Chatbot technology improves access to and engagement with diabetes education. However, few studies have evaluated the feasibility and rigorously assessed the impact of chatbots among individuals with type 2 diabetes (T2DM) using theory-based approaches. This pilot study assessed the feasibility and preliminary impact of a chatbot on glycemic targets, loneliness, and perceived health beliefs among adults with T2DM. An explanatory mixed-methods approach, comprising a one-group experimental design and qualitative interviews, was used. The chatbot simulation, named "TakonGendhis," was developed based on conceptual models derived from the technology acceptance model and the health belief model. Feasibility included usefulness, ease of use, and intention to use. Preliminary impact was evaluated based on changes in glycemic targets, loneliness, and health beliefs from baseline to 12 weeks post-intervention. Qualitative data were gathered through individual interviews and focus group discussions and were analyzed thematically. Narrative synthesis was employed to integrate findings from the quantitative and qualitative phases of the study. The scores for usefulness, ease of use, and intention to use were 26.55, 27.32, and 34.03, respectively. Quantitative analysis revealed reduced loneliness, improved health beliefs, and lower glycemic scores after the 12-week intervention. The qualitative study identified 4 themes: feasibility, beliefs, emotional support, and areas for improvement. The intervention was feasible and had beneficial preliminary impacts on glycemic targets, loneliness, and health beliefs. Addressing feasibility, beliefs, emotional support, and identified areas for improvement may increase patients' willingness to use the chatbot.
Health-promoting behaviors are essential for maintaining independence and enhancing quality of life in aging populations. This study aimed to investigate the relationship between social support and health-promoting behaviors among older adults in Fasa, Iran in 2020. A cross-sectional study was conducted involving 300 older adults attending a specialized outpatient clinic in Fasa, Iran. Data were collected using a demographic questionnaire, the Walker Health-Promoting Lifestyle Profile, and the Canty Perceived Social Support Scale, administered either through self-report or structured interviews. Statistical analyses were performed using SPSS version 25 and included descriptive statistics, analysis of variance, the chi-square test, and multiple linear regression analyses. The mean age of participants was 68.9±7.8 years. Most participants were women (56.6%), married (81.7%), and had less than a high school education (41.3%). The mean scores for health-promoting behaviors and perceived social support were 124.2±31.3 and 24.4±9.4, respectively. A statistically significant positive association was observed between perceived social support and health-promoting behaviors (r=0.10, p=0.04). Social support, gender, and education level were identified as significant predictors of health-promoting behaviors, collectively explaining 34% of the variance. These findings emphasize the pivotal role of social support in promoting health-related behaviors among older adults. Interventions that strengthen social support networks, foster enabling environments, and address gender and educational disparities are recommended to improve health outcomes and quality of life in aging populations. Policymakers and healthcare planners should incorporate these determinants into the design of targeted, evidence-based interventions for older adults.
Artificial intelligence (AI)-enabled technologies have the potential to significantly increase diagnostic accuracy, optimize treatment strategies, and improve patient outcomes. They are revolutionizing the field of preventive and personalized medicine by providing data-driven insights. AI is capable of analyzing large and complex datasets such as genomic, environmental, and lifestyle information much faster and more conveniently than traditional methods. Advanced algorithmic architectures in AI can predict disease risks, identify biomarkers, and tailor interventions to individual needs. The enabling role of AI in real-time monitoring, predictive analysis, and drug discovery demonstrates its transformative potential in healthcare. The role of AI in multi-omics integration, wearable technologies, and precision therapies promises to redefine global healthcare paradigms, making personalized medicine more accessible and effective. However, ethical concerns that need to be addressed to ensure fair and transparent implementation include data privacy, algorithmic bias, and regulatory gaps. This article examines the integration of AI technologies with personalized healthcare. The study also highlights the need for interdisciplinary collaboration to maximize the benefits of AI in preventive and personalized healthcare and overcome barriers.
The objective of this study was to develop machine learning models to predict health insurance claim costs among older adults in Indonesia. This study utilized secondary data from the Indonesian National Health Insurance program (Jaminan Kesehatan Nasional [JKN]) spanning 2017 to 2023. Three modeling techniques-linear regression, random forest, and XGBoost-were employed to predict individual claim costs. Model performance was assessed using the root mean square error (RMSE), coefficient of determination (R2), and mean absolute error (MAE). Additionally, variable importance analysis was conducted to identify key predictors. XGBoost with 500 boosting rounds yielded the best performance, with an RMSE of 11 360 283, an R2 of 0.81, and an MAE of 4 485 917, outperforming both linear regression (RMSE, 13 710 035; R2=0.72) and random forest (RMSE, 12 434 238; R2=0.78). Notably, outpatient care was identified as the most consistent predictor across all models. Other significant predictors included length of stay (LOS), diagnosis type (International Classification of Diseases, 10th revision chapter), facility type, facility classification, and severity of illness, particularly for moderate cases. Although LOS and diagnosis type were important predictors, these findings should be interpreted in the context of Indonesia's fixed Indonesian Case-Based Groups payment system. XGBoost provides reliable predictions of claim costs among older adults, capturing clinical, utilization, and structural drivers. These findings can inform targeted interventions, improve chronic disease management, optimize the referral system, and support integration of predictive tools into JKN to enhance responsiveness and promote sustainable, equitable financing.
Health literacy (HL) is a key determinant of health behaviors and health outcomes. However, the lack of validated Hindi-language instruments limits its assessment in India. This study aimed to translate, culturally adapt, and psychometrically validate 3 internationally recognized tools-the Short Assessment of Health Literacy in English (SAHL-E), the All Aspects of Health Literacy Scale (AAHLS), and the European Health Literacy Survey Questionnaire (HLS-EU-Q47)-for Hindi-speaking adults in rural North India. A community-based cross-sectional study enrolled 250 adults from 5 villages in Uttar Pradesh. Translation followed forward-backward procedures with expert review and pretesting. Psychometric evaluation included internal consistency (Cronbach α), test-retest reliability (intraclass correlation coefficients, ICC), construct validity (exploratory factor analysis), convergent and known-groups validity, and feasibility indicators (completion rates and interview duration). All instruments demonstrated strong psychometric performance. Cronbach α values were 0.84 (SAHL-E), 0.87 (AAHLS), and 0.93 (HLS-EU-Q47), and ICCs ranged from 0.86 to 0.94. Factor structures aligned with theoretical expectations. Convergent correlations ranged from 0.42 to 0.61 (p<0.001), and known-groups validity analyses showed significant differences according to education and occupation. Completion rates exceeded 98%, and the mean interview duration was approximately 32 minutes. The Hindi-adapted SAHL-E, AAHLS, and HLS-EU-Q47 demonstrated strong reliability, validity, and feasibility for assessing HL among rural adults in India.
Mental illness remains among the top 10 causes of the global burden of disease. According to the National Mental Health Survey of India, 10.6% of adults exhibit mental disorders. India ideally requires 3 psychiatrists per 100 000 population, yet the current ratio is only 0.7 per 100 000. The country thus faces an urgent need to strengthen mental health infrastructure and expand training programs. Vulnerable groups-particularly residents of rural and remote areas, women, and older adults-are disproportionately affected by this situation. Individuals with mental illness often suffer in silence, enduring human rights violations, stigma, and discrimination. India's National Mental Health Programme seeks to ensure the availability and accessibility of minimum mental health care for all, with a focus on the most vulnerable and underserved populations. The World Health Organization recommends task shifting or task sharing to improve access and deliver healthcare services in remote areas. Community Health Officers (CHOs) and Accredited Social Health Activists use community-based assessment checklists to identify individuals at risk of communicable, non-communicable, and mental health disorders. CHOs then ensure continuity of care through regular follow-up, bridging the gap between diagnosis and ongoing treatment. This practice significantly augments the effectiveness of community-level mental health interventions. Integrating mental health into primary health care should facilitate earlier detection and treatment of mental health disorders.
Cancer is the leading cause of morbidity and mortality worldwide. To reduce this burden, the Korean government established the National Cancer Screening Program (NCSP) in 1999, initially offering stomach, breast, and cervical cancer screening to Medical Aid Program (MAP) beneficiaries. By 2019, the NCSP had broadened both its eligible population and the range of cancers screened-stomach, liver, cervical, breast, colorectal, and lung-for both MAP recipients and health insurance beneficiaries. Since its inception, participation and adherence to recommended screening have risen steadily, driven by nationwide policy initiatives and expanded access. Over the past 2 decades, the NCSP has played a key role in reducing the incidence of stomach, liver, colorectal, and cervical cancers while increasing detection at precancerous stages, especially for cervical and colorectal cancers. Five-year relative survival rates for major cancers-most notably stomach, colorectal, and breast-have also improved substantially. Accumulated evidence, including cancer detection rates, stage distribution at diagnosis, and mortality reduction, underscores the program's effectiveness in facilitating early detection and reducing cancer-specific deaths. Notably, Korea's mortality-to-incidence ratio for major cancers remains well below the Organization for Economic Cooperation and Development average, illustrating the impact of the nation's comprehensive cancer control strategies. Continued research, surveillance, and refinement of evidence-based screening guidelines will be critical to further enhancing the efficiency and effectiveness of the NCSP.
Catastrophic health expenditures (CHE) is a well-established indicator of financial risk protection. This study aimed to examine the contribution of medication expenditure to CHE and the associated socioeconomic inequalities. Data were drawn from 6 nationally representative income and expenditure surveys covering the period 2019-2024. Using the budget share method, CHE was defined as out-of-pocket (OOP) health payments exceeding 25% of a household's total consumption expenditure. The contribution of medication expenditures to CHE was then calculated as the difference in the proportion of households experiencing CHE with and without medication payments. Socioeconomic inequalities were quantified using the Concentration Index (CI), and decomposition analysis was conducted to identify the primary drivers of overall socioeconomic inequality in the contribution of medication expenditures to CHE. During the study period, medications represented a substantial share of household health expenditures and contributed to CHE. In 2024, OOP spending on medications accounted for 31.2% of total health expenditures, while the contribution of medication expenditures to CHE was 1.28%. The CI indicated that the contribution of medication expenditures to CHE was concentrated among poorer households. Decomposition analysis further identified medium-sized households, male-headed households, households with employed heads, insured households, and urban households as the main contributors to this socioeconomic inequality. In Iran, OOP payments for medications constitute a substantial share of household healthcare expenditures and contribute to CHE. Because the roots of inequality extend beyond the healthcare system, addressing this issue requires a comprehensive, cross-sectoral strategy that integrates broader social and economic policies.
This study aimed to develop and test a comprehensive model analyzing direct and indirect relationships among workload, demographic factors, fatigue, work stress, and quality of life among aircraft maintenance personnel (AMP). This cross-sectional study was conducted at the maintenance, repair, and overhaul facility at Sultan Hasanuddin Airport, Makassar. Data collection combined structured interviews, standardized questionnaires (the NASA Task Load Index, Work Fatigue Feeling Measurement Questionnaire, Depression Anxiety Stress Scale-21, and World Health Organization Quality of Life-BREF), and objective measures (a Cocoro Meter for stress and an oximeter for physical workload). The model was examined using partial least squares structural equation modeling (PLS-SEM), which is well-suited to complex models with latent variables and non-normally distributed data. In the PLS-SEM analysis, physical workload (β=0.229, p=0.018) and work experience (β=0.277, p=0.007) were significantly and directly associated with fatigue. Age significantly predicted work stress (β=0.371, p=0.001). Crucially, fatigue (β=-0.344, p=0.002) and work stress (β=-0.385, p<0.001) had significant negative direct effects on quality of life and were central mediators. No direct effects of exogenous variables on quality of life were observed. Cross-tabulation supported these findings; subgroups with higher physical demands, longer tenure, and older age reported greater fatigue, higher stress, and lower quality of life. Fatigue and work stress are pivotal mediators that are significantly associated with reduced quality of life among AMP. Interventions to reduce physical workload and provide targeted support for more experienced and older workers may improve well-being and safety in the aviation maintenance industry.
Indonesia has the second-highest number of tuberculosis (TB) cases globally, after India. The estimated TB incidence in Indonesia is 1 090 000 cases (387 cases per 100 000 population), with an associated mortality of 131 000 deaths (47 deaths per 100 000 population). The 2023-2024 TB Inventory Study in Indonesia aimed to quantify the extent of under-reporting by identifying TB cases that were diagnosed and/or treated but not reported to the National TB Surveillance System (Sistem Informasi Tuberkulosis [SITB]). This study specifically assessed the magnitude of under-reporting of TB cases among children younger than 15 years in Indonesia. This study used a cross-sectional design and analyzed data from the 2023-2024 TB Inventory Study (SIV-TB) in Indonesia. The sample included all TB cases in children younger than 15 years identified from eligible health facilities. Under-reported cases were defined as those that were diagnosed and/or treated but not reported to the SITB. Descriptive statistics were used to characterize under-reporting. A record-linkage process was performed to compare SIV-TB data with SITB data after deduplication. A total of 12 293 TB cases in children younger than 15 years were identified across health facilities in 31 districts and cities. The overall under-reporting rate for childhood TB was 23.5%. The highest under-reporting rate was observed in Eastern Indonesia (28.0%). Under-reporting of childhood TB was significantly associated with both age group and type of health facility.
Studies of the associations between coronavirus disease 2019 (COVID-19) control measures and infant health in Vietnam are limited. This study investigated differences in birth outcomes between pregnancies during the COVID-19 pandemic and those before the pandemic. Data on infants born alive between 2016 and 2023 in Ho Chi Minh City (HCMC) were collected. For each infant, the estimated first day of pregnancy was calculated based on birth date and gestational age. Linear and logistic regression analyses were conducted to identify significant associations. The birth outcomes examined included decreased birth weight (BW), low birth weight (LBW), term LBW, and preterm birth (PTB). The models were adjusted for infant sex, birth order, gestational age, and maternal age. The COVID-19 pandemic period in HCMC was defined as April 2020 to December 2022. Among 172 017 infants, 31.4% had at least 1 trimester of gestation during the COVID-19 pandemic, 44.2% were first births, and 52.0% were male. Infants with full gestation during the pandemic had significantly lower BW (by 20.7 g) compared to those born pre-pandemic. Pregnancy during the COVID-19 pandemic was associated with higher rates of LBW, term LBW, and PTB compared to the pre-pandemic period. The odds ratios (95% confidence intervals) were 1.21 (1.15 to 1.27), 1.28 (1.18 to 1.39), and 1.10 (1.06 to 1.15), respectively. The COVID-19 pandemic was associated with elevated risk of adverse birth outcomes. Lessons learned from the COVID-19 response should be applied to prepare for future outbreaks.
Karoshi, or "death from overwork," has been recognized for decades; however, epidemiological findings regarding long working hours (LWH) and ischemic heart disease (IHD) remain inconsistent. This study aimed to provide new evidence on the association between LWH and IHD, while accounting for job strain among Japanese workers, both male and female. This study utilized data from 6670 workers participating in the Jichi Medical School Cohort Study. Baseline working hours were categorized as <5.0, 5.0 to 6.9, 7.0 to 8.9 (reference), 9.0 to 10.9, and ≥11.0 hr/day. Fatal and non-fatal incident IHD cases were determined during follow-up using International Classification of Diseases, 10th revision codes. Multivariable Cox proportional hazards models were used to examine associations, adjusting for socio-demographic factors, lifestyle behaviors, cardiometabolic characteristics, and job strain. During a mean follow-up of 12 years, 58 incident IHD cases (42 male and 16 female) were documented. Long working hours (≥11.0 hr/day) were significantly associated with an increased risk of IHD in the total sample (hazard ratio, 2.92; 95% confidence interval, 1.15 to 7.39), and the overall pattern of associations was similar in sex-stratified analyses. These findings suggest that LWH independently increases the risk of IHD among Japanese workers, even after adjustment for job strain, underscoring the importance of managing working hours to reduce karoshi in both male and female workers.
Assessing healthcare quality at the national level is essential for evaluating health system performance and identifying areas requiring improvement. This study examined long-term trends in healthcare quality in Korea from 2008 to 2023 using internationally comparable indicators. We conducted a trend analysis of healthcare quality in Korea using the Organization for Economic Cooperation and Development (OECD) Health Care Quality and Outcomes framework and quality indicators. Indicators across multiple domains, including acute care, primary care, prescribing in primary care, mental healthcare, and patient experiences, were analyzed and compared with OECD averages. Healthcare quality in Korea improved across several domains. Thirty-day mortality for acute myocardial infarction decreased from 14.2% in 2008 to 10.2% in 2023, while mortality for ischemic stroke declined from 8.7% to 5.5%. Avoidable hospitalizations decreased substantially, with hospitalizations for chronic obstructive pulmonary disease declining by 59.7%. The proportion of patients with diabetes receiving cholesterol-lowering treatment increased from 44.1% to 82.5%. However, the proportion of broad-spectrum antibiotic prescriptions remained substantially higher than the OECD average (40.3 vs. 15.5%). In mental healthcare, excess mortality ratios increased from 4.3 in 2010 to 4.9 in 2023 for schizophrenia and from 3.5 to 4.3 for bipolar disorder, while post-discharge suicide rates showed little improvement. Patient experience indicators related to patient-physician communication improved and approached OECD averages. Healthcare quality in Korea improved substantially between 2008 and 2023, particularly in acute care outcomes and chronic disease management. However, persistent challenges remain in areas such as antibiotic use, polypharmacy, and mental healthcare. These findings provide internationally comparable evidence to inform future health policy and healthcare quality improvement efforts.
This study investigated how the mediating effect of health literacy (HL) on the association between income and cancer screening participation varies by age among Korean adults aged 40 years and older, with the aim of identifying the optimal timing for HL interventions. Data from 4171 adults aged ≥40 years in the 2023 Korea National Health and Nutrition Examination Survey were analyzed using moderated mediation analysis implemented with the lavaan.survey package, accounting for the complex sampling design. The Johnson-Neyman technique was used to identify age thresholds at which the mediation effect became statistically significant, and the number needed to benefit (NNB) was calculated to estimate the potential efficiency of interventions targeting this pathway. Each 1-quintile increase in income was associated with a 16.0% higher likelihood of undergoing cancer screening (odds ratio=1.16, p<0.001). The mediating effect of HL increased significantly with age (index of moderated mediation=0.000438, p=0.048). Mediation became statistically significant from age 54.2 years (Johnson-Neyman threshold), with the proportion of the total effect mediated rising from 0.1% among adults aged 40-49 years to 8.1% among those aged ≥70 years. The NNB for this pathway indicated substantial intervention efficiency in older adults (NNB=372 for ages ≥70), whereas the mediation effect was not statistically significant in the 50-59 age group. HL significantly mediated the relationship between income and cancer screening participation from the mid-50s onward, with progressively greater contributions at older ages. These findings support age-differentiated strategies, including structural accessibility improvements for adults in their 40s and early 50s and integrated income-HL interventions for individuals aged ≥55 years. Experimental studies are warranted to confirm these associations.
Particulate matter with an aerodynamic diameter of less than 2.5 µm (PM2.5) from motor vehicle emissions has increased air pollution, negatively affecting both the environment and human health. This study aims to evaluate the concentration of fine particulate matter, assess associated health risks, and simulate the spatial distribution of PM2.5. PM2.5 samples were collected from 36 key congestion points along the main roads of Makassar City. Measurements were taken for one hour during the morning, afternoon, and evening sessions. The hazard quotient (HQ) was calculated to estimate non-carcinogenic health risks. A total of 175 volunteer traffic assistants participated in the study. Spatial analysis was performed using the kriging method. The highest recorded PM2.5 concentration was 65 µg/m3 on Hertasning Street, while the lowest was 2 µg/m3 on AP Pettarani Street. The average concentration across all locations was 23.20 µg/m3. Although PM2.5 levels remained below Indonesia's regulatory limit of 65 µg/m3, they exceeded the World Health Organization guideline of 15 µg/m3. The highest HQ value was 12.94, and the lowest was 0.22. The spatial analysis showed a direct correlation between higher pollutant concentrations and congested areas. The findings indicate that the HQ for PM2.5 exceeds the acceptable standard (HQ>1), signifying a health risk that increases with frequent exposure. Effective air quality management strategies-including the use of masks, promotion of green transportation, and expansion of green open spaces-are essential to reduce pollutants and minimize health risks, especially for individuals with regular exposure.
Seasonal influenza poses significant global health challenges, with healthcare professionals (HCPs) particularly vulnerable due to frequent exposure to infected patients. Influenza vaccination is a proven method to reduce morbidity and mortality. Despite recommendations by health authorities, vaccination uptake among HCPs remains suboptimal globally and within Jordan. This study aimed to assess knowledge, attitudes, barriers, and influenza vaccine uptake among physicians in Jordan. A cross-sectional study was conducted from March 2023 to June 2023 involving 389 physicians from Ministry of Health facilities across Jordan. A structured and validated questionnaire was used to collect demographic data, vaccination history, and insights guided by the health belief model. Multivariate logistic regression analyses were performed to identify predictors of vaccine uptake and patient vaccination practices. The influenza vaccination rate during the 2022-2023 season was 47%. Vaccination uptake was associated with factors such as age, geographic location, professional designation, and training. Vaccinated physicians demonstrated better knowledge and more favorable attitudes toward vaccination. Common barriers included misconceptions about personal risk, concerns over vaccine efficacy, and forgetting to vaccinate. Physicians who received training were more likely to recommend vaccination to patients. The low vaccination rate among Jordanian physicians highlights the need for targeted educational interventions and policies to address misconceptions and barriers. Improving influenza vaccination uptake among HCPs is critical to enhancing patient confidence, reducing transmission, and improving public health outcomes.
Low-income and middle-income countries in Asia bear a disproportionate burden of particulate matter with an aerodynamic diameter of 2.5 micrometers or less (PM2.5) pollution, yet data remain scarce. This systematic review and meta-analysis aimed to quantify the association between PM2.5 exposure and the risks of coronavirus disease 2019 (COVID-19) infection and mortality in this vulnerable region. A systematic search was conducted in PubMed, Scopus, and other major databases for studies published up to December 31, 2024. We included observational studies reporting associations between PM2.5 and COVID-19 outcomes in low-income and middle-income Asian countries. Pooled effect sizes and 95% confidence intervals (CIs) were calculated using a random-effects model. The study was registered with PROSPERO (CRD42022316008). Fourteen studies met the inclusion criteria. Separate analyses demonstrated statistically significant positive associations between PM2.5 exposure and COVID-19 infection for both short-term exposure (pooled risk ratio [RR], 1.12; 95% CI, 1.07 to 1.18) and long-term exposure (pooled RR, 1.41; 95% CI, 1.28 to 1.56). For mortality, the analysis identified a statistically non-significant positive association with short-term exposure (pooled RR, 1.37; 95% CI, 0.80 to 2.33). Substantial heterogeneity was observed across all analyses (I²>75%); however, sensitivity analyses confirmed that the findings for infection were robust. Our findings provide robust evidence that PM2.5 exposure is a significant risk factor for COVID-19 infection in low-income and middle-income Asian countries. The available evidence was insufficient to establish a clear association with mortality. These results underscore the urgent need for strengthened air quality control policies as a critical component of public health strategies to mitigate the burden of respiratory pandemics.
Korea is one of the fastest-aging societies, and a large proportion of its older population lives alone. This study examined the impact of family interaction frequency on the association between living alone and depressive symptoms among older adults aged ≥80 years using nationally representative survey data. Among the 229 099 participants of the 2019 Korea Community Health Survey, 15 672 participants aged ≥80 years who either lived with close family or lived alone were included in the analysis. Participants living alone were classified according to the frequency of family interaction, ranging from less than once a month to more than once a week. The outcome variable was moderate to severe depressive symptoms, defined as a Patient Health Questionnaire-9 score of ≥10. The prevalence of depressive symptoms was higher among older adults living alone (9.4-14.1%, depending on the frequency of family interaction) than among those living with close family (6.5%). Older adults living alone who interacted with family less than once a month were more likely to report depressive symptoms compared with those living with close family (adjusted odds ratio [aOR], 1.71; 95% confidence interval [CI], 1.36 to 2.15). Weekly family interaction mitigated the impact of living alone on the prevalence of depressive symptoms (aOR 1.10; 95% CI, 0.84 to 1.42). The influence of family interaction on the association between living alone and depressive symptoms remained consistent across subgroups of men, women, and those with difficulty in daily activities. Encouraging regular interaction among family members could serve as an effective strategy to protect the mental health of older adults.
Child sexual abuse is the most frequently reported form of violence against children in Indonesia, with reported cases increasing over the past 5 years. This study aimed to identify risk and protective factors associated with sexual abuse among adolescents aged 13-17 years in Indonesia. The analysis used data from the 2024 National Survey of Children's and Adolescents' Life Experiences (SNPHAR), including 6811 respondents. Bivariate analyses were conducted using chi-square tests to identify variables associated with sexual abuse. Variables with p-values less than 0.25 in binary logistic regression were included in multivariable logistic regression. Odds ratios, adjusted odds ratios (aORs), and 95% confidence intervals (CIs) were calculated to identify risk and protective factors associated with the experience of sexual abuse. Overall, 8.7% of respondents reported experiencing sexual abuse. Protective factors included never having worked (aOR, 0.77; 95% CI, 0.61 to 0.99; p<0.05), never having witnessed violence (aOR, 0.20; 95% CI, 0.17 to 0.24; p<0.001), and no history of sexual intercourse (aOR, 0.08; 95% CI, 0.04 to 0.15; p<0.001). Conversely, positive gender attitudes (aOR, 1.56; 95% CI, 1.29 to 1.87; p<0.001) and knowledge of child protection services (aOR, 3.85; 95% CI, 3.15 to 4.72; p<0.001) were unexpectedly associated with elevated risk. Violence-free environments and limited exposure to early sexual experiences appear to represent critical protective factors. Counterintuitive associations suggest potential influences of cultural norms, patriarchy, and limited access to services.
This study was performed to determine the prevalence and severity of depression among patients previously diagnosed with anemia and to explore associated clinical and socio-demographic factors. This cross-sectional study was conducted from October 2024 to February 2025, among 300 patients with anemia attending the outpatient clinic at the Rural Health Training Centre, Amrita School of Medicine, Faridabad, Haryana. Data on socio-demographic and clinical variables were collected using a structured questionnaire. Depression was evaluated using the Patient Health Questionnaire-9 (PHQ-9). Associations of anemia severity with depression presence and severity were analyzed using the chi-square test, logistic regression, and ordinal logistic regression, with adjustment for potential confounders. The prevalence of depression (PHQ-9 score>9) among patients with anemia was 31.3%. Severe anemia was significantly associated with higher odds of depression (adjusted odds ratio [aOR], 3.02; 95% confidence interval [CI], 1.13 to 8.07; p=0.027) and more severe depression (aOR, 2.87; 95% CI, 1.14 to 7.27; p=0.026). Symptoms such as weakness (aOR, 3.57) and shortness of breath (aOR, 2.71) were also significantly associated with depression. Moderate anemia displayed a non-significant trend. Severe anemia is independently associated with both the presence and severity of depression. Routine mental health screening should be integrated into anemia management protocols, especially in rural healthcare settings.