BMC Public Health最新文献

{"title":"Associations of family support and loneliness with underlying depression in Chinese children and adolescents.","authors":"Gang Tian, Jinming Wang, Jialiang Zhu, Hengyu Hu, Yibin Hao","doi":"10.1186/s12889-025-23771-4","DOIUrl":"https://doi.org/10.1186/s12889-025-23771-4","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to examine whether loneliness mediate associations of family support with depression and the extent of interaction of family support and loneliness with depression in children and adolescents.</p><p><strong>Methods: </strong>There were 2755 children and adolescents aged 18 and below from the China Family Panel Studies (CFPS) that participated in our study. Depression in children and adolescents was assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Data were analyzed using logistic regression models, mediation analysis models and the interaction effect models.</p><p><strong>Results: </strong>Of the 2,755 children and adolescents, 848 (30.8%) reported feelings of loneliness and 2,452 (88.7%) reported feelings of depression. The results of the multivariate logistic regression analysis indicated that, in comparison to children and adolescents who reported having family support, those who lacked such support exhibited a higher probability of experiencing loneliness (odds ratio (OR) = 1.668, 95% confidence interval (CI): (1.318-2.111) and depression (OR, 95%CI = 2.267, 1.402-3.664). The results of the mediation analysis indicated that loneliness exerted a partial mediating effect on the relationship between family support and depression (β=-0.087, P < 0.001), with a mediation proportion of 33.21%. No significant multiplicative or additive interactions were observed between family support and loneliness on depression.</p><p><strong>Conclusion: </strong>The findings indicate that family support exerts a direct and indirect influence on depression, mediated by loneliness. The results suggest that parents should provide more support to children and adolescents to mitigate the risk of loneliness and underlying depression.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"2524"},"PeriodicalIF":3.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of cytomegalovirus in severely ill patients with intractable COVID-19; a retrospective study.","authors":"Yea-Yuan Chang, Shu-Chen Kuo, Stephane Wen-Wei Ku","doi":"10.1186/s12889-025-23753-6","DOIUrl":"10.1186/s12889-025-23753-6","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate whether cytomegalovirus (CMV) reactivation affects the length of stay (LOS) and mortality of critically ill patients with coronavirus disease 2019 (COVID-19) following standard steroid and anti-cytokine treatments.</p><p><strong>Study design: </strong>Retrospective data analysis of an observational cohort study.</p><p><strong>Methods: </strong>We included all inpatients aged ≥ 20 years with severe acute respiratory syndrome coronavirus 2 infection in Northern Taiwan between May and July 2021. Blood, sputum, or endotracheal aspirate samples were collected weekly from critically ill patients with COVID-19 who did not respond to steroid treatment and sent for CMV reverse transcriptase-polymerase chain reaction testing. We investigated whether there were differences in comorbidities and prognoses between patients who tested positive for CMV and those who tested negative.</p><p><strong>Results: </strong>Of the 167 inpatients with COVID-19, 43.3% (13/30) were critically ill, refractory to steroid treatment, and had CMV reactivation. Most (69.2%, 9/13) patients with CMV DNAemia had concurrent CMV positivity in the tracheal aspirate. Compared with CMV-negative patients, CMV-positive patients had a longer LOS but not higher 14- and 28-day mortality rates.</p><p><strong>Conclusions: </strong>A high proportion of critically ill patients with COVID-19 who were refractory to steroid treatment developed CMV DNAemia. In critically ill patients with COVID-19, CMV reactivation can prolong hospitalization.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"2522"},"PeriodicalIF":3.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic and sociodemographic differences in the consequences of the COVID-19 pandemic and their impact on self-rated health and mental well-being: results from a cross-sectional study in Germany.","authors":"Birgit Babitsch, Cristina Ciupitu-Plath","doi":"10.1186/s12889-025-23698-w","DOIUrl":"https://doi.org/10.1186/s12889-025-23698-w","url":null,"abstract":"<p><strong>Background: </strong>Although the COVID-19 pandemic has demonstrably led to an increase in health inequities, only a few studies have analyzed their underlying mechanisms by taking into account socioeconomic status and sociodemographic differences at the same time. Similarly, only few studies have explored the impact of COVID-19 containment measures on inequities in living conditions, health-related risks, and coping resources. This study aims to address these gaps by exploring the complex associations of socioeconomic and sociodemographic factors with changes in life circumstances, pandemic-related experiences, self-rated health, and well-being among adults living in Germany.</p><p><strong>Methods: </strong>A total of 2,123 adults (women: 49.8%, men: 50.2%) living in Germany participated in the cross-sectional online study ExCo:Well between July and August 2022. The survey included questions on socioeconomic status, sociodemographic factors, social circumstances, resources and burdens, as well as health outcomes. The data were analyzed using bivariate and multivariable logistic regression analyses.</p><p><strong>Results: </strong>Our results show significant disparities in self-rated health and mental well-being based on socioeconomic status. For sociodemographic differences, the results are mixed, with only women consistently showing worse health outcomes than men. Immigration status played a limited role. Although measures to contain the COVID-19 pandemic more commonly affected the life and work conditions of more privileged participants, socioeconomically disadvantaged participants experienced higher burdens and had fewer coping resources. Logistic regression analyses showed that health inequities decreased when resources and burdens were considered.</p><p><strong>Conclusions: </strong>By covering the whole period of the COVID-19 pandemic, our data allow for an overall assessment of this critical time as well as a better understanding of mechanisms underlying health inequities. Our findings suggest that more important than the number of government-induced social changes is their quality and their potential to negatively impact material and social livelihoods in the long run. To improve health equity, tailored social security and health promotion interventions need to be systematically integrated in pandemic or crisis response plans.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"2523"},"PeriodicalIF":3.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a distance-learning vs standard training in the integrated management of childhood illnesses: a cluster randomized controlled trial.","authors":"Saidul Abrar, Assad Hafeez, Sana Rahim, Suhail A R Doi, Muhammad Naseem Khan","doi":"10.1186/s12889-025-21771-y","DOIUrl":"10.1186/s12889-025-21771-y","url":null,"abstract":"<p><strong>Background: </strong>The Integrated Management of Childhood Illnesss (IMCI) strategy has a lower coverage. The World Health Organization (WHO) introduced the concept of distance learning IMCI in 2014 to improve uptake of the strategy. This study was conducted to evaluate the effectiveness of a distance learning IMCI training compared with the standard IMCI training in the correct management of children presenting to primary health centers.</p><p><strong>Methods: </strong>This cluster randomized controlled trial with a 1:1 parallel design was conducted at 26 Basic Health Units (BHUs) in Pakistan. Healthcare workers in BHUs (n = 13) randomized to the intervention arm were trained as per the dIMCI protocols while those (n = 13) randomized to the control arm were trained as per the standard protocol. The trained heathcare workers were followed for around five months and were evaluated in the management of childhood illnesses at their respective health facilities. Correct management, the principal outcome, was defined based on a case being correctly assessed (proficiency score of ≥ 6 out of the total score of 10), classified (compared to the gold standard physician), treated (compared to the gold standard physician), and counseled (proficiency score of ≥ 5 out of the total score of 7). Descriptive statistics, binary logistic regression, and 95% confidence interval were calculated using Stata version 18 adjusted for the clusters. P-values < 0.05 were regarded as significant.</p><p><strong>Results: </strong>Under-five children presented to the two arms were mostly similar in gender, age, duration of consultation with the healthcare worker, and presenting complaints. On logistic regression, the dIMCI training was found to be a significant factor in the correct classification (OR = 1.77, 95% CI 1.22-2.58), correct counseling (OR = 6.11,95% CI 3.06 - 12.19), and the overall management of children (OR = 3.35, 95% CI 2.03 - 5.52) with strong evidence against the model hypothesis at this sample size. The dIMCI training showed weak evidence against the model hypothesis in the domains of correct assessment (OR = 1.84, 95% CI 0.99-3.40) and correct treatment (OR 1.46, 95% CI 0.92 - 2.31).</p><p><strong>Conclusions: </strong>Health policymakers could consider the dIMCI an effective, feasible, and flexible alternative to standard IMCI training for scaling up the IMCI strategy.</p><p><strong>Trial registration: </strong>Registered with www.chictr.org.cn , under ChiCTR1900027201 on 05/11/2019.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"2521"},"PeriodicalIF":3.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes, knowledge, and practices of Turkish dentists regarding HIV/AIDS: a cross-sectional study.","authors":"Ilkay Akbulut, Zeynep Sedef Varol, Sarp Singil, Ilker Ödemiş, Sabri Atalay, Hüsnü Pullukçu, A Deniz Gökengin","doi":"10.1186/s12889-025-23730-z","DOIUrl":"10.1186/s12889-025-23730-z","url":null,"abstract":"<p><strong>Background: </strong>HIV/AIDS remains a global public health concern with considerable amounts of stigma impacting patient care. Dentists, as primary care providers, play a crucial role in providing healthcare to people living with HIV (PLWH). However, there are gaps in knowledge and attitudes among dentists regarding HIV/AIDS, resulting in discrimination and barriers to care.</p><p><strong>Methods: </strong>This national cross-sectional study assessed the knowledge and attitudes of Turkish dentists toward HIV/AIDS using an adapted and validated questionnaire. The questionnaire included sections on discriminatory attitudes and behaviors, scientific knowledge regarding HIV/AIDS, and infection control practices. Data were collected from November to December 2024 via an online survey distributed by the Turkish Dental Association. The target sample size was 381 participants, and 383 were included in the study. Since all eligible participants were enrolled, a response rate is not applicable. In total, the data from 383 dentists were analyzed using descriptive and inferential statistics.</p><p><strong>Results: </strong>Among participants, 43.6% reported hesitation to treat PLWH due to fear or insufficient training. Dentists in the private sector were more likely to express hesitation than those in the public sector (OR = 2.05, p = 0.002). Knowledge gaps were evident: 41.5% were unaware of the HIV window period, with dentists unaware of this period significantly more likely to work in the private sector (OR = 2.15, p = 0.001). Female dentists were more likely to state the importance of knowing a patient's HIV status (OR = 0.42, p = 0.004), while male dentists more often reported patient inquiries about infection control (OR = 1.62, p = 0.032).</p><p><strong>Conclusions: </strong>Despite generally good adherence to infection control protocols, significant gaps in knowledge and attitudes persist among Turkish dentists. Findings from multivariate analyses underscore that sector of employment and gender significantly influence dentists' attitudes and knowledge regarding HIV/AIDS. Targeted educational interventions are needed to reduce stigma and improve the quality of dental care for PLWH.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"2520"},"PeriodicalIF":3.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'A post-test experimental study on the effects of message framing and the use of a patient testimonial on intentions of osteoarthritis patients to adhere to treatment advice'.","authors":"J M H Oomen, C H van den Ende, H J Schers, S Koëter, W J J Assendelft, E Das","doi":"10.1186/s12889-025-22436-6","DOIUrl":"10.1186/s12889-025-22436-6","url":null,"abstract":"<p><strong>Background: </strong>Recent findings show that intentions to adhere to conservative treatment of osteoarthritis are negatively influenced by certain beliefs and rely strongly on testimonies of others. Message framing, i.e., focusing on either gains or losses, and the use of a patient testimonial in educational material are commonly used techniques to influence beliefs, and ultimately, health behaviors.</p><p><strong>Objectives: </strong>To study the effects of 1) message framing and 2) patient testimonials on osteoarthritis patients' beliefs about and intentions to be physically active and to use pain medication.</p><p><strong>Methods: </strong>Members of a research panel (n=639) with a self-reported diagnosis of knee OA were, after informed consent, randomly allocated to watching one out of four video messages combining a framing condition (gain or loss-frame) with the use of a testimonial (yes/no). After watching this video, participants completed a questionnaire on attitudes, behavioral beliefs, attitudes towards physical activity and pain medication (1=completely disagree, 7=completely agree), and intentions towards physical activity and pain medication (1=I do not do this now and am not planning on doing this, 7=I am doing this already for more than 6 months). ANOVA was used to assess the main and interaction effects.</p><p><strong>Results: </strong>A total of 154 respondents completed the questionnaire. Message framing and the use of a testimonial did not impact attitudes, beliefs, or intentions on physical activity. However, loss framing resulted in more positive attitudes towards pain medication (mean (SD) 5.5 (1.6)) than gain framing (mean (SD) 4.9 (1.9), mean difference=0.6, 95% CI [0.0, 1.1]). Furthermore, the patient testimonial induced more positive pain medication attitudes (mean (SD) 6.0 (1.1)) than the informative control message (mean (SD) 5.0 (1.7), mean difference=0.9, 95% CI [0.1, 1.6]) when the message used a loss, rather than a gain-frame.</p><p><strong>Conclusion: </strong>This study suggests that describing the disadvantages of nonadherence to pain medication resulted in more positive beliefs about pain medication than stating the advantages of adherence. The use of a patient testimonial within this loss-frame strengthened the effect. Our findings indicate that the use of framing and testimonials in OA care can matter and that healthcare providers should be aware of the potential effects of emphasising either gains or losses in communicating with their patients.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"2517"},"PeriodicalIF":3.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimates of the prevalence of autism spectrum disorder in the Middle East and North Africa region: A systematic review and Meta-Analysis.","authors":"Aishat F Akomolafe, Bushra M Abdallah, Fathima R Mahmood, Amgad M Elshoeibi, Aisha Abdulla Al-Khulaifi, Elhassan Mahmoud, Yara Dweidri, Nour Darwish, Duaa Yousif, Hafsa Khalid, Majed Al-Theyab, Muhammad Waqar Azeem, Durre Shahwar, Madeeha Kamal, Majid Alabdulla, Salma M Khaled, Tawanda Chivese","doi":"10.1186/s12889-025-23651-x","DOIUrl":"10.1186/s12889-025-23651-x","url":null,"abstract":"<p><strong>Background: </strong>Prevalence estimates for autism spectrum disorder (ASD) in the Middle East and North Africa (MENA) region are not readily available, amid a lack of recent evidence. In this study, we estimated the prevalence of ASD in the MENA region by synthesising evidence from published studies.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis, searching PubMed, EMBASE, Scopus, and CINAHL for studies assessing ASD prevalence in the MENA region. Risk of bias was assessed using the Newcastle Ottawa scale. A bias-adjusted inverse variance heterogeneity meta-analysis model was used to synthesize prevalence estimates from included studies. Cochran's Q statistic and the I² statistic were used to assess heterogeneity, and publication bias assessed using funnel and Doi plots.</p><p><strong>Results: </strong>Of 3,739 studies identified, 19 met the inclusion criteria, published during the period 2007-2025, from Iran, Oman, Libya, Egypt, Saudi Arabia, Lebanon, United Arab Emirates, Bahrain, and Qatar, Iraq. Country specific prevalence estimates ranged from 0.01% in Oman in 2009 to 6.50% in one study from Iraq in 2024. The overall prevalence of ASD in the MENA region was 0.14% (95%CI 0.02- 0.36%), with significant heterogeneity (I² = 99.8%). Overall ASD prevalence was 0.04% (95%CI 0.00-0.13, I² = 99.4%) for studies done before 2015 and 0.45% (95%CI 0.17-0.87, I² = 99.4%) for studies after 2015. Overall ASD prevalence was high in studies that used the Modified Checklist for Autism in Toddlers (M-CHAT) only [1.66% (95%CI 0.15-4.33, I² = 97.5%)] while the overall ASD prevalence was 0.14% (95%CI 0.00-0.46, I² = 99.9%) for studies that used the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for diagnosis.</p><p><strong>Conclusion: </strong>Estimates of the prevalence of ASD vary widely across the MENA region, with variability in ASD prevalence estimates by diagnostic methods and sampling approaches. While the data suggest a possible increase in prevalence during the study period, this observation warrants further investigation through more robust, longitudinal, and methodologically consistent studies.</p><p><strong>Registration: </strong>PROSPERO registration ID CRD42024499837.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"2519"},"PeriodicalIF":3.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mediating role of psychological inflexibility in the association between physical activity and depressive symptoms among college students.","authors":"Xiumin Dou, Erkang Cai, Yiting Liu, Tianle Chen, Teck Cheng Tan, Qian Gu, Tao Huang","doi":"10.1186/s12889-025-23673-5","DOIUrl":"10.1186/s12889-025-23673-5","url":null,"abstract":"<p><strong>Background: </strong>Depressive symptoms are prevalent mental health issues among college students. Physical activity has been recognized as a potential protective factor. However, the mechanisms through which physical activity alleviates depressive symptoms remain unclear.</p><p><strong>Purpose: </strong>This study aimed to investigate the associations between physical activity, psychological flexibility, psychological inflexibility, and depressive symptoms among Chinese college students. The mediating roles of psychological flexibility and psychological inflexibility on these associations were also examined.</p><p><strong>Methods: </strong>A cross-sectional study was conducted with 1205 college students from four universities in Shanghai, China. The International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Center for Epidemiological Studies Depression Scale (CESD-10) were used to assess physical activity and depressive symptoms, respectively. Psychological flexibility and psychological inflexibility were measured using the Multidimensional Psychological Flexibility Inventory Short Form (MPFI-24). PROCESS macro models were used to analyze the mediating effects of psychological flexibility and psychological inflexibility on the relationship between physical activity and depressive symptoms.</p><p><strong>Results: </strong>The results showed a significant negative correlation between physical activity and depressive symptoms (r = -0.15, p < 0.01). Psychological inflexibility played a partial mediation role in the association between physical activity and depressive symptoms (indirect effect: -0.24, 95% CI: -0.48 ~ -0.01). However, psychological flexibility did not mediate the association between physical activity and depressive symptoms.</p><p><strong>Conclusions: </strong>The study suggested that psychological inflexibility partially mediated the association between physical activity and depressive symptoms among college students. Interventions targeting physical activity and psychological inflexibility may be effective strategies for lowering depressive symptoms in this population.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"2518"},"PeriodicalIF":3.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial disparities in diabetes care and outcomes for people with visual impairment: a descriptive analysis of the TriNetX research network.","authors":"Charisse Madlock-Brown, Austin Lee, Jaime Seltzer, Anthony Solomonides, Nisha Mathews, Jimmy Phuong, Nicole Weiskopf, William G Adams, Harold Lehmann, Juan Espinoza","doi":"10.1186/s12889-025-23606-2","DOIUrl":"10.1186/s12889-025-23606-2","url":null,"abstract":"<p><strong>Background: </strong>This research delves into the confluence of racial disparities and health inequities among individuals with disabilities, with a focus on those contending with both diabetes and visual impairment.</p><p><strong>Methods: </strong>Utilizing data from the TriNetX Research Network, which includes electronic medical records of roughly 115 million patients from 83 anonymous healthcare organizations, this study employs a directed acyclic graph (DAG) to pinpoint confounders and augment interpretation. We identified people with visual impairments using ICD-10 codes, deliberately excluding diabetes-related ophthalmology complications. Our approach involved multiple race-stratified analyses, comparing co-morbidities like chronic pulmonary disease in visually impaired patients against their counterparts. We assessed healthcare access disparities by examining the frequency of annual visits, instances of two or more A1c measurements, and glomerular filtration rate (GFR) measurements. Additionally, we evaluated diabetes outcomes by comparing the risk ratio of uncontrolled diabetes (A1c > 9.0) and chronic kidney disease in patients with and without visual impairments.</p><p><strong>Results: </strong>The prevalence of diabetes was nearly doubled in individuals with visual impairments across White, Asian, and African American populations. Higher rates of chronic kidney disease were observed in visually impaired individuals, with a risk ratio of 1.731 for African Americans, 2.252 for White, and non-significant for the Asian group. A statistically significant difference in the risk ratio for uncontrolled diabetes was found only in the White cohort with one GFR reading (1.042). White individuals without visual impairments were less likely to receive an A1C test or a GFR test, while African American individuals with visual impairment were more likely to get both. Differences in testing were not significant for the Asian population.</p><p><strong>Conclusions: </strong>This study uncovers pronounced disparities in diabetes prevalence and management among individuals with visual impairments who seek care, particularly among White and African American groups. Our DAG analysis illuminates the intricate interplay between SDoH, healthcare access, and frequency of crucial diabetes monitoring practices, highlighting visual impairment as both a medical and social issue.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"2508"},"PeriodicalIF":3.5,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding barriers to breast screening: an online survey of non-attenders as part of a service evaluation in the breast screening programme in England.","authors":"Gemma Hutton, Shuping J Li, Samantha L Quaife, Adam Brentnall, Jacqui Cookson, Jacquie Jenkins, Sue Hudson, Sharon Webb, Emma O'Sullivan, Stephen W Duffy, Judith Offman, Jo Waller","doi":"10.1186/s12889-025-23691-3","DOIUrl":"10.1186/s12889-025-23691-3","url":null,"abstract":"<p><strong>Background: </strong>Early detection of breast cancer through organised mammography screening of asymptomatic individuals reduces breast cancer mortality. Breast screening is offered every three years to women aged 50 to 71 years in England. However, over a third of eligible women did not attend in 2022-2023. Understanding reasons for non-attendance is critical to ensuring the effectiveness of the breast screening programme by highlighting ways to improve access to screening.</p><p><strong>Methods: </strong>As part of a service evaluation in the NHS Breast Screening Programme (NHSBSP), we conducted a cross-sectional survey using an online questionnaire in February 2024. Participants were non-attenders from 15 NHSBSP services in England. All women invited to breast screening who subsequently did not attend in October or November 2023 and had a valid mobile number recorded on their records received a single text message containing a link to the survey. The online survey gathered demographic and basic screening history information and assessed endorsement of common barriers to breast screening. Descriptive analysis was used to identify the most commonly endorsed barriers and chi-squared tests were used to explore demographic variation in barrier endorsement.</p><p><strong>Results: </strong>Overall, 27,729 women were identified as not attending a screening appointment in October or November 2023. Of these, 17,221 had mobile numbers and were sent a text message inviting them to participate in the survey. In total, 1,074/17,221 (6%) participants completed the survey. The most frequently endorsed barriers to breast screening were: difficulties making a convenient appointment (30%), concern that a man may do the mammogram (28%), worry about the mammogram being painful (27%), previously experiencing pain during a mammogram (26%), having too many other things to worry about (25%) and the appointment being located too far away (23%). Endorsement of the most common barriers varied significantly by age, ethnicity, mental health status and disability but not by educational level.</p><p><strong>Conclusions: </strong>These findings identify barriers that could be targeted to increase screening uptake including increasing appointment availability and proximity, reinforcing the message that breast screening is a female-only environment as well as developing interventions to reduce and manage pain during breast screening.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"2509"},"PeriodicalIF":3.5,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}