Journal of Global Health最新文献

{"title":"Rethinking mental healthcare: operationalising intersectionality through a community-driven social clinic model.","authors":"Anuj Kapilashrami, George Kokkinidis, Marco Checchi","doi":"10.7189/jogh.15.03034","DOIUrl":"10.7189/jogh.15.03034","url":null,"abstract":"<p><p>Here we examine the critical need for rethinking mental healthcare through a social clinic model, informed by intersectional equity perspective. Drawing on insights from the INtersectional Network Of community and stakeholder Voices, And research to Tackle (in)Equities (INNOVATE) project, we highlight significant gaps in current mental health services, including fragmentation, stigmatisation, and lack of person-centred care. Intersectionality recognises intersecting disadvantages that shape differential mental healthcare access and outcomes. By applying an intersectionality lens, we reveal how overlapping forms of disadvantage arising from social positions such as race and ethnicity, gender, geography, and immigration status interact with social drivers like socio-economic deprivation, legal status, and exclusion to create complex barriers to accessing care. For instance, young people in remote areas, asylum seekers with housing insecurity and experiencing disability, and those in socioeconomically deprived areas carry a disproportionate burden of poor mental health in Essex, UK. Social clinics, as autonomous, self-managed centres that combine medical care with social support and community participation, constitute a promising approach to reduce the gap. We argue for a community-led process of the integration of intersectionality into community engagement processes for establishing and implementing social clinics to build sustainable, inclusive, and responsive mental health services. We propose a five-step framework for operationalising this model, centred around co-design, collective action, and participatory governance, aiming to address power asymmetries and promote equity in mental health service delivery.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"03034"},"PeriodicalIF":4.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092880","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":"Use and implications of the Apgar score in evaluating resuscitation of newborns with birth asphyxia in a lower-middle-income country.","authors":"Jayashree Ramasethu, Indira Narayanan, Jeffery Kodjo Arhin, Rita Fosu Yeboah, Genevieve Insaidoo, Eunice Mintah, Evans Awutey","doi":"10.7189/jogh.15.04244","DOIUrl":"10.7189/jogh.15.04244","url":null,"abstract":"<p><strong>Background: </strong>The Helping Babies Breathe (HBB) programme has been used worldwide to address neonatal mortality due to birth asphyxia in low resource countries. We aimed to use the Apgar score to evaluate the impact of the programme on neonatal mortality in three district and one regional hospital in Ghana, a lower middle-income country.</p><p><strong>Methods: </strong>We used Apgar scores as an objective measure of newborn infants' condition soon after birth and their response to resuscitation, with the assessment carried out primarily by midwives who were trained in HBB. We analysed correlations between Apgar scores and mortality in newborns ≥34 weeks gestation who had birth asphyxia (BA), i.e. a one-minute Apgar score <7, and severe BA, i.e. a one-minute Apgar score ≤3.</p><p><strong>Results: </strong>Over the 18-month period from October 2019 to March 2021, 12 995 newborns were delivered at ≥34 weeks gestation or with a birth weight of at least 2000 grams. There were 12 702 live births and 293 stillbirths, of which 134 were intrapartum stillbirths. Among the live births, 2387(18.9%) had BA, including 352 (2.8%) who had severe BA. There was no significant difference in the trend of cases of severe BA or deaths due to BA in the four hospitals, either individually or combined, but there was a 55% decline in intrapartum stillbirths, from 1.6% to 0.89% (P = 0.03). Although many babies with BA showed improvement in Apgar scores with resuscitation efforts, the mortality rate among 352 newborns with severe BA was 15.6% - twenty times higher than in the 2045 newborns with a one-minute Apgar score of 4-6, among whom 0.78% died (P < 0.001). The mortality rate in newborns with severe BA was higher in those whose scores remained ≤3 than in those whose scores rose to 4-6 or more at five minutes (odds ratio = 19.93, 95% confidence interval = 9.4-42.1, P < 0.0001).</p><p><strong>Conclusions: </strong>The Apgar score provides valuable information about where additional interventions may decrease BA related neonatal mortality in low- and middle-income countries.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04244"},"PeriodicalIF":4.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092853","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":"Barriers and enablers to centre-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease in low- and middle-income countries: a systematic review.","authors":"Yue Lei Lim, Julia Patrick Engkasan, Jayakayatri Jeevajothi Nathan, Hilary Pinnock, Ee Ming Khoo, Monsur Habib, Soo Chin Chan","doi":"10.7189/jogh.15.04255","DOIUrl":"10.7189/jogh.15.04255","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity in low- and middle-income countries (LMICs). Despite the proven benefits of pulmonary rehabilitation (PR) for patients with COPD, its referral, uptake, and completion rates remain low. This systematic review aimed to identify the barriers and enablers to centre-based PR among patients with COPD in LMICs.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases from their inception to September 2023 and updated in May 2025. Studies involving patients with COPD, their caregivers, and healthcare professionals (HCPs), were included if they reported barriers or enablers to centre-based PR in LMICs. Data were extracted based on the socio-ecological model of health behaviour, and a narrative synthesis was conducted.</p><p><strong>Results: </strong>Five articles met the inclusion criteria, comprising four quantitative and one qualitative study, involving 1544 patients with COPD, 11 caregivers, and 84 HCPs, which were conducted in Iran, China, Colombia, and Brazil. The most frequently identified barrier to PR was personal financial constraints. Other frequently reported barriers included symptom severity of COPD, lack of family and social support, inadequate competency of HCPs, and logistical challenges. Enablers to PR included higher proficiency of HCP, higher personal and family income, higher educational levels, better patient awareness of PR, and awareness programmes.</p><p><strong>Conclusions: </strong>Barriers and enablers to PR referral, uptake, and completion in LMICs were identified at multiple levels: intrapersonal, interpersonal, organisational, community, and policy. Some factors were common to both LMICs and high-income countries, such as frequency of hospitalisation, social support, HCP knowledge and skills, logistical challenges, and awareness programmes, but personal financial constraints were a unique barrier to LMICs. To improve existing PR services or to effectively implement new PR programmes, these factors need to be considered.</p><p><strong>Registration: </strong>PROSPERO: CRD42024528467.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04255"},"PeriodicalIF":4.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087806","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":"Relationship between admission serum uric acid to lymphocyte ratio and the risk of ischemic stroke recurrence and death: a prospective study.","authors":"Chenning Song, Guangxiao Li, Yuanmeng Tian, Li Jing, Dong Chen, Weizhong Wang, Yonggang Shi, Dongyu Wang, Dongqun Li, Xinbin Hao, Liying Xing, Shuang Liu","doi":"10.7189/jogh.15.04240","DOIUrl":"10.7189/jogh.15.04240","url":null,"abstract":"<p><strong>Background: </strong>This study aims to explore the relationship between the Serum uric acid to lymphocyte ratio (ULR) level at admission and the long-term risk of recurrence and death in patients with acute ischemic stroke (AIS) in Liaoning Province.</p><p><strong>Methods: </strong>This multicentre prospective study enrolled 7966 subjects who experienced ischemic stroke (IS) across Liaoning Province, China. The Cox proportional hazards model and Kaplan-Meier curves were used to explore the association of ULR with the risk of recurrence and death in IS.</p><p><strong>Results: </strong>During a median follow-up period of 4.08 (3.35, 4.43) years, there were 1311 cases of stroke recurrence or death, 1429 cases of cardiovascular (CVD) death, and 910 cases of stroke-cause death. In analysis comparing the Q4 and Q1group, after multivariate adjustment, ULR was significantly positively associated with the incidence of stroke recurrence or death (Q4 vs. Q1: HR = 1.21; 95% CI = 1.04, 1.42), CVD death (Q4 vs. Q1: HR = 1.16; 95% CI = 1.00, 1.34), and stroke-cause death (Q4 vs. Q1: HR = 1.26; 95% CI = 1.05, 1.52). Additionally, the significant correlation between ULR and the risk of IS recurrence or death was partially mediated by diastolic blood pressure (DBP) (8.53%) and systolic blood pressure (SBP) (3.59%) in a positive manner.</p><p><strong>Conclusions: </strong>This study demonstrates that higher ULR is significantly associated with an increased risk of recurrence and death following IS. The findings suggest that ULR could serve as a valuable prognostic marker in clinical practice, particularly in managing patients with IS.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04240"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041896","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 association between all-cause mortality with drinking habits and water sources: a nationwide longitudinal study on Chinese elderly.","authors":"Shisi Shen, Ning Ma, Tingting Wu, Yang Xiong, Jialu Yang, Xiaoai Wu, Xianhong Xiang","doi":"10.7189/jogh.15.04120","DOIUrl":"10.7189/jogh.15.04120","url":null,"abstract":"<p><strong>Background: </strong>Few studies have reported on the association between drinking habits, water sources and all-cause mortality among the elderly, who are susceptible to toxic environmental factors. We aimed to address this gap by conducting a longitudinal study among the Chinese population.</p><p><strong>Methods: </strong>We conducted a 16-year longitudinal study using data of individuals aged >65 years at baseline enrolled in the Chinese Longitudinal Healthy Longevity Study. A formal questionnaire was used to collect data on drinking habits and water sources. The former to whether participants consumed boiled or unboiled water, while the latter queried the use of well water, surface water, spring water, and tap water. We used Cox proportional hazard adjusted for sociodemographic factors, lifestyle, and common diseases to calculate the risk of all-cause mortality associated with drinking water. We further conducted subgroup analyses to evaluate potential interaction effects.</p><p><strong>Results: </strong>We used data on 15 664 individuals, among whom 4472 men and 6166 women died from any reason. Participants who drank unboiled water were more likely than those who drank boiled water to eventually reach a high risk of all-cause mortality (hazard ratio (HR) = 1.14; 95% confidence interval (CI) = 1.06-1.23). Compared to drinking well water, drinking tap water in childhood (HR = 0.80; 95% CI = 0.68-0.95), being around 60 years of age (HR = 0.81; 95% CI = 0.76-0.86), and at present (HR = 0.90; 95% CI = 0.86-0.95) were all associated with lower risks of all-cause mortality. Drinking surface water in childhood was also related to a lower risk of all-cause mortality (HR = 0.94; 95% CI = 0.90-0.98). However, drinking spring water was not associated with all-cause mortality across the entire lifespan in the total sample.</p><p><strong>Conclusions: </strong>Drinking unboiled water was associated with a higher risk of all-cause mortality. In comparison to well water, tap water emerged as a safer and healthier option for the elderly Chinese population throughout their whole life cycle.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04120"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041889","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":"Machine learning-based risk factor analysis and prediction model construction for mortality in chronic heart failure.","authors":"Qian Xu, Ruicong Yu, Xue Cai, Guanjie Chen, Yueyue Zheng, Cuirong Xu, Jing Sun","doi":"10.7189/jogh.15.04242","DOIUrl":"10.7189/jogh.15.04242","url":null,"abstract":"<p><strong>Background: </strong>Given the high global mortality burden of chronic heart failure (CHF) and the limitations of traditional risk prediction tools in accuracy and comprehensiveness, along with the potential of machine learning (ML) to improve prediction performance and the ability of a health ecology framework to systematically identify multi-dimensional risk factors, we aimed to develop an ML-based mortality risk prediction model for CHF and analyse its risk factors using a health ecology framework.</p><p><strong>Methods: </strong>We enrolled 489 CHF patients from the Jackson Heart Database, with all-cause mortality during a 10-year follow-up period designated as the outcome measure. Guided by a five-layer health ecology framework (individual traits, behavioural characteristics, interpersonal relationships, work/living conditions, and macro policies), we selected 58 variables for analysis. The cohort was split into 7:3 training/validation sets. Random forest (RF) and k-nearest neighbour (KNN) models identified mortality predictors after five oversampling techniques addressed data imbalance before modelling. We trained seven ML algorithms, validated them via 10-fold cross-validation, and compared them using accuracy, the area under the curve (AUC), and other metrics.</p><p><strong>Results: </strong>We identified 24 key factors: 19 for individual traits (age, body mass index (BMI), antihypertensive medication, hypoglycaemic medication, antiarrhythmic medication, systolic blood pressure, glycated haemoglobin, glomerular filtration rate, left ventricular ejection fraction, left ventricular diastolic diameter, left ventricular mass, high-density lipoproteins, low-density lipoproteins, triglycerides, total cholesterol, cardiovascular surgical history, mitral annular early diastolic peak velocity of motion); three for individual behavioural characteristics (dark greens intake, egg intake, and night-time sleep duration); and two for living and working conditions (favourite food shop at three-kilometre radius, proportion of poor people in the place of residence). The model constructed using synthetic minority over-sampling technique combined with edited nearest neighbours (SMOTE-ENN) processing and applying extreme gradient boosting (XGBoost) model was optimal, with an accuracy of 81.58%, an AUC value of 0.83, a precision of 0.87, a recall of 0.84, and an F1 value of 0.86 for the prediction of mortality at 10-year follow up.</p><p><strong>Conclusions: </strong>We systematically categorised CHF mortality risk factors by integrating health ecology theory and ML. The SMOTE-ENN and XGBoost model demonstrated high accuracy, though further optimisation is needed to enhance clinical utility in CHF risk prediction.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04242"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041734","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":"Inequities in effective coverage of family planning services in low- and middle-income countries: linking household and facility surveys.","authors":"Shenning Tian, Elizabeth A Hazel, Melinda Munos, Abdoulaye Maïga, Safia S Jiwani, Emily B Wilson, Gouda Roland Mesmer Mady, Agbessi Amouzou","doi":"10.7189/jogh.15.04211","DOIUrl":"10.7189/jogh.15.04211","url":null,"abstract":"<p><strong>Background: </strong>Despite decades of family planning (FP) programme successes in low- and middle-income countries (LMICs), women still face an unmet need for contraceptives, as well as inequalities in coverage. Including elements of service readiness in FP intervention coverage measures will better inform population-level programme performance.</p><p><strong>Methods: </strong>We identified five LMICs that had health facility and household surveys conducted <5 years apart within the past ten years: Bangladesh, Haiti, Malawi, Nepal, and Tanzania; only Nepal had time-trend data available. We developed quality readiness-adjusted FP coverage measures by linking health facility assessments (i.e. readiness) and household surveys (i.e. intervention coverage) according to ecological linking methods. We defined linking units by facility type, managing authority, and geographic location using women's reported source of contraceptives. We defined intervention coverage as the percentage of women aged 15-49 years who needed contraceptive services and were using a modern method, and calculated readiness-adjusted intervention coverage with the average FP readiness score in each linking unit. We used a coverage cascade model to understand gaps in health service readiness and access, and performed a health equity analysis for wealth, locality, and age.</p><p><strong>Results: </strong>Large gaps in FP intervention coverage and readiness were present in all settings. Facility readiness scores ranged from 0.58 to 0.66, with gaps in coverage and readiness-adjusted coverage ranging from 49 percentage points (pp) in Bangladesh to 21 pp in Haiti. Urban, wealthier, and adolescent women had lower readiness-adjusted coverage because they also obtained their contraceptives outside of health facilities. Coverage cascades changed little for Nepal between 2015 and 2021.</p><p><strong>Conclusions: </strong>By calculating readiness-adjusted FP coverage using a cascade model in five geographically diverse countries, including time trends in one country, we found large gaps in intervention and readiness-adjusted coverage with related inequalities.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04211"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041767","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 impact of sleep duration, depressive symptoms, and cognitive function on daily activity among Chinese older adults: a serial multiple mediation model.","authors":"Jiayi Sun, Hao Li, Jun Deng, Jianing Liu, Nachuan Hu, Hui Liu, Yangdong Fan, Lei Shi","doi":"10.7189/jogh.15.04267","DOIUrl":"10.7189/jogh.15.04267","url":null,"abstract":"<p><strong>Background: </strong>Few studies have explained the mechanisms underlying the relationship between sleep duration and the activities of daily living (ADL). We aim to explore the multiple mediating roles of depressive symptoms and cognitive function in this relationship among Chinese older adults.</p><p><strong>Methods: </strong>A total of 5858 older adults participated in the China Health and Retirement Longitudinal Study, completing the Center for Epidemiologic Studies Depression Scale, the ADL Scale, and the Telephone Interview for Cognitive Status Scale. We performed serial multiple mediation analysis using the Hayes' PROCESS macro.</p><p><strong>Results: </strong>Sleep duration influenced ADL both directly and indirectly through three significant pathways (P < 0.001). For individuals sleeping 6-8 hours, depressive symptoms accounted for 56.50% of the total effect. In contrast, for those sleeping ≥8 hours, depressive symptoms accounted for 65.50%. Cognitive function contributed to 1.79% of the total effect in the 6-8-hour group, whereas in the ≥8-hour group, cognitive function had a negative mediating effect of -4.60%. Combined mediation by depressive symptoms and cognitive function accounted for 2.42% of the total effect in the 6-8-hour group and 2.76% in the ≥8-hour group. The total mediating effect was 60.70% for the 6-8-hour group and 63.70% for the ≥8-hour group.</p><p><strong>Conclusions: </strong>The action mechanisms between different levels of sleep duration and ADL differed, but all showed significant effects from sleep duration, depressive symptoms, and cognitive function regarding ADL among older adults. Therefore, promoting sleep education and addressing depressive symptoms and cognitive decline in older adults are essential for the early detection and prevention of ADL impairment.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04267"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041918","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":"Age-period-cohort analysis of cardiovascular disease trends in middle-aged and older adults: cross-country comparison across HRS, ELSA, SHARE, and CHARLS.","authors":"Jiajia Li, Shiqi Lin, Heming Pei, Guilan Xie, Lijun Pei, Gong Chen","doi":"10.7189/jogh.15.04260","DOIUrl":"10.7189/jogh.15.04260","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is a leading cause of death globally, while the dynamics of CVD risk across different age groups, periods, and birth cohorts remain unclear. This study investigates how age, period, and cohort effects contribute to CVD risk across regions differently.</p><p><strong>Methods: </strong>We employed a repeated cross-sectional design, analysing data from four large longitudinal surveys in the USA, UK, Europe, and China. A hierarchical age-period-cohort analysis was conducted using Bayesian inference through the integrated nested Laplace approximation to model the effects of age, period, and cohort on CVD risk across these regions. Subgroup analyses were also conducted to examine the moderation effects of social-demographic factors.</p><p><strong>Results: </strong>CVD risk increases with age across all regions, peaking at age 75 in China while continuously rising in other areas. Period effects showed a significant increase in CVD risk over time in the USA, UK, and China, while a decline was observed in Europe after 2017. More recent birth cohorts showed a lower CVD risk, especially in the USA and UK. In China, the decrease in risk among recent cohorts was less pronounced. Gender, marital status, education, rural residence, and smoking moderated CVD risk trends across regions.</p><p><strong>Conclusions: </strong>This study highlights the importance of age, period, and cohort effects in understanding regional differences in CVD risk among middle-aged and older adults. Findings suggest that public health interventions should be tailored to specific regions and demographic groups to reduce CVD burden effectively.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04260"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042057","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":"Trends of infectious diseases, epidemic patterns, and the association with meteorological events: 2500 years of evidence from an observational study.","authors":"Qiao Liu, Chenyuan Qin, Shimo Zhang, Jue Liu","doi":"10.7189/jogh.15.04254","DOIUrl":"10.7189/jogh.15.04254","url":null,"abstract":"<p><strong>Background: </strong>Meteorological factors are known to influence the transmission of infectious diseases. Studying historical epidemics in ancient China provides valuable insights into how environmental stressors shaped public health, with implications for modern disease control. We aimed to quantitatively assess the relationship between meteorological events and epidemic severity in China from 674 BC to 1911 AD.</p><p><strong>Methods: </strong>We extracted data from 'A Compendium of Chinese Meteorological Records of the Last 3000 Years'. We digitised epidemic events, consequences, and associated meteorological conditions and categorised them into ordinal levels. We used descriptive statistics and multivariable logistic regression to analyse annual patterns and associations across historical periods.</p><p><strong>Results: </strong>We identified 5338 epidemic-related records. While the number of reported epidemics increased over time, the proportion associated with meteorological events declined by 0.24% (95% confidence interval (CI) = 0.17-0.31) per decade between 1451 and 1911. Flood frequency was associated with higher epidemic severity: each additional flood increased the odds of moderate (vs. mild) consequences by 42% (95% CI = 8-87) and severe (vs. moderate) consequences by 46% (95% CI = 12-91). Droughts similarly raised the risk of severe consequences by 23% (95% CI = 7-41). Famines were also linked with heightened epidemic severity and were among the most commonly co-reported meteorological events, along with drought.</p><p><strong>Conclusions: </strong>As global climate intensifies, the historical relationship between environmental stressors and epidemic severity offers crucial lessons for modern public health. Regions vulnerable to climate extremes may require targeted, climate-informed epidemic preparedness and response strategies.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"15 ","pages":"04254"},"PeriodicalIF":4.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001689","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}