Journal of Global Health最新文献

{"title":"Diagnostic accuracy of a molecular-based point-of-care test for rapid detection of respiratory syncytial virus in children admitted to high-dependency care in Nepal.","authors":"Arun Kumar Sharma, Hari Prasad Kattel, Ram Hari Chapagain, Rupesh Shrestha, Prakash Joshi, Naresh Bahadur Khadka, Sangita Sharma, Yvette Löwensteyn, Neele Rave, Mattheus Cornelis Viveen, Louis Bont","doi":"10.7189/jogh.16.04191","DOIUrl":"10.7189/jogh.16.04191","url":null,"abstract":"<p><strong>Background: </strong>Rapid respiratory syncytial virus (RSV) diagnostics are largely unavailable in low-resource settings. We compared the diagnostic accuracy of a molecular-based point-of-care test (POCT) with standard reverse transcription polymerase chain reaction (RT-PCR) in children admitted to high-dependency care.</p><p><strong>Methods: </strong>We analysed data from a larger study (RSV GOLD - ICU Network study) in two Nepali tertiary hospitals over two respiratory seasons. Children aged ≥4 days and <2 years admitted to high-dependency units were tested for RSV using POCT at admission. We calculated sensitivity, specificity, and predictive values of POCT against laboratory RT-PCR on stored samples as the gold standard.</p><p><strong>Results: </strong>We analysed 124 randomly selected stored samples, of whom 70 (56.5%) tested positive with POCT and 74 (59.7%) with RT-PCR. The median cycle threshold (CT) value was 29.1 (interquartile range = 25.1-33.4). All cases with false-negative POCT had low viral loads (CT value >31). The sensitivity (93.2%; 95% confidence interval (CI) = 86.0, 97.5), specificity (98.0%; 95% CI = 91.5, 99.9), positive predictive values (98.6%; 95% CI = 93.9, 99.9), and negative predictive values (90.7%; 95% CI = 81.1, 96.6) of POCT for RSV infection were all satisfactory.</p><p><strong>Conclusions: </strong>We conducted the first prospective study showing excellent accuracy of molecular RSV POCT in a poor resource setting. Affordable molecular-based POCT in resource-constrained settings can improve care of children with acute respiratory infections and strengthen surveillance for vaccine effectiveness during rollout of RSV interventions.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04191"},"PeriodicalIF":5.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841457","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":"Spatial distribution, clustering patterns, and economic burden of comorbidities among hospitalised pulmonary tuberculosis patients in Guangdong province: a spatial epidemiological study based on inpatient big data.","authors":"Lianrong Ji, Liang Chen, Yunlian Xue, Yue Wu, Huizhong Wu, Xue Jiang, Guihao Liu, Xiaowan Wang, Shasha Yuan, Lin Zhou","doi":"10.7189/jogh.16.04284","DOIUrl":"10.7189/jogh.16.04284","url":null,"abstract":"<p><strong>Background: </strong>Comorbidities may complicate the treatment of pulmonary tuberculosis and exacerbate both the clinical and economic burden. We aimed to examine comorbidity patterns, spatial clustering, and economic burden in hospitalised pulmonary tuberculosis (PTB) patients in Guangdong Province, supporting targeted prevention strategies.</p><p><strong>Methods: </strong>Based on the Hospital Discharge Records Database of Guangdong Province from 2016 to 2024, we collected data on hospitalised PTB patients to analyse the characteristics and temporal trends of comorbidity spectra. We used Global Moran's I and local indicators of spatial association analyses to examine the spatial clustering patterns of major comorbidity pairs. Generalised linear models evaluated the impact of comorbidity count and spatial clustering patterns on economic burden among hospitalised PTB patients.</p><p><strong>Results: </strong>A total of 646,114 hospitalised PTB patients were included from 2016 to 2024, of whom 66.42% had at least one comorbidity. Hypertension (HTN), diabetes mellitus (DM), and chronic obstructive pulmonary disease (COPD) were the top three comorbidities among hospitalised PTB patients. Spatial analysis indicated that high-high clusters of PTB-HTN were mainly concentrated in the central Pearl River Delta; high-high clusters of PTB-DM in eastern Guangdong and low-low clusters in western Guangdong. High-high clusters of PTB-COPD were primarily located in eastern and northern Guangdong, while low-low clusters remained relatively stable in several cities of the Pearl River Delta region. Among hospitalised PTB patients, the number of comorbidities was significantly positively associated with both direct and indirect economic burden (P < 0.001), with economic burden progressively increasing as the number of comorbidities increased, and the impact of spatial clustering patterns on economic burden exhibited heterogeneity across different comorbidity types.</p><p><strong>Conclusions: </strong>The burden of comorbidities among hospitalised PTB patients in Guangdong Province is substantial, with significant spatial clustering characteristics closely linked to direct and indirect economic burden. It is recommended to incorporate regional comorbidity epidemiological characteristics into PTB comorbidity management and resource allocation optimisation. In addition, both direct medical costs and productivity losses should be considered in prevention and control strategies to reduce the socioeconomic burden associated with PTB.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04284"},"PeriodicalIF":5.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841759","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":"Delivering and beyond: insights about the ExpandTPT community advisory board experience in Brazil.","authors":"Ezio Távora Dos Santos Filho, Anete Trajman","doi":"10.7189/jogh.16.03026","DOIUrl":"10.7189/jogh.16.03026","url":null,"abstract":"<p><p>Expansion of tuberculosis (TB) preventive treatment (TPT) in contacts has been a challenge worldwide. Brazil is no exception, despite the publication of TB treatment guidelines as early as 1980. The ExpandTPT operational research programme was conducted from 2023 to 2025 in two phases across eight Brazilian high TB-burden cities to scale up TPT among contacts as per national guidelines. The programme was a partnership among the Brazilian TB Research Network (REDE-TB), the national TB programme, and civil society, consisting mainly of capacity building and local service reorganisation based on needs assessment at the municipal and clinic level. During the ExpandTPT implementation, TPT prescriptions increased by 70% in the five participating cities, which is a 30% increase in overall national TPT prescriptions from 2023 to 2024. In this viewpoint, we describe the working method of the ExpandTPT community advisory board, its key elements, role in the programme, and the authors' insights into its challenges and contribution to community engagement in TB research. Lessons learned from this experience may contribute to other operational research projects in public health.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"03026"},"PeriodicalIF":5.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841452","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":"From delay to action: rethinking Chagas disease diagnosis with rapid testing in Colombia.","authors":"Mario Javier Olivera","doi":"10.7189/jogh.16.03025","DOIUrl":"10.7189/jogh.16.03025","url":null,"abstract":"<p><p>Chagas disease remains one of the most underdiagnosed neglected tropical diseases in Latin America despite the availability of accurate diagnostic tools. In Colombia, the number of diagnostic tests reported between 2017 and 2023 corresponded to fewer than 4% of the estimated population at risk, reflecting persistent diagnostic inequities associated with centralised laboratory-based algorithms that are poorly adapted to rural and underserved settings. National administrative data revealed substantial geographic disparities in testing intensity, particularly in departments with the largest populations at risk. Evidence from Colombian implementation experiences and recent economic evaluations indicates that sequential rapid diagnostic test (RDT)-based strategies can substantially reduce diagnostic costs while maintaining high diagnostic accuracy and operational feasibility. Expanding access to timely diagnosis may also contribute to preventing congenital transmission and reducing the long-term burden of chronic Chagas cardiomyopathy. Integrating RDTs into a phased national diagnostic strategy represents a feasible, evidence-based opportunity to reduce diagnostic inequities and strengthen Chagas disease control in Colombia.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"03025"},"PeriodicalIF":5.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between reproductive history and chronic low back pain in the US women: a cross-sectional study.","authors":"Yihui Zhang, Lixin Zhao, Dexin Hu, Xueru Shen, Xiaoxue Dong, Yuheng Lu","doi":"10.7189/jogh.16.04238","DOIUrl":"10.7189/jogh.16.04238","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is more prevalent in women, particularly peripartum, suggesting a link between reproductive history and chronic LBP (CLBP). Nationally representative evidence on this association is limited.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using NHANES 1999-2004 and 2009-2010 data. Weighted multivariable logistic regression examined associations between reproductive factors and CLBP. Restricted cubic splines assessed dose-response relationships. Subgroup and sensitivity analyses ensured robustness; multiple imputations addressed missing data.</p><p><strong>Results: </strong>Women with CLBP had a significantly younger age at first live birth (22.01 vs. 23.05 years, P < 0.001) and elevated gravidity and parity. In fully adjusted models, both gravidity (odds ratio (OR) = 1.08; 95% confidence interval (CI) = 1.05-1.10) and parity (OR = 1.07; 95% CI = 1.04-1.11) were positively associated with CLBP, while older age at first (OR = 0.96; 95% CI = 0.94-0.97) and last live birth (OR = 0.97; 95% CI = 0.95-0.98) were associated with lower odds of CLBP. The highest odds were observed in women with a history of pregnancy but no live birth (OR = 2.33; 95% CI = 1.71-3.16). Birth at age ≤16 years was associated with 66% higher odds of CLBP (OR = 1.66; 95% CI = 1.26-2.18).</p><p><strong>Conclusions: </strong>First live birth, higher gravidity and parity, earlier last parity, and pregnancy without live birth are independently associated with a higher CLBP prevalence in women. Integrating reproductive history into pain-related clinical assessment and preventive care may be beneficial for targeted CLBP screening and prevention.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04238"},"PeriodicalIF":5.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842014","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-dependent health risks of smoking: greater harm associated with initiation before alveolar maturation (age 24).","authors":"Ziyi Liu, Zhiqi Zhao, Yutong Xiao, Ruoyan Xiong, Huiru Zheng, Yifan Liu, Qixuan Huang, Rui Zhao, Junxia Yan, Yan Chen, Huihui Zeng","doi":"10.7189/jogh.16.04215","DOIUrl":"10.7189/jogh.16.04215","url":null,"abstract":"<p><strong>Background: </strong>Smoking during the alveolar developmental stage (ADS) (≤24 years) may increase cardiopulmonary disease risk beyond the effects of cumulative exposure, but these interactions remain unclear. We aimed to determine whether smoking initiation during ADS modifies the associations between cumulative smoking exposure and cardiopulmonary disease, multimorbidity, and all-cause mortality.</p><p><strong>Methods: </strong>We analysed 15,077 participants from the US National Health and Nutrition Examination Survey and two UK Biobank cohorts: 121,852 individuals in the disease cohort and 136,528 in the mortality cohort. Multivariable logistic regression and Cox proportional hazards models examined associations of smoking initiation timing (≤24 vs. >24 years), cumulative exposure (>20 vs. ≤20 pack-years), and their interaction with chronic obstructive pulmonary disease (COPD), cardiovascular disease, all-cause mortality, and multimorbidity. We assessed both multiplicative and additive interactions. We also evaluated an ordinal exposure score combining initiation timing and pack-years. Zero-inflated negative binomial regression quantified comorbidity burden, and stratified analyses assessed the effects of smoking cessation duration.</p><p><strong>Results: </strong>Smoking initiation in the ADS amplified smoking-related disease risk. For COPD, ADS initiators with high cumulative exposure had a greater risk (hazard ratio (HR) = 3.45; 95% confidence interval (CI) = 3.29, 3.62) than post-ADS initiators with high exposure (HR = 2.33; 95% CI = 1.91, 2.83; P for multiplicative interaction <0.001). Additive interaction was also observed, with a relative excess risk due to interaction of 0.43 (95% CI = 0.08, 0.79) and an attributable proportion of 0.16 (95% CI = 0.02, 0.29). Each one-point increase in the exposure score was associated with higher COPD risk (HR = 2.29; 95% CI = 2.20, 2.38) and mortality (HR = 1.39; 95% CI = 1.36, 1.43), with 82.1% of COPD burden attributable to score ≥1 exposure. High exposure was associated with a larger reduction in comorbidity-free probability among ADS initiators (OR = 0.55) than post-ADS initiators (OR = 0.65) (P for interaction <0.001). Smoking cessation reduced COPD and mortality risks in both groups, with greater relative reductions among ADS initiators.</p><p><strong>Conclusions: </strong>Smoking initiation during ADS, combined with greater cumulative exposure, is associated with increased risks of COPD, cardiovascular morbidity, multimorbidity, and all-cause mortality. Incorporating developmental timing may improve smoking-related risk stratification.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04215"},"PeriodicalIF":5.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841992","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 of multi-system health status and its longitudinal changes with cardiovascular disease risk: insights from a secondary analysis of four multinational cohort studies.","authors":"Yijing Xin, Xifeng Qian, Yanmin Yang","doi":"10.7189/jogh.16.04277","DOIUrl":"10.7189/jogh.16.04277","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular diseases (CVDs) are influenced by multiple interrelated health domains, including cognitive, psychological, anthropometric, and physical functioning. However, little is known about whether overall health status across these domains and their concurrent changes over time are associated with the subsequent development of CVDs. We examined the associations of baseline multi-system health status, its longitudinal trajectories, and cumulative burden with incident CVDs.</p><p><strong>Methods: </strong>We retrieved data on 32,661 adults aged ≥45 years from four population-based studies: the China Health and Retirement Longitudinal Study, the Health and Retirement Study, the English Longitudinal Study of Ageing, and the Survey of Health, Ageing and Retirement in Europe. We followed up the participants between 2006 and 2018, depending on cohort. We assessed multi-system health across four domains (cognitive function, depressive symptoms, body mass index, and grip strength), used group-based multi-trajectory modelling to identify its distinct longitudinal patterns, and applied multivariable logistic regression to evaluate its associations with incident CVDs.</p><p><strong>Results: </strong>Greater baseline multi-system impairment was associated with higher odds of incident CVDs across cohorts, particularly among individuals with multiple unhealthy systems. We identified three distinct multi-system health trajectories: favourable maintenance, intermediate decline, and accelerated decline. Participants assigned to trajectories characterised by accelerated multi-system decline generally showed higher risk of incident CVDs than those in the other two trajectories, although the magnitude and statistical significance of associations varied across cohorts. A higher cumulative burden of unhealthy systems was associated with progressively greater odds of incident CVDs, indicating a dose-response pattern.</p><p><strong>Conclusions: </strong>In our study, poorer baseline multi-system health, unfavourable longitudinal trajectories, and greater cumulative impairment were associated with higher odds of incident CVDs. These findings highlight the potential value of monitoring multiple health domains simultaneously and longitudinally to identify individuals at elevated cardiovascular risk and to support integrated healthy ageing strategies.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04277"},"PeriodicalIF":5.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841692","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":"Seasonal dynamics and burden of respiratory syncytial virus, influenza, and COVID-19 in Brazil: a national surveillance study (2019-2023).","authors":"Guilherme Silva Julian, Julia Regazzini Spinardi, Ana Paula Flora, Srinivas Rao Valluri, Florence Lefebvre d'Hellencourt, Caihua Liang, Elizabeth Begier, Thaís Zamboni Berra, Lucas Vieira Cortez, Renato Vitorasso, Moe Hein Kyaw","doi":"10.7189/jogh.16.04251","DOIUrl":"10.7189/jogh.16.04251","url":null,"abstract":"<p><strong>Background: </strong>The burden and seasonal patterns of respiratory syncytial virus (RSV), influenza, and COVID-19 remain poorly characterised in Brazil and other Latin American countries. Understanding their epidemiological patterns is essential to inform public health interventions and preventive strategies. We aimed to assess respiratory virus seasonality using national surveillance data to guide vaccination timing and strengthen preparedness strategies in Brazil.</p><p><strong>Methods: </strong>We conducted a retrospective, observational, descriptive population-based study using national surveillance data collected through the SIVEP system between 2019 and 2023. We analysed confirmed cases, hospitalisations, and deaths attributed to RSV, influenza, and COVID-19. We performed time-series decomposition and seasonal trend analysis using the multiple seasonal-trend decomposition via locally estimated scatterplot smoothing method. We calculated monthly mean values for each aetiology component to assess their seasonal burden.</p><p><strong>Results: </strong>There were 69,389 RSV, 45,881 influenza, and 2,299,712 COVID-19 cases among the laboratory-confirmed severe acute respiratory infection (SARI) cases reported in SIVEP. Each year, more than 90% of RSV diagnoses were reported in children aged 0-10 years, while influenza and COVID-19 were more common among older adults. The proportion of deaths in children related to RSV increased from 19.2% in 2020 to 62.0% in 2023. Seasonal peaks occurred from March to June for RSV, influenza cases peaked in January, while COVID-19 showed less consistent seasonality. Geographic variation was observed, with higher case concentrations in the Southeast and South regions of Brazil.</p><p><strong>Conclusions: </strong>The burden of respiratory viruses among SARI cases reported in the national surveillance system in Brazil differed by pathogen, age group, region, and season, and may be influenced by variations in testing strategies. Strengthening diagnostic capacity and surveillance is critical, particularly for adult RSV cases, which are likely underreported due to limited testing and reduced diagnostic sensitivity. Seasonal vaccination programmes, such as those for influenza, remain essential and may be further enhanced by integrating new preventive measures, such as RSV vaccination for older adults and maternal immunisation to protect infants.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04251"},"PeriodicalIF":5.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841764","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":"Delayed treatment initiation is associated with worse survival in screening-detected patients with upper gastrointestinal cancer in rural China: a 10-year cohort study.","authors":"Ruyue Liu, Liangliang Wu, Chengxu Long, Chao Zheng, Xiaoyu Fang, Nan Zhang, Qiang Sun","doi":"10.7189/jogh.16.04293","DOIUrl":"10.7189/jogh.16.04293","url":null,"abstract":"<p><strong>Background: </strong>Time to treatment initiation (TTI) following cancer detection is a critical component of effective cancer control. In low-resource and rural settings, delays in TTI often reflect health system constraints and may undermine the survival benefits of screening programmes. However, evidence on the association between TTI and long-term survival among screening-positive patients with upper gastrointestinal cancer (UGC) in China is unknown.</p><p><strong>Methods: </strong>This retrospective cohort study included 265 screening-positive UGC patients identified from a population-based screening programme conducted between 2014 and 2015 in rural China (total screened population = 13,255). Time to treatment initiation was defined as the interval between confirmed diagnosis and initiation of treatment. Patients were categorised into ≤30 days, >30 days, and untreated groups. The primary outcome was 10-year overall survival (OS). Cox proportional hazards models were used to estimate hazard ratios (HRs), adjusting for demographic, socioeconomic, and clinical variables.</p><p><strong>Results: </strong>The median TTI was 55 days. Patients with TTI≤30 days had significantly higher 10-year OS (90.39%) compared with those with TTI>30 days and untreated patients. After adjustment, delayed treatment (>30 days) was associated with worse OS (HR = 2.50; 95% CI = 1.29-4.82) and cancer-specific survival (HR = 2.41; 95% CI = 1.21-4.79). Factors associated with delayed treatment included male, non-normal BMI, and earlier-stage lesions, indicating socioeconomic and structural barriers to timely treatment.</p><p><strong>Conclusions: </strong>Delays in treatment initiation represent a critical health system bottleneck that significantly compromises long-term survival among screening-detected UGC patients. A TTI threshold of 30 days may serve as a pragmatic quality-of-care indicator. Strengthening linkage-to-care pathways and addressing socioeconomic barriers are essential to maximise the effectiveness of cancer screening programmes in low-resource settings.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04293"},"PeriodicalIF":5.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841206","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":"Exercise intervention improves fertility outcomes in females and males: an umbrella review of meta-analyses.","authors":"Lai Kwan Lam, Bekalu Kassie Alemu, Margie H Davenport, Chi Chiu Wang, Yiu Leung Chan, Yao Wang","doi":"10.7189/jogh-16-04282","DOIUrl":"10.7189/jogh-16-04282","url":null,"abstract":"<p><strong>Background: </strong>Infertility is a major global health burden, yet scalable lifestyle strategies to improve reproductive outcomes remain limited. Exercise is low cost and biologically plausible, but evidence on its association with fertility-related outcomes is dispersed across multiple meta-analyses. We therefore conducted an umbrella review of meta-analyses of randomised controlled trials evaluating exercise and fertility-related outcomes in females and males.</p><p><strong>Methods: </strong>Six databases (PubMed, Cochrane Library, Web of Science, Scopus, EBSCOhost, and Google Scholar) were searched from database inception to 24 November 2025. Eligible studies were systematic reviews with meta-analyses of randomised controlled trials. Overlap among reviews was managed using citation matrices. Methodological quality, risk of bias, and certainty of evidence were assessed using AMSTAR 2, ROBIS, and GRADE, respectively.</p><p><strong>Results: </strong>Thirteen meta-analyses were included, covering 24,470 females and 8068 males. In females, exercise showed positive effects in reproductive hormonal profiles, including sex hormone-binding globulin and anti-Müllerian hormone. It also associated with higher ovulation rate, pregnancy rate and clinical pregnancy rate. In males, exercise was linked to amelioration in sperm quality, regarding concentration, morphology, count, and semen volume. Moreover, exercise in male participants was accompanied by higher pregnancy rate in their female partners.</p><p><strong>Conclusions: </strong>Exercise is associated with improved fertility and reproductive health outcomes in both females and males, supporting its potential role as an adjunctive, low-cost, noninvasive component of fertility management. However, the certainty of evidence ranged from high to very low across outcomes, with most evidence rated as low or very low certainty. Heterogeneity across populations and exercise intervention components also limited confidence in these findings. Further high-quality trials are needed to clarify optimal exercise prescriptions and strengthen the certainty of evidence.</p><p><strong>Registration: </strong>PROSPERO: CRD42025638675.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"16 ","pages":"04282"},"PeriodicalIF":5.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841379","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}