Public Health最新文献

{"title":"Regional inequities in colon cancer surgical care: Patterns of treatment delay across U.S. facilities","authors":"Rushabh H. Doshi ,&nbsp;Bhav Jain ,&nbsp;Rachana Tanksali ,&nbsp;Tenzin Dhondup ,&nbsp;Shamik Bhat ,&nbsp;Nina N. Sanford ,&nbsp;Miranda B. Lam ,&nbsp;Edward Christopher Dee","doi":"10.1016/j.puhe.2025.106091","DOIUrl":"10.1016/j.puhe.2025.106091","url":null,"abstract":"<div><h3>Objectives</h3><div>Timely surgical resection is critical for optimal survival in colon cancer, yet delays remain common. Persistent inequities in access to surgery may contribute to these delays, but how these disparities vary across U.S. regions and over time is not well understood. We aimed to assess regional variation in surgical treatment delays (&gt;8 weeks from diagnosis) for Stage I–III colon cancer in the United States and determine how racial, insurance, and geographic disparities manifest and evolve across regions from 2004 to 2021.</div></div><div><h3>Study design</h3><div>Retrospective cohort study.</div></div><div><h3>Methods</h3><div>We analyzed patients treated at Commission on Cancer-accredited facilities across the nine U.S. Census Divisions using data from the National Cancer Database (2004–2021). Adults diagnosed with Stage I-III colon cancer who underwent surgical resection as first-course treatment and had complete demographic, clinical, and facility data available were included. The primary outcome was surgical delay &gt;8 weeks from diagnosis to surgery. Multivariable logistic regression models were used to assess factors associated with surgical delay and interactions to evaluate variation by U.S. Census Division and over time. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated, with adjusted predicted probabilities for disparities by region and year.</div></div><div><h3>Results</h3><div>Of 664,312 patients, 48,579 (7.3 %) had surgical delays &gt;8 weeks, increasing from 4.5 % in 2004 to 12.2 % in 2021 (aOR 2.77; 95 % CI, 2.61–2.94). Compared with New England, delays were less common in East South Central (aOR 0.60) and West North Central (aOR 0.67) regions. Higher odds occurred among Black (aOR 1.34), American Indian/Alaska Native/Aleut/Eskimo (aOR 1.24), Asian American (aOR 1.06), Medicaid (aOR 1.19), and Other/Unknown/Government-insured patients (aOR 1.16). Disparities varied by region (p &lt; 0.001), with the largest Black–White gap in West North Central (9.0 % vs 4.9 %) and the smallest in East South Central (5.2 % vs 4.6 %). The Pacific had the steepest delay increase over time.</div></div><div><h3>Conclusions</h3><div>From 2004 to 2021, colon cancer surgery delays rose nationwide, with substantial regional variation in racial, insurance, and geographic disparities. Targeted strategies are needed to address systemic and regional barriers.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106091"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational disparities in mortality mediated by modifiable behavioral factors: Findings from the Japan Multi-Institutional Collaborative Cohort Study","authors":"Masayoshi Zaitsu ,&nbsp;Kazuhiko Watanabe ,&nbsp;Mako Nagayoshi ,&nbsp;Hiroaki Ikezaki ,&nbsp;Takuma Furukawa ,&nbsp;Yasufumi Kato ,&nbsp;Yuriko N. Koyanagi ,&nbsp;Nobuaki Michihata ,&nbsp;Chihaya Koriyama ,&nbsp;Sadao Suzuki ,&nbsp;Daisuke Matsui ,&nbsp;Kiyonori Kuriki ,&nbsp;Naoyuki Takashima ,&nbsp;Masashi Ishizu ,&nbsp;Itsuki Kageyama ,&nbsp;Takashi Tamura ,&nbsp;Kenji Wakai ,&nbsp;Keitaro Matsuo ,&nbsp;for the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study","doi":"10.1016/j.puhe.2026.106142","DOIUrl":"10.1016/j.puhe.2026.106142","url":null,"abstract":"<div><h3>Objectives</h3><div>The extent to which modifiable behavioral factors mediate educational disparities in mortality nationally remains unelucidated. Therefore, we examined whether educational level affects overall and cause-specific mortalities in Japan.</div></div><div><h3>Study design</h3><div>A multi-centered cohort study.</div></div><div><h3>Methods</h3><div>This national, multicenter study included 58,831 participants (57 % female) from the Japan Multi-Institutional Collaborative Cohort Study (mean age: 54 years). Baseline data were collected between 2004 and 2014, with a maximum 12-year follow-up period. Outcomes included mortalities from cancer, cardiovascular disease, and other causes. Participants were categorized by educational level: high school or lower, junior college, and university or higher. The hazard ratio (HR) for mortality was estimated using Cox regression, with the university or higher cohort as the reference. Causal mediation analysis was conducted to assess the mediated effect of modifiable behaviors on education-related mortality risk.</div></div><div><h3>Results</h3><div>Among male participants, the high school or lower cohort exhibited a higher overall mortality rate (adjusted HR: 1.23; 95 % confidence interval = 1.08–1.41) and elevated risks for cancer-related and other causes of death (HRs: 1.18 and 1.75, respectively). This disparity was most pronounced in men aged 35–59 years. Smoking, excessive alcohol consumption, and inadequate leisure-time physical activity accounted for 11 %, 9 %, and 12 % of the educational mortality discrepancy, respectively. Female participants did not exhibit a significant educational mortality disparity.</div></div><div><h3>Conclusions</h3><div>Educational disparities in mortality persist among the younger male population in Japan, with modifiable behavioral risks identified as key mediators.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106142"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of the Israeli sugar sweetened beverage tax implementation and repeal on beverage price and purchases","authors":"Naomi Fliss Isakov ,&nbsp;Yitzhak Ben Menachem ,&nbsp;Michal Yackobovitch Gavan ,&nbsp;Caroline Parker ,&nbsp;Adi Levy ,&nbsp;Ronit Endevelt ,&nbsp;Laura Sol Grinshpan ,&nbsp;Moran Blaychfeld Magnazi","doi":"10.1016/j.puhe.2025.106118","DOIUrl":"10.1016/j.puhe.2025.106118","url":null,"abstract":"<div><h3>Objectives</h3><div>Israel's sugar-sweetened beverage (SSB) tax, combining ad-valorem and tiered components, was implemented in January 2022 and repealed after one year. We evaluated the effect of tax implementation and repeal, on beverage price and sales.</div></div><div><h3>Study design</h3><div>A longitudinal analysis using national sales data.</div></div><div><h3>Methods</h3><div>Beverages were categorized by sugar content and volume into 6 beverage groups: Large non-taxed, large reduced-tax, large full-tax, small non-taxed, small reduced-tax and small full-taxed beverages. Changes in price and sales across three periods (pre-tax, tax and post-tax) were assessed between groups using Welch ANOVA test (Games-Howell post-hoc analysis, Bonferoni adjustment), and the linear mixed-effects model with restricted maximum likelihood estimation.</div></div><div><h3>Results</h3><div>With implementation of the tax, the prices of all beverage categories increased by 3.03–38.89 % and remained high after tax repeal by 6.8–13.63 %, compared to pre-tax levels. Negative correlations between the change in beverage price and sales were observed during the tax (r = −0.54, p &lt; 0.001) and post-tax (r = −0.29, p &lt; 0.001) periods. A price increase of ≥17 % was associated with significant sales declines during the year of the tax. Sales of large reduced-tax beverages declined by −30.7 % and those of large full-taxed beverages by −24.1 % following tax implementation. After tax repeal, sales levels gradually increased compared to those during the tax period, but remained below pre-tax levels by −24 % and −13 %, respectively. Small-taxed beverages showed no significant change in sales between study periods<strong>.</strong></div></div><div><h3>Conclusions</h3><div>The Israeli SSB tax implementation and repeal, provides critical insights regarding the significant effectiveness of this public health policy. The tax led to a significant increase in the price of all beverage categories, and reduced sales of large-taxed beverages, which contribute the vast majority of national beverage sales. Tax repeal was followed by a gradual rise in sales of taxed beverages, having a potentially negative effect on public health. An effective policy should consider higher tax rates for smaller packaged beverages. Future studies should address longer follow-up and assessment of individual purchase and consumption practices.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106118"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145929273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trust at risk: Why public health must lead the use of AI in pandemic preparedness","authors":"James O'Connell ,&nbsp;Keith Ian Quintyne","doi":"10.1016/j.puhe.2026.106152","DOIUrl":"10.1016/j.puhe.2026.106152","url":null,"abstract":"<div><div>Artificial intelligence (AI) is poised to play a transformative role in pandemic preparedness, with the potential to enhance surveillance, risk assessment, and outbreak response. Indeed, AI is already embedded in several areas of public health practice, including infectious disease modelling, syndromic surveillance, and health system demand forecasting, where it has demonstrated advantages in speed, scale, and scenario analysis. However, the successful integration of AI into public health practice depends not only on technological advancement but also on maintaining the public trust upon which effective pandemic response relies. This article examines the ethical, governance, and trust dimensions of AI integration in pandemic preparedness, arguing that public health leadership is essential to ensure its safe and equitable use. Without such leadership, there is a risk that AI will be driven by commercial rather than public interests, undermining trust and legitimacy in public health actions. It calls for a robust governance framework, applied research to determine where AI can add value, and leadership in shaping legal and digital infrastructures that support safe AI use. By proactively guiding AI's integration, public health can ensure this emerging technology strengthens, rather than compromises, the collective and ethical foundations of pandemic preparedness.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106152"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Khat chewing and its association with oral/esophageal squamous cell carcinoma and oral white lesions: A systematic review and meta-analysis","authors":"Abdiwahab M. Ali ,&nbsp;Nina Huang ,&nbsp;Jason J. Liu","doi":"10.1016/j.puhe.2026.106177","DOIUrl":"10.1016/j.puhe.2026.106177","url":null,"abstract":"<div><h3>Objectives</h3><div>To systematically evaluate the association of khat (<em>Catha edulis</em>) chewing with the risk of oral and esophageal squamous cell carcinoma (SCC) and oral white lesions in epidemiological studies.</div></div><div><h3>Study design</h3><div>Systematic review and random-effects meta-analysis.</div></div><div><h3>Methods</h3><div>We searched PubMed/MEDLINE, Web of Science, and Google Scholar for studies published between 2000 and 2025. We included eligible epidemiological studies assessing khat chewing in relation to oral or esophageal SCC and oral white lesions. Methodological quality was critically appraised, and pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were estimated using random-effects models.</div></div><div><h3>Results</h3><div>Of 143 identified articles, 11 studies were included. For oral/esophageal SCC, the pooled analysis showed no significant association (odds ratio (OR) = 1.18, 95 % confidence interval (CI): 0.40–3.48, 5 studies) with high heterogeneity (I² = 79.4 %). For oral white lesions, a significant positive association was found (OR = 17.89, 95 % CI: 4.99–64.21, 6 studies), also with high heterogeneity (I² = 89.0 %). A sensitivity analysis for the SCC outcome resolved the heterogeneity. The risk of bias across studies was moderate to high, primarily due to selection bias and confounding.</div></div><div><h3>Conclusions</h3><div>Khat chewing is associated with oral white lesions, supporting targeted oral examinations in khat-endemic regions to identify mucosal changes for further clinical assessment and potential biopsy. However, the evidence for oral and esophageal SCC is inconclusive. High-quality prospective cohort studies are needed to confirm these findings and inform public health policies.</div></div><div><h3>Registration</h3><div>PROSPERO 2025 CRD420251072476 (<span><span>https://www.crd.york.ac.uk/PROSPERO/view/CRD420251072476</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106177"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive accuracy of the 8- and 12-item versions of the DASS-21 in measuring depression, anxiety and stress in Brazilian university students","authors":"Luiz Menezes-Júnior ,&nbsp;Waléria de Paula ,&nbsp;Bruna Carolina Rafael Barbosa ,&nbsp;Carolina Martins dos Santos Chagas ,&nbsp;Clareci Silva Cardoso ,&nbsp;Eulilian Dias de Freitas ,&nbsp;Fernanda de Carvalho Vidigal ,&nbsp;Helian Nunes de Oliveira ,&nbsp;Luciana Neri Nobre ,&nbsp;Luciana Saraiva da Silva ,&nbsp;Adriana Lúcia Meireles","doi":"10.1016/j.puhe.2026.106150","DOIUrl":"10.1016/j.puhe.2026.106150","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the predictive value of the DASS-8 and DASS-12 scales, derived from the full DASS-21, in assessing mental health among Brazilian university students, highlighting the innovation of validating ultra-brief instruments specifically designed to maintain high psychometric performance while enabling rapid, large-scale mental health screening in resource-constrained academic settings.</div></div><div><h3>Study design</h3><div>Multicenter cross-sectional study.</div></div><div><h3>Methods</h3><div>Study carried out with students at eight public universities in Brazil. Data was collected through a self-completed online questionnaire. Symptoms of depression, anxiety, and stress were assessed using the DASS-21. The concurrent validity of the reduced versions of the DASS-12 and DASS-8 was determined using ROC curve analyses and sensitivity, specificity, and accuracy tests, using the DASS-21 as a reference standard. Regression models evaluated the invariance between sociodemographic and health factors with mental health outcomes in the DASS-21; DASS-12 and DASS-8.</div></div><div><h3>Results</h3><div>A total of 8650 study participants were evaluated, the majority were female (65.7 %) and aged between 18 and 22 (54.2 %). The DASS-21; 12 and 8 had excellent internal consistency (α and ω ≥ 0.91). ROC curve analysis yielded AUC values indicating strong predictive validity, with the DASS-12 reported 0.93, 0.91, and 0.90, while the DASS-8 showed AUCs of 0.92, 0.90, and 0.89 for depression, anxiety, and stress, respectively. Sensitivity ranged from 94 % to 97 % for depression, 84 %–94 % for anxiety, and 87 %–96 % for stress, with high specificity and accuracy across all subscales (&gt;90 %). Factors associated with symptoms across the three subscales by DASS-21 were similar to those identified by DASS-12 and DASS-8.</div></div><div><h3>Conclusion</h3><div>The DASS-8 and DASS-12 scales showed reliability and effectiveness in screening for symptoms of depression, anxiety, and stress in Brazilian university students.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106150"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of ban and ordinances against indoor smoking on the proportion of smoke-free establishments in restaurants, izakaya, and bars in Japan: Interrupted time-series analysis of restaurant database","authors":"Isao Muraki ,&nbsp;Aoi Kataoka ,&nbsp;Yuri Ito ,&nbsp;Kota Katanoda ,&nbsp;Masakazu Nakamura","doi":"10.1016/j.puhe.2026.106146","DOIUrl":"10.1016/j.puhe.2026.106146","url":null,"abstract":"<div><h3>Objectives</h3><div>To protect workers and individuals from second-hand smoke exposure, Japan's national indoor smoking ban was enforced on April 1, 2020. However, certain exemptions were made for eating and drinking establishments. Local ordinances restricted these exemptions to increase their effectiveness. We aimed to evaluate the 2-year impact of the national ban and local ordinances on indoor smoking policies in eating and drinking establishments over a 2-year period.</div></div><div><h3>Study design</h3><div>Panel data analysis.</div></div><div><h3>Methods</h3><div>From a commercial database of eating and drinking establishments, we used area-level summary data of 320,693 establishments for August 2016 and individual establishment data extracted biannually between January 2020 and December 2022 (n = 329,322 to 403,133). We calculated the category-specific and weighted proportions of smoke-free establishments. We analysed the short-term and trend changes using an interrupted time-series analysis.</div></div><div><h3>Results</h3><div>The proportion of smoke-free establishments increased after the national ban (+5.7 % points). Local ordinances restricting the exemption for the establishments with non-family employees enhanced the impact of the national ban (+7.8 % points). In December 2022, the proportions of smoke-free establishments were 68.3 % in restaurants, 70.2 % in cafés, 32.8 % in izakaya, and 25.0 % in bars.</div></div><div><h3>Conclusions</h3><div>The indoor smoking ban has promoted indoor smoke-free policies in eating and drinking establishments in Japan. However, many establishments, nearly two-thirds of izakaya and bars, remain smoking-allowed, probably owing to exemptions and non-compliance. To effectively reduce second-hand smoke exposure in eating and drinking establishments, it is necessary to minimise exemptions by revising laws or enforcing additional ordinances and promoting compliance with these legislations.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106146"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent non-suicidal self-injury, contextual and area-level inequalities: Insights from ten years of emergency department visits in northern Italy","authors":"Alberto Borraccino ,&nbsp;Roberta Onorati ,&nbsp;Alessandro Migliardi ,&nbsp;Carlo Mamo","doi":"10.1016/j.puhe.2026.106172","DOIUrl":"10.1016/j.puhe.2026.106172","url":null,"abstract":"<div><h3>Objective</h3><div>Non-suicidal self-injury (NSSI) is a growing mental health concern among adolescents. While individual-level risk factors are well documented, less is known about how area-level determinants influence pathways to emergency care for NSSI. This study aimed to examine the association between area-level contextual factors and Emergency Department (ED) visits for NSSI among adolescents in the Piedmont Region of Northern Italy.</div></div><div><h3>Study design</h3><div>Retrospective cross-sectional analysis.</div></div><div><h3>Methods</h3><div>A retrospective cross-sectional analysis of administrative health data covering all ED presentations for NSSI among individuals aged 5–19 years from 2011 to 2021 was conducted. Cases were georeferenced using three validated territorial indicators: the regional socioeconomic deprivation index, the Health Action Zones (HAZ) classification, and the national Inner Areas classification. Sex-stratified multivariable logistic regression models were used to assess the association between each contextual indicator and NSSI-related ED visits.</div></div><div><h3>Results</h3><div>Contrary to conventional expectations, adolescents living in less deprived areas showed significantly higher odds of NSSI-related ED visits, particularly among girls and those aged 15–19 years. In addition, a clear gradient was observed across territorial marginality, with higher odds among adolescents residing in belt and peripheral areas. These associations remained robust after adjustment for age and contextual interrelations. Traditional deprivation measures alone may therefore fail to capture emerging or context-specific vulnerabilities, while differential access to services and help-seeking pathways may contribute to observed patterns of ED utilisation.</div></div><div><h3>Conclusions</h3><div>Structural and contextual factors play an important role how adolescent self-injury is detected within emergency services. Place-sensitive prevention strategies and cross-sectoral planning are needed to address both visible and less readily detected vulnerabilities across diverse communities.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106172"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive modeling and spatiotemporal analysis of TB in Argentina: Advancing control efforts through machine learning","authors":"Iganacio Garcia ,&nbsp;Leonardo Giovanini ,&nbsp;Leonardo López","doi":"10.1016/j.puhe.2026.106151","DOIUrl":"10.1016/j.puhe.2026.106151","url":null,"abstract":"<div><h3>Objectives</h3><div>To improve prediction and understanding of TB dynamics in Argentina, identifying key risk factors and high-incidence areas to inform surveillance and public health control strategies.</div></div><div><h3>Study design</h3><div>Retrospective observational study.</div></div><div><h3>Methods</h3><div>We applied (i) machine learning models (Histogram-Based Gradient Boosting, XGBoost, Random Forest, and Logistic Regression) to predict treatment outcomes, (ii) time series models (ARIMA, SARIMAX, and LSTM) to forecast weekly TB case counts, and (iii) spatial analysis tools (LISA, Moran's I) to identify high-incidence clusters.</div></div><div><h3>Results</h3><div>Weekly TB notifications increased after the onset of the COVID-19 pandemic (t = 4.75, p = 2.10 × 10⁻⁶), with LISA revealing two significant clusters (p &lt; 0.05). HGB predicted treatment outcomes (ROC–AUC = 0.86; top predictors: HIV, treatment duration, age). LSTM outperformed SARIMAX (RMSE 3.50 → 2.88 in Salta–Jujuy; 3.82 → 0.89 in Autonomous City of Buenos Aires (CABA)–Buenos Aires; −18 %/−77 %). A sex-difference test indicated higher infection among men (p &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Combining ML and spatial tools enhances TB monitoring by supporting early identification of high-risk areas, improving epidemiological surveillance, and enabling targeted, data-driven public health interventions in Argentina.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106151"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How early adversity shapes adult physical health: Structural disadvantage and gendered pathways to cardiovascular risk","authors":"Hayun Jang ,&nbsp;Jinho Kim","doi":"10.1016/j.puhe.2026.106134","DOIUrl":"10.1016/j.puhe.2026.106134","url":null,"abstract":"<div><h3>Objectives</h3><div>Adverse childhood experiences (ACEs) are well-established predictors of mental health problems, yet their long-term impact on physical health, especially cardiovascular disease (CVD), remains less well understood. Guided by a life course perspective, this study investigates the association between ACEs and adult CVD risk, with a focus on the mediating role of structural disadvantage and gender-specific pathways.</div></div><div><h3>Study design</h3><div>Using data from Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we analyzed a sample of 12,224 individuals.</div></div><div><h3>Methods</h3><div>Longitudinal regression models with school fixed effects were used to estimate the association between ACEs and a 30-year Framingham CVD risk score in adulthood. We examined four mediators measured in early adulthood: educational attainment, personal earnings, incarceration history, and unmet healthcare needs. Multivariate bootstrapped mediation models and gender-stratified analyses were conducted.</div></div><div><h3>Results</h3><div>ACEs were significantly associated with higher CVD risk in adulthood, even after adjusting for individual, familial, and contextual factors. Structural disadvantage, most notably lower educational attainment, partially explained this association. Incarceration history and unmet healthcare needs also served as mediators. Gender-stratified models revealed distinct pathways: incarceration was a stronger mediator among men, while unmet healthcare needs were more salient for women.</div></div><div><h3>Conclusions</h3><div>Findings underscore the enduring influence of early adversity on adult cardiovascular health and highlight the importance of structural pathways in shaping health trajectories. Policy interventions targeting educational access, healthcare equity, and criminal justice reform, with attention to gender-specific mechanisms, may help mitigate the long-term health burden of childhood adversity.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"252 ","pages":"Article 106134"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}