Clinical Epidemiology and Global Health最新文献

Reasons for medication non-adherence among diabetes mellitus patients in Kelantan: A cross-sectional study 吉兰丹州糖尿病患者服药不依从的原因：一项横断面研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-14 DOI: 10.1016/j.cegh.2026.102297

Thamron Keowmani , Erwan Ershad Ahmad Khan , Siti Farhain Amir , Suzita Mukhtar , Raja Nurul Fatin Raja Kamaruzaman , Kok Han Lim , Mohd Azri Mohd Khatib , Nurul Ezzati Arifin , Siti Nur Sarah Saharudin

Objectives

The main objective of this study was to investigate self-reported reasons for medication non-adherence among type 2 diabetes mellitus (T2DM) patients in Kelantan.

Methods

A cross-sectional study was conducted among a representative sample of the Kelantanese population of T2DM patients who refilled their medications at government health clinics between April 15th and May 31st, 2025 (n = 458). Medication adherence was measured using the Simplified Medication Adherence Scale (SMAQ). Reasons for medication non-adherence were obtained via a structured interview. Associations between baseline characteristics and low adherence were estimated using the chi-squared test.

Results

The survey response rate was 83.2 % (472/566). Three percent (14/472) of respondents were excluded from the analysis due to missing data. The top five reasons for non-adherence were ‘I forgot’ 92.3 % (385/417), ‘I was late for/missed the medication refill appointment at the pharmacy counter’ 31.2 % (130/417), ‘Nobody reminds me to take the medications’ 24.7 % (103/417), ‘There are too many medications to take’ 22.1 % (92/417) and ‘I feel healthy’ 21.6 % (90/417). The prevalence of low adherence was 18.8 % (86/417). Distance from home to clinic >5 km (p = 0.045) and the need for assistance in medication taking (p = 0.035) were significantly associated with low adherence.

Conclusions

Our study identified several key reasons for medication non-adherence among patients with T2DM in Kelantan, including forgetfulness, missed refill appointments, lack of reminders, polypharmacy, and the perception of being healthy. Distance to the clinic and reliance on others for medication administration were significantly associated with low adherence. These findings highlight the need for patient-centred interventions that address both behavioural and structural barriers to adherence.

目的本研究的主要目的是调查吉兰丹2型糖尿病（T2DM）患者自我报告的药物不依从性原因。方法对2025年4月15日至5月31日期间在政府卫生诊所补药的吉兰丹岛T2DM患者的代表性样本（n = 458）进行横断面研究。采用简化药物依从性量表（SMAQ）测量药物依从性。不坚持服药的原因通过结构化访谈获得。使用卡方检验估计基线特征与低依从性之间的关联。结果调查回复率为83.2%（472/566）。3%（14/472）的受访者因数据缺失而被排除在分析之外。不遵守规定的前五大原因是“我忘记了”92.3%(385/417)，“我迟到/错过了药房柜台的药物补充预约”31.2%(130/417)，“没有人提醒我吃药”24.7%(103/417)，“药物太多”22.1%（92/417）和“我觉得自己很健康”21.6%（90/417）。低依从性患病率为18.8%（86/417）。从家到诊所的距离>；5 km （p = 0.045）和在服药方面需要帮助（p = 0.035）与低依从性显著相关。结论我们的研究确定了吉兰丹州T2DM患者药物不依从性的几个关键原因，包括健忘、错过补药预约、缺乏提醒、多药和健康的感觉。与诊所的距离和对他人用药的依赖与低依从性显著相关。这些发现强调需要以患者为中心的干预措施，解决行为和结构障碍。

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引用次数: 0

Survival analysis of syphilis infection in pregnant women of Papuan and non-Papuan ethnicities in Jayapura City and Regency, Papua, Indonesia 印度尼西亚巴布亚省查亚普拉市和摄政市巴布亚族和非巴布亚族孕妇梅毒感染的生存分析

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-08 DOI: 10.1016/j.cegh.2025.102278

Mona Safitri Fatiah , Yane Tambing , Sarni Rante Allo Bela , Titi Iswanti Afelya , Genoveva C.C. Mollet , Wilma Florensia , Apriyana Irjayanti , Maxsi Irmanto , Ilmidin

Problem considered

In Papua, Indonesia, syphilis in pregnancy persists as a public health concern, yet the role of ethnicity and culture in infection risk is poorly understood.

Methods

We conducted a prospective cohort study with an embedded mixed-methods design among 977 pregnant women attending their first Antenatal Care (ANC) visits across 15 health centers in Jayapura City and Regency (July 2025–August 2025).

Results

the overall cumulative incidence of syphilis during pregnancy was 11.7 %, differing significantly by ethnicity—13.8 % among Papuan women and 8.7 % among non-Papuan women (log-rank p = 0.03). Papuan women exhibited a higher syphilis risk compared to non-Papuans (AHR = 1.43; 95 % CI: 0.98–2.08), associated with cultural taboos against premarital pregnancy. Additional risk factors included unmarried status (AHR = 1.78; 95 % CI: 1.34–2.36), hepatitis B coinfection (AHR = 2.33; 95 % CI: 1.31–4.16), inconsistent condom use, and uncircumcised partners. Kaplan–Meier curves showed a steep decline in syphilis-free probability during the second and third trimesters. Qualitative insights underscored the influence of stigma, gendered sexual decision-making, and reliance on ANC for diagnosis and treatment.

Conclusion

Maternal syphilis in Jayapura is influenced by intertwined biological, behavioral, and socio-cultural factors. Targeted, culturally sensitive interventions, enhanced ANC utilization, integrated STI/Hepatitis services, and promotion of safe sexual practices are essential to reduce incidence and support elimination efforts.

考虑到的问题在印度尼西亚巴布亚，妊娠期梅毒一直是一个公共卫生问题，但种族和文化在感染风险中的作用却知之甚少。方法采用嵌入式混合方法设计，对查亚普拉市15个卫生中心的977名首次产前护理（ANC）孕妇进行前瞻性队列研究（2025年7月- 2025年8月）。结果妊娠期梅毒的总累积发病率为11.7%，种族差异显著——巴布亚妇女为13.8%，非巴布亚妇女为8.7% （log-rank p = 0.03）。与非巴布亚妇女相比，巴布亚妇女患梅毒的风险更高（AHR = 1.43; 95% CI: 0.98-2.08），这与反对婚前怀孕的文化禁忌有关。其他危险因素包括未婚状态（AHR = 1.78; 95% CI: 1.34-2.36）、乙肝合并感染（AHR = 2.33; 95% CI: 1.31-4.16）、不一致使用安全套和未割包皮的伴侣。Kaplan-Meier曲线显示妊娠中期和晚期无梅毒概率急剧下降。定性的见解强调了污名化、性别化的性决策以及依赖ANC进行诊断和治疗的影响。结论查亚普拉地区孕产妇梅毒受生物学、行为学和社会文化因素的综合影响。有针对性的、具有文化敏感性的干预措施、加强对非注射药物的利用、性传播感染/肝炎综合服务以及促进安全性行为对于降低发病率和支持消除工作至关重要。

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引用次数: 0

LDL-cholesterol goal achievement and guideline adherence among middle-to older-age Irish adults in a primary care setting 低密度脂蛋白胆固醇目标的实现和指南的遵守在初级保健设置中老年爱尔兰成年人

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-07 DOI: 10.1016/j.cegh.2026.102286

Rehab Elhiny , Linda M. O'Keeffe , Seán R. Millar , Stephen Byrne , Margaret Bermingham , Maria Donovan

Background

A significant gap exists between recommended low-density lipoprotein cholesterol (LDL-C) treatment goals and the achievement of these goals in clinical practice. In addition, there remains suboptimal utilization of lipid-lowering therapies (LLT). This study examines the prescribing pattern of LLT and the level of LDL-C goal achievement among Irish adults in a primary care setting. In addition, it identifies patient factors associated with the prescribing of LLT and LDL-C goal achievement.

Methods

This was a cross-sectional analysis of rescreen data from the Mitchelstown Cohort Study. Demographic, medication and diagnosis data were obtained from participant electronic health records. Cardiovascular risk was assessed using the SCORE tool. LDL-C goal achievement was determined using the LDL-C goals set out in the 2011 ESC/EAS guidelines for the management of dyslipidemia.

Results

Among 1183 participants (median age = 65 years), 48.5 % were prescribed LLT, 42 % of whom attained their LDL-C goal. Only 17.5 % were prescribed high-intensity statin therapy and 13 % were prescribed combination therapy. In multivariable analysis, diabetes history, polypharmacy, and hyper-polypharmacy were associated with prescribing LLT. Being male or ≤59 years of age was associated with lower likelihood of LLT prescription. Target LDL-C goal achievement was associated with male sex and age ≤64 or ≥70 years, while BMI 25–29 kg/m² was associated with lower LDL-C goal achievement.

Conclusion

Dyslipidemia is undertreated in this Irish primary care population with limited use of high-intensity statins. This study highlights the gap between guideline recommendations for LLT prescription and LDL-C target goals and real-world implementation of guidelines.

推荐的低密度脂蛋白胆固醇（LDL-C）治疗目标与临床实践中这些目标的实现存在显著差距。此外，降脂疗法（LLT）的应用仍不理想。本研究考察了初级保健环境中爱尔兰成年人的LLT处方模式和LDL-C目标实现水平。此外，它还确定了与LLT处方和LDL-C目标实现相关的患者因素。方法：对来自mitchell stown队列研究的再筛查数据进行横断面分析。从参与者的电子健康记录中获得人口统计、药物和诊断数据。使用SCORE工具评估心血管风险。LDL-C目标的实现是根据2011年ESC/EAS血脂异常管理指南中设定的LDL-C目标来确定的。结果在1183名参与者（中位年龄= 65岁）中，48.5%的人接受了LLT治疗，其中42%的人达到了LDL-C目标。只有17.5%的患者接受了高强度他汀类药物治疗，13%的患者接受了联合治疗。在多变量分析中，糖尿病病史、多重用药和过度多重用药与处方LLT相关。男性或≤59岁与LLT处方的可能性较低相关。LDL-C目标达成与男性性别、年龄≤64岁或≥70岁相关，BMI 25-29 kg/m2与较低的LDL-C目标达成相关。结论：在爱尔兰初级保健人群中，由于高强度他汀类药物的使用有限，血脂异常治疗不足。本研究强调了指南建议的LLT处方和LDL-C目标目标与指南的实际实施之间的差距。

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引用次数: 0

Assessing the hotspot analysis and spatial clustering for pulmonary tuberculosis from 2019 to 2023 in Mysuru district, India 2019 - 2023年印度迈苏尔地区肺结核热点分析及空间聚类分析

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01 DOI: 10.1016/j.cegh.2025.102272

Suhail Azam Khan , M.C. Manjunatha , B.S. Jayaraj , S.K. Chaya , K.S. Lokesh , Mohammad Shiraz Ahmed , P.A. Mahesh

Background

Pulmonary Tuberculosis (PTB) remains a major cause of morbidity in India despite progress in TB elimination, accounting for roughly 25 % of global TB cases. Ongoing spatial and demographic disparities hinder further reduction. The study aims to assess PTB syndemic profiles, spatial distribution, and persistent hotspots in a high-burden Indian district from 2019 to 2023 using geospatial analytics to inform precision public health policies.

Methods

A retrospective cross-section analysis of 10,201 PTB cases in Mysuru district used ArcGIS and Google Earth Pro to examine point density by age, gender, HIV status, and diabetes. Spatial autocorrelation (Moran's I, Getis-Ord Gi∗) identified hotspot clusters, while chi-square tests evaluated demographics and comorbidity trends.

Results

Between 2019 and 2023, PTB cases declined by 7.7 % (from 2245 to 2029). Cases among individuals aged 0–18 and 19–44 fell by 22 % and 22.3 %, respectively. Both male and female cases dropped by about 9.5 %, while diabetes cases rose by 10 % and non-diabetes cases fell by 6.5 %. HIV-positive cases declined by 52.6 %. A Moran's Index of 0.381799, z-score of 31.45, and p-value <0.001 indicate strong, statistically significant spatial clustering.

Conclusion

Despite the overall decline in disease burden, persistent urban PTB clusters continue to affect the elderly and individuals with diabetes. While TB-HIV comorbidity has significantly decreased, the enduring Diabetes-TB overlap highlights the need for integrated, geospatially targeted interventions and continuous GIS-based surveillance to address high-risk clusters and advance TB elimination in urban areas.

背景：尽管在消除结核病方面取得了进展，但肺结核仍然是印度发病的主要原因，约占全球结核病病例的25%。目前的空间和人口差距阻碍了进一步减少。该研究旨在利用地理空间分析，评估2019年至2023年印度高负担地区肺结核的症状概况、空间分布和持续热点，为精确的公共卫生政策提供信息。方法采用ArcGIS和谷歌Earth Pro软件对Mysuru地区10201例PTB病例进行回顾性横断面分析，按年龄、性别、HIV感染状况和糖尿病进行点密度分析。空间自相关（Moran's I, Getis-Ord Gi *）确定了热点集群，而卡方检验评估了人口统计学和合并症趋势。结果2019 - 2023年，肺结核病例下降7.7%（从2245例下降到2029例）。0-18岁和19-44岁的病例分别下降了22%和22.3%。男性和女性病例均下降了约9.5%，而糖尿病病例上升了10%，非糖尿病病例下降了6.5%。艾滋病毒阳性病例下降了52.6%。Moran's Index为0.381799，z-score为31.45，p值<；0.001表明空间聚类性很强，具有统计学意义。结论尽管疾病负担总体下降，但持续存在的城市肺结核集群继续影响老年人和糖尿病患者。虽然结核病-艾滋病毒合并症已显著减少，但长期存在的糖尿病-结核病重叠突出表明，需要采取综合的、有地理空间针对性的干预措施和基于地理信息系统的持续监测，以解决高风险群集问题，并推动城市地区消除结核病。

{"title":"Assessing the hotspot analysis and spatial clustering for pulmonary tuberculosis from 2019 to 2023 in Mysuru district, India","authors":"Suhail Azam Khan , M.C. Manjunatha , B.S. Jayaraj , S.K. Chaya , K.S. Lokesh , Mohammad Shiraz Ahmed , P.A. Mahesh","doi":"10.1016/j.cegh.2025.102272","DOIUrl":"10.1016/j.cegh.2025.102272","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary Tuberculosis (PTB) remains a major cause of morbidity in India despite progress in TB elimination, accounting for roughly 25 % of global TB cases. Ongoing spatial and demographic disparities hinder further reduction. The study aims to assess PTB syndemic profiles, spatial distribution, and persistent hotspots in a high-burden Indian district from 2019 to 2023 using geospatial analytics to inform precision public health policies.</div></div><div><h3>Methods</h3><div>A retrospective cross-section analysis of 10,201 PTB cases in Mysuru district used ArcGIS and Google Earth Pro to examine point density by age, gender, HIV status, and diabetes. Spatial autocorrelation (Moran's I, Getis-Ord Gi∗) identified hotspot clusters, while chi-square tests evaluated demographics and comorbidity trends.</div></div><div><h3>Results</h3><div>Between 2019 and 2023, PTB cases declined by 7.7 % (from 2245 to 2029). Cases among individuals aged 0–18 and 19–44 fell by 22 % and 22.3 %, respectively. Both male and female cases dropped by about 9.5 %, while diabetes cases rose by 10 % and non-diabetes cases fell by 6.5 %. HIV-positive cases declined by 52.6 %. A Moran's Index of 0.381799, z-score of 31.45, and p-value <0.001 indicate strong, statistically significant spatial clustering.</div></div><div><h3>Conclusion</h3><div>Despite the overall decline in disease burden, persistent urban PTB clusters continue to affect the elderly and individuals with diabetes. While TB-HIV comorbidity has significantly decreased, the enduring Diabetes-TB overlap highlights the need for integrated, geospatially targeted interventions and continuous GIS-based surveillance to address high-risk clusters and advance TB elimination in urban areas.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"37 ","pages":"Article 102272"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intersecting cultural beliefs and structural barriers: Healthcare-Seeking for buruli ulcer in Imo State, Nigeria 交叉的文化信仰和结构性障碍：尼日利亚伊莫州布鲁里溃疡的求医情况

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01 DOI: 10.1016/j.cegh.2025.102283

Chigozie Divine Onwuka , Evangeline Tochi Oparaocha

Problem

Buruli ulcer (BU), caused by Mycobacterium ulcerans, is a neglected tropical disease endemic to parts of Nigeria. Despite its public health impact, healthcare-seeking behavior in rural communities’ remains poorly understood, limiting targeted interventions.

Methods

A cross-sectional mixed-methods study was conducted in four endemic LGAs of Imo State. Quantitative data were collected from 300 respondents using structured questionnaires, while qualitative data were generated through 30 in-depth interviews with patients and caregivers, 12 interviews with traditional healers, 9 key informant interviews with health workers, and 7 focus group discussions. Quantitative analysis employed descriptive statistics and logistic regression, while qualitative transcripts were analyzed thematically using the Socio-Ecological Model

Results

Only 27.4 % of respondents sought biomedical care within two weeks of symptom onset, while 34.7 % consulted traditional healers first. Delayed hospital presentation was associated with low education (AOR = 2.14; 95 % CI: 1.4–3.8), belief in spiritual causation (AOR = 1.88; 95 % CI: 1.1–3.3), residing more than 5 km from the nearest health facility (AOR = 1.76; 95 % CI: 1.5–4.5), and lack of health insurance (AOR = 1.54; 95 % CI: 1.1–2.8). Qualitative data revealed spiritual interpretations, poverty, gender inequities, stigma, and mistrust of health facilities as barriers

Conclusion

Healthcare-seeking for BU in Imo State is constrained by the intersection of cultural beliefs and structural barriers. Interventions should combine culturally sensitive education, stigma reduction, financial protection, and decentralized service delivery to improve timely access to care.

问题由溃疡分枝杆菌引起的布鲁里溃疡是尼日利亚部分地区流行的一种被忽视的热带病。尽管它对公共卫生有影响，但对农村社区的求医行为仍然知之甚少，这限制了有针对性的干预措施。方法采用横截面混合方法对伊莫州4例地方性lga进行研究。使用结构化问卷从300名受访者中收集定量数据，同时通过对患者和护理人员的30次深度访谈、对传统治疗师的12次访谈、对卫生工作者的9次关键信息提供者访谈和7次焦点小组讨论产生定性数据。定量分析采用描述性统计和逻辑回归，定性记录采用社会生态模型进行主题分析。结果只有27.4%的受访者在症状出现两周内寻求生物医学治疗，而34.7%的受访者首先咨询传统治疗师。延迟就诊与受教育程度低（AOR = 2.14; 95% CI: 1.4-3.8）、信仰精神因果关系（AOR = 1.88; 95% CI: 1.1-3.3）、居住距离最近的医疗机构超过5公里（AOR = 1.76; 95% CI: 1.5-4.5）以及缺乏医疗保险（AOR = 1.54; 95% CI: 1.1-2.8）有关。定性数据显示精神解释、贫困、性别不平等、耻辱和对卫生设施的不信任是障碍。结论伊莫州布鲁里溃疡的求医受到文化信仰和结构性障碍的交叉制约。干预措施应结合文化敏感教育、减少污名、财务保护和分散服务提供，以改善及时获得护理的机会。

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引用次数: 0

Factors associated with lymphatic filariasis in Indonesia 印度尼西亚与淋巴丝虫病相关的因素

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01 DOI: 10.1016/j.cegh.2025.102277

Sinta Dewi Lestyoningrum , Adistha Eka Noveyani , Debri Rizki Faisal , Wahyu Pudji Nugraheni , Syarifah Nuraini , Indah Pawitaningtyas , Linta Meyla Putri

Problem considered

Lymphatic filariasis (LF) remains a significant public health issue in Indonesia despite global progress and national elimination efforts. This study aimed to comprehensively assess the influence of socioeconomic characteristics, preventive behaviors, and housing environmental factors on the risk of LF among Indonesian adults.

Methods

This cross-sectional study used the 2023 Indonesia Health Survey to examine associations between socioeconomic factors, protective behaviors, housing characteristics, and lymphatic filariasis (LF) among 570,618 adults. Associations with LF were analyzed using multivariable logistic regression, with results reported as adjusted odds ratios (AORs) and 95 % confidence intervals.

Results

The prevalence of LF was 0.14 %. Socio-demographic characteristics (age, sex, education, wealth index, and residence) were not statistically associated with LF risk. However, regular use of mosquito repellents (sprays, coils, electric devices) was significantly associated with a 25 % reduction in LF risk (AOR 0.75, 95 % CI: 0.59–0.95). Living in houses with non-permanent roofing (AOR 1.49, 95 % CI: 0.97–2.28) and without ceilings (AOR 1.20, 95 % CI: 0.93–1.54) showed increased, though non-significant, odds of LF occurrence.

Conclusion

LF risk in Indonesia is not distinguished by socioeconomic status but is more strongly determined by consistent adoption of protective behaviors and housing quality. Universal access to mosquito repellents and targeted improvement in housing infrastructure should be prioritized as equitable and effective LF control strategies.

考虑的问题淋巴丝虫病（LF）在印度尼西亚仍然是一个重大的公共卫生问题，尽管全球取得了进展，国家也在努力消除。本研究旨在综合评估印尼成人社会经济特征、预防行为和居住环境因素对LF风险的影响。方法：本横断面研究使用2023年印度尼西亚健康调查来检查570,618名成年人的社会经济因素、保护行为、住房特征和淋巴丝虫病（LF）之间的关系。使用多变量逻辑回归分析与LF的关联，结果报告为调整优势比（AORs）和95%置信区间。结果LF患病率为0.14%。社会人口特征（年龄、性别、教育程度、财富指数和居住地）与LF风险无统计学关联。然而，经常使用驱蚊剂（喷雾剂、蚊香、电子装置）与LF风险降低25%显著相关（AOR 0.75, 95% CI: 0.59-0.95）。生活在非永久性屋顶（AOR 1.49, 95% CI: 0.97-2.28）和没有天花板（AOR 1.20, 95% CI: 0.93-1.54）的房屋中，尽管不显著，但LF发生的几率增加。结论印度尼西亚的lf风险不受社会经济地位的影响，而更大程度上取决于是否采取保护行为和住房质量。普及驱蚊剂和有针对性地改善住房基础设施应作为公平和有效的疟疾控制战略予以优先考虑。

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引用次数: 0

Tranexamic acid in bleeding management of advanced cancer in palliative care: A systematic review 氨甲环酸在姑息治疗中晚期癌症出血管理中的应用：系统综述

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01 DOI: 10.1016/j.cegh.2025.102274

Ian Huang , Dion Ravinder Theodeus Subroto , Felicia Nathania Kosasih , Stephen Tjandra , Darien Alfa Cipta

Problem considered

Bleeding complications in patients with advanced cancer receiving palliative care pose a significant clinical challenge. Tranexamic acid (TXA) has been explored as a potential therapeutic option for bleeding control. This review aimed to summarize the evidence on TXA, with a primary focus on the efficacy and safety profile of TXA in addressing bleeding issues in advanced cancer patients within palliative care.

Methods

A systematic literature search using relevant keywords was conducted in medical databases, including PubMed, EBSCO, Google Scholar and Cochrane Central Library, from inception to September 14th, 2023. Randomized controlled trials (RCTs), observational studies, and case series or case reports that evaluated the use of TXA in advanced cancer patients for bleeding management in palliative care settings were included.

Results

A total of eleven studies were included, comprising one observational study, one non-randomized study, six case reports, and three case series. Among the advanced cancer patients, the majority (87 %) had solid tumors. The overall success rate for bleeding cessation was 91.3 %, with a median of 3 days (ranging 15 min to 30 days) to achieve complete bleeding cessation. All routes of TXA administration with varying dosages were documented, including subcutaneous (46.5 %), oral (23.3 %), intravenous (18.6 %), and topical (11.6 %). Thromboembolic events were observed in 4.3 % of patients. No RCTs were identified during our search.

Conclusion

Tranexamic acid appears to be an effective and well-tolerated option for managing bleeding in advanced cancer patients receiving palliative care. Further research is needed to establish optimal dosing regimens and confirm its safety.

接受姑息治疗的晚期癌症患者的出血并发症是一个重大的临床挑战。氨甲环酸（TXA）已被探索作为一种潜在的治疗选择出血控制。本综述旨在总结有关TXA的证据，主要关注TXA在姑息治疗中解决晚期癌症患者出血问题的有效性和安全性。方法采用相关关键词系统检索PubMed、EBSCO、谷歌Scholar、Cochrane Central Library等医学数据库自成立至2023年9月14日的相关文献。随机对照试验（rct）、观察性研究、病例系列或病例报告评估了在姑息治疗环境中使用TXA治疗晚期癌症患者出血的情况。结果共纳入11项研究，包括1项观察性研究、1项非随机研究、6例病例报告和3个病例系列。在晚期癌症患者中，大多数（87%）存在实体瘤。止血的总成功率为91.3%，中位数为3天（15分钟至30天）达到完全止血。所有不同剂量的TXA给药途径均被记录在案，包括皮下给药（46.5%）、口服给药（23.3%）、静脉给药（18.6%）和局部给药（11.6%）。4.3%的患者发生血栓栓塞事件。在我们的搜索中没有发现随机对照试验。结论氨甲环酸是一种治疗晚期癌症姑息治疗患者出血的有效且耐受性良好的选择。需要进一步研究以确定最佳给药方案并确认其安全性。

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引用次数: 0

Determinants of permanent contraceptive use among multiparous women in Indonesia: The role of education and other demographic factors 印度尼西亚多胎妇女永久使用避孕药具的决定因素：教育和其他人口因素的作用

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01 DOI: 10.1016/j.cegh.2025.102280

Maya Fitria , Agung Dwi Laksono , Isyatun Mardhiyah Syahri , Ratna Dwi Wulandari , Yuly Astuti , Ratu Matahari , Purwo Setiyo Nugroho

Problem considered

Increased education for women, in line with their increased independence in making decisions for their good. The study analyzed the role of education and demographic factors in permanent contraceptive use among multiparous women in Indonesia.

Methods

This cross-sectional study examined 33,471 respondents. We used permanent contraceptives as an outcome variable and education level as an exposure variable. The study also uses nine control variables (residence, age, partner, employment, wealth, family planning (FP) information exposure from the radio, television, and the internet, and the number of living children). The study used binary logistic regression to assess the association between education level and the use of permanent contraceptives, adjusting for relevant control variables.

Results

The results showed that the average permanent contraceptive use among multiparous women in Indonesia is 78.7 %. Primary education was 1.747 times more likely than no formal education to use permanent contraceptives (AOR 1.747; 95 % CI 1.458–2.092). Meanwhile, secondary education was 3.295 times more likely to use permanent contraceptives than no formal education (AOR 3.295; 95 % CI 2.720–3.991). Moreover, higher education was 5.360 times more likely than no formal education to utilize permanent contraceptives (AOR 5.360; 95 % CI 4.227–6.796).

Conclusions

The study concluded that education level was associated with permanent contraceptive use among multiparous women in Indonesia. The higher the education level, the higher the possibility of using permanent contraceptives. Moreover, the study also found all control variables associated with permanent contraceptive use among multiparous women in Indonesia.

考虑到的问题妇女受教育程度的提高，与她们为自己的利益作出决定的独立性的提高相一致。该研究分析了教育和人口因素在印度尼西亚多胎妇女长期使用避孕药具方面的作用。方法本横断面研究调查了33471名受访者。我们使用永久性避孕药作为结果变量，教育水平作为暴露变量。该研究还使用了9个控制变量（居住地、年龄、伴侣、就业、财富、从广播、电视和互联网获取的计划生育信息，以及活着的孩子数量）。本研究采用二元逻辑回归评估教育水平与使用永久性避孕药具之间的关系，并对相关控制变量进行调整。结果调查结果显示，印度尼西亚多胎妇女的平均永久避孕药具使用率为78.7%。接受过初等教育的人使用永久性避孕药具的可能性是未接受过正规教育的人的1.747倍（AOR 1.747; 95% CI 1.458-2.092）。与此同时，中等教育人群使用永久性避孕药具的可能性是未接受正规教育人群的3.295倍（AOR 3.295; 95% CI 2.720-3.991）。此外，受过高等教育的人使用永久性避孕药具的可能性是没有受过正规教育的人的5.360倍（AOR 5.360; 95% CI 4.227-6.796）。结论教育水平与印度尼西亚多胎妇女长期使用避孕药具有关。受教育程度越高，使用永久性避孕药具的可能性越高。此外，该研究还发现了与印度尼西亚多胞胎妇女长期使用避孕药具相关的所有控制变量。

{"title":"Determinants of permanent contraceptive use among multiparous women in Indonesia: The role of education and other demographic factors","authors":"Maya Fitria , Agung Dwi Laksono , Isyatun Mardhiyah Syahri , Ratna Dwi Wulandari , Yuly Astuti , Ratu Matahari , Purwo Setiyo Nugroho","doi":"10.1016/j.cegh.2025.102280","DOIUrl":"10.1016/j.cegh.2025.102280","url":null,"abstract":"<div><h3>Problem considered</h3><div>Increased education for women, in line with their increased independence in making decisions for their good. The study analyzed the role of education and demographic factors in permanent contraceptive use among multiparous women in Indonesia.</div></div><div><h3>Methods</h3><div>This cross-sectional study examined 33,471 respondents. We used permanent contraceptives as an outcome variable and education level as an exposure variable. The study also uses nine control variables (residence, age, partner, employment, wealth, family planning (FP) information exposure from the radio, television, and the internet, and the number of living children). The study used binary logistic regression to assess the association between education level and the use of permanent contraceptives, adjusting for relevant control variables.</div></div><div><h3>Results</h3><div>The results showed that the average permanent contraceptive use among multiparous women in Indonesia is 78.7 %. Primary education was 1.747 times more likely than no formal education to use permanent contraceptives (AOR 1.747; 95 % CI 1.458–2.092). Meanwhile, secondary education was 3.295 times more likely to use permanent contraceptives than no formal education (AOR 3.295; 95 % CI 2.720–3.991). Moreover, higher education was 5.360 times more likely than no formal education to utilize permanent contraceptives (AOR 5.360; 95 % CI 4.227–6.796).</div></div><div><h3>Conclusions</h3><div>The study concluded that education level was associated with permanent contraceptive use among multiparous women in Indonesia. The higher the education level, the higher the possibility of using permanent contraceptives. Moreover, the study also found all control variables associated with permanent contraceptive use among multiparous women in Indonesia.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"37 ","pages":"Article 102280"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Associated factors for low modern contraceptive use and high unmet needs among postpartum women in Nepal: A cross-sectional study 尼泊尔产后妇女现代避孕药具使用率低和未满足需求高的相关因素：一项横断面研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01 DOI: 10.1016/j.cegh.2025.102281

Gita Shrestha, Minato Nakazawa

Problem considered

Postpartum family planning (PPFP) plays a crucial role in reducing unintended pregnancies. However, many low-resource countries, including Nepal, have limited uptake of modern contraceptives. This study assessed PPFP use and unmet contraceptive needs among women within six months postpartum and identified factors associated with it.

Methods

This was a cross-sectional study. Of the 33 healthcare facilities screened, eight met the inclusion criteria. A total of 241 women who provided consent were enrolled in the study. Descriptive analyses were conducted using Jamovi version 2.6.2.0, and multivariate logistic regression was performed in R version 4.4.2 to identify predictors of modern contraceptive use. Odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated, with statistical significance set at p < 0.05.

Result

Logistic regression revealed key predictors of modern family planning: higher parity (OR = 2.55, 95 % CI: 1.02–6.39, p = 0.045), knowledge of ovulation (OR = 3.20, 95 % CI: 1.03–9.88, p = 0.043), and past family planning (FP) use (OR = 4.57, 95 % CI: 1.86–11.22, p < 0.001) were significantly associated with modern contraceptive use. Conversely, having a last child under two years (OR = 0.49, 95 % CI: 0.25–0.98, p = 0.043) was associated with a negative outcome.

Conclusion

Almost two-thirds of the women wish to delay or prevent a future pregnancy, and one in six women adopted modern contraceptives within six months postpartum. Interventions aimed at increasing the adoption of effective contraceptive methods are urgently needed to reduce unmet needs and improve maternal and child health outcomes.

产后计划生育（PPFP）在减少意外怀孕方面起着至关重要的作用。然而，包括尼泊尔在内的许多资源匮乏的国家对现代避孕药具的使用有限。本研究评估了产后6个月内妇女PPFP的使用和未满足的避孕需求，并确定了与之相关的因素。方法采用横断面研究。在筛选的33家医疗机构中，有8家符合纳入标准。共有241名提供同意的妇女参加了这项研究。使用Jamovi 2.6.2.0版本进行描述性分析，并使用R 4.4.2版本进行多因素logistic回归，以确定现代避孕措施使用的预测因素。计算95%置信区间（ci）的优势比（ORs）， p <； 0.05为统计学显著性。结果logistic回归分析显示，现代计划生育的主要预测因素为：较高胎次（OR = 2.55, 95% CI: 1.02 ~ 6.39, p = 0.045）、排卵知识（OR = 3.20, 95% CI: 1.03 ~ 9.88, p = 0.043）、过去计划生育（FP）使用情况（OR = 4.57, 95% CI: 1.86 ~ 11.22, p < 0.001）与现代避孕措施的使用有显著相关性。相反，最后一个孩子在两岁以下（OR = 0.49, 95% CI: 0.25-0.98, p = 0.043）与负面结果相关。结论近三分之二的妇女希望推迟或预防未来怀孕，六分之一的妇女在产后六个月内采取了现代避孕措施。迫切需要采取旨在增加有效避孕方法的干预措施，以减少未得到满足的需求并改善孕产妇和儿童健康结果。

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引用次数: 0

Optimizing predictive analytics for childhood anaemia: A machine learning model approach 优化儿童贫血的预测分析：机器学习模型方法

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-01-01 DOI: 10.1016/j.cegh.2025.102275

Baby Das , Manash Pratim Barman , Manas Jyoti Kotoky

Problem considered

Anaemia remains a prevalent public health concern, particularly among children under five, with multifactorial causes including nutritional deficiencies, maternal health, and socioeconomic status. This study aims to enhance the prediction and understanding of childhood anaemia of Assam, India using machine learning (ML) techniques.

Methods

Using data from the National Family Health Survey-5 (NFHS-5) in Assam, India, a total of 8411 children were analyzed. Ten key predictors were identified using the Boruta algorithm and chi-square tests. Due to class imbalance, the dataset was balanced using Synthetic Minority Over-sampling Technique for Nominal and Continuous (SMOTE-NC). Four supervised ML models Logistic Regression, Random Forest, K-Nearest Neighbors (KNN), and Gradient Boosting were trained and evaluated using k-fold cross-validation.

Result

Gradient Boosting outperformed other models, achieving an accuracy of 77.2 %, precision of 79.2 %, recall of 77.2 %, F1-score of 76.7 %, and AUC value of 0.83 after balancing. Model interpretability was achieved by using an explainable AI tool i.e. SHAP (SHapley Additive exPlanations), which revealed that environmental, socio-economic and maternal factors such as roof and floor material, child's age, mother's anaemia level, and place of de-livery (Home/Public sector) significantly influenced anaemia risk.

Conclusion

The study demonstrates the effectiveness of ML in not only predicting anaemia with high accuracy but also uncovering actionable risk factors for public health interventions. It highlights the need for data-driven approaches in addressing childhood anaemia, especially in low-resource settings.

贫血仍然是一个普遍存在的公共卫生问题，特别是在五岁以下儿童中，其病因有多种因素，包括营养缺乏、孕产妇健康和社会经济地位。本研究旨在利用机器学习（ML）技术提高对印度阿萨姆邦儿童贫血的预测和理解。方法利用印度阿萨姆邦国家家庭健康调查-5 （NFHS-5）的数据，对8411名儿童进行分析。使用Boruta算法和卡方检验确定了10个关键预测因子。由于类不平衡，使用名义和连续合成少数过采样技术（SMOTE-NC）对数据集进行平衡。使用k-fold交叉验证对逻辑回归、随机森林、k-近邻（KNN）和梯度增强四个监督机器学习模型进行了训练和评估。结果gradient Boosting的准确率为77.2%，精密度为79.2%，召回率为77.2%，f1得分为76.7%，平衡后的AUC值为0.83，优于其他模型。模型的可解释性是通过使用可解释的人工智能工具，即SHAP （SHapley加性解释）来实现的，该工具揭示了环境、社会经济和孕产妇因素，如屋顶和地板材料、儿童年龄、母亲贫血程度和分娩地点（家庭/公共部门）对贫血风险有显著影响。结论ML不仅能准确预测贫血，还能揭示可操作的危险因素，为公共卫生干预提供依据。报告强调，在解决儿童贫血问题时，特别是在资源匮乏的环境中，需要采用数据驱动的方法。

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引用次数: 0