搜索结果：Journal of health, population, and nutrition

The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.

HomeHealth is a home-based, voluntary sector service supporting older people with mild frailty to maintain independence through behaviour change. Support workers discuss the person's priorities and enable setting/achieving goals around mobility, nutrition, socialising and/or psychological well-being. We tested clinical and cost-effectiveness of HomeHealth for maintaining independence in older people with mild frailty in a randomised controlled trial. Design: Single-blind, parallel randomised controlled trial open between 18 January 2021 and 4 July 2023, with mixed-methods process evaluation. Setting: Community-dwelling older people aged 65+ years with mild frailty from 27 general practices and community settings in London, Yorkshire and Hertfordshire. Randomisation: Participants were randomised 1 : 1 to receive HomeHealth or treatment as usual. Outcomes: Primary outcome was independence in activities of daily living (modified Barthel Index), analysed using linear mixed models. Secondary outcomes included frailty phenotype score, extended activities of daily living, well-being, psychological distress, loneliness, cognition, falls and mortality. Health economic outcomes included quality of life, capability and service use, including hospital admissions. Cost-effectiveness acceptability curves and cost-effectiveness planes were used to represent the probability of cost-effectiveness compared to treatment as usual. Process evaluation: We conducted semistructured interviews with participants receiving the intervention, HomeHealth workers and other stakeholders supporting service delivery. Interviews were thematically analysed. Fidelity of audio-recorded appointments was assessed by two independent raters. We evaluated potential mechanisms of impact using data from appointments attended, types of goals set and progress towards goals. We recruited 388 participants, mean age 81.4 years (standard deviation 6.5), 64% female and 94% White British/European. HomeHealth did not improve Barthel Index scores at 12 months (0.250, 95% confidence interval -0.932 to 1.432). At 6 months, we found small significant reductions in psychological distress (-1.237, 95% confidence interval -2.127 to -0.348), and frailty phenotype score (-0.252, 95% confidence interval -0.487 to -0.017). At 12 months, we found significant improvements in well-being (1.449, 95% confidence interval 0.124 to 2.775), reduced unplanned admissions (incidence rate ratio 0.65, 95% confidence interval 0.54 to 0.92) with lower associated costs (-£586/participant, 95% confidence interval -351 to -821). There were no differences in other outcomes. HomeHealth dominates treatment as usual with a negative point estimate for incremental costs (-796, 95% confidence interval -2016 to 424), positive point estimate for incremental quality-adjusted life-years (0.009, -0.021 to 0.039) and high probability of cost-effectiveness. Process evaluation: Sixty-four semistructured interviews were completed, including 49 participants and 15 HomeHealth workers/stakeholders. The service was acceptable and safe, with good fidelity of delivery. Participants made progress on personalised goals, most working on enhancing mobility. They found the service empowering, and received emotional/practical support. Engagement was more challenging when participants identified no need for change, had significant memory impairment or new/declining illness. Flexibility around varying symptoms and incorporating behaviour change into existing routines promoted engagement. HomeHealth did not improve independent functioning for older people with mild frailty. There were small significant improvements in frailty status, psychological distress and well-being and a 35% reduction in unplanned admissions, with high probability of cost-effectiveness. We used a pragmatic design with intervention delivery in real-world settings during/after the COVID-19 pandemic, potentially with more variability in delivery. Our findings might not apply to other geographical settings/healthcare systems. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR128334. As we age, we may develop several health conditions that affect how we feel and our ability to manage without help. For some, it can mean they have less energy and muscle strength, and it is harder to do routine tasks such as shopping or cooking. Few services exist to prevent things getting worse. We designed a new service, ‘HomeHealth’, to enable older people to maintain their independence and activities they enjoy. Over six visits with a dedicated support worker, they identified concerns such as tiredness, low mood and anxiety, poor appetite, weakness and memory problems and developed goals and plans to address difficulties. Our research aimed to explore if HomeHealth helped people to stay independent for longer and provided value for money. Our study recruited 388 older people who were struggling with their everyday activities like cooking/shopping and getting out due to their health. Half were randomly allocated to the HomeHealth service, and half received usual care for 6 months. All participants were assessed by researchers at the beginning, 6 and 12 months later. We also interviewed 49 participants, and 15 people delivering the service about their experiences. We found that HomeHealth did not improve participants’ independence compared to usual care, though it showed small positive effects on mood and frailty at 6 months and well-being after 1 year. Those receiving the service were 35% less likely to be admitted to hospital for acute illness and had lower hospital care costs. The service was acceptable, safe, provided emotional and practical support and empowerment. Most older people made progress on goals to improve their health and well-being. Some found this more challenging, particularly those with worsening health or memory, or those who felt no need to change. The HomeHealth service is a promising intervention to reduce unplanned (emergency) hospital admissions.

Access to safe abortion remains a public health concern in sub-Saharan countries, where restrictive policies and limited access to quality healthcare contribute to preventable maternal morbidity and mortality related to unsafe abortion. This study synthesised the available evidence on abortion care experiences and self-reported outcomes of people seeking abortion care. And explored the existing tools to assess abortion care experiences and outcomes in sub-Saharan Africa (SSA). We searched eight databases: Embase, Cochrane Library, CINAHL, Global Health, PsycINFO, Scopus, Medline, and Web of Science, to include studies published between 1 January 2010 and 18 October 2025. All original (quantitative, qualitative, and mixed methods) studies that focused on induced abortion care and assessed people's experiences and outcomes of abortion care in SSA were included. The Joanna Briggs Institute (JBI) data extraction tool and critical appraisal checklist were adapted. We undertook narrative synthesis for data analysis. The review protocol was registered in PROSPERO: CRD42023461963. Of 20,180 records retrieved, 35 were eligible for the final review. Eighteen studies reported both experiences and outcomes of abortion care, nine reported abortion care experiences, seven reported abortion care outcomes, and one reported the development of a tool. The included studies identified negative experiences such as delays in obtaining care, stigmatisation, concerns about privacy and confidentiality, misinformation, and overstating risks, as well as psychological and emotional outcomes such as feeling guilt, sadness, and worry about future pregnancies. The findings also showed positive outcomes, including feelings of relief, happiness, and satisfaction with the services received. The review also identified the absence of reliable tools to assess patient-reported experiences and outcomes of abortion care in SSA. People experienced undesirable challenges while receiving abortion care. Despite negative psychological and emotional outcomes, satisfaction with care, relief, and happiness after abortion revealed in this review may indicate that abortion care is supportive in reducing the consequences of unwanted birth, which is not easily accessible in countries with restrictive abortion policies. A lack of validated measurement tools assessing abortion care experiences and outcomes requires the development of tools in this area. People experience various challenges while receiving abortion care due to limited access to safe abortion and abortion-related stigma in sub-Saharan countries. This systematic review aimed to synthesise the available evidence on abortion care experiences and outcomes and explored the existing tools to assess abortion care experiences and outcomes in sub-Saharan countries. Experiences and outcomes of abortion care were varied, with some facing delays to receive care, stigma, psychological and emotional challenges, while others reported relief and satisfaction with services. This review highlighted a need for reliable tools to measure abortion care experiences and outcomes from the perspectives of patients receiving care, offering actionable insights for improving the safety and quality of abortion care.

Social vulnerability during pregnancy correlates with an increased risk of negative maternal and neonatal outcomes. The World Health Organization (WHO) and the International Confederation of Midwives (ICM) endorse the implementation of continuous care strategies to enhance outcomes. This project aims to implement and evaluate the effectiveness of a continuous midwifery care model during pregnancy and delivery, as well as its impact on various maternal and neonatal outcomes for socially disadvantaged women in Iran. This research will utilize a convergent parallel mixed-methods framework. The study will be executed in two simultaneous phases: a quantitative randomized controlled trial and a qualitative descriptive analysis. In the quantitative phase, 92 socially disadvantaged pregnant women facing poverty or domestic violence or unplanned pregnancies will be recruited from health centers in Bonab, Iran, and randomly allocated to either an intervention group (n = 46) or a control group (n = 46). The intervention group will receive continuous midwifery care from 14 weeks of gestation until 6 weeks postpartum, whereas the control group will receive standard care. The primary outcomes encompass the experiences related to pregnancy and childbirth, as well as evaluations of maternal depression. Secondary outcomes encompass the mode of delivery, maternal and neonatal complications, and satisfaction with care. The qualitative phase will employ conventional content analysis of comprehensive, semi-structured interviews with women in the intervention group to investigate their perceptions and experiences regarding the care model. The outcomes from both phases will be amalgamated to yield a holistic comprehension of the model's influence. This study is the inaugural investigation in Iran assessing a continuous midwifery care model designed for socially disadvantaged women, utilizing a mixed-methods approach. The findings are expected to yield substantial evidence to inform the formulation of national policies and clinical guidelines designed to mitigate health disparities and enhance maternal and child health outcomes in at-risk communities. Iranian Registry of Clinical Trials (IRCT) (IRCT20120718010324N84/ Date of registration 20250823). URL https://irct.behdasht.gov.ir/trial/74,206. Women encountering social challenges, including poverty, domestic violence, or unplanned pregnancies, experience an elevated risk of complications for themselves and their infants. These may encompass an increased probability of cesarean delivery, the occurrence of postpartum depression, and additional health complications. The standard maternity care provided to these women is frequently fragmented, resulting in interactions with multiple healthcare providers, which complicates the establishment of a trusting relationship. The continuous midwifery care model is a promising approach in which a woman receives support from the same midwife throughout her pregnancy, during birth, and in the early postpartum period. This approach emphasizes the establishment of a trusting, supportive, and empowering relationship. Nonetheless, research on the effectiveness of this model for socially vulnerable women, particularly in Iran, is limited. This study aims to implement and evaluate the continuous midwifery care model for socially vulnerable pregnant women in Iran, thereby addressing the identified research gap. This study will employ a dual approach: a clinical trial to evaluate health outcomes between women receiving the new model and those receiving standard care, alongside in-depth interviews to gain insights into the women’s personal experiences. This research contributes to understanding how to support vulnerable women, improve self-care, and enhance the overall experience of pregnancy and childbirth.

As a result of decades of migration in Germany, the number of persons with migration backgrounds from different cultures in residential long-term care nursing facilities will increase. As a result, cultural diversity may also have an impact on nutritional aspects in long-term care. The project 'Digitally supported diversity and culturally sensitive nursing care on nutritional intake' (NUTRI-SENSE) examines strategies to improve the nutritional and fluid intake of residents with migration backgrounds in long-term care facilities. The interdisciplinary project aims to improve their health and quality of life with a digitally supported nursing process to prevent undernutrition and dehydration. To synthesize the evidence on diversity- and culturally sensitive approaches in nutrition and fluid intake management, a scoping review was conducted. This research led to the question of the extent to which cultural sensitivity with regard to nutrition and fluid intake is addressed in long-term care nursing homes. A literature search of different databases (PubMed, CINAHL, LIVIVO, CareLit®, manual search: Google Scholar) was conducted in May and June 2025. From the 8.010 findings, 28 publications were screened, and 6 publications were included in the review. The evidence on diversity- and culturally sensitive approaches in institutional long-term care nursing regarding nutrition and fluid intake is limited. The main topics are the relationship of culture-specific and dementia-specific needs; the emotional aspects of belonging, food and memories of residents with dementia; meals as a vital source of well-being in nursing homes; the meaning of mealtime experiences in a multicultural society; and, finally, the involvement of family members in the food supply. The findings from the scoping review revealed that a systematically developed, diverse and culturally sensitive framework for managing residents' nutritional and fluid intake in long-term care facilities has not yet been established. Such a framework is the goal for subsequent research and the development of interventions within the NUTRI-SENSE project. In the context of international population ageing and increasing needs in the long-term care sector, the development and evaluation of culturally and diversity-sensitive nutPrition and hydration strategies are of broad, cross-national relevance.

Child and Youth Care Centres (CYCCs) play an important role in providing nutritional support to disadvantaged children and youth. However, little is known about how food handlers apply national nutrition and food hygiene standards in resource-constrained CYCC settings in South Africa. The aim of the study was to examine food, nutrition, and hygiene practices among food handlers at CYCCs in KwaZulu-Natal Province of South Africa. A qualitative exploratory research design was used in the study. Three online focus group discussions (FGDs) were conducted in August and September 2020, with 18 food handlers from two CYCCs participating. COVID-19 Alert Level 5 restrictions necessitated online FGDs. The discussions were audio-recorded, transcribed verbatim, and analysed thematically. Co-researchers' independent coding, peer debriefing, member checking, and safeguarding of an audit trail all assisted to assure trustworthiness. The study revealed different levels of awareness about nutrition guidelines and food-based dietary guidelines, with a significant gap between knowledge and practical application. While participants exhibited a high level of awareness of food safety, hygiene, and storage practices, implementation was hindered by limited financial resources, inadequate nutrition instruction, a lack of standardised recipes, and insufficient access to hygiene supplies and personal protective equipment. Budget constraints significantly affected meal planning and dietary diversification. While food handlers in CYCCs have a basic understanding of food safety and cleanliness, they face systematic and structural impediments to effectively apply nutrition requirements. Strengthening practical nutrition training, improving resource allocation, and increasing institutional and policy support are critical for improving food, nutrition, and hygiene practices and promoting improved health outcomes for children in CYCCs.

Stunting remains highly prevalent in Angola. Multisectoral interventions are essential to prevent this public health issue, and while economic evaluations have assessed the costs and consequences of these interventions, they have largely overlooked costs incurred by participants. The MuCCUA trial evaluates the cost-effectiveness of three interventions to prevent stunting during the first 1000 days: standard of care (SOC), SOC plus nutritional supplementation (SOC + NS), and SOC plus cash transfers (SOC + CT). This study aimed to estimate participants' opportunity costs and to explore women's experiences. After 12 months of implementation, data were collected from participant women through focus group discussions, interviews and questionnaires on travel and waiting times, and transport costs for attending health posts and community sessions in the SOC arm, and for quarterly distribution visits in the SOC + NS and SOC + CT arms. Total opportunity costs per participant were estimated by intervention arm and community category (close/far from services and/or distribution points). The total opportunity cost of participants over 1 year were US$9373.91 for SOC, US$16,142.09 for SOC + NS and US$18,231.38 for SOC + CT, corresponding to US$1.69, US$2.80 and US$3.17 per participant per month respectively. Value of travel and waiting times accounted for 75%-85% of opportunity costs, with women in remote villages facing substantially higher burdens. These findings highlight the importance of accounting for opportunity costs, especially time and geographic accessibility, when designing maternal and child health and nutrition interventions. Incorporating a societal perspective in economic evaluations is essential to capture unintended participant burdens and promote equitable, effective participation. Trial Registration: NCT05571280. Registered 7 October 2022.

Nutrition has a profound impact on male reproductive well-being through its influence on molecular mechanisms involved in spermatogenesis, sperm function, and endocrine regulation. Elucidation of these nutrition-fertility relationships at the molecular level may inform future research directions, although clinical application remains uncertain. The review critically assesses how nutritional interventions regulate gene expression, protein synthesis, and cellular signaling pathways controlling sperm concentration, motility, morphology, and DNA integrity. This review discusses molecular mechanisms connecting nutritional components to male fertility results. Micronutrients such as vitamins C, D, E, zinc, selenium, and folate have been implicated in oxidative stress regulation through molecular processes, primarily based on preclinical and observational evidence. Zinc has been primarily shown in experimental and observational studies to act as a cofactor in enzymes of testosterone biosynthesis, preserve sperm membrane phospholipid integrity through metallothionein binding, and modulate flagellar dynein ATPase activity; however, randomized controlled evidence remains limited. In mechanistic and animal studies, Omega-3 fatty acids, particularly DHA, are incorporated into sperm membrane phospholipids in mechanistic and animal models, increasing membrane fluidity and influencing mitochondrial respiratory chain efficiency through cardiolipin modification; while human interventional findings remain heterogeneous. Mechanistic data indicate that Vitamin C quenches hydroxyl radicals as an electron donor, whereas coenzyme Q10 facilitates efficient mitochondrial electron transport, together inhibiting oxidative damage to sperm DNA; although clinical benefits are not consistently demonstrated. However, diets high in processed foods and saturated fats have been associated with increased lipid peroxidation and inflammatory signalling, which may adversely influence spermatogenesis, potentially involving epigenetic regulation. A scoping narrative literature review was conducted using PubMed, Scopus, and Web of Science (January 2000-March 2025). Human, animal, and in vitro studies examining nutritional exposures, molecular mechanisms, and semen parameters were included. This review synthesizes molecular evidence linking nutrition to male fertility through defined biochemical and cellular pathways. By critically evaluating supportive, null, and context-dependent findings, it highlights where mechanistic data align with clinical observations and where translation remains limited. This study identifies key gaps in long-term adaptation, nutrient-gene interactions, and dose-response relationships, underscoring the need for well-designed clinical trials incorporating validated molecular biomarkers. The existing literature is predominantly derived from preclinical and observational studies, with limited high-quality randomized controlled trials. Future research integrating nutrigenomics and epigenetic mechanisms will be essential to determine whether targeted nutritional strategies can be reliably applied in male reproductive health before routine clinical implementation can be recommended.

Mixed methods OBJECTIVES: Individuals with spinal cord injuries and disorders (SCI/D) experience several chronic and SCI-specific secondary health complications that are influenced by nutrition, which is a modifiable risk factor. Improving nutritional knowledge is essential to support healthy dietary behaviors, yet no validated tool exists in this population. This study describes the development and content validation of a nutrition knowledge questionnaire for individuals with SCI/D. Veterans Health Administration and a research rehabilitation hospital in Chicago, USA. A 106-item questionnaire was developed based on two literature reviews and a nutrition advisory member focus group. Content validity was evaluated by subject matter experts who rated the relevance of each item. Experts rated the clarity of each item and provided open-ended feedback. With clarity scores and open-ended feedback, the item-level Content Validity Index (I-CVI) and the scale-level Content Validity Index (S-CVI/Ave) were calculated to select items for pilot testing. An I-CVI of 0.78 and a S-CVI/Ave of 0.90 were considered the thresholds for excellent content validity. Content validity was evaluated by 14 subject matter experts. The I-CVI for 23 items fell below the threshold and the S-CVI/Ave was 0.83, falling short of the threshold. In response to these evaluations, of 106 initial items, 13 were removed, and 5 were modified. Scoring and open-ended feedback from experts allowed the questionnaire to be refined before psychometric testing. This measure represents the first of its kind to be developed and validated to assess the nutrition knowledge of people with SCI/D.

This study aimed to systematically evaluate the efficacy and safety of different doses of domperidone (DOM) combined with esomeprazole (ESM) in the treatment of reflux esophagitis, providing a basis for precise clinical medication. This prospective single-center study enrolled a total of 376 eligible patients with reflux esophagitis (intention-to-treat [ITT] population) between January 2022 and December 2024, among whom 361 completed the full treatment course (per-protocol [PP] population). A total of 361 patients were randomly divided into four groups: control group (oral ESM, n&#x2009;=&#x2009;90), low-dose group (oral ESM&#x2009;+&#x2009;5&#xa0;mg DOM, n&#x2009;=&#x2009;92), medium-dose group (oral ESM&#x2009;+&#x2009;10&#xa0;mg DOM, n&#x2009;=&#x2009;91), and high-dose group (oral ESM&#x2009;+&#x2009;15&#xa0;mg DOM, n&#x2009;=&#x2009;88), all for an 8-week duration. The primary outcome was the endoscopic remission rate at 8&#xa0;weeks, defined as the achievement of Los Angeles classification grade 0 or A (ITT and PP population). Secondary outcomes (PP population) included changes in symptom scores (Gastroesophageal Reflux Disease Questionnaire, Reflux Symptom Index, Reflux Disease Questionnaire), quality of life (GERD-Health Related Quality of Life scale, EuroQol Five-Dimension Five-Level Scale), high-resolution esophageal manometry parameters, 24-hour impedance-pH monitoring indices, serum inflammatory cytokine levels, and the incidence of adverse events. The medium-dose DOM combination group demonstrated the most favorable efficacy across all key endpoints. Its endoscopic remission rate was significantly higher than that of the other three groups (P&#x2009;<&#x2009;0.05). The results of the ITT analysis were highly consistent with the PP analysis. In the ITT population, the medium-dose group demonstrated a significantly superior endoscopic remission rate (94.68%) compared to the other three groups (P&#x2009;<&#x2009;0.05). This finding was corroborated by the PP analysis, which also showed the optimal efficacy in the medium-dose group (97.80%). Concurrently, this group exhibited the most pronounced improvements in symptom scores and quality of life, the greatest recovery in esophageal motility parameters, the most significant reduction in all types of reflux episodes, and the greatest decrease in inflammatory cytokine levels (all P&#x2009;<&#x2009;0.05). The high-dose group ranked second in efficacy, while the low-dose group showed superiority over the control group only in partial indicators. Although there was no significant difference in the incidence of adverse events as reported in the study, the overall event incidence and the increasing trend among different groups suggest the possible existence of a dose-response relationship, especially in the high-dose group. Based on standard esomeprazole therapy, the addition of medium-dose DOM (10&#xa0;mg three times daily) synergistically improves reflux control, mucosal healing, motility recovery, and inflammatory status. This dose achieves an optimal balance between efficacy and safety, providing high-level evidence for implementing individualized and precise medication strategies in clinical practice. Although overall adverse event rates did not differ significantly among groups, a dose-dependent trend was observed. Higher doses offer no additional benefit and may increase safety concerns.

Hip fracture in older adults is a leading traumatic cause of death in this population. Our study provides a comprehensive assessment of the burden of hip fracture among the elderly and, using multiple analytical approaches, demonstrates a strong association between falls and hip fracture in this age group. Using the Global Burden of Disease (GBD) database, we reported the disease burden and risk factors of hip fractures in older adults and analyzed the relationship between falls and the associated disease burden. We employed Mendelian randomization (MR) to estimate the causal relationships between various risk factors (including falls) and hip fractures in the elderly. Furthermore, we described the epidemiological trends and projected future incidence of fall-related hip fractures in this population. In 2021, the global incidence of hip fractures in the elderly was 13,286,199 (9,285,138-18,354,164), with an ASIR of 1,311.94 (918.51-1,807.04). Based on the GBD study, in 2021 more than 90% of the age-standardized incidence, prevalence, and years-lived-with-disability rates for hip fractures in older adults were attributable to falls. Among all fall-related geriatric diseases, the ASIR of geriatric hip fractures is the highest, significantly exceeding that of other conditions. The MR findings revealed that falls are significantly associated with an increased risk of hip fractures in the elderly. In 2021, the global incidence of fall-related hip fractures in the elderly was 12,103,660 (8,116,663-17,145,727), with an ASIR of 1,201.05 (808.88-1,693.91). Based on the Joinpoint regression analysis, it can be observed that from 1990 to 2021, the AAPC for the global ASIR of fall-related hip fractures in the elderly was 0.33 (95% CI: 0.31 to 0.34), with a P-value of less than 0.05. Based on the BAPC model, the global number of incident cases of fall-related hip fractures in the elderly is projected to reach 40,833,020 by 2050, with an age-standardized incidence rate (ASIR) of 1,540.20 per 100,000. There is a close association between falls and hip fractures in the elderly. In recent years, fall-related hip fractures have resulted in a significant disease burden, and the epidemiological trend has been upward. In the future, fall-related hip fractures may continue to lead to an even more severe disease burden.

Rapid urbanisation and occupational demands have contributed to unhealthy dietary habits in Nigeria, particularly among professionals. Male academic professionals may be especially vulnerable to poor eating habits due to demanding schedules and work-related stress. We assessed dietary habits, dietary diversity, and the influence of work-related stress and other associated factors among male academic professionals in Ibadan, Nigeria. A cross-sectional study was conducted among 235 male academic professionals at selected universities and research institutes in Ibadan. Multistage sampling was employed for larger institutions, while a census approach was used for smaller institutions. Data were collected using a structured WHO STEPS-based questionnaire and a 24-hour recall-based Dietary Diversity Tool. Work-related stress and depression were assessed using the Workplace Stress Scale and the Male Depression Risk Scale-7, respectively. Descriptive statistics summarised participants' characteristics and dietary habits. Binary logistic regression with a priori covariate selection was used to identify factors associated with dietary outcomes. The mean age was 46.4&#x2009;&#xb1;&#x2009;9.5 years; the majority were married (88.1%), Christian (78.7%), PhD holders (67.7%), and university-based staff (72.3%), but 17.5% were current alcohol users. The distribution by rank was: early-career researcher (32.8%), mid-career (37.9%), and high-career (29.4%). Regarding their dietary habits,69.4%z skipped breakfast weekly, 61.7% snacked, and 30.2% ate out frequently. High dietary diversity was 55.7%. Muslims had lower odds of skipping breakfast (AOR&#x2009;=&#x2009;0.15; 95% CI: 0.07-0.35), whereas high professional rank had higher odds (AOR&#x2009;=&#x2009;5.30; 95% CI: 1.33-21.14). Severe work-related stress predicted breakfast skipping (AOR&#x2009;=&#x2009;3.49; 95% CI: 1.05-11.61). Higher income was associated with lower odds of frequent eating out, whereas both institution type and income predicted eating-out frequency. Moderate depression was associated with lower odds of achieving high dietary diversity (AOR&#x2009;=&#x2009;0.44; 95% CI: 0.20-0.99). Work-related stress showed no significant association with dietary diversity. Unhealthy dietary habits persist among male academic professionals despite relatively high dietary diversity. Work-related stress, professional rank, religion, income, and depression independently shape dietary outcomes in this population. Academic institutions should implement workplace nutrition programmes, structured meal break policies, stress management initiatives, and accessible healthy food options to improve dietary quality and overall well-being among academic professionals.

Iron-deficiency anemia is the most common micronutrient deficiency and a leading cause of disability-adjusted life years among adolescent girls and young women (AGYW) globally. Although multiple micronutrient supplementation (MMS) provides a broader range of micronutrients than iron-folic acid supplementation (IFAS) prior to conception, the acceptability of MMS and home-based supplementation strategies remains underexplored. We assessed the acceptability of MMS, IFAS, and a contextualized nutrition curriculum delivered via school clubs in a two-arm cluster-randomized trial across three rural secondary schools in Monapo District, Mozambique. Fourteen teachers (clusters) were randomized to deliver either weekly school-based IFAS or daily home-based MMS. A total of 492 AGYW aged 13-20 years were enrolled (240 IFAS; 252 MMS); both arms received the same nutrition curriculum. Participants in both arms reported increased energy, improved appetite, and relief from menstrual symptoms. IFAS was significantly more acceptable than MMS for smell, and some participants perceived the once-weekly IFAS regimen as less burdensome than daily MMS. Some AGYW also reported that male peers perceived MMS as birth control, or assumed the girls were pregnant, due to the image of a pregnant woman on the pill bottle. Ratings of the nutrition curriculum and teachers' facilitation were positive in both arms. Participants generally preferred the regimen they were assigned, and family support facilitated adherence. These findings suggest home-based supplementation may be a feasible and acceptable strategy for reaching in-school and out-of-school AGYW in Mozambique. Including boys in future interventions and redesigning the MMS label could help reduce misconceptions and enhance acceptability.

Rheumatic fever and rheumatic heart disease (RF/RHD) remain important causes of preventable cardiovascular morbidity in low- and middle-income settings, including Southeast Asia. Although research output on these conditions has increased globally, the extent, thematic focus, and distribution of research productivity within Southeast Asia have not been comprehensively characterized. This study aimed to examine the publication trends, collaboration patterns, funding distribution, thematic focus, and selected socio-economic correlates of rheumatic fever and rheumatic heart disease research in Southeast Asia using bibliometric methods. Original articles and conference papers on RF/RHD in SEA from 1900 to 2024 were identified using the Scopus database. Bibliometric indicators and citation data were extracted and summarized descriptively. Country collaboration networks and author keyword co-occurrence maps were visualized using VOSviewer. Associations between selected country-level socio-economic indicators and bibliometric measures were explored using correlation analysis. A total of 333 records on RF/RHD published between 1900 and 2024 from various SEA countries were obtained. Regional publication output remained relatively high in recent years, although annual counts fluctuated and the 2024 output was incomplete at the time of search. Thailand, Indonesia, Malaysia, Singapore, and the Philippines accounted for the largest share of regional output. However, despite this positive trend, SEA's contribution to the global output for RF/RHD research is still below 2.5%. Notably, only one-fifth of the regional publications reported funding support, with marked disparities across countries. The retrieved literature was concentrated in themes related to diagnosis, surgery and complications, registries and epidemiology, anticoagulation, and valvular assessment. In contrast, topics such as social determinants of health, cost-effectiveness, implementation research, and patient-centered care appeared less represented. Country-level research productivity showed positive associations with selected socio-economic indicators and international collaboration, although these findings should be interpreted cautiously. Research on RF/RHD in Southeast Asia has grown, but publication output and funding remain unevenly distributed across countries. Continued efforts to strengthen international collaboration and research support are needed to amplify research productivity in low-resource Southeast Asian settings.

The integration of artificial intelligence (AI) into healthcare is transforming nursing practice, introducing both opportunities and challenges. This qualitative systematic review and meta-synthesis examines nurses' encounters with AI technologies across clinical, managerial, and educational domains. It aims to provide a comprehensive understanding of nurses' lived experiences with AI technologies across clinical, managerial, and educational domains, identify barriers and facilitators to its integration, and derive an interpretive framework for nurses' positioning in AI-enhanced care environments. Following PRISMA and ENTREQ guidelines, a comprehensive literature search was conducted across PubMed, CINAHL, Scopus, Web of Science, and Embase for peer-reviewed qualitative studies from January 2017 to June 2025. The SPIDER framework defined eligibility, focusing on nurses' experiences with AI. Two reviewers independently screened 284 deduplicated records, with 26 studies included after full-text review. Data were extracted using a tailored form, and quality was assessed via the CASP checklist. A combined meta-ethnography and thematic analysis synthesized findings, generating themes through iterative coding and consensus. Verbatim quotes ensured fidelity to nurses' voices, with methodological rigor maintained through reflexivity and member checking. Five themes emerged from 26 studies: (1) Enhancing Clinical Efficiency and Decision-Making, where AI improves risk prediction and workflows; (2) Navigating Barriers to AI Integration, highlighting technical and organizational challenges; (3) Ethical and Cultural Considerations, emphasizing patient autonomy and bias concerns; (4) Evolving Nursing Roles, reflecting shifts to supervisory and technical competencies; and (5) AI's Role in Enhancing Communication, noting its facilitation and depersonalization risks. Nurses value AI's efficiency but stress user-friendly design and ethical safeguards. Continuous training is needed to balance technical skills with empathy. AI significantly enhances nursing efficiency and decision-making but introduces technical, ethical, and role-related challenges. User-centered AI design, comprehensive training, and ethical frameworks are essential to address barriers and biases. Nurses' evolving roles require balancing technical proficiency with humanistic care. Future research should explore longitudinal impacts to ensure AI supports equitable, patient-centered nursing practice.

Primary care is essential for health care systems to promote health, prevent disease, and manage chronic conditions. However, a shortage of primary care physicians challenges the delivery of high-quality primary care services to the population, especially for those living with multimorbidity. To address this challenge, interprofessional primary teams consisting of primary care physicians, nurses, and allied health professionals (AHPs) have been rolled out in many jurisdictions. This approach allows physicians to focus on complex patient care, where less complex care can be delegated to nurses and AHPs. We conducted a scoping review of the literature on the scope of practice of nurses and AHPs in interprofessional primary care teams in Ontario, Canada. Nurse practitioners and registered nurses are heavily involved in providing direct patient care, whereas registered practical nurses are less involved. Pharmacists focus on medication management and patient education, dieticians focus on dietary assessments and nutrition education, and social workers focus on counselling and psychosocial assessments. Pharmacists and nurse practitioners often face challenges in defining their independent roles. Some physicians struggle with teamwork, whereas others appreciate multidisciplinary approaches. Effective integration of nurses and AHPs in a primary care setting would enable physicians to delegate several tasks and address primary care physician shortages in various jurisdictions. Clarifying the professional roles of AHPs in primary care would enhance interprofessional team functioning, helping to increase both the quality and quantity of primary care.

Cervical cancer remains a significant public health concern, particularly among women living with HIV/AIDS, who are at increased risk due to compromised immunity. Despite the high burden of cervical cancer in sub-Saharan Africa, including Tigray, Ethiopia, the magnitude of cervical lesions within screening programs and its associated determinants remain inadequately addressed. This study assesses the magnitude and risk factors of precancerous cervical lesion among HIV-infected women in conflict-prone and resource- limited settings of Tigray, Ethiopia. We conducted a facility-based cross-sectional study involving 2004 women attending antiretroviral therapy clinics. As part of the routine standard of care for cervical cancer screening in Ethiopia, participants underwent Visual Inspection with 5% Acetic Acid (VIA) at five sites of Mekelle public health institutions between June, 21, 2023, to May 30, 2024. Data were collected through structured interviews using Kobo toolbox and analyzed using SPSS version 23 with the use of logistic regression to examine associations between VIA positivity, demographics, and other risk factors. Of 2004 clients with HIV/AIDS who received cervical cancer screening, 378 (18.9%) had a VIA+ result. The odds of being VIA+ were 2.39 times higher among women with a history of sexually transmitted infections (AOR&#x2009;=&#x2009;2.39; 95% CI: 1.72-3.31). Women who had multiple life time sexual partners had 1.94 times higher odds of being VIA+ (AOR&#x2009;=&#x2009;1.94; 95% CI: 1.45-2.58). Similarly, women whose spouse with unknown life time number of sexual partners had 1.7 times higher odds of being VIA&#x2009;+&#x2009;as compared with monogamous [AOR&#x2009;=&#x2009;1.71, 95% CI&#x2009;=&#x2009;1.09, 2.68].The odds were also higher among women with increased parity (AOR&#x2009;=&#x2009;2.06; 95% CI: 1.28-3.30) and those who initiated sexual activity before the age of 18 (AOR&#x2009;=&#x2009;1.57; 95% CI: 1.23-2.01). This study showed a high magnitude of precancerous cervical lesions, affecting nearly to one- fifth of women living with HIV. Key risk factors identified multiple sexual partners, history of sexually transmitted infections (STIs), parity, and early sexual debut. This study demonstrates the need to support implementation efforts that prioritize and facilitate STIs prevention and safer sexual practices.

This study investigated the association between lifestyle exposures (work stress, dietary patterns, and physical activity) and metabolic and hepatic biomarkers among healthcare professionals in Ghana. A cross-sectional survey was conducted among 119 participants at the Kibi Government Hospital. The survey included demographic and lifestyle questionnaires, work stress assessments, anthropometric measurements, and biochemical analyses. Metabolic syndrome (MetS) was defined according to the International Diabetes Federation criteria. Binary logistic regression models were applied to determine the associations. The prevalence of MetS was 11.0%, with high blood pressure (29.7%) and abdominal obesity (57.1%) being the most prevalent MetS components. The majority of participants reported high stress levels (60.4%), and 59.7% engaged in moderate physical activity. Approximately 65.3% had AST/ALT greater than 1. Four dietary patterns were identified: Western Pattern, Traditional mixed pattern, Protein-rich pattern, and Fruit and Dairy pattern. Moderate and high adherence to the Western dietary pattern were significantly associated with increased odds of abdominal obesity (Tertile 2: OR 3.244, 95% CI 1.219-8.629, p-value 0.018, Tertile 3: OR 4.231, 95% CI 1.550-11.546, p-value 0.005). A non-significant association was also observed between elevated triglycerides and ALT (OR 1.03, 95% CI 0.998-1.05, p&#x2009;=&#x2009;0.066). This study highlights a considerable burden of metabolic risk factors among hospital staff in Ghana, with abdominal obesity and elevated blood pressure being the most prevalent components of metabolic syndrome. High work stress levels, moderate physical activity, and elevated AST/ALT ratios (indicating a predominance of hepatocellular injury and suggesting potential liver dysfunction) were also common. Greater adherence to the western dietary pattern was significantly associated with increased odds of abdominal obesity while marginal association was observed between elevated triglycerides and ALT. These findings highlight the need for regular screening for metabolic risk factors and liver function among health professionals. Healthcare institutions should introduce targeted interventions such as nutrition education and improved access to healthy food options to prevent related complications such as liver cirrhosis and diabetes.

Low back pain (LBP) in perimenopause and postmenopausal women is an important public health concern because of its high prevalence and associated social and economic burden. Dietary patterns and physical activity have attracted increasing attention as modifiable determinants of LBP, but the impact of their interaction, particularly across menopausal stages, has not been well characterized. This cross-sectional analysis included 1530 adult women from the Ordos Resident Health White Paper Program. Dietary patterns were derived using principal components analysis of food frequency questionnaire data. Physical activity was assessed using the International Physical Activity Questionnair. LBP was defined as self-reported pain, ache or discomfort in the lumbosacral region (Verbal Rating Scale score 1-3). Logistic regression models were used to examine associations between dietary patterns, physical activity and LBP. Interaction between dietary patterns and physical activity was assessed overall and stratified by menopausal status. The prevalence of LBP was 12.6%. Three major dietary patterns were identified: a plant-based dietary pattern (PBDP), a northern pastoral dietary pattern (NPDP) and a northern traditional dietary pattern (NTDP). Only PBDP was significantly associated with LBP. Compared with women in the highest quartile of adherence to PBDP (Q4), those in the lowest quartile (Q1) had higher odds of LBP (adjusted OR&#x2009;=&#x2009;2.879, 95% CI: 1.749-4.739). No significant association with LBP was observed for NPDP. In joint analyses, the highest odds of LBP were observed among women with higher-intensity physical activity and non-adherence to PBDP (Q1) (adjusted OR&#x2009;=&#x2009;3.777, 95% CI: 1.991-7.166). In analyses stratified by menopausal status, the risk associated with higher-intensity physical activity and non-adherence to PBDP increased from perimenopausal to postmenopausal women, with adjusted ORs of 3.600 (95% CI: 1.029-12.592) and 5.752 (95% CI: 2.189-15.114), respectively. In this population of midlife women, higher-intensity physical activity was associated with increased risk of LBP, and this risk rose from perimenopause to postmenopause. Adherence to PBDP attenuated the LBP risk associated with higher-intensity physical activity, with the beneficial effect becoming more pronounced after menopause. These findings suggest that menopause-specific combinations of dietary improvement and appropriate physical activity may help mitigate the burden of LBP in perimenopausal and postmenopausal women.