Frontiers in Public Health最新文献

{"title":"Human papillomavirus vaccine uptake and its determinants among women in Africa: an umbrella review.","authors":"Berihun Agegn Mengistie, Amlaku Nigusie Yirsaw, Gebeyehu Lakew, Gebrehiwot Berie Mekonnen, Adamu Ambachew Shibabaw, Alex Ayenew Chereka, Gemeda Wakgari Kitil, Wubet Tazeb Wondie, Alemken Eyayu Abuhay, Eyob Getachew","doi":"10.3389/fpubh.2025.1537250","DOIUrl":"10.3389/fpubh.2025.1537250","url":null,"abstract":"<p><strong>Background: </strong>Globally, cervical cancer is the fourth most prevalent disease among women. It is primarily caused by persistent infections with human papillomavirus (HPV). The World Health Organization (WHO) strongly recommends HPV vaccination for girls aged 9 to 14 years. Although HPV vaccination is the most effective form of primary prevention against cervical cancer, the accessibility and uptake of the HPV vaccine remain low in developing nations, particularly in Africa. Therefore, this umbrella review aimed to determine the pooled prevalence of human papillomavirus vaccine uptake and its determinant factors in Africa.</p><p><strong>Methods: </strong>The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under reference number CRD42024560032. Eligible systematic review and meta-analysis (SRM) studies were retrieved from PubMed, Hinari, ScienceDirect, and Google Scholar. Data were extracted using Microsoft Excel 2019 and analyzed using Stata software (version 17). The methodological quality of the included studies was examined using A Measurement Tool to Assess systematic Reviews (AMSTAR 2). Publication bias was checked using a funnel plot and Egger's test. A random-effects model (DerSimonian-Laird method) was used to estimate the pooled prevalence of HPV vaccine uptake. The I-squared (I²) test was performed to assess statistical heterogeneity among the included studies.</p><p><strong>Results: </strong>This umbrella review included five SRM studies conducted across Africa, encompassing a total of 707,005 study participants. The pooled prevalence of HPV vaccine uptake in Africa was 41.38% (95% CI: 34.70, 48.06). Women's knowledge of HPV vaccination (AOR: 3.22, 95% CI: 1.64-6.33) and attitudes toward HPV immunization (AOR: 2.48, 95% CI: 2.18-2.81) were significantly associated with HPV vaccine uptake.</p><p><strong>Conclusion: </strong>The uptake of the HPV vaccine in Africa remains significantly lower (41.38%) than the WHO's global HPV vaccination target of 90% by 2030. Therefore, increasing vaccine uptake requires promoting women's knowledge and attitudes toward HPV vaccination through facility-based education and counseling, planned campaigns, community-based programs, and advocacy for HPV vaccination and cervical cancer prevention using various mass media platforms.</p><p><strong>Systematic review registration: </strong>Berihun Agegn Mengistie, Muluken Demeke, Abebaw Setegn. An Umbrella review of Human Papillomavirus (HPV) Vaccine Uptake and its predictors among females in Africa, 2024. PROSPERO 2024 Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD42024560032.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1537250"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparedness and response to the international poliovirus and diphtheria reintroduction alert: public health interventions and strategy review in the Veneto Region, Italy.","authors":"Marco Milani, Michele Nicoletti, Michele Tonon, Davide Gentili, Stefan-Alexandru Panaite, Filippo Da Re, Andrea Basso, Gloria Pagin, Marco Zampini, Debora Ballarin, Francesca Zanella, Vanessa Groppi, Silvia Cocchio, Francesca Russo, Vincenzo Baldo","doi":"10.3389/fpubh.2025.1510785","DOIUrl":"10.3389/fpubh.2025.1510785","url":null,"abstract":"<p><strong>Background: </strong>Diphtheria and polio continue to pose significant public health challenges globally, making sustained high vaccination coverage crucial. This study examines the strategies adopted in the Veneto Region to enhance vaccination rates for diphtheria and polio among priority target groups and improve poliovirus surveillance, following the WHO alert about the potential reintroduction and circulation of the two pathogens.</p><p><strong>Aim: </strong>The main objective of this study is to assess the effectiveness of supplementary vaccination strategies implemented in the Veneto Region in response to international poliomyelitis and diphtheria alerts. Additionally, it aims to identify municipalities at higher risk of poliovirus AFP based on georeferenced vaccination coverage, enhancing environmental surveillance strategies. Ultimately, the study evaluates regional preparedness and response efforts, offering insights to mitigate the risk of reintroducing these diseases and providing a framework adaptable to similar contexts.</p><p><strong>Methods: </strong>The Regional Directorate of Prevention, Food Safety, Veterinary Public Health analysed regional vaccination coverage and provided Local Health Authorities (LHAs) with a georeferenced representation of vaccination coverage across municipalities. Directives on targeted vaccination strategies were issued to address identified gaps and improve readiness. Ten months later, the Regional Directorate assessed the approaches implemented by LHAs to improve vaccine uptake and evaluated the resulting vaccination coverage. Based on this georeferenced analysis, the effectiveness of current environmental poliovirus surveillance was reviewed, and recommendations for optimising surveillance efforts were proposed.</p><p><strong>Results: </strong>Following the implementation of the vaccination strategies recommended by the Regional Directorate, vaccination rates improved across all LHAs, especially among children aged 0-2 years who had not received any vaccine doses. The georeferenced analysis of vaccination coverage revealed critical gaps in environmental poliovirus surveillance and underscored the need for targeted interventions to reach unvaccinated populations.</p><p><strong>Conclusion: </strong>This study demonstrates that centralised governance, combined with georeferenced vaccination data, environmental poliovirus surveillance, and clinical AFP surveillance, enhances the ability to identify coverage gaps and respond to infectious disease threats. While improvements in vaccination rates were achieved, the findings underscore the need for targeted, community-specific interventions and continuous monitoring to address disparities. Strengthening data integration and adopting innovative surveillance methods will be crucial to sustaining high vaccination coverage and ensuring public health security.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1510785"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tearing down inequalities in the healthcare system across Europe: the BEACON project.","authors":"Chrysanthi Koukoutzeli, Giulia Ferraris, Veronica Coppini, Maria Vittoria Ferrari, Elisa Fragale, Dario Trapani, Ida Minchella, Roberto Grasso, Giuseppe Curigliano, Gabriella Pravettoni","doi":"10.3389/fpubh.2025.1520772","DOIUrl":"10.3389/fpubh.2025.1520772","url":null,"abstract":"<p><p>Equity in healthcare remains a pressing issue in cancer care across the European Union. Although numerous European initiatives address prevention, early diagnosis, and treatment, significant disparities in access to innovative cancer therapies persist. Time-to-reimbursement for new anticancer drugs varies widely between member states, depending on national health policies, economic capacity, and healthcare infrastructure. These differences particularly affect countries in Central and Eastern Europe, where delays in reimbursement, limited access to clinical trials, and restricted availability of specialized care contribute to worse outcomes. This narrative review examines how disparities in reimbursement timelines and access to new cancer therapies may affect factors such as early detection, specialized treatment availability, clinical trial participation, and socioeconomic status. The discussion is framed within the BEACON project, a European Union-funded initiative under the EU4Health programme. BEACON brings together patients, healthcare providers, researchers, and policymakers to create a cross-border network for quality-assured diagnosis and treatment. Through its multilingual digital platform, the project fosters collaboration, supports health literacy, and enhances access to innovative cancer therapies, aiming to reduce inequities regardless of geographic or socioeconomic background.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1520772"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"<i>No forest, no future, but they don't see us</i>\": eco-anxiety, inequality, and environmental injustice in São Paulo.","authors":"Marcia Thereza Couto, Marina Senent-Valero, Lorruan Alves Dos Santos, Milena Mateuzi Carmo, Alicia Matijasevich, Maria Pastor-Valero","doi":"10.3389/fpubh.2025.1555386","DOIUrl":"10.3389/fpubh.2025.1555386","url":null,"abstract":"<p><strong>Introduction: </strong>Eco-anxiety disproportionately affects vulnerable populations and younger generations. High and chronic levels of eco-anxiety may have significant impacts on mental health.</p><p><strong>Methods: </strong>This qualitative study, utilizing a guided group discussion methodology, aimed to explore perceptions of climate change, eco-anxiety, health impacts, resilience, pro-environmental behaviors, and opinions on governmental and institutional actions in São Paulo, Brazil. Six focus groups were conducted: four with young residents and women community leaders from marginalized communities, and two with university students from higher-socioeconomic backgrounds.</p><p><strong>Results: </strong>Perceptions of climate change varied: more vulnerable participants linked it to personal experiences but lacked understanding of its causes, while higher-income students relied on formal education. Though unfamiliar with \"eco-anxiety,\" participants expressed related feelings. Vulnerable communities reported greater trauma and health impacts, with Black women leaders emphasizing how climate change exacerbates racial and gender inequalities. Community networks were vital for resilience, but climate change disrupted future plans-vulnerable groups faced immediate losses, while higher-income students made long-term choices like delaying parenthood. Poverty hindered collective pro environmental behavior in vulnerable communities. Participants from the outskirt criticized environmental messaging for neglecting their heightened risks. Across all groups, government inaction and prioritization of economic interests over environmental policies were key concerns.</p><p><strong>Conclusion: </strong>Poverty and exclusion drive and exacerbate climate vulnerability, with marginalized populations often feeling their experiences are overlooked in climate discourse. These findings may offer valuable insights into the socio-political dimensions of climate vulnerability in other Global South contexts.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1555386"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of key factors and equity in influenza vaccination among Chinese adults-evidence from a large national cross-sectional survey.","authors":"Bo Dong, Hengxuan Xu, Ning Tang, Menghan Jiang, Zhihao Lei, Yue Han","doi":"10.3389/fpubh.2025.1601577","DOIUrl":"10.3389/fpubh.2025.1601577","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Influenza is prevalent globally, leading to severe morbidity and mortality. Vaccination remains a critical strategy for influenza prevention. Although previous studies in China have primarily focused on influenza vaccination among children, limited research has addressed the key determinants and equity issues concerning adult influenza vaccination.The purpose of this study was to investigate the key factors influencing influenza vaccination and its equity among Chinese adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study uses data from the 2021 Chinese General Social Survey (CGSS) (N = 2695).Initially, differences in influenza vaccination among adults with various baseline characteristics were analyzed using the chi-square test. Subsequently, the importance of influencing factors was assessed through a random forest model, with LASSO used for variable selection. Following this, weighted logistic regression analysis was applied to quantify the significant influencing factors. Finally, the concentration index was employed to identify and determine the contribution of important variables to influenza vaccination.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The influenza vaccination rate among Chinese adults is low (6.75%). Key factors identified as influencing adult vaccination include government trust, physician trust, income, aging concerns, health insurance, age, education, and health status. These factors not only have independent effects but also interact to influence vaccination behavior. Regarding individual effects, government trust, physician trust, income, and aging concerns showed positive associations with vaccination rates. Conversely, health insurance status, age, educational attainment, and health status demonstrated negative associations. Regarding the interaction terms, there were positive associations between health insurance and government trust, education and government trust, health and physician trust, government trust, as well as education level and age with the target variables. In contrast, interactions between income and health insurance, as well as income and physician trust negatively influenced vaccination rates. The concentration index for adult influenza vaccination was 0.092. There was inequity in vaccination, with the distribution of vaccinations being skewed toward higher-income individuals. Decomposition analysis further revealed that the primary contributors to vaccination inequity, in descending order of magnitude, were income (32.6%), government trust (9.1%), education (8.7%), age (8.2%), and aging concerns (2.6%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;This is the first study to leverage a large micro-survey database in China to analyze the key factors affecting adult influenza vaccination and its equity. By providing new evidence on influenza vaccination among Chinese adults, the findings may inform the optimization of adult immunization policies. To further increase influenza vaccination rates ","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1601577"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging the translational science benefits model to enhance planning and evaluation of impact in CTSA hub-supported research.","authors":"Andrea Molzhon, Pamela M Dillon, Deborah DiazGranados","doi":"10.3389/fpubh.2025.1593920","DOIUrl":"10.3389/fpubh.2025.1593920","url":null,"abstract":"<p><strong>Introduction: </strong>Increasingly, the public, policymakers, and funders expect clinical research to show tangible effects on public health. However, assessing research impact is challenging. Most researchers are not trained to consider the broad-ranging impacts of their work. The TSBM is a conceptual framework that includes four domains of impact: clinical, community, economic, and policy. We assess the utility and acceptability of using a survey based on the TSBM as a means to help researchers identify their potential research impacts.</p><p><strong>Methods: </strong>CTSA program-supported investigators self-reported the potential benefits of their research projects in an electronic survey based on the TSBM. Responses were reviewed and scored by program evaluators. Survey acceptability was measured by response and completion rates; utility was measured by comparing benefits identified in the survey but not described in the researcher's grant application; and quality was measured by the degree of congruence between investigators' responses and evaluators' determinations regarding the potential benefits of the research.</p><p><strong>Results: </strong>Of the investigators invited to participate, 67% completed the survey. Half of the investigators identified at least one benefit from their research not described in their research proposals. The rate of agreement across all responses between the investigators and the evaluators was 60%.</p><p><strong>Discussion: </strong>Our study showed that a survey based on the framework of the TSBM was an acceptable and useful tool to help investigators identify research impact. However, our work also suggested that there are opportunities to educate investigators especially about the long-term, broad-reaching effects of their work. Ultimately, this work may help researchers conceptualize and realize the public health impact of their research.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1593920"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The independent and combined effects of blood heavy metal concentrations on all-cause mortality and cardiovascular mortality in adult patients with diabetes mellitus.","authors":"Lipeng Cai, Jiangrong Yan, Lei Sun, Weichao Dan","doi":"10.3389/fpubh.2025.1588078","DOIUrl":"10.3389/fpubh.2025.1588078","url":null,"abstract":"<p><strong>Background: </strong>Most epidemiological studies have focused on the association between single metal exposure and cardiovascular disease risk, utilizing a single-pollutant model for analysis. However, multiple metals may interact with each other, leading to misjudgment of health risks. This study sought to ascertain both the independent and combined effects of various blood heavy metal concentrations on all-cause mortality and cardiovascular mortality in patients with DM.</p><p><strong>Methods: </strong>Patients (≥20 years) with DM from the NHANES (2011-2018) were selected. To explore the relationships of exposure to individual metals, including cadmium (Cd), mercury (Hg), manganese (Mn), lead (Pb), and selenium (Se), with all-cause mortality and cardiovascular mortality, weighted logistic regression and RCS analysis were leveraged. The WQS model was utilized to estimate the effects of combined blood metal exposures.</p><p><strong>Results: </strong>1,798 patients with DM were included. In the unadjusted model, ln-transformed blood Pb level (OR = 2.3, 95% CI: 1.70-3.10, <i>p</i> < 0.001) and ln-transformed Cd level (OR = 1.54, 95% CI: 1.27-1.87, <i>p</i> < 0.001) demonstrated positive associations with the all-cause mortality risk. According to RCS analysis, a nonlinear dose-response relationship was noted between Pb, Cd, Se, and the all-cause mortality risk (p-nonlinear < 0.05), while Hg and Mn showed linear relationships (p-nonlinear > 0.05).</p><p><strong>Conclusion: </strong>According to this study, a high blood concentration of a combination of heavy metals is a significant risk factor for both cardiovascular disease and all-cause mortality of patients with diabetes, with Pb contributing a relatively higher proportion to these risks.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1588078"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geospatial patterns and socioeconomic determinants of the global acute viral hepatitis burden.","authors":"Ke-Jie He, Guoyu Gong","doi":"10.3389/fpubh.2025.1581484","DOIUrl":"10.3389/fpubh.2025.1581484","url":null,"abstract":"<p><strong>Background: </strong>Acute viral hepatitis remains a persistent global health challenge, with significant morbidity and mortality associated with different hepatitis subtypes. Understanding the spatial distribution and underlying drivers of the acute hepatitis burden is crucial for developing targeted interventions.</p><p><strong>Methods: </strong>This study leveraged data from the Global Burden of Diseases, Injuries, and Risk Factors Study to analyze the geographical disparities and temporal trends in the incidence of acute hepatitis A, B, C, and E. A multifaceted approach was employed, including spatial mapping, decomposition analysis, and frontier analysis, to elucidate the key factors shaping the epidemiological landscape.</p><p><strong>Results: </strong>The spatial analysis revealed pronounced global heterogeneity in acute viral hepatitis incidence, with the highest rates concentrated in parts of Africa, while Western Europe and North America exhibited significantly lower incidence levels. Decomposition analysis demonstrated that population growth was the leading driver of the increasing global burden across all hepatitis subtypes, particularly in low-SDI and low-middle SDI countries, whereas epidemiological improvements were more prominent in high-SDI countries for hepatitis B and C. Frontier analysis highlighted that countries such as Japan, South Korea, and Singapore, despite their advanced socioeconomic status, still lag behind optimal incidence thresholds, while low-SDI nations like Nepal and Burundi have made remarkable progress relative to their development level. These findings underscore considerable disparities and untapped potential for burden reduction globally.</p><p><strong>Conclusion: </strong>Our findings confirm substantial spatial variation and development-related disparities in acute viral hepatitis incidence worldwide. The global burden is shaped by a combination of transmission routes, sociodemographic dynamics, and healthcare capacity. Context-specific interventions must be aligned with regional epidemiological profiles-targeting sanitation and vaccination in high-burden areas and optimizing harm reduction and screening in more developed settings. The integration of spatial analysis, decomposition, and frontier benchmarking provides a valuable framework for prioritizing national and global hepatitis control strategies.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1581484"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scaling up the Med-South Lifestyle Program in public health settings to reduce chronic disease risk: a hybrid implementation-effectiveness study.","authors":"Carmen D Samuel-Hodge, Lisa Pham, Kiira Lyons, Lindy B Draeger, Li Jiang, Feng-Chang Lin, Rachel Ram, Jennifer Leeman","doi":"10.3389/fpubh.2025.1564567","DOIUrl":"10.3389/fpubh.2025.1564567","url":null,"abstract":"<p><strong>Introduction: </strong>Major disparities persist in heart disease, diabetes, and obesity, with rates highest among those living in the southeastern and central parts of the US. Intervening to improve lifestyle behaviors represents an opportunity to address health inequities. Although the scientific rationale for lifestyle interventions is robust, evidence is limited on how to implement these interventions at scale.</p><p><strong>Methods: </strong>Using a type 3 hybrid implementation-effectiveness design, we evaluated a statewide scale-up trial implementing the Med-South Lifestyle Program in mostly rural community health centers and health departments across North Carolina, in the southeastern US. Implementation outcomes were measured at the site level and program effectiveness outcomes were assessed by physiologic and behavioral changes at the participant level. Descriptive statistics and paired <i>t</i>-tests comprised our statistical analyses.</p><p><strong>Results: </strong>We invited 200 public health sites to participate in the study and 28 (14%) expressed interest. Among those expressing interest, 21 (75%) signed a Memorandum of Agreement. The statewide scale-up resulted in the enrollment of 95% (19/20) of the proposed sites-13 health departments (68%) and six community health centers. The majority of the 235 study participants who started the program were adults self-identifying as non-Hispanic White (45%) or non-Hispanic Black (37%); 11% identified as Hispanic and 5% as American Indian. Most participants were female (88%), with a mean age of 51 years, and educational attainment of a 2- or 4-year college degree (57%). Implementation outcomes included 17 sites (89%) retained throughout the study and a 79% participant retention rate. Program uptake was high, with 87% of planned counseling sessions and 83% of follow-up calls completed. For our effectiveness outcomes we observed small but statistically significant changes in weight of -2.3 lbs. Similarly, systolic but not diastolic blood pressure was reduced significantly (-2.3 mm Hg). There was a significant increase in the mean weekly intakes of nuts and healthy fats, improved daily fruit-vegetable-bean scores, and a decrease in daily sugar-sweetened beverage intake. For sedentary behaviors, daily sitting time was significantly reduced.</p><p><strong>Conclusions: </strong>These results show successfully adapted implementation and delivery approaches to fit Med-South into the context of public health settings during the COVID-19 pandemic.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT05067816, October 5, 2021.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1564567"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The contemporary spell of heat stroke in Karachi amid global warming and power crisis: a threatened call for medical emergency.","authors":"Ayesha Saadat, Rooja Zubair, Urooba Inam Siddiqui, Sanila Mughal","doi":"10.3389/fpubh.2025.1469486","DOIUrl":"10.3389/fpubh.2025.1469486","url":null,"abstract":"<p><p>The study examines the impact of population density, air pollution, and temperature on heat stroke cases in Karachi, focusing on stroke-related mortality from 2010 to 2024. It develops an intelligent system for adaptive forecasting, incorporating population increase, air quality, meteorological activity, and mortality data, presenting urban vulnerability to health crises. A Pearson correlation analysis was used to determine the association between these factors, which makes it possible to present urban vulnerability to health crises from various angles that are systematically relevant and interdependent at the same time. This study is unique because it takes an integrated approach, relating urban stressors and climate conditions to public health outcomes in Karachi, a context that has been neglected in previous studies.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1469486"},"PeriodicalIF":3.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}