Journal of Global Health最新文献

{"title":"Journal of Global Health's GUidelines for Authors on Requesting and DIsclosing changes in Authorship Nominations (GUARDIAN).","authors":"Luka Ursić, Harry Campbell, Igor Rudan","doi":"10.7189/jogh.16.01003","DOIUrl":"https://doi.org/10.7189/jogh.16.01003","url":null,"abstract":"<p><p>We address the growing concern of requests for post-submission and post-acceptance changes in authorship which our editorial team has observed in recent years. We emphasise that authorship order should be agreed upon by all contributors before submission, as all authors are expected to approve the final version of their manuscript and agree on their respective authorship positions. This editorial identifies seven categories of authorship change requests, ranging from adding or removing ordinary authors to modifying first or last authorship positions, or introducing group authorship. We consider some of these requests legitimate, such as adding author(s) who performed additional analyses based on reviewers' feedback or removing author(s) disagreeing with such revisions. We consider some others indicative of potentially concerning practices, particularly those involving changes to first or last authorship positions. We place this trend within a broader context of questionable research practices, including 'honorary' or 'gift' authorships driven by institutional power dynamics and the more recent emergence of 'paper mills'. These practices seem to be increasing in frequency with the rise of artificial intelligence (AI) and large publicly available data sets, which have lowered the barriers to producing large volumes of research of questionable value. Existing safeguards developed by organisations such as the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE) are helpful, but limited in their ability to prevent such practices. To address these challenges, the Journal of Global Health introduces the GUidelines for Authors on Requesting and DIsclosing changes in Authorship Nominations (GUARDIAN), which mandate full transparency whenever authorship changes occur after submission. Specifically, in the part of the standard 'acknowledgements' section at the end of each paper, where the mandatory 'authorship contributions' statement is typically detailed, the authors will be required to: (i) declare that the authorship byline has been changed since submission; (ii) disclose precisely what changes to the byline occurred between these two versions; (iii) provide an explanation for this change; and (iv) provide the final authorship contributions accordingly. Supporting documentation will also be archived by our editors and may be shared upon legitimate requests. The GUARDIAN aim to deter misconduct through transparency, protect early-career researchers from authorship pressure, and improve accountability in academic publishing. Together with our previously introduced Guidelines for Reporting Analyses of Big Data Repositories Open to the Public (GRABDROP) and other integrity initiatives, the GUARDIAN represent a proactive effort to safeguard credibility of authorships, while allowing legitimate adjustments whenever they are properly justified.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"01003"},"PeriodicalIF":4.3,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693069","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 of public primary care facilities, economic development, and the health service transition.","authors":"Krishna D Rao, Austin Schmidt, Yifeng Zhao","doi":"10.7189/jogh.16.04142","DOIUrl":"10.7189/jogh.16.04142","url":null,"abstract":"<p><strong>Background: </strong>Many low- and middle-income countries (LMICs) have large networks of public primary care facilities (PCF) to provide affordable and quality health services close to communities. Public PCFs are expected to serve as the principal source of primary care. This study documents the extent to which public PCFs are used for illnesses treatable at the primary care level, and investigates the association between public PCF use, economic development, and UHC achievement.</p><p><strong>Methods: </strong>A cross-section of Demographic and Health Surveys conducted after 2014 in 46 LMICs were analysed. The sources of medical advice for children seeking care outside their home for the following illnesses were identified - acute respiratory infections (ARI), diarrhoea, and fever.</p><p><strong>Results: </strong>There is considerable between-country variation in utilisation of public PCFs; in most countries public PCFs received less than half the patients seeking medical advice for conditions treatable at the primary care level. Second, economic development is associated with a 'health service transition' characterised by two related trends - decline in the share of patients seeking medical advice at public providers overall and at public PCFs, and a proportionate increase in the share of patients seeking medical advice at private providers; use of public PCFs declined by around 24 percentage points between the average low-income and middle-income country. However, most of the between-country variation in public PCF use was due to factors other than income. Third, cross-country regression analysis indicated that public PCF use was not associated with UHC achievement because a similar range of services are offered by private providers. Public PCF use was associated with lower catastrophic health expenditures.</p><p><strong>Conclusions: </strong>The changes in care-seeking patterns and use of public PCFs brought about by economic development makes it critical to re-think primary health care service delivery models and financial protection mechanisms in transition countries.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04142"},"PeriodicalIF":4.3,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13067298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647151","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":"Integrated genomic and clinical indicators for predicting foetal chromosomal abnormalities: development and validation of a nomogram model.","authors":"Yingjie Zhou, Peng Liu, Xiaolin Zhang, Qiaoling Geng, Hanbing Jia, Zi Wang, Xiaojing Zhou, Haiyan Li, Jia Zhang, Ci Liu, Xuejun Liu, Weijun Kang","doi":"10.7189/jogh.16.04092","DOIUrl":"10.7189/jogh.16.04092","url":null,"abstract":"<p><strong>Background: </strong>Foetal chromosomal abnormalities are identified as one of the leading causes of adverse pregnancy outcome in pregnancies that are referred on suspicion of structural abnormalities in the foetus. While various types of genomic analyses can be carried out in order to determine prenatal risk factors, no single nomogram in existence combines these factors to provide the probability of chromosomal abnormalities in the foetus.</p><p><strong>Methods: </strong>This was a retrospective cohort analysis among pregnant women referred for possible foetal structural anomalies who received invasive prenatal diagnostic tests at two tertiary referral centres within Hebei Province. The study participants received uniform prenatal evaluation and genomic analysis that included non-invasive prenatal testing as well as copy number variation analysis. Foetal anomalies identified by ultrasound were re-evaluated by expert reviewers, with confirmed structural anomalies being candidate predictors. Predictors were assessed with multivariable logistic regression analysis. Performance of the models was assessed by the discrimination method, calibration with bootstrap resampling, decision curve analysis, and internal validation with repeated cross-validation.</p><p><strong>Results: </strong>Abnormal results from Down syndrome screening, non-invasive prenatal testing, copy number variation sequencing, the presence of foetal structural abnormalities confirmed by ultrasound, and high gravidity were found to be independently associated with foetal chromosomal abnormalities. The nomogram showed high discriminative power, as evidenced by the area under the curve in the receiver operating characteristic curve graph, which exceeded 0.90. Calibration plots demonstrated good agreement between predicted and observed risks. Results from decision curve analysis suggested significant clinical benefit over a broad range of threshold probabilities. Validation results confirmed the stability of the nomogram.</p><p><strong>Conclusions: </strong>The proposed nomogram incorporates genomic technologies into clinical and ultrasound indicators for the precise estimation of risk on an individual basis for foetal chromosomal abnormalities. This tool may support prenatal counselling and assist clinicians in optimising diagnostic decision-making in pregnancies with suspected foetal structural abnormalities.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04092"},"PeriodicalIF":4.3,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13067297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647128","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":"Epidemic trends and characteristics of notifiable infectious diseases in mainland China during the COVID-19: a nationwide surveillance study, 2020-2024.","authors":"Jingjuan Xu, Yang Xu, Zhenhua Dai, Zhenna Xu, Hui Cai, Zhiming Zhao, Wei Shang, Yanqi Dang","doi":"10.7189/jogh.16.04118","DOIUrl":"10.7189/jogh.16.04118","url":null,"abstract":"<p><strong>Background: </strong>The implementation of COVID-19 control and prevention measures has significantly influenced the incidence rates of multiple notifiable infectious diseases. We aimed to investigate the epidemiological trends of notifiable infectious diseases in mainland China from 2020 to 2024, a period spanning both stringent interventions and their subsequent relaxation.</p><p><strong>Methods: </strong>We systematically analysed surveillance data from the National Center for Disease Control and Prevention (2020-2024). We excluded COVID-19, monkeypox, and neonatal tetanus to ensure methodological consistency and comparability. We classified the diseases into Class A, B, and C notifiable infectious diseases and further grouped them by transmission routes: intestinal, respiratory, sexually transmitted and blood-borne, vector-borne/zoonotic, and others. We focused on incidence rates, mortality rates, seasonal patterns, and trends to inform future prevention and control strategies.</p><p><strong>Results: </strong>Between 2020 and 2024, mainland China recorded 38 notifiable infectious diseases (excluding COVID-19, monkeypox, and neonatal tetanus). The average incidence rate was 734.8945/100 000, showing an upward trend. Class A notifiable infectious diseases were extremely rare, Class B encompassed 25 types and showed a rising trend with minimal seasonal variation, and Class C included 11 types. Class C notifiable infectious diseases incidence remained relatively low from 2020 to 2022, but rose sharply in 2023 after the relaxation of COVID-19 restrictions, maintaining elevated levels in 2024, with pronounced winter/spring peaks observed, especially in 2023-2024. Respiratory infectious diseases (RIDs) exhibited the highest incidence, while blood-borne and sexually transmitted infectious diseases accounted for over 90.35% of the deaths.</p><p><strong>Conclusions: </strong>In mainland China, strict COVID-19 measures between 2020 and 2022 significantly reduced the incidence of RIDs. However, after COVID-19 management was downgraded and restrictions were relaxed in early 2023, these diseases resurged, demonstrating a 'suppression-rebound' effect.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04118"},"PeriodicalIF":4.3,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647166","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":"Geospatial analysis of COVID-19 vaccine access in Kenya: the interplay of travel time, perceived availability, and vaccine uptake.","authors":"Jiashuo Sun, Yanjia Cao, Karen Ann Grépin, Tianyu Li, Huanfa Chen, Qunshan Zhao, Primus Che Chi","doi":"10.7189/jogh.16.04143","DOIUrl":"10.7189/jogh.16.04143","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 vaccines have reduced severe illness and mortality, yet inequitable distribution delayed rollout in many low- and middle-income countries (LMICs), including Kenya, where only 36% of adults were fully vaccinated by October 2022. While sociodemographic and attitudinal determinants of uptake are well documented, role of geographic access remain underexplored at individual level. This study assessed population coverage by travel time to COVID-19 vaccination sites in Kenya and examined how travel time was associated with perceived vaccine availability and vaccine uptake.</p><p><strong>Methods: </strong>We conducted a secondary analysis of cross-sectional data from Round 3 (October-December 2021) of the COVID-19 Gendered Risks, Impact, and Response Survey. Vaccination site locations were obtained from the Kenyan Ministry of Health. Travel times from constituency population-weighted centroids to the nearest site were estimated using a cost-path distance algorithm in AccessMod. Two binary outcomes were analysed: perceived vaccine availability and vaccine uptake. Logistic regression with restricted cubic splines modelled associations with travel time in the full sample and a restricted sample excluding respondents who reported vaccines as 'unavailable' despite modelled travel time <15 minutes.</p><p><strong>Results: </strong>Nationally, 55% of the population lived within 30 minutes of a vaccination site, 69% within 60 minutes, and 21.6% more than 120 minutes away, with shorter travel times concentrated around major cities and longer times in eastern and northern Kenya. In the full analytic sample, travel time was not significantly associated with perceived availability or uptake. In the restricted sample, longer travel time showed strong, nonlinear associations with lower perceived availability and uptake.</p><p><strong>Conclusions: </strong>Geographic barriers, captured by modelled travel time, are important determinants of perceived vaccine availability and uptake in Kenya. Combining high-resolution geospatial modelling with individual-level data can guide expansion of vaccination services to improve vaccine equity and preparedness for future health emergencies in Kenya and similar LMICs.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04143"},"PeriodicalIF":4.3,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13067299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647097","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 exposure to air pollutants and latent tuberculosis infection prevalence in the elderly population: a population-based cross-sectional study from China.","authors":"Yaqi Zhao, Haitao Li, Yijun He, Xiaoyan Guo, Jin Jin, Taifeng Li, Shuping Wang, Xuesong Cao, Yunfeng Deng, Boxuan Feng, Zihan Li, Qian Wang, Shan Cao, Zhonghui Zhao, Xiaoguo Zhang, Aihua Zhu, Jianguo Liang, Hong Geng, Yong Sang, Jing Li, Li Wang, Xiankun Fan, Henan Xin, Jiang Du, Xuefang Cao, Zhongfa Zhang, Lei Gao","doi":"10.7189/jogh.16.04116","DOIUrl":"10.7189/jogh.16.04116","url":null,"abstract":"<p><strong>Background: </strong>Globally, research on the direct correlation between air pollutants and latent tuberculosis (TB) infection (LTBI) is still relatively scarce. We aimed to conduct a cross-sectional study of LTBI across regions with varying air quality to assess whether air pollution affects the burden of TB infection.</p><p><strong>Methods: </strong>We selected the cities of Liaocheng and Weihai in Shandong Province, China, as the research sites from 13-30 April 2025. We used the γ-interferon release assay to detect LTBI. We assessed the concentrations of particulate matter (PM)_2.5, PM₁₀, carbon monoxide (CO), nitrogen dioxide (NO₂), sulphur dioxide, and ozone across various time periods by integrating satellite remote sensing data with ground-based monitoring data. We used logistic regression and weighted pollution models to assess the relationship between air pollutants and the prevalence of LTBI.</p><p><strong>Results: </strong>A total of 2504 participants were included in the study, and 271 latent infected individuals were identified. The LTBI prevalence in Liaocheng city and Weihai city were 11.8% and 9.7%, respectively. During the three-year exposure window, for every 10 μg/m³ increase in PM_2.5, the odds of LTBI were 35.0% higher in Liaocheng city (odds ratio (OR) = 1.35; 95% confidence interval (CI) = 1.04-1.78) and 6.0% higher in Weihai city (OR = 1.06; 95% CI = 1.03-1.09). For every 10μg/m³ increase in NO₂ concentration, the odds of LTBI in Liaocheng city was 35% higher than in Weihai city (OR = 1.50 vs. OR = 1.15). The results of the weighted pollution model indicated that the comprehensive exposure index was positively correlated with the LTBI prevalence. The subgroup analysis results indicated that the association between exposure to PM_2.5, PM₁₀, CO, and NO₂ and the prevalence of LTBI was more pronounced in populations with a household per capita income < 5000 RMB, daily ventilation time < 0.5 hours, and the use of non-renewable energy for cooking (P < 0.05).</p><p><strong>Conclusions: </strong>The research indicates that prolonged exposure to air pollutants substantially elevates the odds of LTBI in Chinese cities, exhibiting regional disparities. This underscores the significance of managing air pollution to prevent and control TB.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04116"},"PeriodicalIF":4.3,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610497","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":"Disclosures of conflicts of interest from the editors of the Journal of Global Health - 2026.","authors":"Harry Campbell, Igor Rudan","doi":"10.7189/jogh.16.01001","DOIUrl":"10.7189/jogh.16.01001","url":null,"abstract":"","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"01001"},"PeriodicalIF":4.3,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595625","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":"Mortality impact of implementing maternal perinatal deaths surveillance and response quality-of-care improvement strategy for maternal and newborn care, northeast Namibia: a quasi-experimental study.","authors":"Gloria Mutimbwa Siseho, Thubelihle Mathole, Debra Jackson","doi":"10.7189/jogh.16.04050","DOIUrl":"10.7189/jogh.16.04050","url":null,"abstract":"<p><strong>Background: </strong>Northeast Namibia's neonatal mortality rate is higher than the national level. From June 2019, Northeast Namibia regional hospital implemented maternal perinatal death surveillance and response system as a part of quality improvement strategy to address increasing newborn deaths. Yet, no documentation exists pre-and-post implementation of the system. This study therefore aims to assess and describes the before-and-after mortality impact of its implementation.</p><p><strong>Methods: </strong>A pre-post intervention study design was conducted. Quantitative routine facility data was collected for women who gave birth and their babies from January 2019-December 2021. Data was gathered from maternity, neonatal and paediatric wards by the hospital health information system officer. The excel for Mac version 28.0.1.1 was used to calculate the proportions, rates/ratios, and descriptive statistics applied. Analysis was done for maternal, perinatal and newborn deaths, number and mode of deliveries, and caesarean section rates.</p><p><strong>Results: </strong>Institutional mortality statistically reduced except for stillbirths. Neonatal mortality rate fell from 11.4 to 7.7 per 1000 live births (P = 0.035), perinatal mortality rate fell from 30.0 to 24.3 per 1000 total births (P = 0.049), while maternal mortality rate statistically reduced from 339.6 to 111.6 per 100 000 live births (P = 0.015). The still birth rate reduced marginally from 18.4 to 17.3 per 1000 total births, but was not statistically significant (P = 0.361). Average percentage intrapartum stillbirths reduced from 46.6 to 33.3%. The proportion of neonatal deaths in the first week of life increased from 75.4 to 83.6%.</p><p><strong>Conclusions: </strong>High perinatal (stillbirths and early neonatal deaths) accounted for most deaths within the neonatal period. Thus, improving the quality-of-care around childbirth and immediate postnatal care when most neonates are highly vulnerable requires urgent health system programmatic and policy attention. Overall, implementation of maternal perinatal death surveillance and response strategy proved feasible in improving care and reducing maternal and newborn mortality.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04050"},"PeriodicalIF":4.3,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610441","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":"Exposure-response association between outdoor activity time and myopia risk in Chinese children and adolescents: a systematic review and meta-analysis.","authors":"Jin Dai, Jing Wang, Yong-Hong Bao, Yang Zhang","doi":"10.7189/jogh.16.04122","DOIUrl":"10.7189/jogh.16.04122","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of myopia among Chinese children and adolescents has increased sharply over recent decades, raising concern about modifiable environmental risk factors. Although outdoor activity is widely recognised as protective, the quantitative exposure-response relationship within the Chinese educational context remains incompletely defined.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies examining the association between daily outdoor activity time and myopia risk among Chinese youth were identified from major English and Chinese databases (Web of Science, PubMed, CNKI, and Wanfang) through October 2025. Random-effects meta-analysis was conducted to pool odds ratios (ORs). Prespecified subgroup and sensitivity analyses examined exposure thresholds, study design, and geographic latitude.</p><p><strong>Results: </strong>We included 31 studies comprising 380 215 participants. Greater outdoor activity was consistently associated with lower myopia risk (pooled OR = 0.75; 95% confidence interval (CI) = 0.71-0.80), although substantial heterogeneity was observed (I² = 94%). Compared with <1 hour per day, outdoor exposure of 1-2 hours (OR = 0.85; 95% CI = 0.79-0.92), 2-3 hours (OR = 0.86; 95% CI = 0.78-0.95), and > 3 hours (OR = 0.74; 95% CI = 0.63-0.87) was associated with reduced risk. When dichotomised at two hours, exposure >2 hours yielded an OR of 0.74 (95% CI = 0.69-0.80). Findings were directionally consistent across study designs and latitude strata.</p><p><strong>Conclusions: </strong>Greater outdoor activity time is associated with lower myopia risk among Chinese children and adolescents. An approximate daily exposure of around two hours appears to represent a pragmatic benchmark under current educational conditions.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04122"},"PeriodicalIF":4.3,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610502","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 caesarean section history with adverse pregnancy outcomes in placenta accreta spectrum: the mediating role of placenta previa.","authors":"Yongdan Ma, Darui Gao, Ruilin Guo, Xin Wen, Huixia Yang, Jingmei Ma","doi":"10.7189/jogh.16.04045","DOIUrl":"10.7189/jogh.16.04045","url":null,"abstract":"<p><strong>Background: </strong>Placenta accreta spectrum (PAS) is a leading cause of severe maternal and neonatal complications, yet its risk pathways remain incompletely understood. We aimed to evaluate the association between the number of prior caesarean sections (CS) and adverse maternal and neonatal outcomes in PAS, and to quantify the mediating role of placenta previa (PP) in this relationship.</p><p><strong>Methods: </strong>Based on a retrospective cohort of 231 patients with PAS (61 with no prior CS, 124 with one CS, and 46 with ≥2 CS), we performed multivariate logistic regression to assess associations between CS history and pregnancy outcomes and conducted mediation analysis to estimate the proportion of the CS effect mediated by PP.</p><p><strong>Results: </strong>Patients with ≥2 prior CS had significantly higher rates of second-trimester surgical abortion, percreta, and higher PAS severity scores. While PP, embolisation, blood transfusion, and prolonged hospitalisation were more common in women with any CS history, their frequencies did not increase proportionally with the number of CS. Multivariate analysis demonstrated that a higher number of prior CS was independently associated with increased risks of invasive PAS, massive intraoperative haemorrhage and transfusion, and preterm delivery. Mediation analysis showed that PP contributed to 8.62% of the association between CS history and invasive PAS, 16.93% for transfusion, 32.83% for preterm birth, and 11.40% for neonatal intensive care unit admission.</p><p><strong>Conclusions: </strong>A higher number of previous CS procedures in our sample was associated with higher risks of several adverse maternal outcomes in PAS. Neonatal outcomes, however, were not significantly influenced by the number of prior CS procedures and were more strongly affected by the gestational age at delivery. These relationships were partially mediated by PP, highlighting its important, but incomplete role in the pathway linking prior CS to PAS-related complications.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04045"},"PeriodicalIF":4.3,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595680","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}