Journal of Global Health最新文献

{"title":"Equity-focused investment strategies to reduce maternal mortality in the Philippines: a subnational analysis using EQUIST.","authors":"Krista Whitley, Polina Lebedeva, Andre Craig Christie, Annabelle Sim, Desere Thompson, Sally Hukpati, Lakshmi Balaji","doi":"10.7189/jogh.16.04360","DOIUrl":"https://doi.org/10.7189/jogh.16.04360","url":null,"abstract":"<p><strong>Background: </strong>Despite sustained national progress in maternal and child health, maternal mortality in the Philippines remains uneven across regions and socioeconomic groups. Women in poor, rural, and conflict-affected areas experience substantially higher maternal mortality than those in higher-income and urban populations. We aimed to assess subnational inequities in maternal mortality and estimate the potential impact and cost-effectiveness of prioritised maternal health interventions in Philippine regions with maternal mortality ratios exceeding the national benchmark.</p><p><strong>Methods: </strong>We conducted an equity analysis and developed an investment case using the UNICEF Equitable Impact Sensitive Tool (EQUIST). Regional maternal mortality ratios were based on 2019 subnational estimates, with the 2017 national maternal mortality ratio used as the benchmark for regional stratification. Intervention effectiveness estimates were drawn from published evidence syntheses and global clinical guidelines, and EQUIST's costing module draws on LiST and the Marginal Budgeting for Bottlenecks approach. Three intervention packages were modelled: upgrading basic and comprehensive emergency obstetric and newborn care facility readiness; ensuring universal availability of uterotonics and magnesium sulphate; and expanding access to modern contraception among adolescents, women from poor households, and high-parity women. Projected maternal deaths averted, disability-adjusted life years averted, and cost per DALY were estimated through 2030.</p><p><strong>Results: </strong>Our modelling suggested that prioritised intervention packages could avert approximately 1,000-2,500 maternal deaths cumulatively through 2030. Facility readiness upgrades were projected to avert 1,000-1,500 maternal deaths, life-saving commodities 1,500-2,000, and modern contraception expansion 2,000-2,500. Sensitivity analysis varying key inputs by ±15% produced corresponding sensitivity ranges of 850-1,750, 1,275-2,300, and 1,700-2,875 maternal deaths averted, respectively. Modern contraception expansion had the lowest modelled cost per DALY averted at approximately US$150, compared with USD 300 for life-saving commodities and USD 450 for facility readiness upgrades.</p><p><strong>Conclusions: </strong>Maternal mortality in the Philippines remains concentrated among disadvantaged subnational populations. Equity-targeted investments, combined with strengthened emergency obstetric care, reliable life-saving commodities, and expanded access to modern contraception, can achieve substantial mortality reductions at highly cost-effective levels.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04360"},"PeriodicalIF":5.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117049","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":"Cost-effectiveness of community-based artificial intelligence screening for retinopathy of prematurity.","authors":"Jiayu Xu, Zhihan Zhang, Guanran Zhang, Yanlin Qu, Zhenyu Wu, Xiaodong Sun, Da He, Huixun Jia","doi":"10.7189/jogh.16.04357","DOIUrl":"https://doi.org/10.7189/jogh.16.04357","url":null,"abstract":"<p><strong>Background: </strong>Retinopathy of prematurity (ROP) is one of the leading causes of childhood blindness globally, but particularly in middle-income countries, where neonatal survival has improved faster than access to specialist ophthalmic care. Although telemedicine and artificial intelligence (AI)-assisted screening show promise for improving access to ROP screening, their economic value within decentralised health systems remains uncertain. To explore this issue, we evaluated the cost-effectiveness of community-based AI-assisted ROP screening in China compared with telemedicine and traditional bedside screening.</p><p><strong>Methods: </strong>We developed a decision tree model to estimate lifetime health outcomes and societal costs for a hypothetical cohort of 100,000 preterm infants eligible for ROP screening. We compared three strategies: community-based AI-assisted screening, community-based telemedicine screening, and bedside screening at specialist healthcare facilities. Separate parameter sets were applied for urban and rural settings. Costs were assessed from a societal perspective.</p><p><strong>Results: </strong>Community-based AI-assisted screening was the most cost-effective strategy in both urban and rural settings. In the base-case analysis, telemedicine screening dominated bedside screening (meaning it was less costly and more effective), and AI-assisted screening further dominated telemedicine screening. AI-assisted screening incurred the lowest lifetime costs (USD 1,507 per infant in urban and USD 2,581 in rural areas) and the greatest health benefits (29.7138 quality-adjusted life-years (QALYs) in urban and 29.5835 QALYs in rural areas). Compared with bedside screening, AI-assisted screening was dominant, with incremental cost-effectiveness ratios of USD -7,307 per QALY gained in urban and USD -3,688 per QALY gained in rural settings. Findings were robust across scenario and sensitivity analyses, with AI-assisted screening ceasing to be cost-effective only at extremely low treatment-requiring ROP incidence (<0.7%) or low screening coverage (11%) in rural areas.</p><p><strong>Conclusions: </strong>Community-based AI-assisted ROP screening is likely the most cost-effective strategy in China. By expanding access to early eye care while reducing societal costs, it may support equitable service delivery and offer a scalable model for other regions facing similar resource constraints.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04357"},"PeriodicalIF":5.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117054","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":"B3GALT5 regulates renal A/B antigen levels: a determinant of prognosis and rejection in ABO-incompatible kidney transplantation.","authors":"Fan Zhang, Saifu Yin, Yang Xiong, Tao Lin, Xianding Wang","doi":"10.7189/jogh.16.04254","DOIUrl":"10.7189/jogh.16.04254","url":null,"abstract":"<p><strong>Background: </strong>ABO-incompatible (ABOi) kidney transplantation alleviates the shortage of donor kidneys. However, interventions targeting blood group antibodies alone cannot fully prevent antibody-mediated rejection. We investigated how blood group antigens affect prognosis and rejection in ABOi kidney transplantation and explored their regulatory mechanisms.</p><p><strong>Methods: </strong>We prospectively enrolled 28 consecutive ABOi kidney transplant recipient-donor pairs. We performed immunohistochemical staining for A/B antigens on intraoperative donor kidney biopsies. Graft A/B antigen expression levels were assessed in relation to post-transplant anti-A/B antibody titres, graft function, and rejection. We used transcriptome sequencing, immunohistochemistry, immunofluorescence, Western blotting, and polymerase chain reaction to preliminarily explore the regulatory mechanisms of blood group antigens.</p><p><strong>Results: </strong>We identified three expression levels of antigen A (strong, medium, and weak) and two of antigen B (strong and weak) in the grafts. Recipients of grafts with strong antigen expression showed a numerically higher proportion of immunoglobulin M (IgM) elevation. Three recipients developed blood group antibody-mediated rejection, and their graft blood group antigen levels were higher than those in other individuals (difference = 10,301.8; 95% confidence interval (CI) = 4,389.5, 14,413.2, uncorrected P = 0.0088). Recipients of grafts with weak antigen expression exhibited an improvement in estimated glomerular filtration rate within one month post-transplant (regression coefficient = 15.13; 95% CI = 0.172, 30.077, uncorrected P = 0.047). Additionally, B3GALT5, B3GNT3, and FUT9 were significantly correlated with renal blood group antigen levels, and B3GALT5 overexpression reduced blood group A antigen levels in human kidney-2 and human umbilical vein endothelial cells.</p><p><strong>Conclusions: </strong>Graft A/B antigen expression levels may be associated with anti-A/B IgM/immunoglobulin G titres, renal function, and rejection, but these findings are exploratory and require validation in larger cohorts. Furthermore, B3GALT5 shows a significant correlation with renal blood group antigen levels, and modulation of B3GALT5 can alter blood group antigen expression.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04254"},"PeriodicalIF":5.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041540","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":"Multimorbidity and the risk of depression: a systematic review of cohort studies.","authors":"Jingjing Wu, Keying Xu, Ping Jiang, Hua Mei","doi":"10.7189/jogh.16.04279","DOIUrl":"10.7189/jogh.16.04279","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity has been associated with an increased risk of depression. In this systematic review, we aimed to evaluate longitudinal evidence on the association between multimorbidity, including specific multimorbidity patterns, and the risk of developing depression.</p><p><strong>Methods: </strong>We searched Web of Science, PubMed, Embase, PsycINFO, China National Knowledge Infrastructure, and Wanfang from database inception to 31 December 2025. Cohort studies examining the association between multimorbidity or multimorbidity patterns and incident depression or depressive symptoms were included. Two reviewers independently screened studies, extracted data, and assessed study quality using the Newcastle-Ottawa Scale. We employed a narrative synthesis approach and presented the results using descriptive forest plots and harvest plots.</p><p><strong>Results: </strong>A total of 17 longitudinal cohort studies were included, conducted in accordance with PRISMA guidelines, with generally high overall quality. Multimorbidity was consistently associated with an increased risk of depression, and the risk generally increased with the number of chronic conditions. This association was relatively stable across genders and populations in different countries. Associations varied across multimorbidity patterns. Cardiovascular-metabolic and respiratory-related patterns showed the most consistent associations with depression, whereas evidence for other patterns was limited and less consistent. Cardiovascular-metabolic multimorbidity showed a cumulative effect. Increasing multimorbidity trajectories may also be associated with subsequent depression risk.</p><p><strong>Conclusions: </strong>Multimorbidity was longitudinally associated with an increased risk of incident depression or depressive symptoms, and this association appeared to vary according to disease burden, multimorbidity patterns, and changes in multimorbidity over time. Cardiovascular-metabolic patterns, respiratory-related patterns, and rapid trajectories of multimorbidity may represent potential high-risk features requiring further validation. Future research should standardise definitions and pattern identification methods, and further investigate dynamic processes and underlying mechanisms to inform early identification, risk stratification, and future intervention development for depression.</p><p><strong>Registration: </strong>PROSPERO: CRD420261302076.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04279"},"PeriodicalIF":5.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041504","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":"Hidden cities, hidden gaps: measuring facility readiness for maternal and newborn health services and its association with person-centred maternity care in sub-Saharan Africa's urban informal settlements.","authors":"Safia S Jiwani, Martin K Mutua, Kadari Cisse, Choolwe Jacobs, Anne Njeri, Mwiche Musukuma, Godfrey Adero, Ashley Sheffel, Melinda K Munos, Elizabeth Stierman, Cheikh Faye, Ties Boerma, Agbessi Amouzou","doi":"10.7189/jogh.16.04343","DOIUrl":"10.7189/jogh.16.04343","url":null,"abstract":"<p><strong>Background: </strong>In sub-Saharan Africa, maternal and newborn deaths remain disproportionately higher among low-income populations, and they are associated with delivery in poorly equipped facilities and a shortage of staff to manage birth complications. We measured facility readiness to provide essential maternal and newborn health services and its association with women's experience of person-centred maternity care (PCMC), and we compared facilities serving and not serving informal settlements in Nairobi, Lusaka and Ouagadougou cities.</p><p><strong>Methods: </strong>We conducted a health facility assessment in public and private facilities serving select urban informal settlements in Nairobi, and we used existing data in Lusaka and Ouagadougou. We computed readiness indices for labour and delivery care, and small and/or sick newborn care (SSNC) in each city, and used t tests to compare them across facilities serving and not serving informal settlements. We linked women's self-reported PCMC scores to the labour and delivery readiness score of the facility they attended and ran 2-level linear regression models testing the association between facility readiness and PCMC scores.</p><p><strong>Results: </strong>Facility readiness scores were computed among 18, 38, and 138 facilities offering delivery services in Nairobi, Lusaka and Ouagadougou respectively. Mean labour and delivery readiness scores in facilities serving informal settlements ranged from 55.9% in Ouagadougou to 73.6% in Lusaka; SSNC readiness ranged from 37.2% in Ouagadougou to 61.3% in Nairobi. While facilities serving informal settlements had statistically significantly poorer readiness in Lusaka and Ouagadougou, key items such as newborn caps, registers, guidelines, and staff trained in Kangaroo Mother Care were lacking across both areas. We found no significant association between facility readiness and PCMC.</p><p><strong>Conclusions: </strong>All facilities have substandard readiness for essential maternal and newborn health services, but those serving informal settlements are more disadvantaged. Investments in service readiness and quality of care remain critical.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04343"},"PeriodicalIF":5.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041471","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":"Non-clinical symptoms associated with polycystic ovary syndrome: evidence from a comparative study in Bangladesh.","authors":"K M Tanvir, Syed Shahadat Hossain, Humayara Mahjebin Turin, Mishkat Mahiuddin, Tasnim Ara, Mahanaz Faiza, Merajul Islam, Arafat Sabbir, Md Rasel Biswas, Tarikul Islam, Tahseen Khan, Saraban Tahura Ether, Ismat Ara Hossain, Anisuddin Ahmed","doi":"10.7189/joghtemplate","DOIUrl":"10.7189/joghtemplate","url":null,"abstract":"<p><strong>Background: </strong>Polycystic ovary syndrome (PCOS) is a common endocrine disorder that occurs in women of reproductive age and is linked to pregnancy, metabolic, and psychological complications. Although it is very prevalent, a significant percentage of the cases are not diagnosed, because of poor awareness and access to diagnostic services. Identifying non-clinical symptom patterns associated with PCOS may support the development of symptom-based risk assessment approaches and facilitate earlier clinical evaluation of women at increased risk of the condition. The objective of the study was to examine differences in non-clinical, self-reported, and observable symptom profiles between women with and without PCOS in Bangladesh.</p><p><strong>Methods: </strong>A cross-sectional study was carried out on 546 women between the ages of 15 and 30 years in Bangladesh, 273 with physician-diagnosed PCOS and 273 controls. χ² tests were conducted on bivariate analyses and multivariate logistic regression was conducted to determine the possible symptoms of PCOS with age and body mass index as confounding variables.</p><p><strong>Results: </strong>There were a number of symptoms that were significantly different in the two groups. The strongest associations with PCOS in multivariate analysis were irregular menstrual cycles (odds ratio (OR) = 4.93), unexpected weight gain (OR = 4.32), and hair growth in the jawline (OR = 4.25). The condition was also significantly related to self-reported sleep difficulty (OR = 2.62) and waist circumference greater than hips (OR = 2.47). Conversely, the symptoms that were frequently reported, including acne, oily skin, loss of hair, anxiety or stress, hair growth in upper lip, thigh, and upper arm, and family history of PCOS were not statistically significant after adjustments.</p><p><strong>Conclusions: </strong>Several observable and self-reported symptoms were associated with PCOS among Bangladeshi women. These findings provide a basis for future research aimed at developing and validating symptom-based risk assessment approaches for PCOS.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04314"},"PeriodicalIF":5.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041479","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":"Implementing innovative financing mechanisms in global health - perspectives of stakeholders from global health organisations: a qualitative study.","authors":"Sze Wan Ching, Marius Wamsiedel, Jinkou Zhao","doi":"10.7189/jogh.16.04260","DOIUrl":"10.7189/jogh.16.04260","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic and recent geopolitical shifts have strained traditional funding for global health, increasing the interest in innovative financing mechanisms. We explore how international organisations perceive and implement these mechanisms as complements to traditional funding.</p><p><strong>Methods: </strong>In this qualitative study, we conducted semi-structured interviews with eleven senior experts from major global health organisations, gathered via purposive and snowball sampling between May and July 2024. We analysed data using systematic coding and thematic analysis, with trustworthiness enhanced through member checking and peer debriefing.</p><p><strong>Results: </strong>Participants revealed that innovative financing mechanisms are not replacements, but strategic complements to traditional aid. We identified three primary patterns in our data: an evolution from direct funding to complex, multi-stakeholder risk-sharing arrangements; a fundamental transformation of stakeholder relationships, increasing coordination complexity; and the critical role of institutional capacity in successful implementation. Analysis of five innovative financing mechanisms, namely Advanced Market Commitments, Blended Finance, the International Finance Facility for Immunization (IFFIm), Debt2Health, and Micro-levies, demonstrated distinct patterns in complexity, coordination, and risk distribution across said mechanisms. The success of the implementation depended on clear problem definition, stakeholder alignment, and robust risk management. Blended Finance and IFFIm showed the highest complexity, while Debt2Health offered a more streamlined, triangular model.</p><p><strong>Conclusions: </strong>The effectiveness of innovative financing mechanisms is heavily dependent on existing institutional frameworks and local context. They represent an evolution in health financing, offering tools for resource mobilisation and efficiency, but their success hinges on careful attention to implementation context, stakeholder coordination, and institutional capacity. Policymakers should focus on matching mechanisms to specific contexts and building coordination capabilities alongside technical innovation.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04260"},"PeriodicalIF":5.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041469","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":"Strengthening biomedical engineering systems in sub-Saharan Africa: a repeated cross-sectional assessment of workshop readiness and medical device maintenance in NEST360-supported hospitals.","authors":"John Wainaina, Christine Alexandra Bohne, George Banda, Vincent Ochieng, Charles Osuagwu, Elizabeth Ngowi, Hope David Peter, Georgia Jenkins, June Madete, Millicent Alooh, Annika Nambiar, Sara Liaghati, Morris Ogero, Rebecca Eliana Penzias, Danica Kumara, Lisa Ruth Hirschhorn, Zillah Maria Oden, Rebecca Richards-Kortum","doi":"10.7189/jogh.16.04270","DOIUrl":"10.7189/jogh.16.04270","url":null,"abstract":"<p><strong>Background: </strong>Biomedical engineering technician (BMET) workshops are essential for maintaining medical devices, yet their service readiness in low-resource settings remains insufficiently described. This study assesses BMET workshop readiness and associated maintenance systems across Newborn Essential Solutions & Technologies 360-supported hospitals in four sub-Saharan African countries.</p><p><strong>Methods: </strong>We conducted repeated cross-sectional health facility assessments of BMET workshops in 2020-2021 (n = 53 hospitals) and 2023 (n = 63 hospitals) across Kenya, Malawi, Nigeria, and Tanzania. We assessed BMET workshop readiness using 186 indicators across six domains: tools and test equipment, spare parts, storage and organisation, systems and processes, human resources, and maintenance and repair capacity. We scored indicators as 1 (available), 0.5 (partially available), or 0 (not available), and aggregated as percentages at hospital level. We summarised domain and overall readiness using medians (Mdn) and interquartile ranges (IQRs). We assessed differences between samples using Wilcoxon rank-sum tests, and explored associations between readiness, planned preventive maintenance (PPM), and device functionality.</p><p><strong>Results: </strong>Overall BMET workshop readiness increased from a median of 28.0% (IQR = 20.9-35.8) to 50.0% (IQR = 36.5-56.5) in 2023 (Wilcoxon rank-sum P < 0.001). We observed improvements across all domains, with the largest gains in tools and test equipment and maintenance and repair capacity, while human resources showed minimal change. Spare parts availability remained low despite improvement, increasing from 4.0% to 14.8%. PPM system presence increased from 68.5% to 90.6%, although implementation varied. Associations between BMET readiness and device functionality were present at baseline but not in 2023.</p><p><strong>Conclusions: </strong>BMET workshop readiness improved across participating hospitals between baseline and 2023, particularly in tools and maintenance systems. However, persistent gaps remain in human resources, spare parts availability, and maintenance system implementation. These findings highlight the need for sustained investment in biomedical engineering workforce capacity, supply chain integration, and system strengthening to support durable improvements in medical device functionality.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04270"},"PeriodicalIF":5.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041505","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":"Clinical trials in the Eastern Mediterranean Region: a ten-year landscape analysis.","authors":"Shrouk M Abdou, Akbar Fotouhi, Arshad Altaf, Ghassan Karam, Arash Rashidian","doi":"10.7189/jogh.16.04287","DOIUrl":"10.7189/jogh.16.04287","url":null,"abstract":"<p><strong>Background: </strong>In 2022, the World Health Organization (WHO) called on countries to strengthen their capacities for the conduct of impactful clinical trials and generating high-quality evidence on health interventions. The Eastern Mediterranean Region (EMR) faces challenges in this regard, with research output concentrated in a few countries and institutions.</p><p><strong>Methods: </strong>We analysed the registration data of clinical trials from the WHO International Clinical Trials Registry Platform for all 22 countries and territories of the EMR from 2013 to 2023. Following data cleaning, deduplication, and intervention classification, we descriptively analysed the trials across time, countries, intervention types, phase, sample size, sponsorship, and participant demographics.</p><p><strong>Results: </strong>We identified 49,529 interventional trials, representing a three-fold increase in annual registrations over the decade. Most studies conducted in 2023 originated from only a few countries: Iran (57%), Egypt (23%), and Pakistan (14%), followed by Saudi Arabia (1.5%), Iraq (1.4%), and Tunisia (1.2%). Despite the increase in absolute numbers, the proportion of clinical trials with pharmacological interventions declined from 61.5% in 2013 to 42.4% in 2023. While the findings demonstrate significant growth in regional clinical trial activity, they also highlight persistent challenges, as interventional studies with small sample sizes remain common.</p><p><strong>Conclusions: </strong>Although our analysis reveals substantial growth in clinical trial registrations across the EMR over the past decade, persistent disparities in research capacity remain, while the role of industry remains limited. Coordinated efforts are required to increase multi-centre and multi-country studies in order to address the key health priorities and contribute more effectively to the development of solutions that address regional needs.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04287"},"PeriodicalIF":5.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041527","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":"Platelet indices and incident hypertension: effect modification by body mass index in a Chinese cohort.","authors":"Zekai Chen, Zhen He, Shasha Zhou, Guanlin Chen, Hong Zheng, Yuxian Wang, Weiqiang Wu, Shouling Wu, Youren Chen","doi":"10.7189/jogh.16.04334","DOIUrl":"10.7189/jogh.16.04334","url":null,"abstract":"<p><strong>Background: </strong>Routine platelet indices have been linked to blood pressure and vascular risk. However, longitudinal evidence on the association between platelet count (PLT), mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) and incident hypertension remains limited, and it is unclear whether these associations differ according to adiposity. We aimed to examine associations of PLT, MPV, PCT, and PDW with incident hypertension and assess whether these associations vary by body mass index (BMI).</p><p><strong>Methods: </strong>We analysed 51,191 hypertension-free adults aged ≥18 years from the 2006 baseline examination of the Kailuan Study, with follow-up through 31 December 2023. We measured PLT, MPV, PCT, and PDW from routine full blood counts. We used weighted Cox regression to estimate overall hazard ratios (HRs) and by Chinese BMI categories, adjusting for age, sex, fasting blood glucose, physical activity, and smoking. Restricted cubic splines assessed dose-response relationships.</p><p><strong>Results: </strong>During a median follow-up of 8.2 years, 29,491 participants developed hypertension (incidence rate = 70.67 per 1000 person-years). Higher PLT (HR = 1.07; 95% confidence interval (CI) = 1.05-1.09) and PDW (HR = 1.03; 95% CI = 1.01-1.04) were associated with greater hypertension risk, whereas MPV showed a modest inverse association (HR = 0.98; 95% CI = 0.96-1.00) and PCT was not significantly associated (HR = 0.99; 95% CI = 0.98-1.01). Absolute incidence rates increased across Chinese BMI categories from 33.59 to 105.13 per 1000 person-years. BMI-stratified analyses suggested heterogeneous patterns, particularly for MPV and PDW. Splines indicated approximately linear positive associations for PLT and PDW, a mild inverse/flat pattern for MPV, and nonlinear associations for PCT.</p><p><strong>Conclusions: </strong>Routine platelet indices showed modest associations with incident hypertension, with heterogeneous patterns across BMI categories. These findings suggest that platelet-related haematological traits may reflect BMI-dependent differences in hypertension risk, but external validation and formal prediction analyses are needed before clinical use.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04334"},"PeriodicalIF":5.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041493","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}