BMC Public Health最新文献

{"title":"Research on the preference of community health communication service utilization by patients with cardiovascular diseases in China.","authors":"Wei Liu, Junhong Dong, Ying Zhang, Haojie Li, Jiayue Sun, Tianyu Xu, Zehui Li, Guangsheng Wan, Hui Yin","doi":"10.1186/s12889-025-22400-4","DOIUrl":"https://doi.org/10.1186/s12889-025-22400-4","url":null,"abstract":"<p><strong>Objectives: </strong>This study sought to examine cardiovascular patients' preferences for community health communication and to offer recommendations to boost the engagement with health communication programs.</p><p><strong>Methods: </strong>We conducted a discrete choice experiment involving 914 cardiovascular patients, assessing their preferences across five attributes: Health information communicator, Health information communication content, Health information communication channel, Health information form, and Cost willing to pay each time. The data were analyzed using a mixed logit model to account for preference heterogeneity.</p><p><strong>Results: </strong>The results of discrete choice model showed that patients with cardiovascular disease were more inclined to choose doctors in terms of health information transmitter preference. In the content of health communication, disease-related knowledge and healthy lifestyle knowledge are more popular. In terms of health information communication channels, offline channels are more popular than online channels. Of the health information formats, \"video + audio\" is the most popular, followed by \"video,\" while \"text + picture\" are less popular. Payment (β=-10.624, P < 0.05) had a negative effect on service utilization of health communication activities. Preferences were heterogeneous among different subgroups.</p><p><strong>Conclusions: </strong>Chinese patients with cardiovascular diseases prefer health information scenarios that feature physicians as communicators, disease-related knowledge as the health communication content, and low-cost, offline \"video + audio\" services. Policymakers are advised to consider both monetary and nonmonetary incentives to engage these patients in health information activities. The identified preference heterogeneity suggests the need for tailored policy incentive packages to effectively address the diverse needs of patient subgroups.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1185"},"PeriodicalIF":3.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742175","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":"Enhancing HIV self-testing uptake among university students in Rwanda: the proportion, barriers, and opportunities.","authors":"Ritah Mukashyaka, Gerald Kaberuka, Alain Favina, Dan Lutasingwa, Fred Mulisa, Everest Turatsinze, Ann Karanja, Deborah Kansiime, Egide Niyotwagira, Basile Ikuzo, Mark Mohan Kaggwa, Aflodis Kagaba, Evans Mantiri Mathebula, Gallican N Rwibasira","doi":"10.1186/s12889-025-22387-y","DOIUrl":"https://doi.org/10.1186/s12889-025-22387-y","url":null,"abstract":"<p><strong>Introduction: </strong>University students in Rwanda are at high risk for HIV, yet they have a low uptake of HIV self-testing, which is crucial for HIV diagnosis and prevention. This study investigated their knowledge, behaviors, and perceptions towards HIV self-testing, highlighting the barriers and opportunities whose consideration is necessary for the improvement of HIV self-testing uptake in this population.</p><p><strong>Method: </strong>A concurrent mixed-method design was used, and it involved 424 students from five universities across Rwanda. Quantitative data was collected through surveys, and descriptive statistics were performed. Chi-square tests were performed, and sociodemographic variables were stratified against the awareness of HIV self-testing and HIV self-testing for the past 12 months variables. Qualitative data was collected through in-depth interviews and focus group discussions using interview guides developed based on the Health Belief Model (HBM) framework; data was then analyzed thematically.</p><p><strong>Results: </strong>The mean age was 23 (IQR: 21; 24), with 51.2% (n = 214/424) females. 64.7% (n = 261/424) of students had never heard of HIV self-testing, yet 37.74% (160/424) were sexually active. Among sexually active students, 17.87% were aware of HIV self-testing, but 35.82% had never used it. The reported perceived HIV self-testing barriers include high cost, unavailability of testing kits, lack of awareness, misinformation, and absence of post-test counseling. However, some HIV self-testing opportunities, like the availability of testing kits and motivating factors for university students to test, were also reported.</p><p><strong>Conclusion: </strong>Although university students reported the needs and benefits of HIV self-testing, uptake remains low due to misinformation, unawareness, unavailability, and the high cost of HIV self-testing kits. Increasing awareness, availing HIVST kits, and addressing the other reported barriers to HIV self-testing, is essential for the achievement of the universal goal of HIV status awareness among university students.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1173"},"PeriodicalIF":3.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741903","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":"Hemoglobin as a mediator between air pollution and growth outcomes in children under 60 months: the moderating role of nutritional supplementation.","authors":"Xingyi Jin, Di Wu, Fei Ge, Dan Cui, Ayidana Jumabieke, Xiaoli Wang, Rui Wang, Niannian Wang, Jihan Sun, Wang Liao, Da Pan, Li Shao, Shaokang Wang, Chunyan Yuan, Guiju Sun","doi":"10.1186/s12889-025-22381-4","DOIUrl":"https://doi.org/10.1186/s12889-025-22381-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Prior research has yielded incongruent results about the association between air pollutants and offspring hemoglobin levels, as well as between air pollutants and child development. This may be because previous studies have not taken both air pollution and nutrition into account. This study sought to examine the correlations between postnatal exposure to air pollution (PM&lt;sub&gt;2.5&lt;/sub&gt;, PM&lt;sub&gt;10&lt;/sub&gt;, SO&lt;sub&gt;2&lt;/sub&gt;, and CO), offspring hemoglobin levels, stunting, and underweight. Furthermore, we investigated whether hemoglobin levels mediate these connections and assessed the moderating influence of dietary supplementation on hemoglobin levels and growth outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A unified nutrition package intervention study was conducted in western, China between 2016 and 2023. In accordance with WHO guidelines, stunting, underweight, height-for-age z score (HFA), weight-for-age z score (WFA), and anemia status were all defined. A daily average of PM&lt;sub&gt;2.5&lt;/sub&gt;, PM&lt;sub&gt;10&lt;/sub&gt;, SO&lt;sub&gt;2&lt;/sub&gt;, and CO levels was collected from the National Urban Air Quality Real-Time Dissemination Platform ( http://www.cnemc.cn/sssj/ ) of the China Environmental Monitoring General Station. Linear regression and logistic regression models were used to assess the correlation between air pollution and the above indicators. The mediating role of hemoglobin and the moderating effect of nutritional supplementation were also evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;This study examined the impact of postnatal air pollution exposure on child growth, mediated by hemoglobin levels and moderated by nutritional supplementation (YingYangBao, YYB). Our findings suggest that air pollution negatively affects growth via reduced hemoglobin levels, but extended nutritional supplementation mitigates this effect. A total of 10,766 children under 5 years of age participated in this study. All four air pollutants were associated with reduced hemoglobin levels, but their effects on growth and development were not uniform. Specifically, PM&lt;sub&gt;2.5&lt;/sub&gt; and PM&lt;sub&gt;10&lt;/sub&gt; showed stronger negative associations with HFA and WFA, while SO&lt;sub&gt;2&lt;/sub&gt; and CO had weaker effects. Air pollution had a greater impact on growth outcomes in anemic children compared to non-anemic children. Hemoglobin levels mediated 13.4% of the effect of air pollution on HFA (VAF = 13.4%, Cohen's f² = 0.15). Furthermore, the duration of YYB moderates the effects of air pollution on hemoglobin and HFA. The direct negative effect of air pollution on HFA was attenuated when the duration of use was &gt; 10 months, whereas in the low use group the pollution effect was enhanced (β=-0.0444, 95%CI: -0.0613, -0.03).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Postnatal exposure to air pollution (PM&lt;sub&gt;2.5&lt;/sub&gt;, PM&lt;sub&gt;10&lt;/sub&gt;, SO&lt;sub&gt;2&lt;/sub&gt;, CO) increases the risk of stunting, particularly during the critical developmental window of 6-23 months of age. This effect is partia","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1187"},"PeriodicalIF":3.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742124","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 effect of parental monitoring in the association between parent-child relationship harmony and smartphone addiction: findings from a nationwide youth survey in China.","authors":"Ziyan Meng, Kaiyuan Min, Runping Ma, Juntao Yang, Hui Zhang, Qing Li","doi":"10.1186/s12889-025-22366-3","DOIUrl":"https://doi.org/10.1186/s12889-025-22366-3","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of smartphone addiction among youth has raised concerns. Previous research has indicated that poor parent-child relationship can lead to youth smartphone addiction. However, parent-child relationship harmony involves multiple parties and is difficult to intervene in due to family authority and other factors. Focusing on the pathways between parent-child relationships harmony and smartphone addiction is crucial for preventing smartphone addiction. This study was conducted to examine the role of parental monitoring as a mediator and the role of self-control as a moderator in the association between the parent-child relationship harmony and smartphone addiction among Chinese youth.</p><p><strong>Methods: </strong>The nationwide survey included 9,270 youth in the Chinese mainland. The data collected included individual characteristics, smartphone addiction status, parent‒child relationship harmony, parental monitoring and self-control were collected. Sample weights were applied to ensure that the composition of our sample was consistent with the official statistics for each provincial-level administrative division on gender and school type. Structural equation modeling was used to analyze the mediating effect of parental monitoring and the moderating effect of self-control in the association between the parent-child relationship harmony and smartphone addiction.</p><p><strong>Results: </strong>Among the 10,000 weighted participants, 5,166 (51.7%) were male, and 3,608 (36.0%) were aged 16 to 18 years. Parental monitoring mediated 48.14% (95% CI: 40.24 to 56.03) of the association between the parent‒child relationship harmony and smartphone addiction. The partial mediating effect of parental monitoring was differed across gender and age groups, and there was no significant heterogeneity. Moreover, self-control negatively moderated the indirect effects of parental monitoring on smartphone addiction (β = -0.12, 95% CI: -0.57 to -0.38), and the mediating effect of parental monitoring decreased as self-control increased.</p><p><strong>Conclusion: </strong>Our study explored the association between parent-child relationship harmony and youth smartphone addiction, which appeared to be partially mediated by efficient parental monitoring. Self-control played a moderating role in the indirect pathway of the mediating effect.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1184"},"PeriodicalIF":3.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742205","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":"Correction: Oral health conditions and unmet need among Chinese male adults: a national oral health survey.","authors":"Hui Li, Xiaohui Wen, Shiting Li, Shichao Chen, Yuanpei He, Hongcai Li, Chaoyan Yang, Yingqing Chen, Jingcheng Fu, Zizhuo Wang, Xiaorong Lan, Gang Li, Rui Wang, Guangwen Li","doi":"10.1186/s12889-025-22345-8","DOIUrl":"https://doi.org/10.1186/s12889-025-22345-8","url":null,"abstract":"","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1175"},"PeriodicalIF":3.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742278","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":"COVID-19 symptomatic community illness, hospitalization, and death burden across all ages - New South Wales, Australia, May 2021-July 2022.","authors":"Kelsey M Sumner, Sandra Carlson, Benjamin Elton, Michelle Butler, Janaki Amin, Melissa A Rolfes, Carrie Reed, A Danielle Iuliano, David J Muscatello, Craig Dalton","doi":"10.1186/s12889-025-22021-x","DOIUrl":"https://doi.org/10.1186/s12889-025-22021-x","url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease 2019 (COVID-19) burden is difficult to quantify with cases missed by surveillance systems. During COVID-19 Delta and Omicron BA.1-5 periods, we assessed the COVID-19 burden in New South Wales (NSW), Australia, from May 2021-July 2022 using a participatory surveillance system of self-reported respiratory disease and a database of people seeking healthcare.</p><p><strong>Methods: </strong>To estimate community illness burden, we adjusted the NSW age-stratified non-case population by reported severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) percent positive and acute respiratory illness (ARI) rates. Hospitalization and death burden were estimated by adjusting reported rates to the NSW population and by the proportion of COVID-19 admissions attributable to COVID-19 illness. Burden estimates were compared to reported case counts.</p><p><strong>Results: </strong>From May 2021-July 2022, an estimated 3,450,516 (95%CI: 2,847,355-4,119,472) symptomatic community ARI illnesses, 24,684 (95%CI: 20,714-29,144) hospitalizations, and 4,638 (95% CI: 3,263-6,049) deaths were attributable to COVID-19 in NSW. Reported cases (3,039,239) were 14% lower than the estimated symptomatic community illness burden but within the estimate's 95% confidence interval. Overall, 0.7% of symptomatic community illnesses resulted in hospitalization and 0.1% resulted in death.</p><p><strong>Conclusions: </strong>Estimated symptomatic case hospitalization and fatality risk could be used for COVID-19 modelling and forecasting.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1177"},"PeriodicalIF":3.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742279","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":"Association between depressive symptoms and thyroid nodule incidence in women: a prospective observational study.","authors":"Qijun Liang, Yan Yang, Aisheng Wei, Jue Zhang, Zhenhong Qi, Shouyi Yu","doi":"10.1186/s12889-025-22352-9","DOIUrl":"https://doi.org/10.1186/s12889-025-22352-9","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the association between depressive symptoms and the incidence of thyroid nodules (TNs) in Chinese adults, and explore whether the development, persistence, or recovery from depressive symptoms influences the risk of developing TNs.</p><p><strong>Methods: </strong>A total of 1,537 Chinese adults who underwent medical check-ups, including blood tests, Zung Self-Rating Depression Scales (SDS), and thyroid ultrasound examinations, were included. The association between depressive symptoms and TN prevalence was evaluated, and 818 participants free of TNs at baseline were followed over time. TN incidence rates were analyzed across different mental health statuses: depression-free, depression-developed, depression-recovered, and depression-persistent.</p><p><strong>Results: </strong>The prevalence of depressive symptoms was 31.95%, significantly higher in women than in men (42.60% vs. 25.82%). The prevalence of TNs was also higher in women (38.68% vs. 21.52%). Among women, participants with depressive symptoms had shorter height, higher levels of fasting plasma glucose (FPG), triglycerides (TG), and glutamyl transpeptidase (GGT), lower high-density lipoprotein cholesterol (HDL-C), and a significantly higher prevalence of TNs (46.44% vs. 32.92%, p < 0.01) compared to those without depressive symptoms. Although the FPG levels in depressive women were significantly higher than in non-depressive women, the levels of FPG in both groups remained within the clinically normal range. These differences were not observed in men. Over a mean follow-up of 2.75 years in women, the depression-persistent group (16.48/100 person-years) had a significantly higher TN incidence compared to the depression-free (6.43/100 person-years; age-adjusted HR: 2.679, 95% CI: 1.513-4.742, p = 0.001).</p><p><strong>Conclusions: </strong>Women with persistent depressive symptoms had a higher risk of developing TNs, suggesting that mental health status may influence TN development in women.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1186"},"PeriodicalIF":3.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742272","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":"Association of chronotype and sleep behaviors with mental well-being, eating behaviors, and adiposity traits: a cross-sectional study among a sample of urban Malaysian adults.","authors":"Yee-How Say, Mimi Shamirah Nordin, Alvin Lai Oon Ng","doi":"10.1186/s12889-025-22340-z","DOIUrl":"10.1186/s12889-025-22340-z","url":null,"abstract":"<p><strong>Background: </strong>We investigated the association of chronotype and sleep behaviors with mental well-being, eating behaviors, and adiposity traits among a sample of urban Malaysian adults at Sunway University and Sunway College, Selangor, Malaysia.</p><p><strong>Methods: </strong>A total of 167 participants were recruited (male/female = 46/121; aged 22.0 ± 5.2). Chronotype was assessed via reduced Morningness-Eveningness Questionnaire (rMEQ). Participants tracked their sleep behaviors using an activity wristband (Xiaomi^® Mi Smart Band 5), and recorded their smartphone screen time usage. Psychometric measures - WHO-5 Well-being Index, Cognitive Distortion Questionnaire (CDQUEST), Three-Factor Eating Questionnaire-R18, Brief Self-Control Scale (BSCS), and Power of Food Scale. Blood pressures (BP), anthropometrics, and body composition like high waist circumference (WC), waist-hip ratio (WHR), waist-to-height ratio (WHtR), body mass index (BMI) and visceral fat level (VFL) were also measured.</p><p><strong>Results: </strong>Men and women did not differ significantly in terms of chronotype and sleep behaviors, except Rapid Eye Movement (REM) sleep. Longer weekday total and deep sleeps significantly correlated with better WHO-5 well-being scores, while longer weekend time awake during sleep significantly correlated with greater cognitive distortion (higher CDQUEST scores). Longer average deep sleep significantly correlated with lower Cognitive Restraint (CR) but higher Food Available scores. Higher rMEQ scores (indicating morningness) significantly correlated with better WHO-5 well-being, BSCS Total and Restraint scores; and significantly correlated with decreased systolic and diastolic BP specifically among men. Evening-type participants had up to six-fold higher risk of becoming obese, and having high WC, WHR, and VFL; however, the significance was abolished after adjustment for socio-demographics. Indeed, WC, weight, WHtR, BMI, VFL, and resting metabolism were significantly higher among evening-types by analysis of covariance. BSCS Total and Impulsivity scores were significantly higher among neither-types. Lifestyle factors and smartphone screen time were not associated with chronotype or sleep behaviors.</p><p><strong>Conclusions: </strong>Although chronotype and sleep behaviors did not differ between sexes, those with a morning chronotype had lower overall, central and visceral adiposity, better well-being and self-control. Those with good sleep behaviors also had better well-being, eating and appetitive behaviors. In conclusion, this study supports the continuous advocacy for a morning-chronotype and good sleep behaviors for better physical and mental health.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1168"},"PeriodicalIF":3.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728353","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":"Associations between air pollution and daily outpatient visits for dry eye disease and the effect modification of temperature.","authors":"Dandan Chu, Juan Chen, Chenlu Yang, Yan Li, Mingwei Wang, Junzhe Bao","doi":"10.1186/s12889-025-22187-4","DOIUrl":"10.1186/s12889-025-22187-4","url":null,"abstract":"<p><strong>Background: </strong>Dry eye disease (DED) is one of the most common ocular surface disorders caused by various contributors. Air pollutants are considered a risk factor for ocular surface diseases. We aimed to investigate the associations between air pollutants (PM_2.5, PM₁₀, NO₂, SO₂, CO and O₃) and PM_2.5 constituents and daily outpatient visits for DED, as well as the modifying effect of temperature on the associations.</p><p><strong>Methods: </strong>Daily data on DED outpatient visits and environmental variables during 2014-2019 were collected in Hangzhou, China. Distributed lag nonlinear models (DLNM) combined with time-stratified case-crossover design were utilized to evaluate the effects of air pollutants and PM_2.5 constituents on DED daily outpatient visits during 0‒3 lag days. Furthermore, we also estimated the modification effect of temperature stratified by median. The attributable fraction (AF) of air pollutants and PM_2.5 constituents on DED outpatient visits were quantified. Stratified analyses of gender, age, and seasons were conducted to assess vulnerable population characteristics and high-risk periods.</p><p><strong>Results: </strong>Every interquartile range increase in PM_2.5, PM₁₀, NO₂, SO₂ and CO concentration were significantly associated with daily DED cases. The AF were 6.42% (95% CI: 1.09%, 11.58%), 8.00% (2.60%, 13.60%), 18.65% (11.52%, 25.21%), 10.82% (3.92%, 17.24%) and 12.28% (0.23%, 22.86%), respectively. For PM_2.5 constituents, NO₃^- and NH₄⁺ were associated with DED, with AF of 4.34% (0.21%, 8.11%) and 4.84% (0.18%, 9.09%), respectively. The effects of air pollution were significant in low-temperature level for PM_2.5, PM₁₀, NO₂, SO₂, and CO; while the effects were statistically insignificant in high-temperature level. Subgroup analyses indicated significant associations were present in winter and among patients aged 21-40 but insignificant in other seasons and age groups.</p><p><strong>Conclusion: </strong>Our results revealed that air pollutants were associated with DED outpatient visits. Low temperatures might increase the hazardous effects of air pollution. Besides, individuals aged 21-40 were vulnerable to air pollution, and winter was the high-risk period.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1163"},"PeriodicalIF":3.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728355","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":"Effect of regular exercise on stroke prevention: an instrumental variables approach.","authors":"Wonseok Jeong","doi":"10.1186/s12889-025-22298-y","DOIUrl":"10.1186/s12889-025-22298-y","url":null,"abstract":"<p><strong>Aims: </strong>In South Korea, around 105,000 individuals experience strokes annually, with over 26,000 deaths and the incidence rate is keep rising due to the aging population. Physical inactivity is a major global health issue, and regular exercise is known to prevent many diseases, including stroke. Yet, previous observational studies may be biased due to unobserved factors influencing exercise and stroke occurrence. Therefore, this study aims to examine an impact of regular physical activity on stroke prevention among South Korean adults using instrumental variable approach in order to avoid problems with reverse causality and other unobserved confounding factors.</p><p><strong>Methods: </strong>Data were obtained from the 2014 and 2016 Korean Community Health Surveys of 416,032 Korean adults. Regular exercise was the main independent variable and proximity to exercise facilities is used as an instrument. The dependent variable, presence of stroke, was defined by a doctor's diagnosis. Probit regression analyses were performed to examine the associations between the independent variable and both dependent variable and an instrument. Causal effect of regular exercise on stroke prevention were estimated with the bivariate probit regressions using proximity to exercise facilities as an instrument for regular exercise.</p><p><strong>Results: </strong>Consistent with prior knowledge, proximity to exercise facilities positively influenced regular exercise. The results from both multivariable probit and bivariate probit models indicate that engaging in regular exercise has a strong negative effect on the incidence of stroke. The estimated effects of regular physical activity on stroke prevention range from -0.174 percentage points (ATE) to -0.154 percentage points (ATT) in the bivariate probit model.</p><p><strong>Conclusion: </strong>This study makes an important contribution by providing IV estimates on the effects of conducting regular exercise on stroke prevention based on a representative sample of South Korean adults. My findings suggest that conducting regular exercise reduces the risk of stroke even after accounting for the potential reverse causality and unobserved related factors.</p>","PeriodicalId":9039,"journal":{"name":"BMC Public Health","volume":"25 1","pages":"1167"},"PeriodicalIF":3.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728362","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}