Healthcare-seeking behavior is a key factor in how well a health system performs and how fair it is. In Saudi Arabia, public healthcare services are free, yet many people still choose private healthcare, especially in cities like Riyadh. It is important to understand why people seek care from private clinics to help shape health policies, distribute resources better, and improve services across the healthcare system. This study aimed to examine the frequency of private healthcare use, defined as the reported usual or concurrent use of private healthcare services, and to identify sociodemographic, behavioral, and health-related factors associated with this choice among adults in Riyadh, Saudi Arabia. A cross-sectional study was carried out in Riyadh from March to July 2023 using a multistage cluster sampling method. We randomly selected 48 government primary healthcare centers and invited adults aged 18 and older who visited these centers to participate. We collected data electronically with a validated questionnaire that covered sociodemographic details, patterns of healthcare use, reasons for choosing private healthcare, behavioral risk factors, and existing health conditions. We used multivariate logistic regression analysis to find independent predictors of private healthcare use, reporting adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Of 14,239 participants, 72.4% reported using private healthcare services either as a usual source of care or alongside public services. The multivariable analysis revealed several factors to be positively related to private healthcare utilization. Those who were married were more likely to use private healthcare services (AOR 1.23, 95% CI 1.11-1.36). Those with insurance coverage were threefold higher odds of private healthcare use (AOR 3.51, 95% CI 3.13-3.94). Smokers were more likely to seek private healthcare (AOR 1.60, 95% CI 1.45-1.77) than non-smokers, and those who exercised reported increased utilization (AOR 1.83, 95% CI 1.67-2.00). Obesity was also positively related to private healthcare utilization (AOR 1.38, 95% CI 1.12-1.71), and those with heart disease had substantially higher odds of using private healthcare services (AOR 2.09, 95% CI 1.59-2.76). Private healthcare use in Riyadh is common and associated with insurance coverage, marital status, behavioral factors, and certain chronic conditions. These findings provide descriptive insights into factors related to private healthcare utilization among public PHC attendees in Riyadh, without implying causal effects or policy recommendations beyond the scope of the data.
Early adolescence is key for adopting healthier lifestyles, yet disadvantaged communities often lack resources to support these changes, perpetuating health inequities. Schools play a crucial role in promoting physical activity and healthy eating. eHealth solutions, like online platforms, offer scalable, cost-effective ways to deliver interventions. These platforms can also enhance adolescent engagement and help bridge health resource gaps. The ePro-Schools project aims to co-design and test an eHealth platform to promote healthy habits among adolescents in socially disadvantaged settings. A randomized controlled trial (RCT) will be carried out with the participation of 6 secondary schools (three controls and three intervention), with a sample size estimated at 1000 students of Central Catalonia (Spain). In the intervention schools, focus groups sessions and meetings with stakeholders have been conducted to co-create the ePro-Schools eHealth platform. Students and school staff are pilot testing the platform to assess the platform's usability, functionality, and layout. Finally, the RCT will be conducted, in which the intervention group will have full access to the ePro-Schools platform (an interactive and informative platform), while the control group will only have access to the informative platform with health literacy content on physical activity, nutrition, and healthy habits. In both groups, adolescents will complete validated questionnaires at baseline, post-intervention, and at the six-month follow-up to assess their physical activity and eating habits, including depressive symptoms, quality of life, social isolation, and mental health. Sociodemographic characteristics will also be collected. Implementation, effectiveness, and cost-effectiveness analysis will be performed. The ePro-Schools project introduces a co-designed eHealth platform that integrates physical activity and healthy eating promotion within schools. The intervention aims to enhance adoption, relevance, and sustainability across diverse settings. ePro-Schools project could reduce health inequalities, improve adolescents' physical and mental well-being, and strengthen daily health habits. The model's scalability and embedded implementation planning may support long-term integration into school systems, informing future policies and contributing to educational engagement, reduced disease risk, and broader population health impact. This trial is registered in ClinicalTrials.gov, with the registration number NCT06792461.
Public Health Emergency Workforce (PHEW) plays a significant role in the detection and rapid response to emerging diseases, thus helping countries manage global threats. In line with the International Health Regulations' call for strengthening national capacities, field epidemiology training programs (FETPs) and rapid response teams (RRTs) have been developed to enhance countries' preparedness and response capacities. This scoping review synthesizes the evidence on available FETPs and RRTs and on their effectiveness as well as the challenges they face. A scoping review was conducted using EMBASE, Ovid Medline and Scopus databases in addition to the grey literature for studies published after year 2000, in the English language. Studies were selected by two independent reviewers and data were extracted into an excel sheet. Included manuscripts were analyzed through a narrative synthesis. Four thousand one hundred ten studies were identified from the three peer-reviewed databases and six articles from the grey literature. Finally, 67 studies were included in the review comprising 47 identified through our search and 20 sourced from the references. The studies on PHEW training included FETPs encompassing those with laboratory and veterinary focus, and training on rapid response. Enhancement in learning acquired, course satisfaction, application of skills in workplace and engagements in key emergency response activities were found. However, lack of funding and a standardized curriculum were still among the most common challenges facing FETPs and RRTs. While PHEW training including FETPs and RRTs are essential for building resilience against health threats, financial challenges, lack of standardized curricula and operating procedures hinders their effectiveness. Integrating One Health and laboratory skills into FETPs are vital, as seen during the COVID-19 pandemic response. Governments should work towards increasing funding and incentivizing graduate retention. They should also collaborate with organizations such as the International Association of National Public Health Institutes (IANPHI) and the Global Field Epidemiology Partnership (GFEP) to establish standardized curricula for FETP and RRT.
Men show a higher mortality than women, especially at a young age (between 15 and 39 years). They are more likely to engage in unhealthy behaviours and tend not to implement preventative efforts or to seek help. While (mental) health promotion programmes aim to foster healthy behaviours, men often do not feel addressed by them and are therefore reluctant to participate. This synthesis aims at drawing together barriers to and facilitators of male participation in (mental) health promotion programmes and identifying how to best address men in health communication and programme promotion. This rapid qualitative evidence synthesis includes a sample of 21 studies. 18 are qualitative studies and 3 are mixed-methods studies with separately reported qualitative findings that captured the perspectives of males aged 12 to 79 years and of professionals working in men's health on the barriers to and facilitators of participation in (mental) health promotion programmes and on preferred health communication. Studies were purposefully selected to maximise variation across interview content, context, and participant characteristics (e.g., age, occupation). The selection was restricted to studies published between 2015 and 2025. Gender norms were one of the main barriers to participation in men's (mental) health promotion programmes. Preferably such programmes should be integrated into settings attractive or familiar to men, such as sport clubs or handicraft workshops, or the workplace. Peers and peer support played a crucial role within men's health promotion and were found to facilitate positive behavioural changes. When reaching out to men, clinical and stigmatising terminology should be avoided in favour of action-oriented language that emphasises control and practical solutions while keeping the messaging simple and focused on tangible benefits. Health promotion programmes for men require embedding interventions within male-relevant contexts, such as sports, workplaces, and peer networks, that ease participation and reduce stigma. To reach and benefit men, communication strategies should use relatable, non-stigmatising language from credible messengers and should frame self-care as compatible with masculine identities.
The prevalence of dental and oral diseases is increasing globally, yet the utilization of dental services has not shown a corresponding rise. Cost remains a major barrier, as dental care ranks among the four most expensive health services globally. These costs are shaped by each country's health payment system, which plays a critical role in determining access to healthcare. This scoping review aims to map the existing evidence on oral health payment systems and examine how these systems influence access, utilization, equity, and financial protection in different settings. A scoping review was conducted of articles published between 2018 and 2025 that examined payment systems for oral health services. Literature searches were performed using PubMed, Google Scholar, and ScienceDirect. Eleven eligible articles revealed two main types of payment systems: insurance-based and non-insurance-based systems. Insurance models included capitation, global budgets, and reimbursement schemes, whereas non-insurance models relied on out-of-pocket or fee-for-service (FFS) payments. The FFS approach, commonly used in countries such as Saudi Arabia, the Netherlands, and Cameroon, imposed significant financial strain on patients. Insurance systems combining public and private schemes were implemented in multiple countries, including the United States, Saudi Arabia, Denmark, the United Kingdom, Hungary, Ireland, Italy, the Netherlands, Scotland, Spain, France, Germany, Romania, and Indonesia. Service coverage varied by country; for instance, government insurance in the Netherlands excluded dental care. Capitation for preventive services has been implemented in Sweden, Australia, and Indonesia. Cameroon did not have a national health insurance system (NHI). Moreover, the Netherlands and Spain had NHIs that did not cover dental health services. No single dental health financing model is universally applicable, as its effectiveness depends on government policies and local contexts. Payment systems should be designed to increase access and alleviate the financial burdens of low-income populations.
Falls are the leading cause of accidental injury among older adults, 30% of community-dwelling adults aged 65 and over fall each year, with nearly half occurring outdoors. These falls are complex, understudied, and insufficiently addressed in current age-friendly cities or walkability frameworks. This study aimed to build interdisciplinary consensus on risks, preventive actions, and barriers to fall prevention in outdoor public spaces through a Delphi process. A three-phase Delphi study was conducted with 64 participants in round 1, 60 in round 2, and 49 in round 3, including four expert groups: older adults who had fallen outdoors, health and research professionals, urban planners, and decision-makers (local and regional policy-makers, elected officials, and public-space managers involved in urban planning). Phase one collected open responses on risks, preventive actions (modification of physical layout, public-space management, and behavior-related factors), and barriers to these actions. Responses were synthesized using AI-assisted analysis with systematic human validation. In phases two and three, the relevance of 124 propositions were rated on a 10-point Likert scale. Consensus was defined as ≥ 70% of ratings ≥ 7/10 and interquartile range ≤ 2.5. Consensus was reached for key intrinsic factors such as gait and balance impairments, visual and vestibular deficits, cognitive decline, and polypharmacy, as well as for environmental factors including irregular or inappropriate surfaces, obstacles, or signage, and crowding. Highly relevant preventive actions included integrating fall prevention into street and sidewalk design, training urban planning professionals, awareness campaigns, systematic maintenance, safer crossings, participatory co-design public-space adaptations and urban design features involving older adults and local stakeholders, and improved data monitoring through surveillance, mapping, and sharing of fall-related and environmental risk information. Main barriers were insufficient budgets, high costs, limited integration of fall prevention into planning priorities, and lack of evaluation of the impact of implemented actions. Outdoor fall prevention is a transversal challenge requiring integration of public health and urban planning. This Delphi highlights actionable priorities to embed fall prevention in local and national strategies, in particular in rapidly aging regions.
Improving adolescent mental health is a priority for public health, with Internet addiction (IA) being notably linked to these problems. In the post-pandemic era, increased screen time and social isolation persist, albeit in a more normalized form, potentially continuing to affect adolescent mental health. The current study aims to examine the relationship between IA and mental health problems among Chinese adolescents in the post-COVID-19 pandemic era. A cross-sectional survey was conducted in two cities of Henan Province, China, between April and May 2023. A total of 8176 junior high school students were recruited from 6 schools using a stratified random cluster sampling method. The associations between IA and mental health problems were assessed using ordinary least squares model and propensity score matching, specifically employing 1:1 nearest neighbor matching, radius matching, and kernel matching. The average treatment effect on the treated (ATT) was reported. The detection rate of IA was 19.37% (1584/8176) in this study . Before matching, IA was correlated with elevated levels of depression (β = 2.766, p < 0.001) and anxiety (β = 2.338, p < 0.001), after adjusting for other variables. After matching, participants exhibiting IA were more likely to experience depression and anxiety compared to those who were not addicted. Nearest Neighbor Matching: ATT for depression and anxiety was 3.026 (95% CI: 2.609 ~ 3.443) and 2.472 (95% CI: 2.096 ~ 2.848); Kernel Matching: ATT for depression and anxiety was 2.980 (95% CI: 2.654 ~ 3.396) and 2.448 (95% CI: 2.072 ~ 2.824); Radius Matching: ATT for depression and anxiety was 2.886 (95% CI: 2.470 ~ 3.302) and 2.349 (95% CI: 1.973 ~ 2.725). IA was associated with depression and anxiety among Chinese adolescents in the context of the post-COVID-19 pandemic era. Policymakers, parents, and school personnel should prioritize addressing IA to decrease mental health problems in this population.
Adherence to integrated 24-hour movement guidelines (moderate-to-vigorous physical activity, recreational screen time, and sleep) is low among young people but has been linked tolinked to better health-related quality of life (HRQoL). However, the evidence is largely cross-sectional and may not adequately capture factors that change over time. This study examined whether adherence across childhood and mid-adolescence is associated with HRQoL in late adolescence, whether adherence predicts HRQoL at subsequent wave, and whether these associations differ by sex. Data from the Longitudinal Study of Australian Children (LSAC; Kindergarten cohort), Waves 2-7 (n = 4,463 at age 6-7 years, followed to 16-17 years) were analysed. Adherence to all three guideline components was derived from time-use diaries at each wave. HRQoL (physical, psychosocial and total; 0-100) was measured using the Pediatric Quality of Life Inventory (PedsQL). We used structural nested mean models fitted via g-estimation to estimate (i) the cumulative association per additional wave of adherence from ages 6-15 with HRQoL at ages 16-17, and (ii) lead-lag associations between adherence at wave t and HRQoL at wave t + 1, adjusting for baseline and time-varying covariates. Sex-stratified analyses were also conducted. Adherence declined from 24.5% at ages 6-7 to 7.2% at ages 14-15. Each additional wave of adherence was associated with higher total HRQoL at ages 16-17 (mean difference 0.81 PedsQL points; Bonferroni-adjusted 95% confidence interval (CI) 0.10 to 1.51). In lead-lag analyses, adherence predicted higher HRQoL at the subsequent wave for physical functioning (1.73; 0.90 to 2.53), psychosocial functioning (1.33; 0.58 to 2.08) and overall HRQoL (1.37; 0.68 to 2.06). In sex-stratified analyses, significant next-wave associations were observed for psychosocial functioning (1.10; 0.12 to 2.06) and overall HRQoL (1.22; 0.28 to 2.06) in boys, and for physical functioning (2.33; 1.02 to 3.56), psychosocial functioning (1.60; 0.63 to 2.64) and overall HRQoL (1.54; 0.57 to 2.53) in girls; in boys, each additional wave of adherence was also associated with higher overall HRQoL at ages 16-17 (1.15; 0.28 to 2.07). Given the low and declining prevalence of adherence, these findings suggest that the 24-h movement guidelines may be relevant to public health, health promotion, and preventive care efforts aimed at supporting HRQoL across childhood and adolescence.
Although healthy lifestyles are prioritized for the self-management of chronic low back pain (LBP) and neck pain (NP), the individual and combined associations of metabolic health and lifestyle with LBP, NP, and related functional limitations remain unclear. This study aimed to evaluate these associations and support risk stratification across different metabolic and lifestyle profiles. This cross-sectional study used data from the US National Health and Nutrition Examination Survey (1999-2018) to analyze two cohorts: pain cohort (n = 10286) and functional limitation cohort (n = 28513). Metabolic factors included abdominal obesity, hyperglycemia, hypertension, and dyslipidemia. Lifestyle factors included smoking, alcohol consumption, diet, and physical activity. Outcomes, including LBP, NP, and back- or neck-related functional limitation (BN-FL), were assessed by self-reported questionnaires. Associations between risk factors and outcomes were assessed using multivariable logistic regression. Individuals with poor metabolic-lifestyle status had the highest prevalence of LBP (42.6%), NP (21.4%), and BN-FL (17.6%). Physical inactivity showed the largest estimated population-attributable fraction (PAF) for LBP and NP (20.8% and 20.5%, respectively), while abdominal obesity (15.1%) and smoking (14.0%) showed the largest estimated PAFs for BN-FL. Poor metabolic status was associated with higher odds of LBP (OR = 1.470, 95% CI: 1.227-1.760) and BN-FL (OR = 2.404, 95% CI: 1.977-2.923), while poor lifestyle was associated with higher odds across all outcomes. Worsening lifestyle status was consistently associated with higher odds of LBP across all metabolic strata. The combination of poor metabolic-lifestyle status was associated with the highest odds of LBP (OR = 3.435, 95% CI: 2.026-5.824) and BN-FL (OR = 4.378, 95% CI: 2.347-8.167). Both metabolic health and lifestyles were associated with LBP and BN-FL, while only lifestyles were linked to NP. Combined unfavorable metabolic and lifestyle profiles were associated with higher odds of LBP and BN-FL, underscoring the importance of both metabolic and lifestyle modification.
Borderline personality disorder (BPD) is highly stigmatized. Stigma, including clinicians' resistance, stigmatizing attitudes, and discriminatory beliefs, could be mitigated by a better knowledge of the disorder. This study evaluates the impact of a one-day training session on stigmatization by health personnel (HP). This two-center study prospectively included 172 HP who completed a face-to-face interactive training day embodying dialectical and destigmatizing positions. Elements of psychoeducation, emotional dysregulation model and practical tools were presented. Stigma attitudes and open-mindedness were assessed by the Opening Minds Stigma Scale for Health Care Providers self-questionnaire (OMS-HC); and beliefs (feeling of incompetence, pejorative perception of prognosis, guilt) by a custom Beliefs Questionnaire (BQ). Scores before and immediately after the training were compared using Student's paired t-test. Most HP worked in psychiatry (69%) and had no prior education on BPD (89%). Nurses were most represented (35%), ahead of nursing assistants (22%), psychologists (18%), and psychiatrists (10%). All scores decreased after training (p < 0.001): total OMS-HC (MD ± SD=-4 ± 8), attitude sub-score (2 ± 4), disclosure sub-score (1 ± 4); total BQ (6 ± 9), nurse feeling of incompetence sub-score (4 ± 4) and pejorative perception of prognosis sub-score (-2 ± 3). A one-day training session reduces HPs' stigmatizing attitudes and beliefs and has a positive impact on knowledge and open-mindedness about BPD patients. Training can lean on education about BPD nature, treatment and prognosis, experience-sharing with practical cases, and testimonies. It would enable compassionate and destigmatizing care. Further research is needed about the clinical impact of BPD training and its wider implementation in mental healthcare settings.
The evolving global disease landscape, in conjunction with the significant impact of an aging population, has led to mental‒physical multimorbidity, imposing unprecedented pressures on healthcare systems and economies. This study aimed to investigate the interrelationships among multimorbidity, depression, and catastrophic health expenditure (CHE) and to test whether the intensity of CHE mediates these links. The analysis employed data from the China Health and Retirement Longitudinal Study (CHARLS), which conducted a longitudinal survey from 2011 to 2018, tracking 5,274 participants aged 45 years and older over a seven-year timeframe. Multimorbidity was ascertained through self-reported data from participants, whereas depression was evaluated via the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The intensity of CHE was calculated as the ratio of out-of-pocket (OOP) payments to the capacity to pay (CTP), adjusted for a catastrophic threshold of 40%. The relationships among the three variables were analysed via an extension of the random intercept cross-lagged panel model (RI-CLPM), which includes covariates to predict the observed variables. Mediation via the intensity of CHE was tested using 5,000 bootstrap resamples. At the between-person level, multimorbidity and depression were positively correlated (Model 1 r = 0.349; Model 2 r = 0.246; both p < 0.001), whereas the intensity of CHE showed negligible between-person associations with either variable. At the within-person level, all variables showed significant autoregressive stability, with multimorbidity demonstrating the strongest persistence (β = 0.808 in Model 1 and 0.936 in Model 2). Cross-lagged associations were clearly asymmetric, with prior multimorbidity exerting the largest prospective effects on the intensity of CHE (β = 3.028) and subsequent depression (β = 0.646 in Model 1 and β = 0.789 in Model 2), whereas prior depression and prior intensity of CHE had much smaller effects on later multimorbidity. Mediation analyses indicated that the intensity of CHE (T) partially mediated the association from multimorbidity (T‑1) to depression (T + 1) (indirect effect = 0.063, 95% CI [0.042, 0.084]), but showed negligible mediation for the reverse pathway from depression (T‑1) to multimorbidity (T + 1) (indirect effect = 0.001, 95% CI [0.000, 0.001]). The study identified asymmetric bidirectional relationships among multimorbidity, depression, and the intensity of CHE in Chinese middle-aged and older adults, with effects predominantly running from multimorbidity to increased intensity of CHE and later depression; the intensity of CHE explained only a small portion of the multimorbidity→depression effect and virtually none of the depression→multimorbidity pathway. Policies that integrate multimorbidity management with routine depression screening could help reduce the combined physical, psychological, and financial burdens among middle-aged and older adults.
Despite decades of mass Ivermectin distribution, onchocerciasis transmission persists in Cameroon. Comorbidities with non-communicable diseases (NCDs) and gaps in treatment uptake may contribute to the sustained transmission of this disease. This study assessed the prevalence of onchocerciasis, its comorbidity with selected NCDs, and determinants of continued transmission in Bafut Health District, Cameroon. A community-based cross-sectional study with health facility-based recruitment was conducted from June to July 2024 among 282 adults aged 30 years or older who had resided in Bafut for at least 5 years. Data on sociodemographic, NCD history, onchocerciasis knowledge, and ivermectin uptake were collected using a structured questionnaire. Laboratory investigations included skin snip microscopy, nodule palpation, blood pressure measurement, and venous blood tests for diabetes and rheumatoid arthritis. The relationship between categorical variables was analysed using the Chi-square test and logistic regression at the 5% significance level. Of the 282 participants examined, 43 (15.2%) had palpable nodules, 17 (6.0%) were positive on skin snip for Onchocerca volvulus, and 6 (2.1%) had both palpable nodules and positive skin snip results. Onchocerciasis infection showed significant associations with sex, age group, marital status, and educational level (p < 0.05). Hypertension (27.8%) and rheumatoid arthritis (25.9%) were the most common comorbidities among infected individuals. Ivermectin uptake was high, with 94.3% of participants reporting that they had ever taken ivermectin at least once during previous community-directed treatment with ivermectin (CDTI) rounds. In comparison, a small proportion (5.7%) declined due to illness or blurred vision. Participants with tertiary education had approximately five times higher odds of taking ivermectin compared to those with no formal education (aOR = 4.62, 95% CI: 1.18-18.12, p = 0.028). Similarly, individuals who had lived in the community for more than 10 years had five times higher odds of adhering to ivermectin treatment than recent residents (aOR = 5.03, 95% CI: 1.11-22.8, p = 0.036), primarily due to a refusal of ivermectin, mainly because of side effects. Nearly half of the participants (48.9%) demonstrated poor knowledge of onchocerciasis. Onchocerciasis remains present in Bafut, with ongoing transmission. Infection was associated with socio-demographic and behavioral factors. Non-communicable diseases were observed; however, no causal relationship can be inferred. Strengthening ivermectin uptake and health education may improve control. Not applicable.
Burkina Faso is experiencing a rapid nutritional transition, yet evidence on the double burden of malnutrition (DBM) at household and individual levels remains limited. This study aimed to estimate the national prevalence of DBMs and identify associated factors with a particular focus on the most common type of DBM. We used data from the 2021 Burkina Faso Demographic Health Survey, a nationally representative cross-sectional survey. The analysis included 4119 households with 5146 women of reproductive age (15-49 years) and 4114 mother-child pair. Eleven (11) potential combinations of maternal and child nutritional status indicators, defined according to WHO standards (anemia, stunting, wasting, underweight, and overweight/obesity) were assessed. Weighted descriptive and bivariate analyses were conducted to identify the most prevalent double burden of malnutrition (DBM) combination, which was selected as the primary outcome. Factors associated with this outcome were examined using multivariate logistic regression with four nested models incorporating household, maternal, and child level characteristics. Overall, 72% of children were affected by anemia, 23% by stunting, and 17% were in underweight condition. Among women, 53% were living with anemia, 17.9% with underweight, and 7.6% with obesity. The predominant DBM form was children with anemia combined with overweight/obesity in women, affecting 14.3% of households. The individual prevalence of anemia and overweight/obesity in women was 9.47%, while stunting paired with overweight in children affected 3.6% of households. Multivariate analysis identified several independent of the predominant form of DBM: region (aOR = 1.94, 95% CI = 1.09-3.45 for Sahel region vs. Boucle du Mouhoun), household wealth (aOR = 3.1, 95% CI = 1.74-5.53 for richest vs. poorest), place of residence (aOR = 0.6, 95% CI = 0.45-0.79 for rural vs. urban), women's age (aOR = 6.48, 95% CI = 2.53-16.61 for 35-39 years compared to 15-19), and women's occupation (aOR = 2.71, 95% CI = 1.5-4.87 for professional manager vs. not working). The most common DBM, child with anemia and maternal overweight/obese women affect more than one in seven households in Burkina Faso, with a higher risk in urban and wealthier settings. Integrated "double duty" interventions are urgently needed to address both mother with overweight/obesity and child with anemia while addressing the structural drivers of nutrition transition and broader social determinants of health.
In Ethiopia, a substantial proportion of women experience physical, psychological, or sexual violence perpetrated by their husbands or intimate partners. There is limited evidence on interventions aiming to improve awareness, alter attitudes, and control behavior related to IPV in Ethiopia. Therefore, this study aimed to evaluate the effectiveness of community-based health education (CBHE) targeting couples on knowledge, attitudes, and controlling behavior among women in Hadiya zone, central Ethiopia. A community-based, parallel-group, two-arm cluster randomized controlled trial design was employed to evaluate the effect of a CBHE intervention on knowledge, attitude, and controlling behavior related to IPV in Hadiya zone, central Ethiopia. A total of 432 women (216 in the intervention groups and 216 in the control groups) were involved in the study. The intervention was provided for couples over a period of six consecutive months. Generalized Estimating Equation (GEE) and difference-in-difference analysis were conducted to evaluate the effectiveness of the intervention on the outcomes. About 94.4% of the mothers in the intervention groups and 95% of the women in the control groups were available for intention-to-treat analysis at the end of the intervention. Women in the intervention groups were about 5 times more likely to have good knowledge of IPV than those in the control groups (AOR = 4.8; 95% CI 2.9-7.9). Mothers in the intervention were 70% less likely to have a supportive attitude towards wife-beating compared to mothers in the control group (AOR = 0.3; 95% CI 0.2, 0.5). Likewise, mothers in the intervention groups were 60% less likely to justify controlling behavior from their husbands compared to those in the control groups (AOR = 0.4; 95% CI 0.3, 0.7). This study highlights that CBHE intervention led to a significant improvement in participants' knowledge of IPV against women. It also resulted in a marked reduction in the acceptance of wife-beating and justification of controlling behaviors. These findings provide strong evidence to support the broader scale-up of this intervention. This trial was recorded in the ClinicalTrials.gov registry with the identifier NCT05856214 on May 4, 2023.
The recent introduction of the right to oncological oblivion in some European states raises critical issues. While designed to protect cancer survivors from discrimination, this right may compromise occupational health surveillance for workers exposed to carcinogenic hazards. This commentary raises questions for future policy and research.
University students are at a key life stage in their lives for the development of health-related behaviors, yet few studies have explored their overall lifestyle using multidimensional tools. The present exploratory study aimed to assess lifestyle through the Short Multidimensional Inventory Lifestyle Evaluation for University Students (U-SMILE) and to determine its sociodemographic and health correlates in a sample of Spanish university students. This cross-sectional analysis was based on baseline data collected at Universidad Loyola Andalucía (Spain) as part of the UNIversity students' LIFEstyle behaviors and Mental health (UNILIFE-M) multicenter project during the 2024 academic year. A total of 671 first-year students (median age = 18 years, 50.1% female) completed validated self-report questionnaires assessing lifestyle behaviors, sociodemographic variables, body mass index (BMI), and diagnosed health conditions. Lifestyle was evaluated using the U-SMILE. Descriptive statistics and robust linear models were applied to identify associated factors. The median overall U-SMILE score was 69.0 points (interquartile range [IQR] = 64-73). Older students (> 18 years old) presented lower scores (unstandardized beta coefficient [B] = -1.59; p = 0.006), as did those enrolled in non-health science degrees (B = -1.47; p = 0.005), single students (B =-1.40; p = 0.013), and those with a mental disorder (B = -2.79; p = 0.001). Heterosexual students scored higher than non-heterosexual peers (B = 2.49; p = 0.007), and students with normal weight showed better results than underweight participants (B = 2.08; p = 0.020). Domain-specific analyses revealed that males scored higher in physical activity, sleep, and social support, whereas females performed better in stress management. Students residing outside university accommodation generally achieved higher domain scores. These exploratory findings suggest that lifestyle, as measured by the U-SMILE, is associated with several sociodemographic and health-related characteristics in Spanish university students. Lower scores were associated with older age, enrolment in non-health science degrees, underweight status, non-heterosexual orientation, single marital status, and the presence of a diagnosed mental disorder. Sex, BMI status, accommodation, and employment status were associated with specific lifestyle domains.
Many Nigerian adolescents lack knowledge about ideal oral hygiene practices, which has contributed to the high prevalence of poor oral health among them. Delivering oral hygiene education using innovative methods, such as board games associated with having fun while also learning, would help increase their understanding and adherence to these practices. A board game operates on the principle that knowledge is acquired and retained through repetition and interaction with peers. This paper highlights the development of a culturally tailored board game based on the Health Belief Model (HBM) and validated for promoting oral hygiene among adolescents. To report how a board game on oral hygiene education for adolescents was developed and validated in southwestern Nigeria. A Research and Development (R&D) framework, incorporating Design-Based Research (DBR) principles, was used to develop a board game containing oral hygiene messages. The messages were adapted from the World Health Organisation's (WHO) promoting Oral Health in Africa manual. This was based on the HBM constructs and tailored to fit the African context. Over a period of three months, the development of the oral hygiene education board game involved five community oral health professionals, a paediatric dentist, and a psychologist specialising in adolescent health from the University of Ibadan. Students of the Faculty of Dentistry of the University of Ibadan, a graphic designer, and an artist also contributed to the project. The board game was developed using English, the official language of Nigeria. In the validation of this tool, the ease of use, duration of play, number of players, and its relevance to this age bracket's daily activities were largely considered. A 20 by 20 inches stainless steel framed board game with an acrylic surface containing 100 small boxes, featuring black-themed oral hygiene graphical illustrations and oral hygiene messages inserted in some boxes, were developed. In addition, 10 cards of size 8.5 cm by 5.4 cm containing oral hygiene questions on one side and the answers on the other side, as well as five colour-coded laminated player identification cards, were also created. Two dice and a plastic cup for throwing the dice were procured. The oral hygiene messages, questions and answers focus on enhancing adolescents' knowledge, attitudes and practices regarding optimal oral hygiene measures in Southwestern Nigeria. Oral hygiene messages, questions and answers were modified accordingly to ensure they were age appropriate and effective for promoting oral hygiene education through a board game. The board game was designed to be colourful to increase its appeal and encourage play. The development of the board game was informed by the need for context-specific, age-appropriate tools to enhance oral hygiene education among adolescents. The design stages integrated culturally relevant content, simple language, and familiar visual elements to improve accessibility and relatability. Interactive components were incorporated to promote peer-to-peer learning and active engagement. The board game was structured for ease of implementation in school-based and community settings. While not yet evaluated through formal intervention, its design features suggest potential to support improved oral health awareness and behaviour among adolescents, particularly in low and middle-income contexts.
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Online antenatal education is increasingly used to improve maternal psychological outcomes and preparedness for childbirth. However, evidence regarding its effectiveness remains inconsistent, particularly due to heterogeneity in intervention types and outcome measures. This systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, EMBASE, Scopus, Web of Science, CINAHL, and the Cochrane Library were searched from inception to March 2026. Randomized controlled trials and observational studies evaluating digital antenatal interventions in pregnant women were included. Outcomes included maternal depression, anxiety, fear of childbirth, self-efficacy, and small-for-gestational-age (SGA) incidence. Random-effects models were used, and standardized mean differences (SMDs) and odds ratios (ORs) were calculated. Heterogeneity was assessed using I² statistics. Twelve studies involving 4,982 participants were included. No significant effects were observed for depression (SMD = - 0.18; 95% CI: -0.45 to 0.09; I² = 86.5%; p = 0.188), anxiety (SMD = - 0.10; 95% CI: -0.66 to 0.46; I² = 92.8%; p = 0.723), or self-efficacy (SMD = 0.56; 95% CI: -0.11 to 1.23; I² = 90.6%; p = 0.102). A reduction in fear of childbirth did not reach statistical significance (SMD = - 0.53; 95% CI: -1.06 to 0.003; p = 0.051. No significant association was found for SGA (OR = 0.73; 95% CI: 0.17-3.14; p = 0.670). Substantial heterogeneity was present across outcomes, limiting the interpretability of pooled estimates. Current evidence, characterized by substantial heterogeneity, does not demonstrate statistically significant effects of online-based antenatal education on maternal depression, anxiety, or fear, nor on improving self-efficacy or preventing SGA infants. However, the high heterogeneity (I² >85% for most outcomes) indicates that these pooled estimates are exploratory, and clinically meaningful effects for specific intervention types cannot be ruled out. Findings should be interpreted cautiously.
Pediatric sepsis is a leading cause of global morbidity and mortality, yet high-resolution, granular subnational assessments remain scarce. Chile and Mexico are the only countries in Latin America that possess robust vital registration systems and open access databases with marginal levels of missing cases. This offers a unique opportunity to quantify the subnational burden of pediatric sepsis, identify healthcare system constrictions, and guide targeted public health interventions. This retrospective longitudinal study analyzed official hospital discharge and non-fetal death records of pediatrics (< 10 years old) from Chile and Mexico between 2014 and 2024. Age-standardized incidence (ASIR) and mortality (ASMR) rates, standardized ratios, and the mortality-to-incidence ratio (MIR), were calculated to assess mortality relative to subnational hospital output. A novel dynamic risk stratification matrix was developed to classify ICD-10 sepsis-related causes into four risk/severity quadrants based on year-specific ASIR and MIR indicators. A total of 656,234 discharges and 2,035 deaths in Chile, and 964,452 discharges and 77,252 deaths in Mexico were analyzed. Subnational trends were highly heterogeneous. Chile exhibited a predominantly low pediatric MIR (median < 1%) with isolated hotspots with significant structural deviations to the North. High-severity sepsis causes in Chile were relatively rare. Conversely, Mexico displayed an alarmingly high MIR (median 7.2%), with systemic persistency in States such as Chiapas and Nuevo León. Strikingly, high-severity causes in Mexico (e.g., unspecified septicaemia, bacterial meningitis) were highly frequent, accounting for 88-97% of pediatric sepsis deaths. Furthermore, systemic instances of code-specific MIR > 1.0 in Mexico suggest significant health system fragmentation and decoupling of hospital discharge from vital statistic registries. Pediatric sepsis in Latin America encompasses distinct realities, ranging from localized critical care gaps to high-lethality persistency. One-size-fits-all national policies may be inadequate. These findings advocate for precision public health, urging the deployment of decentralized, data-driven interventions and specialized resource allocation based on high-risk subnational hotspot identification.