace using vegetation indices. Little is known...
BACKGROUND: Existing longitudinal studies examining the relationship between greenspace exposure and incidence of type-2 diabetes (T2D) have primarily operationalized greenspace using vegetation indices. Little is known about the effect of greenspace types (e.g., private gardens) and public park access. METHODS: We investigated the associations between residential greenspace exposure, including private gardens (determined using Ordnance Survey MasterMap™ Greenspace) and public park access, with the incidence of T2D using the UK Biobank (UKBB) data. Public park access, such as nearest distances (i.e., walkable road network and Euclidean), and the number of parks were calculated for each participant. The incidence of T2D was ascertained through linkage of hospital admissions data. Cox proportional hazard models, adjusting for covariates, were used to estimate the hazard ratios (HR) and 95% confidence intervals (CI). We also performed stratified analyses by age, sex, neighbourhood deprivation, and family history of diabetes. RESULTS: Of the 423,282 UKBB participants (mean age:56.36 years) included in the study, 19,648 developed T2D over a median follow-up of 15.41 years. Compared to the first quartile, participants in the highest quartile of private garden cover (%) had a reduced risk of T2D (HR: 0.932; 95%CI: 0.88, 0.983). For park access, nearest distance (whether walkable or Euclidean) was not associated with the incidence of T2D. However, having a higher number of parks, particularly three or more parks within an 800-m buffer of the home location, was found to lower the incidence of T2D (HR: 0.943; 95% CI: 0.906, 0.981). Stratified analyses revealed that the beneficial effects of private gardens were stronger among participants in deprived areas and those without a family history of diabetes. CONCLUSION: Private residential gardens exposure (often overlooked in greenspace-health research) and a higher number of parks around homes were found to lower the incidence of T2D. This has implications for urban planning and public health, particularly in the prevention and management of diabetes.
Medications for opioid use disorder, recovery supports, and overdose risk -- a database linkage study of a rural cohort of people who inject drugs and use opioids.
Gicquelais RE, Ballard HK, Becker M … +3 more , Doyle S, Bailey E, Westergaard RP
BMC Public Health · 2026 Jul · PMID 42393605 · Full text
BACKGROUND: Medications for opioid use disorder (MOUD) are the gold standard treatment for opioid use disorder, but rural-dwelling people who inject drugs (PWID) may have lower access. PWID may also receive outpatient or...
BACKGROUND: Medications for opioid use disorder (MOUD) are the gold standard treatment for opioid use disorder, but rural-dwelling people who inject drugs (PWID) may have lower access. PWID may also receive outpatient or residential treatments, attend mutual help groups, or reside in recovery housing. We aimed to investigate which supports were associated with time to first fatal or nonfatal opioid-involved overdose in a cohort of PWID who used opioids in the past 30 days. METHODS: PWID who used opioids (N = 751) in the past 30 days were recruited in Wisconsin using respondent-driven sampling and completed a cross-sectional survey in 2018-2019. Fatal and nonfatal opioid-involved overdose incidence was estimated through 2022 via linkage with vital records, emergency department, and hospitalization data. Cox proportional hazards models summarized associations of reporting MOUD, outpatient counseling, residential treatment, mutual help group participation, and living in recovery housing in the 30 days before enrollment with time to first fatal/nonfatal opioid overdose adjusted for sociodemographic characteristics, health insurance, drug use frequency, substance use severity, criminal legal system involvement, and overdose history. Self-reported barriers to MOUD were summarized among those who had never used each MOUD. RESULTS: Approximately 18.1% (N = 136) used MOUD, 22.0% (N = 165) had outpatient counseling, 7.2% (N = 54) had residential treatment, 19.7% (N = 148) participated in mutual help, and 7.2% (N = 54) lived in recovery housing in the 30 days before enrollment. During follow-up, 10.7% of participants experienced ≥ 1 opioid-involved overdose, including 114 nonfatal overdoses (incidence: 3,291.6 per 100,000 person-years) and 26 fatal overdoses (incidence: 784.5 per 100,000 person-years). Past 30-day MOUD was associated with a 78% reduction in risk of future opioid-involved fatal/nonfatal overdose (95% CI: 0.08, 0.57). Past 30-day counseling, residential treatment, mutual help, and recovery housing were not associated with fatal/nonfatal overdose. The top barrier to MOUD reported was being unable to afford MOUD (reported among 33.2% who never used buprenorphine, 27.7% who never used methadone, 22.7% who never used naltrexone). CONCLUSIONS: Recent MOUD was highly protective against experiencing fatal or nonfatal overdose in a cohort of PWID who used opioids in the past 30 days, reinforcing the need for widespread MOUD access in rural communities.
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