Journal of Global Health最新文献

{"title":"Associations of cumulative exposure and dynamic trajectories of the combined atherogenic-frailty index with incident cardiometabolic multimorbidity: a prospective cohort study.","authors":"Haidi Wu, Zikai Song, Tengfei Ye, Chunhua Yang","doi":"10.7189/jogh.16.04319","DOIUrl":"10.7189/jogh.16.04319","url":null,"abstract":"<p><strong>Background: </strong>Cardiometabolic multimorbidity (CMM) poses a growing global health burden, yet effective tools for early risk stratification remain limited. The combined impact of atherogenic dyslipidaemia and physiological frailty, captured by the atherogenic index of plasma-frailty index (AIP-FI), on CMM development is poorly understood. This study aimed to investigate the associations of cumulative exposure and longitudinal trajectories of AIP-FI with incident CMM.</p><p><strong>Methods: </strong>This prospective cohort study included 4,157 participants aged ≥45 years without baseline CMM from CHARLS. The AIP-FI was constructed as the product of AIP and a 37-deficit frailty index. Cumulative AIP-FI was calculated from repeated measurements. Longitudinal trajectories were identified using K-means clustering. Associations with incident CMM were evaluated by multivariable Cox models, RCS, K-M curves, ROC/NRI/IDI, mediation, interaction, subgroup, and sensitivity analyses.</p><p><strong>Results: </strong>Over a mean 8.5-year follow-up, 612 incident CMM cases occurred. Both higher baseline and cumulative AIP-FI were significantly associated with increased CMM risk, with cumulative exposure showing a stronger effect (fully-adjusted HR per SD increment: 1.46; 95% CI = 1.38-1.54). Participants in the highest quartile of cumulative AIP-FI had a near 4-fold higher CMM risk compared to the lowest (HR = 3.95; 95% CI = 2.95-5.29). Clustering analyses revealed that groups with high-stable AIP-FI exhibited the highest CMM risks. Cumulative AIP-FI demonstrated superior predictive performance for CMM (AUC = 71.17%) and significantly improved risk reclassification over traditional markers (NRI = 0.157). Mediation analyses suggested bidirectional synergistic effects between AIP and FI.</p><p><strong>Conclusions: </strong>In this national cohort, both the cumulative burden and adverse longitudinal trajectories of AIP-FI were independently associated with an elevated risk of CMM. Dynamic monitoring of this composite biomarker could facilitate the early identification of high-risk individuals, thereby informing targeted prevention strategies for middle-aged and older adults in China.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04319"},"PeriodicalIF":5.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty and healthy working life expectancy: a multicohort modelling study.","authors":"Yuhang Shui, Jingjie Zhu, Zeyu Huang, Huazhen You, Junling Gao","doi":"10.7189/jogh.16.04338","DOIUrl":"10.7189/jogh.16.04338","url":null,"abstract":"<p><strong>Background: </strong>Raising the retirement age and extending working years have become key strategies for many countries to mitigate the challenges of global population ageing. However, the association of frailty, a dynamic and reversible clinical condition, with healthy working life expectancy (HWLE) remains unclear.</p><p><strong>Methods: </strong>We used data from five harmonised health and retirement cohorts from across 33 countries, from which we tracked participants aged ≥50 years from baseline until their last available data point or death. Using this data, we evaluated frailty through the Frailty Index based on the cumulative deficit model, which classifies frailty status as robust, pre-frail, or frail. Then, we used discrete-time multistate Markov models to explore the association between frailty and HWLE, and further stratified our analyses by individual and country-level factors.</p><p><strong>Results: </strong>Among 180,314 participants, HWLE at the age of 50 years was 11.87 years (95% confidence interval (CI) = 11.74-12.00) for participants in the robust group, 7.34 years (95% CI = 7.19-7.50) for participants in the pre-frail group, and 3.77 years (95% CI = 3.57-3.97) for participants in the frail group. Compared with participants in the robust group, HWLE was 4.53 years shorter for those in the pre-frail group (Bonferroni-adjusted 95% confidence interval (95% CI_BA) = -4.76, -4.29) and 8.11 years shorter for those in the frail group (95% CI_BA = -8.38, -7.84). Men had longer HWLE than women in the robust and pre-fail groups. Higher educational attainment and current non-smoking, as well as favourable national economic and political factors, were associated with longer HWLE across frailty strata.</p><p><strong>Conclusions: </strong>While frailty was generally associated with shorter HWLE at the age of 50 years, individual and country-level inequalities were also evident across frailty statuses. These results highlight a need to integrate targeted frailty prevention and intervention programmes with broader initiatives aimed at fostering national economic and political development, thereby promoting healthier, voluntary, and supported work participation in later life.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04338"},"PeriodicalIF":5.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of prenatal pyrethroid pesticide exposure on neonatal lymphocyte subsets and apoptosis: a birth cohort study.","authors":"Zhiye Qi, Lili Zhang, Xia Xiao, Kun Wu, Shuqi Chen, Xiaoxiao Song, Yan Li","doi":"10.7189/jogh.16.04318","DOIUrl":"10.7189/jogh.16.04318","url":null,"abstract":"<p><strong>Background: </strong>Prenatal pyrethroid pesticides (PYRs) exposure may elevate infection diseases susceptibility of children. However, it is unclear the relationship of PYRs exposure and neonatal immune function. We explored the association of PYRs exposure during three trimesters with neonatal immunity and the roles of lymphocyte apoptosis.</p><p><strong>Methods: </strong>Maternal urinary PYRs metabolites (3PBA, 4F3PBA, cis-DBCA) were measured in each trimester. Cord blood lymphocyte subsets and lymphocyte apoptosis rates were assessed by flow cytometry. Multivariate linear regression models were used to examine the associations of trimester-specific and repeated PYRs exposure during pregnancy with neonatal immune function.</p><p><strong>Results: </strong>High-level cis-DBCA exposure (>75th percentile, 0.78 μg/g) in the third trimester was negatively associated with cord blood CD3⁺ T cell counts (β = -0.06; 95% CI = -0.12, -0.01) and CD8⁺ T cell counts (β = -0.09; 95% CI = -0.16, -0.01). Repeated high-level cis-DBCA exposure across two or more trimesters was associated with reduced CD3⁺ T cell counts (β = -0.09; 95% CI = -0.16, -0.02), CD4⁺ T cell counts (β = -0.13; 95% CI = -0.22, -0.04), CD8⁺ T cell counts (β = -0.13; 95% CI = -0.22, -0.04), B cell counts (β = -0.10; 95% CI = -0.20, -0.01), and NK cell counts (β = -0.14; 95% CI = -0.25, -0.03). High-level 3PBA exposure in the first trimester (β = 0.11; 95% CI = 0.01, 0.22) and high-level cis-DBCA exposure in the second trimester (β = 0.16; 95% CI = 0.04, 0.28) were positively associated with cord blood lymphocyte apoptosis rates. Repeated high-level cis-DBCA exposure in two or more trimesters was associated with increased cord blood lymphocyte apoptosis rates (β = 0.19; 95% CI = 0.03, 0.35).</p><p><strong>Conclusions: </strong>High-level maternal PYRs exposure during pregnancy may reduce neonatal lymphocyte counts and increase lymphocyte apoptosis. These effects persist throughout gestation, with the third trimester may represent a sensitive window for adverse effects on immune development.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04318"},"PeriodicalIF":5.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large-scale plasma proteomic profiling enhances prediction of heart failure among hypertensive individuals: prospective insights from the UK Biobank.","authors":"Maohua Li, Xiao He, Shasha Xiao, Jixiang Wang, Lunchang Wang, Xin Li, Chang Shu, Zhaowei Zhu, Jiehua Li","doi":"10.7189/jogh.16.04313","DOIUrl":"https://doi.org/10.7189/jogh.16.04313","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is a major risk factor for heart failure (HF), but current clinical models have limited ability to identify high-risk individuals before overt disease. Plasma proteomics may capture early molecular changes and improve risk prediction.</p><p><strong>Methods: </strong>We analysed 16,128 hypertensive UK Biobank Pharma Proteomics Project participants without baseline HF. Plasma levels of 2,911 proteins were measured using the Olink Explore platform. Participants were randomly split 1:1 into training and validation sets. HF-associated proteins were identified using Cox models in the training set, followed by LASSO regression to construct a protein risk score (PRS). Model performance was assessed in the validation set using Harrell's C-index, time-dependent ROC analysis, Net Reclassification Improvement (NRI), Integrated Discrimination Improvement (IDI), calibration, and bootstrap validation. A parsimonious panel was derived using LightGBM and sequential forward feature selection.</p><p><strong>Results: </strong>During a median follow-up of 15.1 years, 1,074 participants developed HF. In the training set, 534 proteins were associated with HF after adjustment for demographic and clinical risk factors and were enriched in cytokine signalling, extracellular matrix organisation, and immune-cell migration pathways. The 101-protein PRS was independently associated with incident HF. In the validation set, adding the PRS increased the C-index from 0.670 to 0.786 beyond age and sex, and from 0.727 to 0.787 beyond the Pooled Cohort Equations to Prevent Heart Failure (PCP-HF) model, with improved reclassification and discrimination. PRS levels were elevated years before HF diagnosis. A six-protein panel comprising NT-proBNP, GDF15, BCAN, WFDC2, CTHRC1, and CNTN5 achieved an AUC of 0.775, outperforming NT-proBNP alone.</p><p><strong>Conclusions: </strong>Plasma proteomic profiling improves HF risk prediction among hypertensive individuals beyond conventional clinical factors and may support earlier risk stratification and precision prevention.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04313"},"PeriodicalIF":5.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From innovation to implementation: a global scoping review of artificial intelligence applications, governance, and challenges in humanitarian contexts.","authors":"Mahima Jose, Fouzia Mueen, Junaid Qadir, Alaa Abd-Alrazaq, Kwalombota Kwalombota, Diana Maddah","doi":"10.7189/jogh.16.04359","DOIUrl":"10.7189/jogh.16.04359","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) is increasingly being explored as a tool for supporting humanitarian action through hazards and crisis prediction, real time monitoring of evolving crisis conditions and humanitarian needs, resource allocation, and decision-making. However, evidence on how AI is implemented, evaluated, and governed across humanitarian contexts remains fragmented. In this scoping review, we mapped the global evidence on the application of AI in humanitarian settings, including its distribution across the emergency management cycle, deployment maturity, and evaluation. We also identified any governance considerations, as well as enabling factors for and challenges to its implementation, with particular attention to the Middle East and North Africa (MENA) region, Gulf Cooperation Council countries (GCC), and Qatar.</p><p><strong>Methods: </strong>The methodology of this scoping review followed the framework set by Arksey and O'Malley, which comprises the formulation of the research question, selection of records, data charting, and synthesis of findings. We searched six databases (ProQuest, IEEE Xplore, ScienceDirect, Embase, Web of Science, and Scopus), queried Google Scholar, and ran targeted grey literature searches through the webpages of major humanitarian organisations for records reporting on the application, implementation, or governance of AI in humanitarian contexts. We descriptively and narratively synthesised the extracted data.</p><p><strong>Results: </strong>We included 57 scholarly publications and 17 grey literature reports. Application of AI was most frequently reported in sudden-onset natural disasters, particularly floods and earthquakes, and was commonly used to support disaster monitoring, crisis informatics, search-and-rescue, logistics optimisation, hazard prediction, and geospatial analysis. Deep learning and machine learning were the most common model families. Across the emergency management cycle, most applications of AI focused on preparedness and response, while recovery was rarely addressed. Geographically, most evidence originated from Asia, while research from the MENA and GCC regions remained limited. Most reported systems remained prototypes or retrospectively validated models, with relatively few seeing operational deployment or field implementation. Governance issues were discussed more extensively in grey literature than in scholarly publications. Community participation, equity considerations, and formal governance frameworks were inconsistently reported.</p><p><strong>Conclusions: </strong>AI is increasingly being applied in humanitarian contexts, but it is heterogeneously distributed across regions, humanitarian contexts, and emergency management. Greater emphasis is needed on real-world deployment, implementation-focused evaluation, participatory approaches, and governance frameworks that support responsible, equitable, and context-sensitive AI adoption.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04359"},"PeriodicalIF":5.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of monotherapy and combination therapy for myopia control in Chinese children.","authors":"Jinghui Wang, Xuan Li, Meinan He, Desheng Song, Bo Zhang, Bei Du, Ruihua Wei","doi":"10.7189/jogh.16.04366","DOIUrl":"10.7189/jogh.16.04366","url":null,"abstract":"<p><strong>Background: </strong>Myopia poses a major public health and economic burden in China, necessitating cost-effectiveness evaluations of control strategies. We aimed to assess cost-effectiveness of single/combined myopia control in children and adolescents to optimise strategies.</p><p><strong>Methods: </strong>We conducted a network meta-analysis to evaluate the efficacy of myopia control interventions in Chinese children (aged 6-18 years). Annual changes in axial length (AL) and spherical equivalent refraction (SER) were the primary outcomes. Additionally, we used a decision-analytic Markov model with clinical and cost data from China to evaluate 16 myopia control strategies for eight-year-old children over eight years from a patient perspective, with 3% discounting. Strategies included monotherapies and combined therapies. Main outcomes were incremental cost per unit reduction in myopic shift (i.e. SER) or AL elongation, compared with single-vision lenses (SVLs). Markov cohort analysis simulated the proportion of individuals progressing to high myopia under various strategies. We assessed robustness through deterministic and probabilistic sensitivity analyses. We performed subgroup analyses by onset age (6, 10, and 12 years) and regional economic development.</p><p><strong>Results: </strong>For SER reduction, outdoor activity was cost-effective (incremental cost-effectiveness ratio = USD -18.29/dioptre (D)). At higher willingness-to-pay thresholds, 0.01% atropine combined with defocus incorporated multiple segment (DIMS) (USD 660.74/D) and repeated low-level red-light therapy (RLRL) (USD 895.36/D) were cost-effective. For AL reduction, outdoor activity (USD -42.68/mm) and DIMS (USD 672.73/mm) were cost-effective at lower thresholds, while RLRL (USD 2011.32/mm) was preferred at higher thresholds. Compared with monotherapy, combination interventions improved preventive efficacy against high myopia. Subgroup analyses confirmed that the cost-effectiveness ranking was preserved across onset ages and regional economic settings.</p><p><strong>Conclusions: </strong>Under limited budget conditions, outdoor activities and defocus spectacles represent advantageous cost-effective treatment options. When the budget is sufficient, RLRL may be considered a promising option pending confirmation of its long-term safety and effectiveness, and 0.01% atropine combined with DIMS is the preferred cost-effective option. Our analysis provides evidence-based guidance for clinicians and families in selecting effective myopia control strategies.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04366"},"PeriodicalIF":5.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating COPD care assistance: a comparative study of ChatGPT-3.5, ChatGPT-4.0, and ERNIE bot performance.","authors":"Zhongshang Dai, Zihang Zeng, Zijie Zhan, Yan Chen","doi":"10.7189/jogh.16.04297","DOIUrl":"10.7189/jogh.16.04297","url":null,"abstract":"<p><strong>Background: </strong>Large language model (LLM) chatbots are increasingly used to provide health information, yet their reliability in addressing chronic obstructive pulmonary disease (COPD) care questions in the Chinese context remains unclear. To evaluate and compare the performance of three publicly available LLM chatbots - ChatGPT-3.5, ChatGPT-4.0 (OpenAI), and ERNIE Bot (Baidu) - in answering chronic obstructive pulmonary disease (COPD) care questions in China.</p><p><strong>Methods: </strong>We performed a cross-sectional comparative evaluation of three publicly available LLM chatbots (ChatGPT-3.5, ChatGPT-4.0, and ERNIE Bot). We developed 40 COPD care questions spanning 7 prespecified domains relevant to patient education and self-management. All questions were submitted in Chinese in independent new chat sessions to minimise context carryover. Three consultant-level respiratory physicians independently rated each response for accuracy (1 = poor, 2 = borderline, 3 = good). We summarised accuracy as the sum of three ratings (range 3-9) and derived a majority-vote accuracy category. For responses rated 'good' by majority vote, physicians additionally rated comprehensiveness on a five-point scale. Information quality was further assessed using a modified DISCERN framework and the Patient Education Materials Assessment Tool (PEMAT) understandability and actionability domains.</p><p><strong>Results: </strong>Most responses were rated as 'good' for accuracy across chatbots. ERNIE Bot achieved higher total accuracy scores than ChatGPT-3.5 and ChatGPT-4.0, and a higher proportion of 'good' ratings in this Chinese-language evaluation. However, comprehensiveness scores for 'good' responses were low across all systems (mean ~ 1.4-2.0/5), and PEMAT actionability was limited, indicating that few responses included concrete, patient-executable steps.</p><p><strong>Conclusions: </strong>Our findings suggest that LLM chatbots may support basic COPD patient education in Chinese settings, but current responses often lack sufficient comprehensiveness and actionable guidance. These tools should not be used as standalone clinical advice and require appropriate safeguards and clinician oversight.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04297"},"PeriodicalIF":5.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare costs of childhood overweight and obesity in Chile: evidence from an analysis of linked administrative records.","authors":"Nieves Valdés, Alejandra Abufhele, Alberto Vega, Florencia Borrescio-Higa","doi":"10.7189/jogh.16.04301","DOIUrl":"10.7189/jogh.16.04301","url":null,"abstract":"<p><strong>Background: </strong>Childhood overweight and obesity are highly prevalent in Chile, affecting over 50% of children under the age of 12, yet evidence on the healthcare costs associated with them remains limited. In this study, we quantify the association between high body mass index (BMI)-for-age and annual health expenditures among school-aged children using linked national administrative data.</p><p><strong>Methods: </strong>We linked anthropometric measurements from a national school-based surveillance system with health expenditure records from the public and private insurance systems. The sample included children in pre-kindergarten, kindergarten, first, and fifth grade. We estimated average annual expenditures by BMI-for-age categories and used generalised linear models to assess associations between nutritional status and total annual medical spending. Models were sequentially adjusted for demographic, socioeconomic, perinatal, and municipal variables, with additional specifications incorporating municipality fixed effects.</p><p><strong>Results: </strong>Among the 652,297 analysed children, those with a high BMI-for-age had higher mean annual expenditures than those with a normal BMI. In adjusted models, high BMI-for-age was associated with approximately 4.2-4.5% higher spending across specifications. When analysed separately, overweight was associated with approximately 2.5% higher spending and obesity with 6.1-6.6%. Expenditures were lower for girls than for boys, and younger age and lower maternal education were associated with higher expenditures.</p><p><strong>Conclusions: </strong>High BMI-for-age is consistently associated with higher medical expenditures among Chilean children, with costs rising from overweight to obesity. The findings indicate that expenditure differences are already present in early childhood and highlight the need for early prevention strategies. Although modest per child, these differences may add up to substantial aggregate costs, given that more than half of children have overweight or obesity.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04301"},"PeriodicalIF":5.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between long-term ambient air pollution exposure and cognitive disorders among older adults in China: the mediating role of lifestyle.","authors":"Yu Zhang, Jiaqi Yang, Yixin Zhang, Quan Yuan, Yanan Li, Ruizheng Ding, Guanling Song, Qiang Niu, Yunhua Hu, Yizhong Yan","doi":"10.7189/jogh.16.04307","DOIUrl":"10.7189/jogh.16.04307","url":null,"abstract":"<p><strong>Background: </strong>Cognitive disorders (CDs) are a major public health concern in ageing societies. The association between air pollution and CDs has received considerable attention; however, the moderating role of lifestyle remains unclear. We aimed to explore the complex associations among lifestyle, its dynamic changes, ambient air pollution exposure, and CDs in older adults.</p><p><strong>Methods: </strong>We included data from the Chinese Longitudinal Healthy Longevity Study. We used Cox proportional hazards models, Bayesian weighted quantile sum models, and mediation analysis to explore associations between lifestyle, air pollution, and CDs risk.</p><p><strong>Results: </strong>Per 10 μg/m³ increase in exposure to particulate matter with diameters ≤2.5 μm (hazard ratio (HR) = 1.005; 95% confidence interval (CI) = 1.001-1.009), sulphates (HR = 1.030; 95% CI = 1.003-1.056), ozone (HR = 1.006; 95% CI = 1.001-1.011), nitrates (HR = 1.020; 95% CI = 1.003-1.037), and ammonium (HR = 1.033; 95% CI = 1.005-1.062) was associated with an increased risk of CDs. The mixture exposure showed a significant positive association with CDs (odds ratio = 1.028; 95% CI = 1.006-1.040). Adherence to both intermediate (HR = 0.732; 95%CI = 0.569-0.940) and favourable (HR = 0.488; 95%CI = 0.336-0.710) lifestyles was associated with a reduced risk of CDs compared to an unfavourable lifestyle, and the protective effect was more significant at high pollution exposure levels (about 52% lower risk). Lifestyle mediated the effect by 8.4-9.4% in the association between single pollutants and CDs, and 9.1-9.5% in the association between mixed pollutants and CDs. Ozone had the highest weight in the pollution mixture.</p><p><strong>Conclusions: </strong>Air pollution increased the risk of CDs among older adults, which was partially offset by a healthy lifestyle. Lifestyle interventions may help address some challenges inherent in controlling air pollution in ageing societies.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04307"},"PeriodicalIF":5.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond static frailty: longitudinal trajectories, nonlinear associations, and muscle strength mediation in osteoporosis risk.","authors":"Junyu Zhou, Jui-Hua Wang, Zhen Huang, Liping Cao","doi":"10.7189/jogh.16.04320","DOIUrl":"10.7189/jogh.16.04320","url":null,"abstract":"<p><strong>Background: </strong>Frailty, a multidimensional indicator of declining physiological reserve, has been consistently linked to adverse health outcomes. However, whether dynamic trajectories of the Frailty Index (FI) predict new-onset osteoporosis remains unclear.</p><p><strong>Methods: </strong>For this longitudinal cohort study, we retrieved data on adults aged ≥50 years from the Health and Retirement Study, the English Longitudinal Study of Ageing, and the Survey of Health, Ageing and Retirement in Europe. We assessed frailty using the FI and identified longitudinal frailty trajectories, examined associations of baseline FI and frailty trajectories with incident osteoporosis, and explored nonlinear relationships and the potential mediating role of grip strength.</p><p><strong>Results: </strong>Over median follow-up periods of 4, 6, and 8 years, 244, 2,693, and 1,986 participants in the ELSA, the SHARE, and the HRS cohorts developed osteoporosis, respectively. Higher baseline FI was independently associated with greater osteoporosis risk across all cohorts, with adjusted hazard ratios of 1.43 (95% confidence interval (CI) = 1.36-1.50, P < 0.001) in the HRS, 1.36 (95% CI = 1.19-1.57, P < 0.001) in the ELSA, and 1.39 (95% CI = 1.33-1.45, P < 0.001) in the SHARE cohort. We identified four FI trajectories. Compared with the low frailty group, participants in higher frailty trajectory groups generally exhibited increased risks of osteoporosis across cohorts. Nonlinear analyses pointed to threshold effects in the HRS and the SHARE, with steeper risk increases at lower FI levels. Grip strength partially mediated this association.</p><p><strong>Conclusions: </strong>In our sample, baseline FI and its longitudinal trajectories were significantly associated with osteoporosis. Our findings suggest that the early identification and monitoring of frailty, as well as muscle strength improvement, may help reduce osteoporosis risk.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04320"},"PeriodicalIF":5.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}