Clinical Epidemiology and Global Health最新文献

{"title":"Undernutrition and recovery in Pulmonary Tuberculosis: Insights from a study in Lucknow, India","authors":"Purnoor Kaur ,&nbsp;Monika Agarwal ,&nbsp;M.A. Akshata ,&nbsp;V.K. Singh ,&nbsp;Surya Kant","doi":"10.1016/j.cegh.2025.102270","DOIUrl":"10.1016/j.cegh.2025.102270","url":null,"abstract":"<div><h3>Problem considered</h3><div>Undernutrition is a major risk factor for tuberculosis (TB), compromising immunity and adversely affecting treatment outcomes. India bears the highest global TB burden, with a large proportion of patients experiencing poor nutritional status.</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted in 2022 among 272 adult pulmonary TB patients enrolled in six tuberculosis units of Lucknow district. Data were collected through a semi-structured questionnaire, anthropometric measurements, and 24-h dietary recall. Nutritional status was assessed using body mass index (BMI), and dietary intake was analysed for adequacy of energy and protein. Treatment outcomes were obtained from programmatic records.</div></div><div><h3>Results</h3><div>The mean age of participants was 33 ± 12 years, with males comprising 62.8 %. At treatment initiation, 61 % were undernourished (BMI &lt;18.5), and only 32 % attained normal weight by completion. The mean caloric intake was 1662.9 kcal, which was below recommended requirements, while protein intake was also insufficient. Although 99 % were enrolled in Nikshay Poshan Yojana, only 4.7 % reported receiving benefits. Dietary diversity was adequate in 66.9 % of participants. Overall, 89.3 % achieved successful treatment outcomes, but no statistically significant association was observed between BMI at treatment completion and outcome.</div></div><div><h3>Conclusion</h3><div>Undernutrition was highly prevalent among TB patients, with minimal nutritional recovery despite treatment. Suboptimal dietary intake and poor implementation of nutritional support schemes highlight the need for integrated interventions. Strengthening delivery of schemes like Nikshay Poshan Yojana and promoting dietary adequacy are critical to improving TB outcomes.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102270"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lived realities of family engagement: A thematic exploration of the family adoption program","authors":"Amogha shree,&nbsp;S. Rashmi,&nbsp;K. Shruddha,&nbsp;Anchu R. Nath,&nbsp;D. Sunil Kumar","doi":"10.1016/j.cegh.2026.102305","DOIUrl":"10.1016/j.cegh.2026.102305","url":null,"abstract":"<div><h3>Background</h3><div>The Family Adoption Program (FAP) was introduced to strengthen community engagement and foster experiential learning in Indian medical education. While most evaluations focus on student perspectives, the lived experiences of families remain underexplored. This study aimed to explore the perceptions, experiences, and suggestions of families participating in the FAP in rural Karnataka.</div></div><div><h3>Methodology</h3><div>A qualitative study was conducted in June 2025 in the villages of Hanchya and Rammanahalli, Karnataka, using a phenomenological approach. Purposive sampling method was used to identify the families who had participated in the program for at least three years. Data were collected through semi-structured, in-depth interviews conducted in Kannada, audio-recorded, and transcribed verbatim. Thematic analysis was performed to identify key patterns across narratives.</div></div><div><h3>Results</h3><div>Twenty families participated in this study. Seven themes emerged(Chepuru et al., 2025 Jan) 1: navigating language and communication,(Shekhawat et al., 2025 Jan 31) 2 disruption versus engagement in daily life,(Shree et al., 2024 Jul 1) 3 scope and nature of student interventions,(Yalamanchili et al., 2023 Feb) 4 perceived gaps in continuity of care,(Shikha et al., 2024 Feb) 5 engagement with health camps,(Reshmi et al., 2024 Aug) 6 relationship dynamics with student visitors, and(Arumugam et al., 2022 Jul 28) 7 community suggestions for program enhancement. Families valued students’ ability to communicate in the local language, provide health education, and offer basic clinical checks, which raised trust and better rapport. However, barriers such as linguistic disconnect, inconvenient scheduling, limited follow-up, and predominantly survey-based interactions diminished program effectiveness.</div></div><div><h3>Conclusion</h3><div>Families perceive FAP as beneficial when visits are regular, with lesser language barrier, and service-oriented. Continuous and regular visits with adaptable schedules to family needs, and including organized feedback mechanisms can improve both community impact and student learning.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102305"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to sexual health services among young Brazilians: Analysis in light of social determinants of health","authors":"William Caracas Moreira ,&nbsp;Guilherme Frederico Abdul Nour ,&nbsp;Mônica Oliveira Batista Oriá ,&nbsp;Ana Kelve de Castro Damasceno ,&nbsp;Jordana de Almeida Nogueira ,&nbsp;Oriana Deyze Correia Paiva Leadebal ,&nbsp;Hellen Lívia Oliveira Catunda Ferreira ,&nbsp;Ana Karina Bezerra Pinheiro","doi":"10.1016/j.cegh.2026.102307","DOIUrl":"10.1016/j.cegh.2026.102307","url":null,"abstract":"<div><h3>Objective</h3><div>Analyze young people's access to two sexual health services in two macro-regions of Brazil.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted with 301 young people aged 15–24 years at two sexual health services in two cities, headquarters of macro-regions in Paraíba, Brazil. Data were collected from February to July 2021 using a validated form and analyzed using descriptive statistics, chi-square tests, and prevalence ratios, based on the World Health Organization's Social Determinants of Health.</div></div><div><h3>Results</h3><div>301 young people, average age 20.83 (±2.30) years, predominantly male (51.50%), non-white (72.10%), cisgender (96.70%), and heterosexual (58.10%). Difficulty accessing services (14.60%) was influenced by income, age group, and discrimination. Difficulty in undergoing rapid testing (22.60%) was influenced by education, work, alcohol consumption, and risky sexual behaviors. Difficulty in acquiring condoms was influenced by victimization by sexual violence, history of incarceration, and transactional sex.</div></div><div><h3>Conclusion</h3><div>These factors had a direct impact on young people's access to sexual health services.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102307"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global research status and hot-spots of Sirt1 in aging: a bibliometric analysis based from 2005 to 2024","authors":"Shiyao Liu ,&nbsp;Congcong Song ,&nbsp;Ziyi Liu ,&nbsp;Yushan Li ,&nbsp;Huimei Chen ,&nbsp;Wei Chen ,&nbsp;Na Wang","doi":"10.1016/j.cegh.2026.102325","DOIUrl":"10.1016/j.cegh.2026.102325","url":null,"abstract":"<div><h3>Background</h3><div>Aging is a complex physiological process, regulated by multiple intertwined mechanisms. In this process, Sirt1 played a vital role with evidences increasing continually. Given the rapid expansion of research in this area, a comprehensive overview of the intellectual landscape is needed to guide future investigations. Based on, we conducted a bibliometric analysis of the relevant literature and visualized the results. Our study aimed to consolidate the current knowledge and provide insights into evolving research trends, thereby contributing to a deeper understanding of Sirt1's roles in aging process.</div></div><div><h3>Methods</h3><div>On August 14th, 2024, we retrieved 2434 issues in Web of Science Core Collection (searching period from 2005 to 2024). Using VOSviewer, Citespace and bibliometrix, we analyzed these records in terms of annual publications/citations, spatiotemporal distribution, collaborations between regions/institutions/authors, co-references, and keywords.</div></div><div><h3>Result</h3><div>We identified a stable development trend of researching on Sirt1 and aging. In the last 2 decades, the average growth rate of publication numbers was 34.52%, while in recent 5 years it fell to 10.8%. So far, China and the United States were more conductive and influential in this field. Their publications accounted for 39.56% and 26.17%, respectively. Of interests, since Hungary's publication numbers just accounted for 7% of the publications worldly, it had the strongest average citations. Besides, some institutions and countries had varieties of publications, but weak link strength, meaning further collaborations of them were needed in future study. Importantly, keywords analysis indicated that oxidative stress and calorie restriction were the main hot-spots of this field. Besides, inflammation, DNA damage, metabolism, mitochondrial dysfunction and autophagy might be new research directions in Sirt1 and aging.</div></div><div><h3>Conclusions</h3><div>Above all, this study provided further insights into recent advances and future progression in researches on Sirt1 and aging.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102325"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147398239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitudes, and practices regarding human papillomavirus vaccination among teenage girls with sickle cell disease at Usmanu Danfodiyo University teaching hospital, Sokoto, Nigeria","authors":"Ibrahim Abdulqadir ,&nbsp;Ahmad Abubakar ,&nbsp;Muhammad Umar Sa'id ,&nbsp;Hadiza Muhammad Ango ,&nbsp;Jonas-Attabo Samson Apeh ,&nbsp;Abdallah Ahmed Adam Belal ,&nbsp;Adam Dawria ,&nbsp;Ali Mohieldin ,&nbsp;Abdelsalam Mohamed Daoud Yahya ,&nbsp;Sami M. HasapAla ,&nbsp;Aeshah Alshehri ,&nbsp;Fatima Garba Muhammad ,&nbsp;Bello Arkilla Magaji","doi":"10.1016/j.cegh.2026.102318","DOIUrl":"10.1016/j.cegh.2026.102318","url":null,"abstract":"<div><h3>Background</h3><div>Sickle Cell Disease (SCD) impairs immune function and increases susceptibility to infections such as Human Papillomavirus (HPV), a primary cause of cervical cancer. Both conditions pose major public health challenges in Nigeria, where overall HPV awareness and vaccine uptake remain low. This study assessed the knowledge, attitudes, and practices (KAP) regarding HPV vaccination among teenage girls with confirmed SCD in Sokoto State, aiming to inform targeted preventive strategies.</div></div><div><h3>Methods</h3><div>This cross-sectional study was conducted at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, involving 85 teenage girls with confirmed SCD. Data were collected using a pretested semi-structured questionnaire administered via ODK, and analysed using descriptive and inferential statistics with Excel and Jamovi respectively.</div></div><div><h3>Results</h3><div>The 85 participants (mean age 15.6 years) were predominantly of the HbSS phenotype (82%). They were mostly diagnosed before the age of five (93%) and managed with hydroxyurea (79%). HPV knowledge was poor: only 8% correctly linked HPV to cervical cancer or knew the correct vaccination age. While 96% feared cervical cancer, fewer than half considered the vaccine useful (47%) or safe (48%). Despite 54% expressing willingness, the overall vaccine uptake was low (12%). Significant associations were observed between KAP and variables including age, education, and history of painful SCD crisis.</div></div><div><h3>Conclusion</h3><div>These findings reveal significant gaps in HPV vaccine knowledge and uptake among high-risk population. We recommend immediate, targeted awareness campaigns, government support, and the integration of HPV vaccination into routine SCD hospital care programs.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102318"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147398237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Connotation of serum levels of vitamin D3 and LL-37 with urinary tract infection in type 2 diabetic patients","authors":"Zahraa A. Hashim","doi":"10.1016/j.cegh.2026.102299","DOIUrl":"10.1016/j.cegh.2026.102299","url":null,"abstract":"<div><h3>Problem considered</h3><div>Type 2 diabetes mellitus (T2DM) is characterized by inappropriacy of innate immunity leading to higher rates of urinary tract infection (UTI), an important risk factor for urinary tract complications. 25-hydroxy vitamin D may donate, via the production of the antimicrobial peptide cathelicidin (LL-37), to epithelial host defense against colonization of uro-pathogens. This study aimed to assess serum levels of vitamin D₃ and LL-37 in T2DM patients with and without UTI and to measure the association of these two parameters with metabolic profile and microbial distribution pattern.</div></div><div><h3>Methods</h3><div>Patients' characteristics were documented and included patients’ age, sex, duration of being diagnosed with T2DM, concurrent treatments, other diseases, body mass index, and smoking status. Blood sample was collected from each enrolled patient for metabolic profiling, serum vitamin D_3, and LL-37 measurement. Urine sample was collected for urinalysis and patients were grouped accordingly into with-UTI (group A) and without-UTI (group B) groups.</div></div><div><h3>Results</h3><div>One hundred and twelve T2DM patients (aged 51.1 ± 5.8 years) were enrolled; 50 patients with UTI and 62 without. Serum levels of vitamin D₃ were found to be significantly lower in patients with UTI (17.9 ± 4.8 ng/mL) than in patients without UTI (25.2 ± 5.7 ng/mL) (p &lt; 0.01). In accordance, LL-37 levels were significantly reduced in group A members (27.5 ± 6.9 ng/mL) when compared to group B members (35.5 ± 8.6 ng/mL) (p-value &lt;0.01). <em>E. coli</em> was the most common isolated uro-pathogen (40 %) followed by <em>P. aeruginosa</em> and <em>S. aureus</em> (14 % each), <em>Enterobacter</em> (10 %), <em>Klebsiella</em> spp (8 %) and <em>Proteus</em> spp (4 %). No significant difference in serum LL-37 levels was encountered between the three types of microbial isolates (p-value &lt;0.05). A strong positive correlation was reported between LL-37 and vitamin D₃ levels in patients without UTI (<em>r</em>_<em>s</em>: 0.9855, p-value: &lt;0.01). A weak, though non-significant, correlation was observed between LL-37 and vitamin D₃ in patients with UTI (<em>r</em>_<em>s</em>: 0.25283, p-value: &gt;0.05).</div></div><div><h3>Conclusion</h3><div>Findings suggest that diminished serum levels of vitamin D₃ and LL-37 could have clinical implications and could act as a potential immunological indicator for the tendency to develop UTI in diabetic patients.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102299"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anthropometric, sociodemographic and metabolic factors associated with clinically expressed insulin resistance in individuals with type 2 diabetes","authors":"Rudminaitė Emilė,&nbsp;Čypaitė Gabrielė,&nbsp;Šimonienė Diana","doi":"10.1016/j.cegh.2026.102322","DOIUrl":"10.1016/j.cegh.2026.102322","url":null,"abstract":"<div><div>Clinically expressed insulin resistance (IR) in type 2 diabetes (T2D) patients usually leads to poor hyperglycaemia control and progression of complications.</div></div><div><h3>Aims</h3><div>to evaluate how selected sociodemographic, metabolic and anthropometric factors are linked to expressed IR among T2D patients and assess the clinical tools for IR evaluation.</div></div><div><h3>Methods</h3><div>A sample of 100 T2D patients aged 18 - 80 years old was divided based on their daily insulin requirement into case (&gt;1IU/kg/d) and control (&lt;1IU/kg/d) groups. The data was obtained by interviewing patients using original questionnaires, analysing their medical history, performing clinical examination and blood tests.</div></div><div><h3>Results</h3><div>The case group subjects were younger (p &lt; 0.001) and the duration of their diabetes was shorter (p &lt; 0.001). The patients with expressed IR more often had metabolic syndrome (p = 0.005) and dyslipidaemia (86.2% vs. 67.8%, p = 0.018), particularly hypertriglyceridemia. All patients with expressed insulin resistance (IR) exhibited elevated levels of visceral adipose tissue (VAT &gt;454 g), and the prevalence of visceral obesity was significantly higher in this group compared to the control group (100% vs. 72.7%, p = 0.032). High insulin requirement strongly correlated with HOMA-IR and eGDR in patients with T2D and could be used in determining IR.</div></div><div><h3>Conclusions</h3><div>Patients with T2D and expressed IR were younger and the duration of diabetes was shorter. The prevalence of metabolic syndrome and dyslipidemia—specifically hypertriglyceridemia—was higher among individuals with expressed IR. Although the percentage of total body fat was comparable between groups, the amount of visceral adipose tissue was significantly greater in patients with expressed IR.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102322"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seroprevalence of Toxoplasma gondii and associated factors among pregnant women consulted in Buhodle Healthcare Centers, Somalia","authors":"Mohamed Osman ,&nbsp;Abdullahi Adan ,&nbsp;Abdulahi Abdiwali Mahamed ,&nbsp;Md Al-Mamun ,&nbsp;Marufa Alam","doi":"10.1016/j.cegh.2026.102293","DOIUrl":"10.1016/j.cegh.2026.102293","url":null,"abstract":"<div><h3>Problem considered</h3><div>Toxoplasma gondii infection is a globally prevalent parasitic disease with serious health consequences, especially for pregnant women due to the risk of congenital transmission. Despite its importance, limited data exist on its prevalence in Somalia. This study aimed to determine the seroprevalence of T. gondii infection and identify associated risk factors among pregnant women attending healthcare centers in Buhodle District, Somalia.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted from March to May 2024 among 384 randomly selected pregnant women. Serum samples were analyzed using competitive ELISA (cELISA) to detect T. gondii antibodies. Data were processed using EpiData and SPSS. Descriptive statistics summarized participant characteristics, while bivariate and multivariate logistic regression analyses identified associations between potential risk factors and seropositivity. A p-value &lt;0.05 and a 95 % confidence interval were considered statistically significant.</div></div><div><h3>Results</h3><div>The overall seroprevalence of T. gondii was 36.4 % (140/384). Among these, 28.1 % (108/140) were positive for anti-T. gondii IgG antibodies, indicating prior exposure, while 8.3 % (32/140) were positive for IgM, reflecting recent infection. Multivariable logistic regression revealed significant associations between T. gondii seropositivity and lower educational attainment, as well as frequent contact with soil (p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>The high prevalence of T. gondii infection among pregnant women in Buhodle District indicates a substantial public health concern. Targeted community awareness programs, enhanced antenatal screening, and further epidemiological and molecular studies are essential to reduce maternal and fetal health risks.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102293"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biologic treatment outcomes in rheumatoid arthritis: Biomarker response and cost-effectiveness analysis in an Albanian cohort","authors":"Dorela Hasankolli ,&nbsp;Mirela Miraci ,&nbsp;Silvi Bozo ,&nbsp;Teuta Backa ,&nbsp;Marsida Mulaj ,&nbsp;Entela Haloci ,&nbsp;Fatjola Ferrollari","doi":"10.1016/j.cegh.2026.102301","DOIUrl":"10.1016/j.cegh.2026.102301","url":null,"abstract":"<div><h3>Background</h3><div>Rheumatoid arthritis (RA) is a chronic autoimmune disease causing progressive joint damage, disability, and high healthcare costs. Biologic DMARDs have improved outcomes, but responses vary. Identifying predictive biomarkers and evaluating cost-effectiveness are essential, particularly in resource-limited settings like Albania.</div></div><div><h3>Methods</h3><div>A retrospective cohort study at Mother Teresa University Hospital Center, Tirana, included 162 RA patients treated with bDMARDs (2021–2024). All met ACR/EULAR criteria and had biomarker data at baseline and six months. ESR, CRP, fibrinogen, RF, and anti-CCP were analyzed using paired t-tests (p &lt; 0.05). Cost-effectiveness analysis compared direct drug costs with biomarker improvement across adalimumab and tocilizumab using ICERs.</div></div><div><h3>Results</h3><div>Tocilizumab (46.8 %), adalimumab (37.1 %), and etanercept (16.1 %) were the main bDMARDs used. ESR, CRP, and fibrinogen significantly decreased (p &lt; 0.01). Six-month direct costs were 1136.20 USD for adalimumab, 2233.40 USD for etanercept, and 4069.00 USD for tocilizumab. Adalimumab demonstrated the best cost-effectiveness, with the lowest cost per unit biomarker reduction (ESR 87.40 USD/mm/h; CRP 59.80 USD/mg/L; fibrinogen 1456.66 USD/g/L). Tocilizumab achieved the greatest biomarker reductions but had the highest price (156.60 USD/unit) and incremental costs, with ICERs of 2932.80 USD vs. adalimumab, below Albania's 3 × GDP threshold (∼21,000 USD) for ESR and CRP, but near/exceeding it for fibrinogen.</div></div><div><h3>Conclusions</h3><div>Among available biologics, adalimumab shows the most favorable cost-effectiveness, while tocilizumab may be justified in non-responders to TNF inhibitors. Etanercept was considered economically dominated and was not included in the incremental cost-effectiveness analysis. Biomarker-guided assessment supports cost-effective and evidence-based management of RA in Albania.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102301"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reasons for medication non-adherence among diabetes mellitus patients in Kelantan: A cross-sectional study","authors":"Thamron Keowmani ,&nbsp;Erwan Ershad Ahmad Khan ,&nbsp;Siti Farhain Amir ,&nbsp;Suzita Mukhtar ,&nbsp;Raja Nurul Fatin Raja Kamaruzaman ,&nbsp;Kok Han Lim ,&nbsp;Mohd Azri Mohd Khatib ,&nbsp;Nurul Ezzati Arifin ,&nbsp;Siti Nur Sarah Saharudin","doi":"10.1016/j.cegh.2026.102297","DOIUrl":"10.1016/j.cegh.2026.102297","url":null,"abstract":"<div><h3>Objectives</h3><div>The main objective of this study was to investigate self-reported reasons for medication non-adherence among type 2 diabetes mellitus (T2DM) patients in Kelantan.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted among a representative sample of the Kelantanese population of T2DM patients who refilled their medications at government health clinics between April 15th and May 31st, 2025 (<em>n</em> = 458). Medication adherence was measured using the Simplified Medication Adherence Scale (SMAQ). Reasons for medication non-adherence were obtained via a structured interview. Associations between baseline characteristics and low adherence were estimated using the chi-squared test.</div></div><div><h3>Results</h3><div>The survey response rate was 83.2 % (472/566). Three percent (14/472) of respondents were excluded from the analysis due to missing data. The top five reasons for non-adherence were ‘I forgot’ 92.3 % (385/417), ‘I was late for/missed the medication refill appointment at the pharmacy counter’ 31.2 % (130/417), ‘Nobody reminds me to take the medications’ 24.7 % (103/417), ‘There are too many medications to take’ 22.1 % (92/417) and ‘I feel healthy’ 21.6 % (90/417). The prevalence of low adherence was 18.8 % (86/417). Distance from home to clinic &gt;5 km (<em>p</em> = 0.045) and the need for assistance in medication taking (<em>p</em> = 0.035) were significantly associated with low adherence.</div></div><div><h3>Conclusions</h3><div>Our study identified several key reasons for medication non-adherence among patients with T2DM in Kelantan, including forgetfulness, missed refill appointments, lack of reminders, polypharmacy, and the perception of being healthy. Distance to the clinic and reliance on others for medication administration were significantly associated with low adherence. These findings highlight the need for patient-centred interventions that address both behavioural and structural barriers to adherence.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102297"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}