Despise the existence of numerous community-based health literacy interventions worldwide, our understanding of their impact on equity and the influence of national policy frameworks and implementation considerations remains limited. This narrative review aims to conduct a comparative analysis of community-based health literacy programs and national policy frameworks post-2020, with a focus on implementation characteristics, system-level integration, and implications for equitable public health initiatives. Effective interventions across various countries exhibited three key action-relevant features: integration into national prevention and broader primary care strategies; utilization of hybrid delivery models combining digital technology with in-person contact; and active targeting of socioeconomically disadvantaged groups. Government-led models demonstrated superior scalability and sustainability, whereas community-based models enhanced outreach to marginalized populations. However, the majority of programs rely on short-term or output-based indicators to assess success, with insufficient evidence regarding their long-term impact on equity. Although digitalization increased accessibility on a large scale, there is a risk of reinforcing existing inequalities in the absence of inclusive design and digital support. This study provides a policy-focused synthesis that positions community-based health literacy as a viable public health intervention rather than merely an educational endeavor. This review provides practical guidance for integrating health literacy into national preventive efforts by identifying transferable implementation characteristics and governance requirements. Main findings: Community-based health literacy programs and national policy frameworks address health literacy at different levels, with long-term benefits appearing when local interventions are integrated into coherent national plans.Added knowledge: This review synthesizes the implementation aspects and common issues of national programs, noting weaknesses in the evaluation methods and the potential for exclusion.Global health impact for policy and action: The findings provide policymakers and public health planners with actionable insights into designing equity-oriented, context-specific, and sustainable health literacy strategies that are capable of generating measurable population-level benefits.
Dental caries remains the most prevalent chronic disease of childhood, with substantial consequences for children's health, development, and educational outcomes. Schools provide a strategic platform for oral health promotion, particularly through structured curricula aligned with the World Health Organization's Health Promoting Schools framework. However, clarity regarding the nature, scope, and implementation of oral health curricula within school settings remains limited. This scoping review aimed to map global evidence on school-based oral health curricula, examining their characteristics, delivery methods, stakeholder involvement, and assessment approaches. This review followed JBI Methodology for scoping reviews and PRISMA-ScR guidelines. Databases searched were Medline (Ovid), Cochrane Library, SCOPUS, CINAHL (Ovid), Dental & Oral Sciences source (Ovid), Web of Science, grey literature (like ProQuest, Google Scholar), ERIC, Epistemonikos, and government and professional dental associations' websites. Covidence software facilitated identification and screening of documents containing information about oral health in school curriculum. From 5,035 records identified, 42 documents met the inclusion criteria. The included evidence was heterogeneous comprising peer-reviewed studies, curriculum documents, websites, dissertations, conference proceedings, and media reports, with most published after 2000. The United States (n = 15) contributed the largest share of evidence, followed by India (n = 7) and United Kingdom (n = 6). Oral health curricula predominantly targeted primary school children focusing mainly on preventive topics such as oral hygiene practices, diet, and regular dental check-ups. Integrated curricula (n = 11)were reported more than stand-alone models (n = 1). Teachers were primary curriculum facilitators(n = 13). Only a minority of documents reported formal assessment methods, most commonly measuring changes in oral health knowledge and attitudes. Despite the high global burden of childhood oral diseases, evidence on structured school-based oral health curricula remains sparse and heterogeneous. Variability in terminology, curriculum design, delivery, and assessment highlights the need for standardized frameworks and clearer conceptualization of oral health curricula within school health programs. Strengthening and systematically integrating oral health into school curricula has the potential to support sustainable improvements in children's oral health and overall well-being.
As a core component of strategic emerging industries, the biomedical industry serves as a key indicator of regional scientific and technological innovation capacity and industrial competitiveness. The Beijing-Tianjin-Hebei (BTH) region possesses inherent advantages for development, including abundant research resources, a solid industrial foundation, and vast market potential. However, it also faces structural challenges such as insufficient collaboration within innovation networks and resource misallocation. Based on multi-source data, including patent data and enterprise panel data from 2013 to 2023, this paper systematically analyzes the evolutionary characteristics of the BTH biomedical industry innovation network and identifies obstacles to its high-quality development. Methods such as social network analysis (SNA), the Temporal Exponential Random Graph Model (TERGM), and an obstacle degree model are employed. The study finds that the regional innovation network has evolved from a "dual-core monopoly" (2013-2018) to a "Beijing-Tianjin-Xiong'an triangle structure" emerging by 2023 forming a multi-level collaborative pattern. However, the main obstacles lie in the low efficiency of R&D personnel, insufficient conversion of patent revenue, and inadequate cross-regional policy coordination, with disconnections existing in the "R&D-conversion-industrialization" chain. To address these issues, this paper proposes strengthening the precise division of labor system: "Beijing for R&D, Tianjin for conversion, and Hebei for manufacturing" to improve full-chain innovation services to bridge conversion gaps, optimizing resource allocation to resolve mismatches, and implementing differentiated policies. From a public health perspective, these measures are designed to shorten the R&D-to-registration cycle, lower the cost of essential medicines, and reduce interregional health disparities. By accelerating the translation of biomedical innovations into accessible diagnostics, vaccines, and therapeutics, the optimized innovation network can directly enhance regional health security and epidemic response capacity. This aims to promote high-quality and coordinated regional industrial development, ultimately con tributing to improved public health outcomes by accelerating the translation of R&D into accessible diagnostics, vaccines, and therapeutics, and strengthening regional health security.
Health promoting school (HPS) interventions have the potential to improve adolescent health and well-being, but evidence regarding implementation and system-level impact in real-world school settings remains limited. "My Life - I Decide" (My Life) is a systems-oriented HPS intervention developed to strengthen positive mental and physical health, school well-being, and health-promoting school practices among 10th-grade students in Denmark. This study aims to describe the intervention, study design, and evaluation framework of the "My Life" intervention and its pragmatic controlled trial, including effectiveness, process, and system-level evaluations. The intervention is informed by the World Health Organization HPS framework and combines curriculum-based health education, action-oriented teaching, life-psychological approaches, and education outside the classroom. The intervention includes four phases: (1) preparation through cross-sectoral collaboration between health and education sectors; (2) planning and local adaptation; (3) delivery of a health education program; and (4) anchoring of health-promoting practices at the school level. Effectiveness is evaluated using a pragmatic controlled waiting-list trial design. Four intervention schools (11 classes) were matched with 4 control schools (15 classes), including approximately 416 students aged 15-17 years. Primary outcomes include social and emotional competences, self-efficacy, mental well-being, health literacy, school connectedness, and student interpersonal relations. Student survey data are collected at baseline, postintervention, and follow-up, and effectiveness will be analyzed using multilevel mixed models. System-level impacts are assessed using a mixed-methods design, including school staff surveys, interviews with school and municipal stakeholders, and student focus groups. A realist-informed multimethod process evaluation examines implementation fidelity, acceptability, contextual factors, and mechanisms of impact across intervention schools. Data sources include observations, interviews, student registration, and postsession surveys completed by health consultants after each teaching session. The study will generate quantitative and qualitative data on student outcomes, implementation processes, intersectoral collaboration, and development of health-promoting practices within schools. Findings from the effectiveness, process, and system-level evaluations will be triangulated to test and refine the initial program theory of the intervention. Recruitment of schools and student enrollment have been completed, and baseline data collection commenced in September 2025. Follow-up assessments are being conducted according to the study timeline. Qualitative data collection for the process and system-level evaluations were completed in June 2026. The "My Life" study will contribute knowledge on the implementation and evaluation of complex HPS interventions in real-world educational settings. The findings may inform future HPS initiatives and provide methodological insights into combining effectiveness, process, and system-level evaluations in adolescent health promotion research.
Globally, 8 million people experience conditions for which rehabilitation services can be beneficial. These services are considered an essential health service for the attainment of Universal Health Coverage. According to the Nepal Demographic and Health Survey 2022 report, 23% of the population has some type of functional disability, among whom 6% have total functional disability. This study aims to assess the readiness of rehabilitation services, knowledge of health workers, experience of service recipients and policy framework. A mixed-methods study design will be conducted to assess the readiness for rehabilitation services over a period of 2 years, from July 2024 to 2026. This study protocol will examine the status of rehabilitation services, knowledge and skill gap of health workers, experiences of elderly and persons with disabilities for rehabilitation service utilisation. Similarly, the perception and experience of stakeholders working in the service sector will be assessed through key informant interviews. The participants of the current study will be 23 health facilities, more than 300 health workers in primary healthcare centre in Karnali and a convenience sample of elderly and disabled population. Furthermore, the study will explore (1) facility readiness index by domain; (2) health worker knowledge/practice score; (3) user-reported barriers; and (4) qualitative themes around governance/financing/workforce/WHO health system building blocks. The study team has designed a study protocol and conducted pre-testing in a similar setting. The present study was approved by Nepal Health Research Council (Ref #49, 21 July 2024). Prior to ethical approval, the study team obtained approval from the Ministry of Social Development, Karnali Province. Informed consent was obtained from all the participants involved in the study. All collected data will be used solely for study purposes. The findings of the study will be published as a report from the Publication of the Ministry of Social Development, and major findings will be published in the Journal.
India's Tele-MANAS (Tele Mental Health Assistance and Networking Across States) programme, launched in October 2022, is the world's largest government-led tele-mental-health initiative. Operating via a multilingual 24/7 helpline, it provides stepped-care support, offering immediate counselling and escalating complex cases to psychiatrists or local services. In its first few years, Tele-MANAS has responded to more than 3.43 million calls across all Indian states and union territories. The majority of callers present with anxiety, depression or psychosocial stressors, while a critical minority report suicidal distress. Features such as linguistic inclusivity, anonymity and integration with India's digital health ecosystem have driven rapid uptake, particularly among young adults. A World Health Organization (WHO) assessment has recognised Tele-MANAS as a scalable and equity-focused solution. The initiative illustrates how low- and middle-income countries can leverage technology and task sharing to reduce the treatment gap, offering a potential global blueprint for digital mental health care. This article aims to provide a programmatic overview of Tele-MANAS, including its design, early outcomes and key implementation challenges.
Learning health systems (LHS) are an approach to translate patient data into actionable clinical insights, empower healthcare teams to drive quality improvement and reduce health inequalities. Here we present a protocol for a realist evaluation to explore what works to implement a learning health system approach in primary care settings in Thailand, for whom does it work, how, why and in what circumstances. A mixed-methods realist evaluation will run in parallel with an interventional trial [Reg No: NCT06873243] in Northern Thailand which aims to improve the management of hypertension (HTN), type 2 diabetes mellitus (T2DM) and chronic kidney diseases (CKDs) using a data-supported learning health systems approach. As part of the trial, 16 primary care units (PCUs) in Chiang Mai and Lamphun provinces will be randomly selected to receive a learning health system intervention to support quality improvement for care of HTN, T2DM and CKD. Performance will be compared between intervention PCUs and all other PCUs in the region. Participants of the realist evaluation will include clinical and other professional staff involved in the development and implementation of the LHS. This realist evaluation will use both quantitative and qualitative data, including semi-structured interviews, surveys and documents from participating sites. Quantitative and qualitative findings will be systematically integrated to test, refine and validate context-mechanism-outcomes to identify consistencies, contradictions and explanatory mechanisms as part of a final programme theory for the successful implementation of the LHS. Ethical approval has been granted by all collaborating university Research Ethics Committees (ref: 1090, 0321, 32540). Results will be disseminated to stakeholders, including patients and the public, health providers, the Thai government and WHO office. Our methods and dissemination will be guided by National Institute for Health Research and Guidelines International Network reporting standards for Patient and Public Involvement and Engagement.
Client satisfaction is a key indicator of abortion care quality, influencing both service use and outcomes. While Ethiopia has expanded access to comprehensive abortion care, limited evidence exists on client satisfaction in conflict-affected areas like South Gondar Zone. This study aims to assess perceived quality, identify associated factors, and explore barriers to accessing abortion services in public health facilities in South Gondar, Amhara Region, Ethiopia, in 2024. A concurrent mixed-methods study was conducted from November 1 to December 31, 2024, using cross-sectional and phenomenological designs. A multi-stage sampling was used for selection. Quantitative data were collected from 477 women using a structured, pre-tested questionnaire and analyzed using SPSS version 25. A binary logistic regression used to identify factors. Additionally, 15 purposively selected participants took part in in-depth interviews, with qualitative data thematically analyzed using Open Code software. Satisfaction with abortion care quality was 38.4% (95% CI: 34.1%-42.8%). Women aged 15-24 (AOR = 3.25, 95% CI: 1.28-8.26), 25-34 (AOR = 2.49, 95% CI: 1.11-5.56), urban residence (AOR = 0.45, 95% CI: 0.24-0.82), family size (< 5) (AOR = 0.32, 95% CI: 0.16-0.63), partners with no formal education (AOR = 0.36, 95% CI: 0.18-0.74), receiving care at health centers (AOR = 0.36, 95% CI: 0.19-0.68) or primary hospitals (AOR = 0.21, 95% CI: 0.10-0.44), and male providers (AOR = 0.43, 95% CI: 0.27-0.69) were significantly associated client satisfaction. Qualitative findings revealed key barriers to satisfaction, including stigma, lack of privacy, supply shortages, and provider reluctance. Client satisfaction with abortion care quality in South Gondar Zone is low compared to national standards and is associated with age, residence, family size, partner's education, facility type, and provider gender. Improving satisfaction requires expanding service access, promoting respectful, client-centered care, upgrading facility conditions, training providers-especially males-and addressing stigma and privacy concerns.
Health and demographic surveillance sites (HDSS) provide sampling frames to conduct longitudinal studies. This review aims to provide a comprehensive characterization of HDSS in Ethiopia and assess its potential as a robust infrastructure for longitudinal studies on aging-related and other health outcomes. We searched databases including PubMed for peer-reviewed articles, HDSS reports, strategic papers, and other pertinent literature, and extracted pertinent information. Projection of adult population (aged ≥40 years) for the respective HDSS was done based on the estimated growth rate. From a total of 979 articles, 56 were included in the review. Currently, 11 HDSS are present in Ethiopia, and each has more than 9,000 households with an average household size of at least three. HDSS have unique characteristics and are designed to focus on respective geographic and demographic contexts. A total of 27 districts (1-6 districts per HDSS) and 12 sub-districts are included across all HDSS. The number of adults aged ≥40 years is projected to rise from 210, 673 in 2024 to 295,780 in 2037, indicating their potential as infrastructure to conduct studies on aging. Limited geographic coverage across regions and resource constraints are identified gaps in HDSS. Major cities, urban areas, and remote areas may lack sufficient coverage or representation. In light of the anticipated significant increase in the number of older adults in the HDSS capture sites, HDSS can serve as an infrastructure for conducting studies on aging-related and other health outcomes in Ethiopia. Main findings: Health and Demographic Surveillance Sites in Ethiopia provide a valuable but underutilized infrastructure for conducting longitudinal health and aging research, with a growing adult population (≥40 years) projected across diverse regions.Added knowledge: This review offers a comprehensive synthesis of Ethiopia’s HDSS capacity, highlighting demographic trends, geographic distribution, and current limitations such as data gaps, limited urban representation, and weak integration with national systems.Global health impact for policy and action: Strengthening and expanding Health and Demographic Surveillance Sites can support evidence-based policymaking on aging and dementia, inform equitable health interventions in Africa, and contribute to globally harmonized research on health and aging.
Environmental degradation and climate change are growing global problems that affect public health. This integrative review aims to consolidate the available evidence concerning environmental awareness, attitudes, and behaviors among healthcare professionals toward climate change and the implementation of sustainable health practices. A systematic integrative review of the qualitative and quantitative studies was conducted. Studies were identified through searches of eight databases until October 2025. The inclusion criteria encompassed studies involving healthcare professionals that focused on environmental awareness, attitudes, and behaviors. Two reviewers independently screened the identified studies, and a third reviewer resolved any discrepancies. Data were analyzed using a thematic analysis approach. The review included 10 studies. Healthcare professionals recognized the link between climate change and health, but highlighted a discrepancy between growing awareness and sustainable practices. Concerns included the environmental impact of healthcare. Barriers to adopting sustainable practices included a perceived lack of institutional support. There was a dissociation between professionals' eco-friendly behaviors in their personal lives and work settings. There is a need for implementing interventions focused on providing education, creating supportive work environments, and involving healthcare professionals in decision-making related to sustainability.
Proportionate universalism aims to improve overall health while decreasing health inequity across the social spectrum. For health visiting in England, the 'universal' offer is five health reviews for children aged under 5 years, with 'proportionate' support provided through additional health visiting contacts when greater need is identified. We synthesised the published findings of four mixed-method studies into variation in health visiting services in England to examine how proportionate universalism works in practice. The studies analysed Community Services Dataset data from 2016-2020 and interviews and observations with parents and professionals (collected 2023-2024). Between 2018 and 2020, up to 98% of infants in 57 areas received their universal contacts, even as services experienced reduced funding and staffing, indicating high reach. However, interview data suggest universal reach was widely achieved by offering a differentiated version of universal contacts based on whether families already have known needs or not. This affects health visiting's ability to identify need across the social spectrum. Similarly, additional contacts were found to be widespread. Health visitors typically reported using these to support families with known complex needs that fell short of thresholds for other services. In an environment of resource constraint and limited specialist services, a proportionate universalist service will be pushed away from identifying unknown needs and pulled towards supporting the most acute known needs. This may reduce the quality of the universal service, even if reach is maintained. Implications for policymakers and service commissioners are discussed.
Aims Associations between behaviours and clinical oral health outcomes have been studied on adults in general and at one time point, overlooking a direct focus on young to middle-aged adults. The aim of this research was to examine the associations between self-reported oral health behaviours and clinical outcomes in young to middle-aged adults in England in 1998 and 2009.Methods Secondary data analyses of the Adult Dental Health Survey 1998 and 2009. Toothbrushing frequency and dental attendance were assessed for their association to dental caries; decayed, missing, and filled Teeth (DMFT); and probing pocket depth (PPD) ≥4 mm, using logistic (caries and PPD) and linear (DMFT) regression models, controlling for demographic and socioeconomic factors.Results In 1998, favourable toothbrushing and dental attendance patterns were associated with lower odds of dental caries. In 2009, both behaviours were associated with all outcomes. Brushing twice or more daily and regular dental attendance were associated with lower odds of caries, higher DMFT, and lower odds of PPD ≥4 mm.Conclusions Favourable toothbrushing and dental attendance were associated with better clinical oral health in 2009, while in 1998 this was only for dental caries. Maintaining good oral health behaviours is an important priority for better clinical oral health among young to middle-aged adults.
The convergence of digital technologies with point-of-care (POC) diagnostics has paved the way for innovative digital POC diagnostics that combine the convenience and accessibility of POC testing with digital connectivity and data analytics capabilities. Given the burden and mortality from infectious diseases such as malaria in many African countries, rapid diagnosis and treatment are essential for effective disease management. Therefore, this study aims to assess the readiness of African health systems, with a focus on Ghana, to integrate new POC digital diagnostic tools for acute febrile illness by directly learning from stakeholders and intended users. This study focuses on Ghana's health system within a broader context of work across six sub-Saharan African countries. It will adopt a mixed-methods approach to assess the readiness of Ghana's health system to use and integrate new POC digital diagnostic tests for diagnosing acute febrile illness.Data will be collected through a realist evaluation approach, policy analysis, surveys (n≈75), key informant interviews (n≥20), focus group discussions and observations in three regions in Ghana.Stakeholders representing various levels of health system governance, including global, national, regional and district levels, will be purposively selected for qualitative interviews. Analysis will be guided by realist evaluation using context-mechanism-outcome configurations, complemented by a four-by-four implementation framework. Qualitative data will undergo thematic analysis, while quantitative survey data will be analysed using descriptive and inferential statistics. Findings will be triangulated across data sources to refine programme theory and identify context-specific pathways for integration. The study aims to contribute to the design of new POC digital diagnostic tests that are context-appropriate for diagnostic testing in Ghana and similar African contexts. Results will be communicated to relevant communities and stakeholders and disseminated through publications and presentations. CRD420251084372.
The objective of this follow-up study was to investigate whether changes in mental health from before and into the COVID-19 pandemic varied between girls and boys, as well as between adolescents with high and low levels of resilience. We included data from Norwegian adolescents (n = 1565, 64% girls) who participated in the Young-HUNT4 (2017-2019) and the Young-HUNT COVID (2021) surveys. We measured six dimensions of mental health using the Strength and Difficulties Questionnaire. The resilience factors-family cohesion, personal competence and social competence-were measured using the Resilience Scale for Adolescents. Linear mixed models were used to investigate whether change in the mental health dimensions depended on sex or level of resilience. Change in mental health appeared to differ by sex and resilience level. Specifically, girls showed greater increases in hyperactivity, emotional symptoms and total difficulties, whereas boys displayed greater increases in peer problems along with greater decreases in prosocial behaviour. Compared with adolescents with low resilience, those with high resilience demonstrated a stronger increase in emotional symptoms, peer problems and total difficulties. Adolescents with low resilience displayed a greater decrease in prosocial behaviour. A decrease in conduct problems was observed among adolescents with low resilience, which was not evident among those with high resilience. The present findings suggest that girls and boys, as well as adolescents with high and low levels of resilience, may have experienced the pandemic situation somewhat differently.
Mental health disorders significantly contribute to the global burden of disease, both as non-communicable diseases (NCDs) and as risk factors for other health conditions. They represent a major public health concern in low- and middle-income countries (LMICs). This study aims to investigate associations between psychological distress, socioeconomic factors, and corruption-related factors among Iranian adults in urban settings using multilevel analysis. This cross-sectional analysis uses data from a survey conducted in 2025 among urban adults across all 31 provinces of Iran, employing a proportional, stratified cluster sampling design with probability proportional to size (PPS). Psychological distress among adults aged 18 years and above was assessed using the 12-item General Health Questionnaire (GHQ-12), with a binary threshold of ≥ 4. Multilevel logistic regression models were used to examine associations between psychological distress and socioeconomic factors, perceived corruption, and experience of paying bribes. Models adjusted for health status and included random effects at the province and county levels. Sensitivity analyses were conducted using alternative GHQ-12 thresholds (≥ 3 and ≥ 5) to assess the robustness of findings to the choice of cut-off. The proportion of participants scoring above the GHQ-12 threshold of ≥ 4 for psychological distress was 41.2% (mean = 3.46, SD = 3.54). Psychological distress showed clustering at both province and county levels. In the fully adjusted model, compared with married participants, single (OR = 1.32, 95% CI: 1.21-1.44) and divorced/separated participants (OR = 1.48, 95% CI: 1.26-1.74) reported higher odds of psychological distress, whereas widowed participants (OR = 1.18, 95% CI: 0.96-1.43) showed no statistically significant difference. Higher education (OR = 0.80, 95% CI: 0.72-0.89) and better subjective socioeconomic status (OR = 0.30, 95% CI: 0.25-0.37 for highest vs. lowest category) were associated with lower odds. Compared with unemployment, all employment categories were associated with lower odds of psychological distress (ORs = 0.65-0.70, all p < 0.001). Poorer health status showed a graded association with higher odds of distress (ORs = 1.30-1.70). After adjustment for socioeconomic and health factors, perceived corruption was weakly but positively associated with psychological distress (OR = 1.024, 95% CI: 1.019-1.028), and experience of paying bribes was associated with higher odds of psychological distress (OR = 1.38, 95% CI: 1.27-1.51). The findings indicate that participants' psychological distress is associated with socioeconomic factors, perceived corruption, and experience of paying bribes, with variation across urban geographic contexts in Iran. These results underscore the relevance of socioeconomic disadvantage, corruption-related conditions in public services, and area-level contextual variation as important factors in understanding psychological well-being.
Adequate antenatal care (ANC) contacts are essential for reducing complications during pregnancy and childbirth. Recognizing that inadequate ANC utilization is associated with high maternal mortality, the World Health Organization (WHO) revised its ANC guidelines in 2016, recommending at least eight ANC contacts for all pregnant women. Despite this recommendation, ANC coverage remains suboptimal globally, particularly in East Africa. In Ethiopia, especially in the Sululta district, evidence regarding adherence to the 8+ contact ANC model is limited. Therefore, this study aimed to assess adherence to the WHO-recommended eight-contact ANC model and identify its associated factors among postpartum mothers attending public health facilities in the Sululta district, Ethiopia, in 2024. An institution-based cross-sectional study was conducted in public health facilities of the Sululta district from October 10 to November 10, 2024. A total of 410 postpartum mothers were selected using systematic random sampling and all participants (100% response rate) provided complete data. Data were analyzed using logistic regression analysis. Variables with p value <0.05% and 95% confidence intervals (CI) were considered statistically significant. Overall adherence to the WHO-recommended eight-contact ANC model was 25.4%(104/410; 95% CI: 21%-30%). Factors significantly associated with adherence included urban residence (AOR: 3.06; 95% CI: 1.17-8.03), previous cesarean delivery (AOR: 3.33; 95% CI: 1.39-7.97), history of obstetric complications (AOR: 6.16; 95% CI: 2.69-14.10), maternal satisfied with ANC services (AOR: 6.78; 95% CI: 2.46-18.66), and receiving ANC at a health center rather than a hospital (AOR: 2.95; 95% CI: 1.24-6.93). Adherence to the WHO-recommended eight-contact ANC model was low among postpartum women in the Sululta district. Interventions led by the regional and district health offices, health facility managers, healthcare providers and community health extension workers should focus on improving maternal satisfaction with ANC service, reducing waiting times and increasing access for rural populations through targeted counseling and community awareness initiatives to enhance adherence.
Poor indoor air quality (IAQ) in schools is of particular concern as it can negatively impact children's cognitive development, health, and well-being. Measuring IAQ-related parameters, assessing children's internal and external exposures, and developing solutions for reducing exposure are therefore critical to protecting children's health. The use of air purifiers can be a good mitigation strategy to improve IAQ in classrooms, but their association with health effects and cognitive outcomes in children remains unclear. The LEARN crossover study protocol aims to address this gap by evaluating the impact of a novel air purification intervention on IAQ, biomarkers of exposure, clinical health parameters, and cognitive performance in primary school children (n = 450). In this single-blinded (teachers/students blinded) crossover study conducted in primary school classrooms in Belgium, Denmark, and Greece, the participating classrooms are cluster-randomized via a computer-generated sequence to the order of receiving the intervention and the sham intervention (air purifiers operated with or without filters), with a washout period between study phases. Active and passive measurements of volatile organic compounds (VOCs) and aldehydes, active measurements of polycyclic aromatic hydrocarbons (PAHs), as well as monitoring of particles (PM10, PM2.5, ultrafine particles, black carbon) and microclimate parameters are performed. At pre-defined timepoints, urine samples, blood samples, and skin swabs are collected and assessed for exposure biomarkers and health parameters. To ensure cross-site comparability, children's cognitive performance is evaluated using Danish, Greek, and Dutch versions of standardized tests: the Continuous Performance Test, Symbol Digit Modalities Test, Memory Span Task, STROOP Task, and Signal Detection Test. Additional health assessments include anthropometric and blood pressure measurements, and psychological well-being questionnaires. Statistical analyses include mixed models to explore exposure-response relationships between children's external and internal exposures, health, and cognitive outcomes. This protocol presents a comprehensive approach to assess indoor air exposures and the impact on children's health and cognition, as well as the effectiveness of the air purification strategy. The results of this study can provide a reference for novel IAQ remediation strategies in schools and help promote the application of human biomonitoring in risk assessment of children's indoor exposure. https://clinicaltrials.gov/study/NCT06197477, Identifier NCT06197477.
Adolescent pregnancy poses serious biopsychosocial challenges and increases maternal and infant health risks. Continuity of Midwifery Care (CMC) is essential to ensure optimal outcomes, yet its implementation for adolescent pregnancies remains suboptimal. This study aims to explore gaps in CMC for adolescent pregnancies and provide recommendations for improvement. This qualitative study was conducted in Padang, West Sumatera Indonesia, from January to June 2022. Using purposive sampling, participants included adolescent pregnant women (n = 4), Private Midwifery Practices (n = 4), maternal and child health (MCH) program holders (n = 3), a maternal care coordinator midwife (n = 1), and a public health division head (n = 1). Data were collected through in-depth, semistructured interviews and analyzed thematically using an inductive approach with triangulation to ensure rigor. Three key themes emerged: (1) Management continuity; care primarily focused on physical health, with limited assessment of psychological well-being. Diagnosis and care planning neglected adolescent-specific needs. Emotional support was minimal during implementation and follow-up. (2) Informational Continuity; Health information was general, lacking relevance to adolescent risks. Verbal explanations and the Maternal and Child Health Handbook were commonly used, with limited digital tools. Retention barriers included judgment, low confidence, and lack of adolescent-friendly materials. (3) Relational Continuity; Midwifery care lacked psychological support and was disrupted by staff rotation, reducing consistency. Family and partner support were often limited, affecting adherence and safety. To improve CMC for adolescent pregnancy in Indonesia, it is essential to integrated psychological support, develop adolescent-specific guidelines, provide personalized health education and strengthen midwife-client continuity.
Population ageing has increased the need for informal caregiving, particularly in Spain, where family care remains central. Informal caregiving has been associated with poorer mental health outcomes. This study aims at investigating the evolution of depressive symptoms over a 10-year period among older adults according to caregiving role. This longitudinal study used data from waves 4 (2011) to 9 (2021/2022) of the Spanish sample of the Survey of Health, Ageing and Retirement in Europe (n = 3482). Depressive symptoms were measured with the EURO-D scale, while informal caregiving status was defined as regular unpaid care provided to household members. Sex-stratified generalized linear mixed models examined trajectories of depressive symptoms over time, including an interaction between wave and caregiving status, while adjusting for sociodemographic and health variables. Caregivers showed worse baseline health status and significantly higher levels of depressive symptoms, with female caregivers reporting the highest (4.5 vs 2.6, p < 0.001). Among male caregivers, depressive symptoms increased significantly in wave 5 (β̂ = 0.281, p = 0.003), wave 6 (β̂ = 0.407, p < 0.001), and wave 8 (β̂ = 0.344, p = 0.014). Among female caregivers, depressive symptoms increased progressively over time, reaching statistical significance in wave 8 (β̂ = 0.230, p = 0.036) and wave 9 (β̂ = 0.366, p = 0.002). Caregivers showed different trajectories of depressive symptoms over time compared with non-caregivers, with patterns differing by sex. These findings emphasize the need for enhanced support for informal caregivers and for public health interventions addressing sex-related disparities in mental health among older caregivers.
Adolescent substance use is a significant public health concern, though the scope of the problem is difficult to ascertain given reliance on self-reported substance use information. Recent, large cohort studies in adolescents and young adults suggest underreporting of substance use. Analyses here aimed to determine concordance between self-reported substance use and biochemical verification through hair samples and to estimate prevalence of the three most reported substances used by adolescents. Observational cohort longitudinal study design. Liquid chromatography and gas chromatography tandem mass spectrometry (LC or GC/MS-MS) were used to test hair samples for biochemically verified substance use, with results compared with self-reported substance use. Multi-step weighting methods estimated prevalence trends of cannabis, alcohol and nicotine use over time, adjusting for discrepancies in sample representation due to recruitment demography, missed visits and hair sample testing. Data came from the United States nationwide Adolescent Brain Cognitive Development Study (n = 11 868; age 9-10 at baseline, age 15-16 at wave 6). Participants were followed annually, with data here from 2016 to 2024. Hair samples objectively detected at least several days of substance use in a subsample of participants (nsamples = 11 865; n = 6133 unique participants). Participants self-reported past 3-month substance use. Sociodemographic, individual and environmental-level factors were included in inverse propensity weights to estimate prevalence rates of cannabis, alcohol and nicotine use in teens. Concordance between self-report and toxicological data improved with age (for cannabis, ages 11-12 = <1%; ages 15-16 = 45%). Weighted estimates of biochemically verified substance use indicated 7.1% [95% confidence interval (CI) = 6.0-8.3] of 15-16 year olds engaged in biochemically detected cannabis use, 0.2% (95% CI = 0.1-0.4) used alcohol and 4.7% (95% CI = 3.7-6.0) used nicotine. In United States youth, the concordance between self-reported substance use patterns and biochemical verification improves with age. Biochemical verification reflects substantive cannabis and nicotine use by United States youth aged 15-16, supporting combining toxicological and self-report data to improve identification of substance use in youth when possible.