Journal of Global Health最新文献

{"title":"Associations between upper limb flexibility and all-cause mortality in the oldest-old.","authors":"Yushan Zhang, Chi Zhang, Jia Hu, Yuting Kang, Jie Zhang, Jianliang Zhao, Hong Shi, Ji Shen","doi":"10.7189/jogh.15.04224","DOIUrl":"10.7189/jogh.15.04224","url":null,"abstract":"<p><strong>Background: </strong>Upper limb flexibility (ULF) is a simple and feasible measure of physical function in long-lived population. This study aimed to explore the association of ULF with all-cause mortality in community-dwelling oldest-old in China.</p><p><strong>Methods: </strong>A total of 21 861 older adults aged ≥80 years were enrolled from five waves of the Chinese Longitudinal Healthy Longevity Survey. The assessment of ULF at baseline involved three objective physical tasks (touching the root of the neck, touching the lower back, and raising arms vertically). All participants were followed up until 2018, during which survival information was collected. Cox proportional hazards regression model was used to analyse the association between ULF and all-cause mortality. Demographic characteristics, health behaviours, and disease history were included as covariates.</p><p><strong>Results: </strong>After 72 586.42 person years of follow-up, 18 570 people died. After adjusting for all confounding factors, both left and right ULF impairments were correlated with an increased risk of all-cause mortality, with adjusted hazard ratio (HR) of 1.06 (95% confidence interval (CI) = 1.01, 1.12) and 1.12 (95% CI = 1.05, 1.20). In the collaborative analyses, individuals exhibiting ULF impairment across both the left and right sides had the highest mortality risk with adjusted HR of 1.29 (95% CI = 1.19, 1.38). We found significant additive interaction between left and right ULF impairment on all-cause mortality (relative excess risk due to interaction = 0.10; 95% CI = 0.02, 0.18). The principal findings maintained stable across sensitivity analyses.</p><p><strong>Conclusion: </strong>Impaired ULF is associated with a higher risk of all-cause mortality among the oldest-old in China, especially when the impairment occurs on the right side. For the oldest-old, ULF may serve as a simple and effective predictor of premature death.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04224"},"PeriodicalIF":4.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214085","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 pathway to child survival in the Birhan Cohort, Ethiopia, 2018-22.","authors":"Negalign Berhanu Bayou, Tsinuel Girma Nigatu, Biruk Hailu Tesfaye, Bezawit Mesfin Hunegnaw, Clara Pons-Duran, Kassahun Alemu, Lisanu Taddesse, Delayehu Bekele, Getachew Tolera, Grace Chan","doi":"10.7189/jogh.15.04270","DOIUrl":"10.7189/jogh.15.04270","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Child mortality remains a concern in Ethiopia despite the significant achievements in the past three decades. Proper implementation of the existing low-cost interventions can prevent two-thirds of the deaths. Understanding illness recognition, care-seeking behaviours, and barriers that caregivers encounter during a child's illness along care pathways is imperative. We aimed to describe illness recognition and reactions of caregivers of children &lt;2 years, and factors associated with severe illness or death related to the care pathways, including the child, caretaker, household, and health system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a prospective cohort study using an open birth cohort of Birhan field site, from December 2018 to November 2022. The analysis included newborns followed up to two years old who had an illness episode and for whom data were available for the mother-child dyad. We extracted and linked data on community follow-up and morbidity visits, clinical signs and symptoms of illness at health facility visits, verbal autopsy of deceased children, and maternal health and healthcare. We used descriptive and logistic regression analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 3969 eligible children enrolled in the Birhan Cohort, 1397 (37.8%) had at least one episode of illness during the first two years of life. Of those, 108 (8%) experienced a severe illness or died, of which the majority (n = 76; 70.4%) were newborns. Most sick children (n/N = 714/1187) did not get treatment from a formal source; 53.1% (n/N = 684/1289) of those with mild or moderate illness and 27.8% (n/N = 30/108) of the severely ill or deceased. The mean delay in care-seeking was 5.9 (standard deviation (SD) = 10.6) days for those with mild or moderate illness, and 1.7 (SD = 0.58) for the severely ill or deceased. Only 4.8% (n/N = 27/559) of children sought care from a health post (HP), and 68.1% (n/N = 94/138) of children were referred for further care. Only 68.4% (n/N = 13/19) of the severely ill or deceased children were referred, of which 3 (4.9%) accepted the referral. Compared to a newborn, being a young infant (adjusted odds ratio (aOR) = 0.05; 95% confidence interval (CI) = 0.008-0.27) and a child (aOR = 0.03; 95% CI = 0.005-0.17) were associated with a reduction in the odds of severe illness or death. Children who sought care from an HP had a higher risk of severe illness or death than those who consulted a government hospital (aOR = 19.6; 95% CI = 2.71-142.40). Belonging to a rich family resulted in a reduction in the odds of the outcome compared to a poor household (aOR = 0.15; 95% CI = 0.02-0.94).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Illness recognition and care-seeking were low in the Birhan field site, and when care was sought, it was delayed. Care was sought from an HP in rare cases. Health workers did not refer about a third of severely ill or deceased children for further care. Being a newborn, consulting a HP rat","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04270"},"PeriodicalIF":4.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214214","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":"Association of loneliness and social isolation with excess risk of cardiovascular events in people with obesity: a prospective cohort study.","authors":"Ying Zhou, Rui Chen, Minzhi Xu, Yanhong Gong, Chengbin Liu, Mengdie Wang, Xiaoxv Yin","doi":"10.7189/jogh.15.04241","DOIUrl":"10.7189/jogh.15.04241","url":null,"abstract":"<p><strong>Background: </strong>Obese individuals face higher degrees of loneliness and social isolation, but evidence on the association between their levels of loneliness and social isolation and the excess risk of cardiovascular disease (CVD) is lacking. Our study aimed to explore the association between the level of loneliness and social isolation and the obesity-related excess risk of CVD events.</p><p><strong>Methods: </strong>We included 432 767 individuals from the UK Biobank at baseline (100 947 with obesity and 331 820 without obesity). The levels of loneliness and social isolation were defined by a two-item scale and a three-item scale at baseline, respectively. We ascertained CVD events, including coronary heart disease, stroke, heart failure, and CVD mortality, through linkage to inpatient records from primary and secondary health care settings and death registries.</p><p><strong>Results: </strong>A total of 29 767 non-obese and 14 312 obese participants developed incident CVD outcomes during a median (interquartile range (IQR)) follow-up of 12.48 (11.61, 13.22) years. The excess risk of CVD events, including CVD subtypes and CVD mortality, in obese people compared to non-obese people progressively decreased with lower baseline levels of loneliness and social isolation. Specifically, the excess risk of all CVD events decreased by 29% (for loneliness) and 15% (for social isolation). The excess risk of CVD mortality decreased by 25% (for loneliness) and 52% (for social isolation), respectively.</p><p><strong>Conclusions: </strong>Lower baseline levels of loneliness and social isolation were associated with lower obesity-related excess risk of CVD events. Our findings call for the integration of community engagement and social support networks into existing intervention programmes to provide more effective cardiovascular care for obese individuals.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04241"},"PeriodicalIF":4.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214092","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":"Global burden, quality of care, and cross-country inequalities in Alzheimer's disease and other dementias from 1990 to 2021.","authors":"Yajie Zhu, Siqing Cheng, Zeyu Luo, Jie Shen, Jin Cao, Lingzi Yao, Jiali Zhou, Shiyi Shan, Peige Song, Changzheng Yuan","doi":"10.7189/jogh.15.04269","DOIUrl":"10.7189/jogh.15.04269","url":null,"abstract":"<p><strong>Background: </strong>As global populations age, the burden of dementia increases, raising challenges for healthcare systems. Care quality is key to supporting individuals with dementia, but few studies have assessed this at a global level. We aimed to assess the burden and care quality of Alzheimer's disease and related dementias (ADRDs) and cross-country inequalities between 1990 and 2021.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the Global Burden of Diseases Study (GBD) 2021, focussing on disability-adjusted life-years (DALYs) and care quality (measured by a variational autoencoder-based Quality of Care Index (QCI-v), range = 1-100) of ADRDs. We assessed trends using average annual percentage changes (AAPCs) and measured cross-country inequalities using the slope index of inequality and concentration index.</p><p><strong>Results: </strong>The global age-standardised DALY rates of ADRDs per 100 000 population slightly increased from 1331.59 (95% confidence interval (CI) = 881.57, 1781.61) in 1990 to 1347.24 (95% CI = 906.36, 1788.12) in 2021, with an AAPC of 0.04% (95% CI = 0.02, 0.05). The global age-standardised QCI-v of ADRDs increased from 51.56 (95% CI = 45.87, 57.26) to 54.27 (95% CI = 48.68, 59.86), with an AAPC of 0.16% (95% CI = 0.12, 0.21). Regions with a low-middle or low sociodemographic index (SDI), as well as the African Region and the South-East Asia Region, experienced an increasing burden, but a decreasing care quality. In 2021, high-middle SDI regions and the Western Pacific Region had the highest burden, while care quality was notably low in low SDI region. The European Region showed the greatest inequality in terms of burden, while the Eastern Mediterranean showed marked disparities in care quality.</p><p><strong>Conclusions: </strong>The disease burden and care quality of ADRDs both increased from 1990 to 2021, accompanied by significant disparities between countries. Regions with low-middle or low SDI, particularly the African and South-East Asia Regions, faced rising burdens and declining care quality.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04269"},"PeriodicalIF":4.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214173","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 future of Ukrainian healthcare: the digital opportunity.","authors":"Gilbert H Mudge, Andrii Vilenskyi, Udai Kumar, Manish Kohli","doi":"10.7189/jogh.15.03039","DOIUrl":"10.7189/jogh.15.03039","url":null,"abstract":"<p><p>Following the dissolution of the Soviet Union in 1991, Ukraine inherited a decaying healthcare system. Significant reform was under way by 2014, laying the framework for creating a robust digital healthcare system. This viewpoint describes the evolution of this digital system and the constraints imposed by the ongoing war. Ukraine's healthcare system is in a unique position to maximise its expsertise in digital healthcare, as it addresses workforce challenges and reconstructs its facilities.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"03039"},"PeriodicalIF":4.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214226","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":"Association between metabolic syndrome and risk of benign prostatic hyperplasia: a prospective cohort study of 163 975 participants.","authors":"Jiaming He, Xinkai Pan, Dingwen Liu, Jiaren Li, Youyou Li, Yichuan Wang, Jinjing Guo, Qing Zhou, Liang Zhou, Long Wang","doi":"10.7189/jogh.15.04275","DOIUrl":"10.7189/jogh.15.04275","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have identified metabolic syndrome (MetS) as a risk factor for benign prostatic hyperplasia (BPH). However, large-scale evidence remains to be established. This study aims to examine the association between MetS and the risk of incident BPH using large-scale cohort data, as well as the underlying biological mechanisms.</p><p><strong>Methods: </strong>We used prospective cohort data from the UK Biobank, including 163 975 male participants. We applied Cox proportional hazards models to estimate the risk of BPH associated with MetS, adjusting for sociodemographic and lifestyle factors. A mediation analysis was conducted to investigate the potential mediating role of various biomarkers.</p><p><strong>Results: </strong>The median follow-up period was 13.40 years, during which 6614 participants (12.03%) with MetS developed BPH. The presence of MetS was associated with an increased risk of BPH (hazard ratio = 1.07; 95% confidence interval = 1.03-1.10). Further analysis showed that longer follow-up duration, individual MetS components (elevated waist circumference, elevated triglycerides, elevated blood pressure, elevated glycated haemoglobin, and reduced high-density lipoprotein cholesterol), and the cumulative number of components were all significantly associated with an increased risk of BPH. Mediation analysis indicated that inflammation, erythrocyte-related biomarkers, liver function, and renal function partially mediated these associations.</p><p><strong>Conclusions: </strong>MetS is a significant risk factor for the incident BPH. Inflammation, erythrocyte-related biomarkers, liver and renal function partially mediate this relationship. Early detection and intervention in MetS may help reduce the risk of developing BPH.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04275"},"PeriodicalIF":4.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214125","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":"Two decades of the CHNRI method (2006-2025): Tracking its evolution and contribution to the emerging field of ideometrics.","authors":"Igor Rudan","doi":"10.7189/jogh.15.01006","DOIUrl":"10.7189/jogh.15.01006","url":null,"abstract":"&lt;p&gt;&lt;p&gt;This paper tracks the evolution of the Child Health and Nutrition Research Initiative (CHNRI) method for setting health research priorities and situates it within a much broader, emerging field of 'ideometrics' - the quantitative study of how ideas can be generated, evaluated, and prioritised. First presented in 2006, the CHNRI method tackled three key barriers to research priority setting: an infinite number of possible research ideas, uncertainty about future payoffs of investing in research, and the need for a fair, transparent, legitimate, and broadly acceptable consensus. Its proposed solutions were based on the systematic nature of idea generation, explicit context framing, transparent criteria, and expert crowdsourcing, while its scores reflected 'collective optimism' towards many ideas that could be optionally weighted by funders and stakeholders. Early demonstrations of its usefulness were followed by the establishment of a landmark World Health Organization (WHO) programme that set priorities across the leading causes of global child mortality. The resulting publications catalysed adoption of the method by major agencies and many national governments. Within a decade, the CHNRI method became the most widely used approach to health research priority setting. The review of the first 50 exercises revealed its practical advantages: its systematic scope, transparency, inclusiveness, flexibility, simplicity, low cost, and publishable outputs. Its 'natural evolution' within the global health research community led most users to sensibly adapt its standard criteria to their specific contexts. Experiments on quantitative properties of human collective knowledge and opinion demonstrated accuracy within domains of expertise. They also showed that saturation of experts' collective opinion occurs with 45-55 scorers, achieving very stable rankings. Subsequent advances introduced bootstrapped confidence intervals, an information-theory expert agreement metric, and clustering analysis to detect scorer sub-structures, strengthening the method. Consultations with funders clarified 'funding attractiveness' as a complementary criterion, improving the method's policy traction. By the year 2025, the CHNRI method underpinned major exercises led by the leading international organisations in all of the world's regions, and supported research prioritisation in many challenging national and regional settings. A pivotal recent shift is the integration of artificial intelligence (AI)-based large language models: the CHNRI method can now accommodate AI as a partner in all steps of the priority-setting process. Moreover, years of CHNRI practice motivated a broader theoretical move: viewing the brain's 'perception of ideas' as an underappreciated human sense. These advances call for a more quantitative, testable, and replicable future developments in which the CHNRI method will contribute to 'ideometrics' - an emerging scientific field devoted to generating, eva","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"01006"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201399","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":"Impact of home-visit counselling on maternal and child health and nutrition by Barangay health workers: a quasi-experimental study from Eastern Visayas, Philippines.","authors":"Yunhee Kang, Ahreum Choi, Heunghee Kim, Anbrasi Edward, Heyeon Ji, Jihwan Jeon","doi":"10.7189/jogh.15.04276","DOIUrl":"10.7189/jogh.15.04276","url":null,"abstract":"<p><strong>Background: </strong>Maternal and child undernutrition and poor mental health remain public health concerns in the Philippines. We evaluated the impact of home visits with timed and targeted care for family (ttCF) strategies for maternal and child nutrition and mental health during the first 1000 days of life.</p><p><strong>Methods: </strong>We designed a quasi-experimental study encompassing 12 municipalities (six intervention and six comparison) and enrolling 1518 pregnant women or mothers with children <12 months. Trained Barangay health workers (BHWs) conducted 12 scheduled home visits from pregnancy through child's second year in the intervention areas, while comparison areas received routine health services. We estimated the intervention's impact using multilevel mixed-effect models and generalised linear models, adjusting for socioeconomic covariates. The outcomes of interest included frequency of BHW's home visits, maternal message recall scores, possible depressive symptoms (Edinburgh Postnatal Depression Scale (EPDS) score >9), maternal and child diet, and child nutritional status.</p><p><strong>Results: </strong>We assessed 1313 women and children (655 in comparison; 658 in intervention) at 12-month follow-up. Women in the intervention areas received higher home visits during pregnancy (mean (x̄) = 3.2, standard deviation (SD) = 2.7 vs. x̄ = 1.7, SD = 2.0; P < 0.001) and postpartum (x̄ = 2.6, SD = 2.1 vs. x̄ = 1.3, SD = 1.4; P < 0.001), and they had higher recall of health and nutrition messages across the intervention period: prenatal care (adjusted mean difference (AMD) = 2.25; 95% CI = 1.57, 2.94), birth (AMD = 1.83; 95% CI = 1.24, 2.41), and postpartum care (AMD = 2.20; 95% CI = 1.43, 2.96). The intervention reduced maternal potential depressive symptoms by 9.16 percentage points (95% CI = -15.7, -2.62) and a reduction of 1.20 points in EPDS score (95% CI = -1.88, -0.52). There were no significant differences between intervention and comparison groups for maternal dietary diversity or child diet and nutrition indicators.</p><p><strong>Conclusions: </strong>The ttCF strategy improved the frequency and quality of BHW home visits and demonstrated promising impacts on maternal mental health. However, additional enabling interventions are needed to improve maternal and child diet and nutrition outcomes.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04276"},"PeriodicalIF":4.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12475952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151465","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":"Advancing the quality of maternal, newborn, and child healthcare: insights from pilot hospitals in the Kyrgyz Republic.","authors":"Nurshaim Tilenbaeva, Sagynbu Abduvalieva, Arsen Askerov, Dmitrii Beglitse, Masara Gapaeva, Anastasia Kisova, Oleg Kuzmenko, Khatuna Lomauri, Asel Orozalieva, Zaure Ospanova, Venera Shukurova, Olga Teplyakova, Dmitry Yasakov, Sophie Jullien, Martin Willi Weber","doi":"10.7189/jogh.15.04256","DOIUrl":"10.7189/jogh.15.04256","url":null,"abstract":"<p><strong>Background: </strong>Maternal, newborn, and child mortality rates in the Kyrgyz Republic are high compared to other countries in the European Region of the World Health Organization (WHO). Global evidence suggests that at least half of the maternal and newborn deaths could be prevented with improved quality of healthcare. To address this, we undertook a quality improvement project over two years in ten pilot hospitals of the Kyrgyz Republic.</p><p><strong>Methods: </strong>We assessed the quality of care for maternal, newborn, and child health using WHO tools at the beginning and end of the project. We evaluated the availability and appropriate use of resources, case management, and key hospital policies. We used a standardised scoring system from 0 to 3, with colour coding scores and a display of trends (improved, deteriorated, remained the same). After the baseline assessment, we conducted a complex improvement process including the development of hospital quality improvement plans, updating clinical guidelines, training activities in priority topics, supportive supervision, and semi-annual collaborative quality improvement meetings between hospitals.</p><p><strong>Results: </strong>The baseline assessment revealed many areas of suboptimal care across the hospitals and technical areas. The endline assessment showed improvements in case management practices (baseline mean (x̄) = 1.6 vs. endline x̄ = 1.9) and policies and organisation of services (baseline x̄ = 1.7 vs. endline x̄ = 1.9). No improvement was achieved in hospital support services (baseline x̄ = 1.7 vs. endline x̄ = 1.8). Eight out of ten hospitals demonstrated overall improvement progress across categories; the two remaining hospitals showed no improvement.</p><p><strong>Conclusions: </strong>A complex intervention process focussed on updating clinical guidelines, selected capacity-building activities, supportive supervision, and semi-annual collaborative meetings led to quality improvements in maternal, newborn, and child health. The improvements achieved were still not reaching international standards, highlighting the need for a comprehensive and system-wide approach to quality improvement.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04256"},"PeriodicalIF":4.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151449","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":"Phenotypic and genetically predicted leukocyte telomere length and prostate cancer risk: results from a large-scale longitudinal cohort study.","authors":"Xiaoyang Liu, Shengzhuo Liu, Yunfei Yu, Pan Song, Luchen Yang, Zhenghuan Liu, Jing Zhou, Xin Yan, Kai Ma, Haiyun Qiu, Xianding Wang, Qiang Dong","doi":"10.7189/jogh.15.04228","DOIUrl":"10.7189/jogh.15.04228","url":null,"abstract":"<p><strong>Background: </strong>Previous studies on the correlation between leukocyte telomere length (LTL) and prostate cancer (PCa) have shown inconsistent results. We aimed to clarify this association by leveraging a large-scale prospective design and Mendelian randomisation.</p><p><strong>Methods: </strong>We enrolled a total of 229 022 male individuals from the UK Biobank (UKB) to investigate the association between LTL and PCa risk. We employed both unadjusted and covariates-adjusted Cox proportional hazards regression models to assess this relationship. We defined the primary outcome as the diagnosis of incident PCa using in-patient data and the death registry of the UK Biobank cohort. To validate the reliability of the primary findings, we conducted secondary analyses, including Mendelian randomisation.</p><p><strong>Results: </strong>The primary analysis demonstrated that longer LTL was substantially associated with higher risk of PCa, with associations remaining robust after adjusting for potential covariates (hazard ratio (HR) = 1.444; 95% confidence interval (CI) = 1.247, 1.673, P < 0.001). We observed similar results when LTL was analysed as both a continuous and categorical variable, and the association was shown to be inversely U-shaped. We further validated the association at the genetic level using Mendelian randomisation across different PCa databases, with results consistent with our primary analysis.</p><p><strong>Conclusions: </strong>Our findings offer evidence that leukocyte telomere length is an important risk factor for PCa. Further studies are needed to elucidate the underlying mechanisms linking leukocyte telomere length to PCa risk.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04228"},"PeriodicalIF":4.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151454","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}