搜索结果：Journal of epidemiology and global health

Prisoners have been identified in various international studies as one of the populations most vulnerable to mental health problems, yet the system's response has been notably limited. Enhancing the prison healthcare system to effectively address the challenges involved a complex undertaking compounded by the prevailing constraints and stressors faced by both inmates and prison staff, particularly in low- and middle-income countries such as Cambodia, where research is lacking. This study aimed to examine the perceptions of prison officials and healthcare staff regarding the health system's challenges in addressing prisoners' mental health and well-being and to explore strategies to improve the Cambodian prison healthcare system. Three focus group discussions were conducted in three prisons located in various regions of Cambodia with a total of 15 participants (11 prison health staff and four prison officials). A qualitative content analysis was applied to the collected data. Despite limited resources, the current prison healthcare system managed to provide basic healthcare, refer severe cases, and implement certain preventive measures. However, our study revealed a lack of mental health focus within the system, although certain emotional support was provided by healthcare staff to prisoners with mental health issues. Staff displayed commitment but expressed a sense of resignation due to skills and resource constraints. Participants recommended various strategies, such as increasing awareness and offering vocational training to prisoners and room leaders, intense training for healthcare staff, and enhancing governance and external support to strengthen the prison healthcare system to foster the mental health and well-being of prisoners. Addressing the mental health needs within the prison setting in Cambodia demands an urgent reform of the current prison healthcare system. This entails a comprehensive collaborative effort among governmental institutions, placing emphasis on enhancing the skills and capabilities of inmates, room leaders and prison staff. Moreover, it is also essential to establish stronger partnerships with external organizations to improve health system governance.

In East Africa and beyond, uncertainty regarding the underlying aetiology of febrile illnesses may result in inappropriate treatment. In our study, we aimed at enhancing our understanding of antibiotic use patterns, prescribing practices and factors influencing antibiotic use in this region by exploring the pathways of care for acute febrile illnesses in three countries in East Africa. Between October 2021 and February 2024, acute febrile patients were enrolled in six health facilities in the eastern Democratic Republic of the Congo (DRC), Kenya, and Uganda. Our cross-sectional study assessed sociodemographic and clinical data along with initial diagnosis and antibiotic treatment record, collected at the initial outpatient and enrolment visit. A total of 4,806 subjects were enrolled: 1,370 in DRC, 1,468 Kenya, 1,968 Uganda. About a quarter of the total population (23.3%) reported having already sought care before enrolment, most frequently in DRC (36.6%) at pharmacies (83.9%), and in Uganda (27.9%) at hospital (84.1%). Fifty percent of the DRC study population reported antibiotics use before enrolment, much higher than Kenya (3.3%) and Uganda (11.2%). Undifferentiated febrile illness was suspected in 37.5% of cases. At enrolment, in all countries, antibiotics were prescribed for 72.9% of cases (DRC 87.2% > Kenya 68.9% > Uganda 65.8%), with a non-negligible prescription of watch antibiotics (33.0%), prevalent in DRC (62.2%). In Kenya and Uganda, access antibiotics prevailed (80.9 and 67.1%, respectively). Prescription of watch antibiotics for undifferentiated febrile illnesses was strongly associated with a positive Widal test and access to hospital. Different patterns of access to care and antibiotic use for acute febrile illness were observed among countries. DRC had the highest level of pharmacy attendance prior to accessing the formal healthcare sector, as well as the highest reported use of antibiotics before formal care. It also showed the highest proportion of watch antibiotic use within the formal healthcare sector, even among patients without a confirmed diagnosis. Urgent targeted action is needed through effective and sustainable antimicrobial stewardship programs targeting both the formal and informal health sectors.

Snakebite envenomation remains a critical health challenge across the culturally and ecologically diverse sub-Saharan Africa (SSA). This study examined healthcare providers' (HCPs') knowledge, attitudes, and practices (KAP), and their determinants towards snakebite envenomation. A cross-sectional study was conducted across nine SSA countries using the validated Knowledge, Attitudes, and Practices of Snake Envenomation - Healthcare Providers Questionnaire (KAPSE-HCPQ). The fractional logistic regression was conducted to identify the factors associated with KAP. A total of 3,544 HCPs were enrolled through professional and digital networks. General practitioners represented approximately half of the participants (50.1%), whereas toxicologists were 3.2%. Considerable variations were reported across sub-Saharan countries. Uganda and Sierra Leone attained perfect median knowledge scores (100%, range: 93-100, 73-100, respectively) yet both demonstrated marked deficiencies in practice (range: 0-25% and 0-75%, respectively). Attitude scores ranged from the lowest in Ethiopia (79%, range: 75-85%) to the highest in Uganda (91%, range: 87-95%). Higher knowledge was significantly associated with advanced training, antivenom availability, curricular inclusion of toxicology, and self-study. Positive attitudes were significantly associated with prior clinical exposure, faculty-based education, informal information sources, and participants' countries. HCPs demonstrated incorrect practices, such as applying a tourniquet above the bite site, attempting to suck out the venom, incising the bite wound, and asking to run to the nearest health facility, which may accelerate the systemic venom spread. In contrast, pharmacists and HCPs unaware of management guidelines demonstrated poorer practices. The study identifies a substantial gap between theoretical knowledge and clinical practice among HCPs across SSA, with variations by country, profession, training, and resource availability. Urgent interventions training, protocol standardization, and reliable antivenom supply are required to improve snakebite outcomes. Although healthcare providers across sub-Saharan Africa generally have good knowledge and favorable attitudes towards snakebite management, their actual practices remain persistently inadequate, irrespective of their country’s income level.Systemic barriers - limited formal training, absent institutional protocols, unreliable antivenom supply, and weak referral systems- are highly associated with inadequate clinical practice.Urgent standardization of training protocols and reliable antivenom supply are needed to improve snakebite outcomes across the SSA region.

Traumatic brain injury is a major cause of death and disability globally, especially moderate/severe traumatic brain injury (MSTBI), which has a significant impact on public health. The aim of this study is to systematically analyze the epidemiological characteristics of MSTBI worldwide from 1990 to 2021. The study measures the burden of MSTBI by gender at global, regional, and national levels based on the results of the Global Burden of Disease study 2021. Using clinically recorded data, it estimates the proportion of each type of injury that requires medical care and is ultimately identified as MSTBI. We applied Global Burden of Disease disability weights to calculate YLDs. It uses Bayesian meta-regression tools for epidemiological modeling, combined with the socio-demographic index (SDI), a composite indicator composed of per capita income, education, and fertility rate, to stratify countries and regions at different levels of development. In 2021, there were 11.8 million new cases of MSTBI worldwide (95% UI, 10.12-13.78 million), with an age-standardized incidence rate of 144.08 cases per 100,000 population (95% UI, 123.64-168.14). In the same year, MSTBI led to 4.42 million YLDs (95% UI, 3.11-5.98 million), corresponding to age-standardized rates of 52.17 per 100,000 population (95% UI, 36.64-70.52). From 1990 to 2021, the estimated annual percentage change of the incidence of MSTBI dropped by 0.5% (95% UI, -0.56 to -0.43), and the estimated annual percentage change of YLDs decreased by 0.49% (95% UI, -0.54 to -0.45). In 2021, high-middle SDI region had the highest age-standardized incidence (171.69 per 100,000 population, 95% UI, 147.16-199.97), while the high SDI region showed the lowest (93.28 per 100,000 population, 95% UI, 77.46-113.95). Similar regional disparities were evident for prevalence and YLDs. Males consistently exhibited higher incidence, prevalence, and YLD rates than females across most age groups and SDI quintiles. This study offers a scientific basis for the prevention and control strategies of MSTBI worldwide and emphasizes the urgency of strengthening preventive measures and enhancing medical conditions, especially in low- and middle-income countries.

Lyme borreliosis (LB), commonly referred to as Lyme disease (LD), is a prominent global health issue, exhibiting a seroprevalence rate of 14.5%. Heightened incidence levels of LD have been recorded in parts of Europe, Poland, Eastern Europe, and the Baltic States. The research aimed to inform the cost of LD and post-treatment Lyme disease syndrome (PTLDS) in Ireland through results from a patient questionnaire, disease modelling, the construction of a patient roadmap, and attempts to arrive at prevalence calculation estimates based on local data. Patient data encompassed sociodemographic particulars, disease attributes, healthcare resource utilization, and the influence on their employment status. Of 301 patients, 210 were diagnosed with LD and/or a tick-borne infection (TBI), the cohort's average age was 40.07 (SD 13.5) (N = 210; Female:Male 60:40). The mean duration of symptoms in PTLDS patients was 7.15 years. The average number of visits to other healthcare professionals was 16.8 per patient. Regarding current employment status, the data indicates that 50.2% of respondents were currently working, 10.1% were unemployed, 8.7% were retired, 5.3% had caring responsibilities, 11.1% were on sick leave, and 14.5% fell into the "Other" category. Additionally, when asked if symptoms had affected their employment status, 69% of respondents said yes, 26% said no, and 5% did not respond. Modeling efforts show that the roadmap to care for PTLDS is challenging, leading to wandering from specialty to specialty and high healthcare utilization. Utilizing a novel method of indirect reverse estimation, our lifetime risk or cumulative incidence of PTLDS estimation is at 0.003%. Lack of data collection from Irish health authorities is leaving the issue of the cost of LD and PTLDS hard to address, despite efforts from our single-site study.

To identify subgroups with similar social determinants of health (SDOH) characteristics using latent class analysis (LCA) and examine their associations with physical and mental health, cognitive function and missed workdays at 3 and 6 months post-SARS-CoV-2 infection. We hypothesised that intersecting SDOH factors would differentially influence COVID-19-related health outcomes across subgroups. Prospective cohort study from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), with longitudinal data collection and cross-sectional analyses at baseline, 3-month and 6-month follow-ups. Multicentre registry across eight US academic medical centres (Chicago, Dallas, Houston, Los Angeles, New Haven, Philadelphia, San Francisco and Seattle). Adults aged &#x2265;18 years, fluent in English or Spanish, with self-reported acute COVID-19 symptoms and a confirmed positive SARS-CoV-2 test within 42 days before enrolment (9 December 2020 to 12 August 2022), and access to an internet-connected device. Exclusions included incarceration, inability to provide informed consent, lack of confirmed SARS-CoV-2 infection or no internet access. Of 3791 eligible participants with complete baseline data, 2897 (76.4%) completed the 3-month follow-up and 2666 (70.3%) completed the 6-month follow-up; most were aged 18-49 years (74-75%), female (66-67%), white (86.6-87.5%) and non-Hispanic (86.6-87.5%). Prespecified primary outcomes were physical and mental health (Patient-Reported Outcomes Measurement Information System (PROMIS)-29 V.2.1 T-scores for depression, anxiety, fatigue, sleep disturbance, pain interference, physical function and social participation), cognitive function (PROMIS Cognitive Function Short Form 8 T-scores) and missed workdays due to illness (binary: >1&#x2009;week vs &#x2264;1&#x2009;week, from a single-item survey). All measures were self-reported and collected at baseline, 3 months and 6 months; no changes from protocol. LCA identified a 4-class model as optimal (lowest Bayesian Information Criterion (BIC) after evaluating 1-7 class models; significant demographic differences (&#x3c7;2 p<0.001 for gender, age, race, ethnicity, education and income distributions)). Sensitivity analysis using four age groups (18-29, 30-49, 50-64, &#x2265;65 years) yielded higher BIC (45 430.8) than three groups (18-49, 50-64, &#x2265;65 years; BIC=42&#x2009;150.9), confirming the primary model. Class 3 (middle-aged, high-income non-Hispanic; n=599 (15.8%)) was the reference group. Compared with Class 3, Class 1 (lower-income, predominantly Hispanic young to middle-aged adults; n=499 (13.2%)) and Class 2 (lower-income, older, predominantly Black non-Hispanic; n=1828 (48.2%)) exhibited significantly worse outcomes across physical and mental health domains (eg, Class 1 3-month anxiety &#x3b2;=4.41 (95% CI 3.25 to 5.56, p<0.001); Class 2 3-month depression &#x3b2;=3.58 (95% CI 2.53 to 4.64, p<0.001)). Classes 1 and 2 also reported significantly worse cognitive function at both time points (eg, Class 1 3-month &#x3b2;=-3.29 (95% CI -4.77 to -1.82, p<0.001)) and Class 2 had significantly higher odds of missed workdays at 6 months (OR=1.853 (95% CI 1.192 to 2.880, p=0.006)). In contrast, Class 4 (young to middle-aged, highly educated, high-income non-Hispanic; n=865 (22.8%)) consistently reported the most favourable outcomes, including better physical function (3-month &#x3b2;=2.04, p<0.001) and lower pain interference compared with the reference group. In this US prospective cohort, SDOH-based subgroups showed persistent disparities in health outcomes post-SARS-CoV-2 infection. Findings highlight the urgent need for intersectional approaches to address systemic inequities in post-COVID-19 recovery. NCT04610515.

Acne is a chronic skin condition that primarily affects adolescents and young adults but can persist into adulthood. It can have repercussions on physical and mental health, self-esteem, and body image. The increasing use of social media for health information and peer support offers an opportunity to explore real-life experiences with acne. This study aims to analyze social media messages from users in the United States and the United Kingdom using artificial intelligence to assess the impact of acne on quality of life (QoL), identify discussion topics, and explore unmet needs. The data were extracted from public platforms using a query containing the word "acne" between January 1 and December 31, 2024. Data cleaning and filtering were performed using natural language processing, machine learning methods, and algorithms. Biterm topic modeling was used to identify the main discussion topics, and QoL impact was assessed using a deep learning algorithm adapted from the EuroQol 5-Dimension Questionnaire or the 36-Item Short Form Health Survey. Unmet needs were identified through manual annotation using the saturation method. A total of 646,809 messages posted by 432,234 users were identified. The main topics included skincare routines and product recommendations (n=154,907, 23.9%), acne scars (n=135,643, 21%), and general treatment information (n=97,177, 15%). Engagement varied across topics and platforms. On Instagram, dietary and nutritional strategies (0.16%, SD 6.36%) showed the highest mean engagement, followed by skincare routines and product recommendations (0.11%, SD 4.81%). In general, engagement scores were higher in the United Kingdom compared to the United States across all topics. On TikTok, content about makeup and acne had the highest mean engagement score (3.03%, SD 92.65%). Overall, 52.9% (228,613/432,234) of the users expressed at least 1 QoL impact, most frequently related to signs and symptoms (175,604/228,613, 76.8%), social functioning (n=149,234, 65.3%), mental health (n=107,155, 46.9%), and cost (n=62,008, 27.1%). Of 3200 annotated messages, 582 contained unmet needs, including effective solutions for hormonal acne (111/582, 19.1%), clarity in identifying acne triggers (n=84, 14.4%), treatment guidance (n=68, 11.7%), and psychological support (n=68, 11.7%). This study revealed the significant physical, psychological, social, and financial impact of acne on QoL and identified several unmet needs. Given the growing role of social media, these findings highlight opportunities for dermatologists and health professionals to educate and engage with the acne community through digital platforms.

Despite the availability of cervical cancer (CC) screening in Bolivia, coverage remains low and uneven across municipalities. This suggests the presence of barriers to effective secondary prevention, which involves early detection through screening and treatment of precancerous lesions. There is limited research on the perceptions of healthcare providers (HCPs) regarding the challenges that women in Bolivia face when accessing CC secondary prevention. This study therefore explored HCPs' perceptions of barriers and facilitators for women's access to CC secondary prevention in Cochabamba, Bolivia. Qualitative interviews were conducted with 30 HCPs working in CC secondary prevention, including gynaecologists, general practitioners, nurses, and auxiliary nurses. The interviews were analysed using reflexive thematic analysis. Levesque's access to healthcare framework informed the study design, and the socio-ecological model was used to discuss the findings across multiple levels. HCPs perceived numerous barriers and limited facilitators in access to CC secondary prevention at different levels. Barriers at the individual level included information gaps among women. Incentive-based campaigns were used to increase screening, but these did not address the actual treatment barriers or root causes. At the interpersonal-community level, barriers included family-transferred misconceptions, gender norms, and women's fear of intimate partner violence if attending screening. Facilitators included the use of the Quechua language during healthcare encounters, and material incentives to encourage attendance. Barriers at the organizational-structural level included a lack of clarity regarding which women should be screened and how often, the concentration of centralized cytology services in a single laboratory, unclear responsibilities among staff for sample collection and result delivery, and bureaucratic and administrative barriers that limited access to screening and timely results. These barriers led to long waiting times, generating mistrust and reluctance to engage with CC screening. HCPs perceive barriers to CC secondary prevention at the individual, community, and organizational levels, including women's lack of information, family-driven misconceptions, gender norms, unclear screening guidelines, centralized cytology services, and bureaucratic delays that erode trust. Facilitators include the use of Quechua language during care and material incentives to encourage screening attendance; however, these do not address treatment barriers or structural causes.

Universal health coverage is a cornerstone for achieving good health and well-being; however, its interaction with demographic and migration pressures remains underexplored, particularly in Southeast Asia. This study investigated how demographic pressure, migration pressure, health system capacity, and universal health coverage (UHC) influenced health burden across World Health Organization South-East Asia Region and Association of Southeast Asian Nations countries between 2000 and 2021 and simulated using a scenario-based model to forecast health burdens in 2030 and 2050. Multiple data sets obtained from Global Repositories, Burden of Disease, Global Health Observatory, World Bank Open Data portal, and International Organization for Migration were extracted. Missing data were addressed using multiple imputations. Composite domains were validated using principal component analysis. Pathways were estimated using multilevel structural equation modelling, and temporal effects were assessed using linear mixed-effects models. Sensitivity analyses were performed to test alternative UHC rollout periods. Migration pressure was positively associated with health system capacity (&#x3b2;&#x2009;=&#x2009;0.757) and UHC (&#x3b2;&#x2009;=&#x2009;0.553), both P&#x2009;<&#x2009;0.001. Health system capacity increased UHC (&#x3b2;&#x2009;=&#x2009;0.582), while demographic pressure reduced it (&#x3b2;&#x2009;=&#x2009;-0.800). Health burden was inversely associated with UHC (&#x3b2;&#x2009;=&#x2009;-0.679) and migration pressure (&#x3b2;&#x2009;=&#x2009;-0.446). Mediation analysis confirmed indirect effects of UHC. Linear mixed-effects models showed that disability-adjusted life years declined before UHC rollout, increased immediately after rollout, then decreased with higher UHC coverage. Scenario-based forecasts indicate moderate reductions by 2030 and greater declines by 2050, particularly in countries with strong and well-structured health systems. UHC directly reduces health burden, whereas migration, health system capacity, and demographic pressure exert indirect effects. Forecasts indicate declining burden by 2030 and 2050, particularly in countries with strong health care systems. Continuous monitoring of sociodemographic pressures - along with sustained system capacity and UHC expansion - is essential for long-term health improvements in Southeast Asia.

Rising global numbers of chronic noncommunicable diseases (NCDs) are commonly interpreted as evidence of a growing epidemic. In 2011, we hypothesised that this perception is partly driven by population ageing, expanding diagnostic criteria, and improved detection rather than a uniform increase in underlying biological risk. This study reassesses that hypothesis using contemporary global data. We conducted a descriptive, comparative epidemiological analysis using publicly available data sets from the Global Burden of Disease, World Health Organization Global Health Estimates, and the International Diabetes Federation. Absolute case counts and deaths were analysed alongside age-standardised mortality rates to distinguish demographic effects (population growth and ageing), diagnostic expansion, and changes in underlying risk. Trends were evaluated relative to 1990 and 2011 baselines. Absolute numbers of cases and deaths from major NCDs have continued to rise globally, largely reflecting population growth and ageing. In contrast, age-standardised mortality rates have declined substantially for cardiovascular disease and chronic obstructive pulmonary disease and have stabilised for other conditions. This divergence between increasing absolute burden and stable or declining age-specific risk is consistent across major diseases. Expanded diagnostic criteria, improved detection, and increased survival have further contributed to rising prevalence, particularly in older populations. Rising absolute counts of NCDs are largely explained by demographic change and diagnostic expansion, while age-standardised trends suggest stable or declining risk for several major conditions. These findings support a more nuanced interpretation of global chronic disease trends, integrating demographic, diagnostic, and risk-factor perspectives. Careful use of age-standardised measures alongside absolute counts is essential for accurate monitoring and for informing public health priorities.

Yemen's health system has faced prolonged shocks, including war, epidemics, and COVID-19, challenging both governance and resilience. This study examines how formal governance structures and institutional capacities shaped the system's ability to anticipate, absorb, adapt, learn, and transform across a decade of crisis (2014-2025). We conducted a longitudinal qualitative analysis based on interviews with health system leaders and technical actors. Using a resilience-capacity framework, we analyzed governance functions across four phases: pre-conflict period (pre-2014), conflict escalation (2015-2019), COVID-19, and the post-pandemic period. Data were thematically coded and interpreted through the sequential resilience lens of preparedness, absorption, adaptation, learning, and transformation. Participants consistently described a health system with intact formal governance structures but fragile functional capacity. Pre-2014 governance was administratively stable yet centralized and poorly prepared for shocks. During the conflict, preparedness collapsed amid fragmented authorities, and absorptive capacity relied heavily on donor-driven service delivery. COVID-19 triggered temporary improvements in coordination and emergency response, but these were largely ad hoc and poorly institutionalized. Post-pandemic, preparedness remained procedural, absorptive capacity weakened as external funding declined, adaptive measures persisted in localized and reversible forms, and transformative governance remained constrained by political instability and weak enforcement. Digital "workaround governance," including WhatsApp-based coordination, facilitated rapid decision-making but highlighted gaps in formal systems and accountability. Across phases, learning was fragmented, donor-driven, and rarely institutionalized, limiting system-wide reform. Yemen's experience demonstrates that maintaining formal governance structures does not guarantee health system resilience. Sustainable resilience requires institutionalized preparedness, domestic contingency financing, integration of adaptive innovations, and embedding learning into routine governance. Efforts to strengthen health systems in fragile and conflict-affected settings must address governance, capacity, and political economy simultaneously to move beyond reactive crisis management toward transformative change.

The global demographic shift has highlighted the co-occurrence of hypertension (HTN) and physical frailty, both of which severely impact the health outcomes and quality of life of middle-aged and older adults. This relationship remains underexplored in India's rapidly ageing population. We conducted a cross-sectional analysis using data from the Longitudinal Ageing Study in India (Wave 1), comprising a nationally representative sample of 66,606 participants. Physical frailty was assessed using a modified Fried phenotype. Multivariable logistic regression and the Karlson-Holm-Breen method were utilised to evaluate associations and quantify the mediating effect of additional comorbidities. The weighted prevalence of physical frailty among participants with HTN was 19.26% (95% CI: 18.43, 20.11). Multivariable analysis revealed that advanced age, lack of education, non-working status, underweight BMI, and presence of additional comorbidities were significantly associated with higher odds of frailty in HTN patients. Mediation analysis showed that additional comorbidities accounted for 21.31% of the total effect of HTN on frailty for all HTN cases, and 38.36% for previously diagnosed cases. Treating HTN in isolation might be insufficient for addressing functional decline. Healthcare policies and clinical practices must adopt comprehensive geriatric assessments that target patients' entire comorbid profiles, while prioritising interventions that address the modifiable risk factors. As the world&#x2019;s population ages, managing conditions like high blood pressure (hypertension) and physical frailty (weakness and fatigue) is a major health challenge. We wanted to understand how these two conditions are linked in middle-aged and older adults living in India.We conducted data analysis of 66,606 adults who were aged 45 and above from a large national survey titled the Longitudinal Ageing Study in India. We looked at people with hypertension and checked how many of them were also physically frail.We discovered that nearly one in five middle-aged and older adults with hypertension were physically frail. People were more likely to be frail if they were aged over 75, had no formal education, were not working, were underweight, or had other health conditions.Upon advanced analysis, we observed that having other diseases alongside hypertension strongly overlapped with the presence of physical frailty.Managing hypertension on its own may not be enough to support middle-aged and older adults who face frailty. Doctors and healthcare policies need to look at the patient&#x2019;s overall health, including all their other medical conditions. By focusing on improving nutrition, education, and overall disease management, we can better support middle-aged and older adults experiencing frailty.

BackgroundCervical cancer remains a major global health challenge, disproportionately affecting low- and middle-income countries. Women living with HIV are at increased risk due to weakened immunity. This study assessed cervical cancer screening utilization and associated factors among HIV-positive women attending antiretroviral therapy (ART) clinics in Gondar town, Northwest Ethiopia.MethodsA multicenter institution-based cross-sectional study was conducted from November 1 to 30, 2025, using systematic random sampling. Data were collected through structured interviewer-administered questionnaires and analyzed using STATA 14. Bivariable and multivariable logistic regression analyses were performed, with P&#x2009;<&#x2009;.05 considered statistically significant.ResultsScreening utilization was 30.2%. Good knowledge (AOR = 3.44; 95% CI: 2.22-5.16), favorable attitude (AOR = 2.81; 95% CI: 2.28-6.61), and history of sexually transmitted infections (AOR = 2.22; 95% CI: 1.83-4.13) were significantly associated.ConclusionScreening utilization was low. Strengthening health education, improving ART counseling, and integrating screening into routine HIV care are recommended. Use of Cervical Cancer Screening and Related Factors Among Women Living with HIV in Public Health Facilities of Gondar Town, Northwest EthiopiaCervical cancer is one of the most common cancers affecting women worldwide. It is especially common in low- and middle-income countries. Women living with HIV have a higher risk of developing cervical cancer because their immune system is weakened. Regular cervical cancer screening can help detect early changes in the cervix and prevent the disease. However, many women living with HIV do not use these screening services. This study examined how many women living with HIV use cervical cancer screening services and what factors influence their use of screening. The study was conducted among women attending antiretroviral therapy (ART) clinics in public health facilities in Gondar town, Northwest Ethiopia. Data were collected using interviews with structured questionnaires. The results showed that only 30.2% of women living with HIV had been screened for cervical cancer. The study found that women who had good knowledge about cervical cancer, those who had a positive attitude toward screening, and those who had a history of sexually transmitted infections were more likely to use cervical cancer screening services. The findings indicate that cervical cancer screening among women living with HIV is still low. Improving awareness and knowledge about cervical cancer, providing better counseling services in ART clinics, and integrating cervical cancer screening into routine HIV care may help increase screening use. Strengthening these efforts could help detect cervical cancer earlier and reduce illness and death among women living with HIV.

Background: The dissociative subtype of posttraumatic stress disorder (D-PTSD) was recognized in DSM-5, and a dissociative subtype of complex posttraumatic stress disorder (D-CPTSD) in ICD-11 was recently proposed. It was documented that the DSM-5 PTSD criteria encompass all symptoms of the ICD-11 CPTSD. Exploring the relationship between D-PTSD and D-CPTSD may help to clarify whether the knowledge on D-PTSD could be extended to D-CPTSD.Objective: The current study aimed to compare the symptomatic characteristics of DSM-5 D-PTSD and ICD-11 D-CPTSD.Methods: The current study re-analyzed a database consisting of 57,984 trauma-exposed adolescents. Posttraumatic stress disorder (PTSD), complex PTSD (CPTSD), trauma-related dissociation, and functional impairment were assessed using the Global Psychotrauma Screen for Teenagers (GPS-T). Generalized anxiety disorder (GAD) and major depressive disorder (MDD) were measured with the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9, respectively. Prevalence, functional impairment, and comorbidities with GAD/MDD were compared between DSM-5 D-PTSD and ICD-11 D-CPTSD. Agreement between the D-CPTSD and D-PTSD was also examined.Results: The agreement between D-PTSD and D-CPTSD was extremely high (Kappa&#x2009;=&#x2009;0.90). All individuals with D-CPTSD met the criteria for D-PTSD and accounted for the majority of the D-PTSD group (82.4%). The D-CPTSD group exhibited higher levels of functional impairment and comorbidity with GAD/MDD compared to the D-PTSD group (All ps&#x2009;<&#x2009;0.001).Conclusions: These findings indicated that ICD-11 D-CPTSD might be a part of DSM-5 D-PTSD, informing that the previous basic, clinical, and practical knowledge on DSM-5 D-PTSD might be applicable to the ICD-11 D-CPTSD. The current study is the first to compare dissociative subtypes of PTSD and CPTSD in a large sample of trauma-exposed adolescents.The prevalence of D-CPTSD was lower than D-PTSD. The agreement between DSM-5 D-PTSD and ICD-11 D-CPTSD was extremely high. Specifically, all individuals with D-CPTSD met the criteria for D-PTSD, and individuals with D-CPTSD represent the majority of the D-PTSD population. Individuals with D-CPTSD exhibited higher levels of functional impairment and comorbidity with GAD/MDD.These findings indicated that ICD-11 D-CPTSD might be a part of DSM-5 D-PTSD, indicating that the knowledge on DSM-5 D-PTSD might be extended to the ICD-11 D-CPTSD. Antecedentes: El subtipo disociativo del trastorno de estr&#xe9;s postraum&#xe1;tico (TEPT-D) fue reconocido en el DSM-5 y recientemente se propuso un subtipo disociativo del trastorno de estr&#xe9;s postraum&#xe1;tico complejo (TEPTc-D) en la CIE-11. Se documento que los criterios para TEPT del DSM-5 engloba todos los s&#xed;ntomas del TEPTc de la CIE-11. Explorar la relaci&#xf3;n entre el TEPT-D y el TEPTc-D puede ayudar a clarificar si el conocimiento sobre el TEPT-D podr&#xed;a extenderse al TEPTc-D. Objetivo: El presente estudio tuvo como objetivo compara las caracter&#xed;sticas sintom&#xe1;ticas del TEPT-D del DSM-5 y el TEPTc-D de la CIE-11. M&#xe9;todos: El estudio actual reanaliz&#xf3; una base de datos compuesta por 57.984 adolescentes expuestos a trauma. El trastorno de estr&#xe9;s postraum&#xe1;tico (TEPT), el TEPT complejo (TEPTc), la disociaci&#xf3;n relacionada al trauma y el deterioro funcional se evaluaron utilizando el Mapeo Global de Psicotrauma para Adolescentes (GPS-T en sus siglas en ingl&#xe9;s). El trastorno de ansiedad generalizada (TAG) y el trastorno depresivo mayor (TDM) se midieron con el Cuestionario de Trastorno de Ansiedad Generalizada-7 y el Cuestionario de Salud del Paciente-9, respectivamente. La prevalencia, deterioro funcional y comorbilidades TAG/TDM se compararon entre el TEPT-D del DSM-5 y el TEPTc-D de la CIE-11. Tambi&#xe9;n se examin&#xf3; la concordancia entre el TEPTc-D y TEPT-D. Resultados: La concordancia entre TEPT-D y TEPTc-D fue extremadamente alta (Kappa&#x2009;=&#x2009;0.90) Todos los individuos con TEPTc-D reunieron los criterios para TEPT-D y representaron la mayor&#xed;a del grupo con TEPT-D (82.4%). El grupo TEPTc-D present&#xf3; niveles m&#xe1;s altos de deterioro funcional y comorbilidad con TAG/TDM en comparaci&#xf3;n al grupo TEPT-D (todos los valores de p&#x2009;<&#x2009;.001). Conclusiones: Estos hallazgos indicaron que el TEPTc-D de la CIE-11 podr&#xed;a ser parte del TEPT-D del DSM-5, lo que sugiere que los conocimientos b&#xe1;sicos, cl&#xed;nicos y pr&#xe1;cticos previos sobre el TEPT-D del DSM-5 podr&#xed;a ser aplicable al TEPc-D de la CIE-11.

Unguided internet-based cognitive behavioral therapy (ICBT) is a low-cost and scalable treatment for major depressive disorder (MDD), but its long-term effects in Chinese populations remain unclear. This study aimed (1) to explore the short- and long-term effectiveness of unguided ICBT in treating adults with MDD; (2) to investigate the short- and long-term effects on disease-related symptoms, individual and social functioning, and quality of life; and (3) to assess the acceptability and satisfaction with the ICBT. An 8-week randomized controlled trial (ChiCTR2100046425) was conducted between August 2021 and June 2023 in Shenzhen, China, with 159 participants in the immediate ICBT group (7-module ICBT course plus usual care) and 158 in the waitlist control (WLC) group (usual care). The WLC group later completed the same ICBT course and follow-up assessments. Outcome measures (depressive and anxiety symptoms, psychological distress, social functioning, self-efficacy, quality of life, and stigma) were assessed before and after treatment and at 3-, 6-, and 12-month follow-ups for ICBT participants. Remission and response, adherence, and satisfaction were evaluated by predefined standards. Among 300 participants analyzed (mean age 28.49, SD 7.0 years; female: n=225, 75%), dropout rates were 22.4% (34/152) in the immediate ICBT group versus 6.3% (10/158) in the WLC group. At posttreatment, the immediate ICBT group showed greater reduction in depressive symptoms versus WLC (mean difference -3.65, SE 0.60; P<.001; d=0.50), with higher remission (80/121, 66.1% vs 58/148, 39.2%; P<.001) and response rates (50/121, 41.3% vs 27/148, 18.2%; P<.001). At 12-month follow-up, the depressive symptoms were improved compared with that at pretreatment (mean difference -3.90, SE 0.32; P<.001; d=0.70), and no significant change was observed in comparison with the outcomes at posttreatment (mean difference -0.81, SE 0.33; P=.33; d=-0.15). ICBT treatment also exhibited similar short- and long-term effects on secondary outcomes, with significant improvement of disease-related symptoms, individual and social functioning, and quality of life. Moreover, the majority of the participants treated with ICBT reported high acceptability of and satisfaction with the ICBT course. Unguided ICBT effectively reduces depressive symptoms and enhances functioning in Chinese patients with MDD, with sustained benefits over 12 months. Its scalability and low-cost nature make it a promising option for resource-limited settings.

Low bone mineral density (LBMD) increases fragility fracture risk and may contribute importantly to disability after falls. Within the Global Burden of Disease (GBD) framework, the attributable fall-related burden is better interpreted as fracture susceptibility and post-fall disability than as a direct effect on the occurrence of falls. However, the magnitude, inequality, and future trajectory of this burden in women aged 50-69 years remain unclear. Using GBD 2021 estimates from 1990-2021, we quantified LBMD-attributable fall-related disability-adjusted life years (DALYs), years lived with disability (YLDs), and age-standardised rates in women aged 50-69 years. Men were included for contextual comparison. We assessed temporal trends, socioeconomic inequality, frontier gaps, burden decomposition, and conditional projections to 2050. We performed two-sample Mendelian randomisation to examine associations of genetically predicted femoral-neck bone mineral density with falls and femoral fractures. From 1990-2021, age-standardised DALY and YLD rates declined modestly, whereas absolute DALYs nearly doubled and YLDs increased markedly. In 2021, women had approximately 35-45% higher age-standardised disability-adjusted life-year rate (ASDR) and about 75% more YLDs than men aged 50-69 years. Relative inequality, as measured by the concentration index, was directionally positive but statistically uncertain, whereas absolute inequality remained substantial. Conditional projections suggested further declines in age-standardised rates by 2050 but continued growth in absolute disability burden. Genetically predicted lower femoral-neck bone mineral density showed no clear association with falls (inverse-variance weighted odds ratio (IVW OR)&#x2009;=&#x2009;1.29; 95% CI&#x2009;=&#x2009;0.86, 1.95) but was associated with higher risk of fracture of femur (OR&#x2009;=&#x2009;1.71; 95% CI&#x2009;=&#x2009;1.37, 2.14). LBMD-attributable fall-related injury burden in women aged 50-69 years remains a substantial and unequally distributed source of disability. The GBD and Mendelian randomisation findings suggest that LBMD contributes more strongly to fracture susceptibility and disability after falls than to fall occurrence itself, supporting earlier osteoporosis risk assessment and integrated bone-, muscle-, and fall-prevention strategies.

Navigating global crises like the Coronavirus Disease 2019 (COVID-19) demands strategic and impactful health interventions. Evaluating these interventions is crucial for fortifying health systems at both national and global scales. This article described and appraised projects carried out under the United States Government-funded, Reaching Impact Saturation and Epidemic Control (RISE) initiative during the pandemic in Ghana, offering insights and lessons learned through six health system building blocks. A mixed study design using qualitative and quantitative approaches: comprehensive document review, engagement with project managers and case narratives of data collections were adopted to appraise 10 novel interventions. Projects were selected using a census method, which included all projects that had been completed at the time of appraisal. Following selection, each project was mapped to the six building components using well-defined criteria; sustainable health financing, service provision, health management and leadership, products and logistics, information systems and data integration, and human resource. Overall, significant improvements in service delivery and health system strength were noted. COVID-19 immunization was successfully integrated into routine service delivery, resulting in 93.2% coverage attainment. Data quality audits and saturation analyses result in the institutionalization of standardized reporting and real-time data utilization. Under the Test-2-Treat (T2T) project, access to COVID-19 medications was provided to 79% confirmed cases. Additionally, RISE-supported oxygen interventions (LOX/PSA systems) improved equitable access to medical oxygen, reducing travel distances for peripheral facilities by 12.1% to 69.7% to procure medical oxygen. Capacity-building activities further strengthened service delivery and equipment maintenance, while generating critical lessons for the Ghana Health Service on integrating pandemic response interventions into routine health system functions.

Chronic conditions are a significant global health challenge that adversely affects the quality of care for patients with type 2 diabetes (T2D). To evaluate and improve the quality of care, the Patient Assessment Chronic Illness Care (PACIC-5As) tool has been developed. It is the most widely used tool designed to assess the perceived quality of care among individuals with chronic conditions, including diabetes. Nevertheless, it has not yet been culturally adapted and validated in the Ethiopian context. Therefore, this study aimed to translate, culturally adapt, and evaluate the psychometric properties of the PACIC-5As tool in Ethiopia. A multicenter cross-sectional study was conducted among individuals with type 2 diabetes from March 24, 2025, to May 5, 2025, in the Amhara region's comprehensive specialized referral hospitals. A systematic random sampling technique was used to select the study participants. Data were collected through face-to-face interviews. The tool consists of 26 items and 5 domains. Content validity was assessed at both the individual and scale levels. Internal consistency was evaluated using Cronbach's alpha (&#x3b1;) and composite reliability (CR), with a value&#x2009;&#x2265;&#x2009;0.70 considered acceptable. Confirmatory factor analysis (CFA) was conducted to evaluate model fit and factor structure. Model fit was assessed using the absolute and incremental fit indices and interpreted based on the recommended thresholds. Convergent validity was computed using average variance extracted (AVE), with a value&#x2009;&#x2265;&#x2009;0.4 considered adequate, while discriminant validity was evaluated using AVE and inter-construct correlations. A total of 520 study participants were enrolled, and 517 (99.4%) were included in the study. The overall mean summary score of PACIC-5As-ET was 2.68 (&#xb1;0.62). The content validity index at the item and scale levels ranged from 80% to 100%, with an inter-rater agreement of 95%. The Cronbach's alpha and composite reliability (CR) of the PACIC-5As-ET were 0.93. The Cronbach's alpha values for the subscales ranged from 0.71 (Assist) to 0.82 (Arrange). The test-retest reliability of PACIC-5As-ET was 0.94. The model fit indices were &#x3c7;&#xb2;/df (2.79), RMSEA (0.06), SRMR (0.08), GFI (0.89), and CFI (0.40). The AVE value of the overall PACIC-5As-ET was 0.93, and the subscales ranged from 0.47 (Advise) to 0.59 (Arrange). The Amharic version of the PACIC-5As-ET tool demonstrated excellent internal consistency and acceptable validity for assessing the perceptions of patients with T2D. The absolute fit indices were generally within the recommended range, whereas the incremental fit indices were low. Therefore, support for the hypothesized five-factor structure is limited and should be interpreted with caution.

Cesarean section is a lifesaving obstetric intervention when medically indicated; however, its utilization remains unequal across sub-Saharan Africa (SSA). Although the World Health Organization recommends cesarean section rates of 10-15%, access remains insufficient in many low-resource settings and excessive in others. Understanding geographic patterns and drivers is essential for maternal health planning. To examine the spatial variation and determinants of cesarean section delivery across SSA. We conducted a cross-sectional analysis using Demographic and Health Survey data (2015-2024) from 201,481 weighted samples across 28 SSA countries. Spatial autocorrelation and hotspot patterns were assessed using Global Moran's I and Getis-Ord Gi* statistics. Spatial regression models, including ordinary least squares, spatial lag, spatial error, geographically weighted regression, and multiscale geographically weighted regression, were fitted. Model performance was compared using corrected Akaike Information Criterion and adjusted R2. Cesarean section delivery showed significant spatial clustering (Moran's I&#x2009;=&#x2009;0.18, z&#x2009;=&#x2009;43.3, p&#x2009;<&#x2009;0.01). Hotspot areas were identified in Uganda, Rwanda, Burundi, Kenya, Tanzania, Malawi, South Africa, Lesotho, Gabon, Ghana, and Senegal, while cold spots were observed in Ethiopia, Madagascar, Angola, Nigeria, Guinea, Cote d'Ivoire, Sierra Leone, Liberia, and Mauritania. Previous cesarean delivery, maternal age&#x2009;&#x2265;35&#x2009;years, pregnancy spacing behavior, and health insurance coverage were significant spatial predictors. Cesarean section utilization in SSA exhibits substantial geographic inequality driven by context-specific determinants. Spatially targeted maternal health policies, improved referral systems, and equitable financing mechanisms are needed to optimize access to medically indicated cesarean delivery while minimizing unnecessary procedures. Main findings: Caesarean section utilization in SSA demonstrated substantial geographic inequalities, with significant spatial clustering and regional variation influenced by previous caesarean sections, maternal age, insurance coverage, and reproductive health behaviors.Added knowledge: This study provides multicounty geospatial evidence using multiscale geographically weighted regression to identify location-specific predictors and geographic inequalities in caesarean section utilization across SSA.Global health impact for policy and action: Geographically targeted maternal health strategies are needed to improve equitable access to medically necessary caesarean section services while preventing unnecessary procedures across underserved regions of SSA.