BMC global and public health最新文献

{"title":"Measuring loneliness at a national scale: The measuring loneliness in England (INTERACT) study's approach and initial findings.","authors":"Austen El-Osta, Aos Alaa, Mahmoud Al-Ammouri, Sami Altalib, Agustin Tristán-López, Azeem Majeed","doi":"10.1186/s44263-026-00296-5","DOIUrl":"10.1186/s44263-026-00296-5","url":null,"abstract":"<p><strong>Background: </strong>Loneliness is increasingly recognised as a major public health challenge with significant implications for mental, physical and social wellbeing. While there were previous large scale studies including loneliness measures, few datasets capture loneliness across the full adult life course, integrate neighbourhood-level social capital and provide geospatial mapping at national scale. The Measuring Loneliness in England (INTERACT) Study was designed to address these gaps by characterising the distribution, intensity and sociodemographic patterning of loneliness within a large volunteer-based sample across diverse population groups in England. The aim of this paper is to describe the development, implementation and early findings of the INTERACT study.</p><p><strong>Methods: </strong>A total of 135,725 adults completed the online survey between March and July 2023. The instrument included validated measures of loneliness: the University of California Los Angeles (UCLA) 3 item loneliness scale and Office for National Statistics Direct Measure (DMOL), social capital indicators and demographic variables. Descriptive statistics were stratified by key subgroups. A geospatial analysis at Lower Super Output Area level was used to visualise clustering of loneliness across England.</p><p><strong>Results: </strong>135,725 participants across the full adult life course (16+) were included. The cohort was predominantly female (61.6%), White (82.6%) and aged over 65 (32.4%). The sample over-represented highly educated individuals and under-represented minority ethnic groups. On DMLO, 16.5% of participants reported feeling lonely \"often or always,\" while the UCLA-3 indicated that 21% to 22.5% frequently felt a lack of companionship, left out, or isolated (median score=6, Interquartile Range (IQR) = 3-7). Social capital perceptions were mixed (median=4, IQR) = 2-6). The COVID-19 pandemic exacerbated feelings of loneliness for 44.0% of respondents and isolation for 48.2%. As a volunteer-based, non-probability sample, findings are descriptive of respondents and are not intended to estimate population prevalence.</p><p><strong>Conclusions: </strong>The INTERACT Study provides a comprehensive national dataset on loneliness and social disconnection in England. The scale, methodological rigour and spatial granularity of the INTERACT study offer indicative insights that may inform the design of targeted, place-based interventions, pending confirmatory analyses in representative samples to mitigate loneliness and promote social connection across communities.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing AI-enabled chest X-ray for community-based integrated screening for tuberculosis, chronic respiratory diseases, and cardiovascular diseases in Nigeria.","authors":"Chidimma Okoye, Jude Ilozumba, John Oko, Amana Effiong, Young Oluokun, Chinwe Eze, Obioma Akaniro, Emperor Ubochioma, Collins Nwachi Ugwu, Rena Fukunaga, Toufiq Rahman, John Bimba, Jacob Creswell, Chukwuebuka Ugwu","doi":"10.1186/s44263-026-00313-7","DOIUrl":"10.1186/s44263-026-00313-7","url":null,"abstract":"<p><strong>Background: </strong>Low- and middle-income countries face a growing dual burden of communicable and non-communicable diseases, while services remain vertically organised. In Nigeria, tuberculosis (TB) services are established at primary care level, whereas access to cardiovascular disease (CVD) and chronic respiratory disease (CRD) care remains limited in rural settings. Artificial intelligence (AI) enabled chest X-ray can integrate TB screening with identification of other cardiopulmonary abnormalities at community level. We describe the screening outcomes and referral cascade of a community-based, AI-enabled integrated programme.</p><p><strong>Methods: </strong>We conducted a non-randomised descriptive study using routinely collected programme data from five Local Government Areas in Ebonyi and Nasarawa States, January 2023 to December 2024. Community outreach used portable digital chest X-ray with AI software to screen individuals aged six years and above. People with presumptive TB underwent Xpert MTB/RIF (Mycobacterium tuberculosis/rifampicin) testing on the GeneXpert platform, while non-TB radiographic abnormalities were referred for further evaluation. Descriptive analyses summarised screening yield, diagnostic outcomes, and linkage to care.</p><p><strong>Results: </strong>In total, 9,585 individuals were screened through 93 outreach activities, and 3,166 (33%) chest radiographs were flagged as abnormal by AI. Overall, 1,336 were classified as having presumptive TB, of whom 1,123 (84%) produced sputum for Xpert MTB/RIF testing. 204 were diagnosed with bacteriologically confirmed TB, and 194 (95%) were initiated on treatment. A further 199 people were clinically diagnosed with TB following radiologist and/or clinical review. Among abnormal radiographs, 2,367 (75%) showed features suggestive of CVDs or CRDs. All such individuals were referred to tertiary facilities; however, only 12% completed the referral. Programmatic adaptations supported TB linkage but had limited impact on non-TB referral completion.</p><p><strong>Conclusions: </strong>AI-enabled community chest X-ray screening is feasible for TB case finding in rural Nigeria and achieves high linkage to TB treatment. Chest radiography also identified many abnormalities requiring further evaluation for CVD and CRD, most not confirmed within the study. Limited decentralisation of non-communicable disease services constrains care continuity for CVDs and CRDs. Integrated screening programmes should be paired with strengthened primary healthcare capacity, complementary tools such as blood pressure measurement, and context-specific community engagement strategies.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equitable digital health systems begin before technology is deployed.","authors":"Gen Li","doi":"10.1186/s44263-026-00311-9","DOIUrl":"10.1186/s44263-026-00311-9","url":null,"abstract":"","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women engaged in commercial sex living with Human Immunodeficiency Virus and viral non-suppression in Uganda: analysis of multiple respondent-driven sampling surveys, 2021-2023.","authors":"George Aluzimbi, Geofrey Musinguzi, Wilford L Kirungi, Moses Ogwal, Kafeero W Bikokye, Sheila Kyobutungi, Rhoda K Wanyenze, Christiana Nöstlinger","doi":"10.1186/s44263-026-00308-4","DOIUrl":"10.1186/s44263-026-00308-4","url":null,"abstract":"<p><strong>Background: </strong>Human Immunodeficiency Virus (HIV) Viral load non-suppression (VNS) among women engaged in commercial sex (WECS) is unknown even with persistent new HIV infections in the general population. The objective of this study was to find out the factors correlated with VNS among WECS living with HIV (WECS-LHIV) in Uganda.</p><p><strong>Methods: </strong>Cross-sectional data were collected through respondent driven sampling (RDS) in Kampala Capital City and 11 upcountry towns. All consented WECS-LHIV reporting commercial sex 3 months prior to the surveys were tested for HIV and viral load (VL), active syphilis and high-risk human papilloma virus (hr.HPV) which was based on genotypes 16 and 18 that are highly associated with all cervical cancer cases. VNS was defined as any VL measure < 1,000 copies/ml. Analysis of correlates of VNS were restricted to WECS-LHIV with VL results irrespective of their antiretroviral therapy (ART) status. We examined variables including - age, marital status, education, active syphilis, hr.HPV and reported ART use to identify correlates of VNS. Sampling weights to reflect the complex sampling design were applied.</p><p><strong>Results: </strong>Of 2,674 WECS-LHIV (median age 32 years, interquartile range (IQR) 27-37), 667 (24.9%) had VNS. The findings show that 19.2% and 29.7% of WECS-LHIV with VNS had active syphilis and hr.HPV co-infections respectively. WECS-LHIV had reduced odds of VNS if they were aged 30-49 years ([adjusted odds ratio (aOR): 0.46, 95% confidence interval (CI): 0.30-0.69, p < 0.001)] vs. 18-24 years and if they self-reported ART use [aOR: 0.38, 95% CI: 0.28-0.52, p = < 0.001 vs. non-self-reporting ART].</p><p><strong>Conclusions: </strong>Young women engaged in commercial sex(YWECS) and none ART disclosure WECS may increase risk of new HIV infections in general population. Increase on frequency of ART adherence and viral load monitoring of YWECS including continuous surveillance of the second and third 95 HIV continuum of care and treatment for hidden populations may aid in reduction of new HIV infections burden in Uganda and other low- and middle-income countries.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal mental health and child development before and after an extreme cyclone in Malawi.","authors":"Megan Kowalcyk, Maria M Crespo-Llado, Christabell Mdhluli, Stella Chifumbi, Victoria Mapemba, Meraby Funsani, Chimwemwe Kalengo, Nginache Nampota-Nkomba, Miriam Laufer, Melissa Gladstone, Andrea Buchwald","doi":"10.1186/s44263-026-00309-3","DOIUrl":"10.1186/s44263-026-00309-3","url":null,"abstract":"<p><strong>Background: </strong>Climate change is increasing the frequency and severity of cyclones and hurricanes, with the most severe impact occurring in low-resource settings. Women and children are among the most vulnerable to adverse health impacts of these severe weather events. Despite this, there is limited data on how cyclones and hurricanes impact maternal mental health or child development in low-resource settings.</p><p><strong>Methods: </strong>We recruited pregnant women and their newborns into a prospective cohort study between 2018 and 2022 in Blantyre, Malawi and assessed maternal mental health, child development, and growth repeatedly from one to five years of age. Tropical Cyclone Freddy hit Blantyre on March 11, 2023, severely impacting our study site. We assessed the impact of cyclone exposure on study outcomes; maternal mental health, child neurodevelopment, and child growth, classifying measurements based on time since cyclone. We utilized generalized estimating equations logistic regression to estimate the effect of cyclone exposure on study outcomes.</p><p><strong>Results: </strong>A total of 858 mother-child dyads were enrolled in the follow up cohort. Of these 838 mothers had at least one mental health assessment, 802 children had neurodevelopmental assessments, and 844 children had growth measurements. Cyclone exposure was associated with an increased odds of stunting with risk rising both in the first six months (Odds Ratio (OR) = 3.40; 95% Confidence Interval (CI): 2.55-4.51) and more than six months after the event (OR = 6.05; 95% CI: 4.3-8.35), compared to pre-Cyclone exposure assessments. In contrast, the odds of maternal distress and developmental delay decreased during the first six months following Cyclone Freddy.</p><p><strong>Conclusions: </strong>The effects of Cyclone Freddy on maternal and child health in Malawi are complex. Strengthening of maternal and child health resources may help mitigate post-disaster consequences and prevent long-term health problems.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conflict, mental health, and labor productivity: evidence from hired farm workers in Myanmar.","authors":"Andrew Laitha, Anna Fabry, Bart Minten, Eva-Marie Meemken","doi":"10.1186/s44263-026-00307-5","DOIUrl":"10.1186/s44263-026-00307-5","url":null,"abstract":"<p><strong>Background: </strong>Violent conflict can affect worker's mental health and labor productivity, with implications for agricultural production and food security. Hired farm workers are particularly vulnerable because they often rely on daily wages, have limited assets, and face insecure employment, yet evidence on how conflict affects their mental health and productivity remains limited. This study examines the associations between conflict exposure, mental health, and labor productivity among hired farm workers in Myanmar.</p><p><strong>Methods: </strong>We conducted a cross-sectional phone survey of 1,504 hired farm workers across Myanmar. The survey collected information on workers' demographic characteristics, work activities during the past 12 months, absenteeism, self-reported labor productivity (presenteeism), agricultural labor market conditions, job characteristics, job and life satisfaction, mental health, workplace harassment, and access to information. These primary survey data were matched with conflict event data from the Armed Conflict Location & Event Data (ACLED). Mediation analysis was used to examine whether mental health mediates the relationship between conflict exposure and labor productivity outcomes.</p><p><strong>Results: </strong>Overall, 39% of workers were exposed to conflict and 20% met the criteria for trauma. Compared with non-exposed workers, conflict-exposed workers were more likely to experience trauma (27% vs. 17%), more frequently absent from work (28% vs. 23%), and reported lower work performance (7.0 vs. 7.4). In multivariable mediation analyses, conflict exposure was associated with a 7-percentage-point higher likelihood of absenteeism and a 0.15-point lower work performance score. Trauma significantly mediated these associations, increasing the total association between conflict exposure and absenteeism by approximately 18%.</p><p><strong>Conclusions: </strong>Our findings highlight the need for greater research and policy attention to the socio-psychological implications of conflict, which can erode labor productivity. They also reinforce the case for increased investment in mental health interventions, which have been severely reduced amid widespread budget cuts despite their potentially high cost-effectiveness.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing healthcare emissions in the United States in the era of federal environmental deregulation: established and emerging mitigation opportunities and concomitant benefits.","authors":"Erica Mascarenhas, Oluseyi A Fayanju, Anna Chen Arroyo, Jyothi Tirumalasetty","doi":"10.1186/s44263-026-00303-9","DOIUrl":"10.1186/s44263-026-00303-9","url":null,"abstract":"<p><p>The United States (US) healthcare sector leads the world in per capita greenhouse gas emissions, contributing disproportionately to global climate change. The recent reversal of federal climate regulations has increased the need for voluntary and urgent action from the US healthcare sector. In 2022, the US healthcare sector emissions resulted in over 425,000 disability-adjusted life years lost, reflecting the direct human cost of healthcare-related greenhouse gas emissions. Climate change worsens health outcomes and disrupts access to care - these impacts fall heavily on vulnerable populations including low-income communities, indigenous populations, the elderly, and children. Three key areas for decarbonization include infrastructure, supply chains, and operations and can be accounted for and addressed through the Greenhouse Gas Protocol framework. Some established mitigation strategies include transitioning to renewable energy, reducing medical waste, adopting lower emissions anesthetics and inhalers, and implementing sustainable food management. However, current greenhouse gas inventories utilized by health systems may not yet account for the rapidly expanding landscape of technology in healthcare and its growing contribution to emissions. Emerging priorities for mitigation that are often overlooked include reducing emissions associated with medical conferences and the growing energy demands of artificial intelligence. Here, we discuss how decarbonization not only reduces emissions but also provides important co-benefits, including better air quality, climate resilience, reduced costs, and improved workforce well-being.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13418147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outbreak preparedness for women and girls in low- and middle-income countries: a qualitative study.","authors":"Danielle Sarraf, Melissa Meinhart, Ilana Seff, Catherine Poulton, Sarah Karmin, Christine Heckman, Lindsay Stark","doi":"10.1186/s44263-026-00305-7","DOIUrl":"10.1186/s44263-026-00305-7","url":null,"abstract":"<p><strong>Background: </strong>Infectious disease outbreaks (\"outbreaks\") pose heightened gender-based violence (GBV) risk for women and girls. However, little is known about the integration of GBV and gender-informed programming within outbreak preparedness and response in low- and middle-income countries (LMICs).</p><p><strong>Methods: </strong>This qualitative study draws on in-depth interviews with ten public health practitioners with experience supporting infectious disease outbreak preparedness and response in LMICs. Participants represented intergovernmental organizations and worked across multiple outbreak contexts, including Ebola, COVID-19, Mpox, Zika, and Cholera, in diverse geographic settings. Interviews examined barriers, gaps, successes, and opportunities for integrating gender-informed programming and GBV considerations into outbreak preparedness and response. Authors employed thematic content analysis with a mixed inductive and deductive coding approach to analyze data.</p><p><strong>Results: </strong>Four major themes emerged. First, participants described the persistent normalization of excluding gender and GBV considerations from outbreak response, driven by competing priorities and inadequate funding. Second, they identified insufficient community engagement and localization, emphasizing that responses often fail to account for existing gender norms, community priorities, and local expertise. Third, participants highlighted fragmented coordination across sectors and organizations, advocating for stronger partnerships with women-led organizations (WLOs), improved collaboration, and more gender-balanced leadership. Finally, they emphasized the need to better institutionalize lessons learned and operationalize existing evidence to strengthen preparedness and support more effective, gender-informed responses during future outbreaks.</p><p><strong>Conclusions: </strong>To strengthen gender integration in global outbreak response, we recommend embedding GBV risk mitigation throughout response planning, improving cross-sector coordination and gender-balanced leadership, strengthening partnerships with local WLOs, and adopting flexible long-term funding mechanisms. Integrating gender-informed approaches into outbreak preparedness is essential to protecting women and girls, strengthening community resilience, and improving the effectiveness and sustainability of public health responses in LMICs.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13417842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drivers of sex differences in Mycobacterium tuberculosis immunoreactivity among adolescents and adults in Blantyre, Malawi.","authors":"Mphatso D Phiri, Hannah M Rickman, Hannah Mbale, Helena Ra Feasey, Marriott Nliwasa, Alvaro Schwalb, Tisungane E Mwenyenkulu, Kuzani N Mbendera, Henry C Mwandumba, Elizabeth L Corbett, S Bertel Squire, Marc Yr Henrion, Katherine C Horton, Peter MacPherson","doi":"10.1186/s44263-026-00302-w","DOIUrl":"10.1186/s44263-026-00302-w","url":null,"abstract":"<p><strong>Background: </strong>Sex differences in Mycobacterium tuberculosis (Mtb) exposure likely contribute to sex differences in tuberculosis (TB) burden. However, population-level age- and sex-specific patterns of Mtb exposure among adolescents and adults have not been recently characterised in Malawi. We therefore conducted a cross-sectional survey to estimate age- and sex-specific Mtb immunoreactivity prevalence in Blantyre City, Malawi, and to assess whether prevalence diverges by sex with increasing age.</p><p><strong>Methods: </strong>We used an open-access dataset of building footprints, known as Open Buildings, to obtain a random sample of households from 33 peri-urban neighbourhoods in Blantyre City. Adolescents and adults aged 10-40 years were recruited, participant characteristics recorded, and venous blood samples collected to determine Mtb immunoreactivity using the QuantiFERON-TB Gold Plus (QFT-Plus) assay. We fitted Bayesian multilevel logistic regression models to estimate the association between age, sex, and other risk factors with Mtb immunoreactivity, and compared predicted immunoreactivity prevalence across age-sex strata.</p><p><strong>Results: </strong>Of 2833 participants, 40.0% (1133/2833) were male, the median age was 21 years (interquartile range: 16-28 years), and 8.7% (179/2047) self-reported living with HIV. Overall, 17.8% (503/2833) of participants were Mtb positive, Mtb immunoreactivity prevalence was 17.8% (95% credible interval [CrI]: 16.4-19.2%), corresponding to an annual risk of TB infection of 0.88% (95% CrI: 0.80%-0.95%). Prevalence was similar by sex among 10-19- and 30-40-year-olds. However, among 20-29-year-olds, prevalence was higher among males compared to females: 26.3% (95% CrI: 22.0%-30.8%) and 17.7% (95% CrI: 14.8%-20.8%), respectively. The annual risk of Mtb immunoreactivity conversion increased, on average, at a faster rate among males compared to females from age 10 years, peaking at 21 years, where it was 1.58 (95% CrI: 0.82-2.80) times higher among males compared to females. Tobacco smoking and alcohol drinking, more prevalent among males compared to females, were associated with increased immunoreactivity probability.</p><p><strong>Conclusions: </strong>Adolescence appears to be a period of vulnerability for Mtb exposure, during which sex-specific vulnerabilities begin to emerge. Identifying the biological and social drivers of these vulnerabilities could inform targeted strategies to reduce sex disparities in TB.</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation science frameworks and strategies to promote adoption of and adherence to oncology clinical practice guidelines in low- and middle-income countries: a scoping review.","authors":"Anya Romanoff, Kathleen Lynch, Lily Martin, Olayide Agodirin, Shilpa Murthy, Olalekan Olasehinde, Chukwuma Okereke, Julia M Jackman, Betel Yibrehu, William E Rosa, Catherine Zivanov, Erica Mann, Joy O Ogunmuyiwa, Colleen E Witty, Victoria L Mango, Olusegun Isaac Alatise, T Peter Kingham, Rachel Vreeman, Benjamin O Anderson, Jamie S Ostroff","doi":"10.1186/s44263-026-00297-4","DOIUrl":"10.1186/s44263-026-00297-4","url":null,"abstract":"<p><strong>Background: </strong>Clinical practice guidelines (CPGs) were developed to standardize and optimize cancer care delivery in low- and middle-income countries (LMICs). The aim of this scoping review is to identify implementation science (IS) frameworks and strategies to promote CPG adoption and adherence in LMICs.</p><p><strong>Methods: </strong>We identified studies that describe, develop, reference, or utilize IS frameworks or strategies to deliver or evaluate adoption of oncology CPGs in LMICs. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we searched Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), African Journals Online, Latin American and Caribbean Health Sciences Literature, Scopus, Web of Science, and PsycINFO on 3/21/2022, 12/20/2022, 01/26/2024, and 10/03/2025. Publications in all languages and of all study types were eligible for inclusion. Titles, abstracts, and full text were screened by two reviewers with conflicts resolved by a third reviewer. Excluded studies did not use an IS framework or strategy, did not focus on cancer care, or were conducted in a high-income country.</p><p><strong>Results: </strong>Searches identified 17,806 unique publications for title/abstract screening. 182 studies met criteria for full-text review; 35 were included. Twenty-four studies were country-specific, most commonly India (n = 5) and Nigeria (n = 5). The most frequent CPGs referenced were national/country-specific guidelines (n = 13) and Breast Health Global Initiative (BHGI) guidelines (n = 9). Only 16 full-text publications described original research to promote or evaluate evidence-based CPG interventions in LMICs. Established IS frameworks used in more than one study were the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework (n = 2) and Consolidated Framework for Implementation Research (CFIR) (n = 2).</p><p><strong>Conclusions: </strong>There is limited research utilizing IS frameworks and strategies to promote CPG adoption and adherence in LMICs and substantial heterogeneity in reporting. Greater utilization of IS frameworks, strengthening implementation capacity and improving consistency in reporting, are needed to improve CPG uptake in LMICs.</p><p><strong>Systematic review registration: </strong>Open Science Framework (https://osf.io/nb75s).</p>","PeriodicalId":519903,"journal":{"name":"BMC global and public health","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13378326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}