Clinical Epidemiology and Global Health最新文献

Development and validation of NutriSmart: A mobile application for nutrition education in South Indian preschool children NutriSmart的开发和验证：南印度学龄前儿童营养教育的移动应用程序

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-03-01 Epub Date: 2026-02-13 DOI: 10.1016/j.cegh.2026.102319

Faseela Mohammed Rasheed , Pratheesh P. Gopinath , Beela G.K

Problem considered

Early childhood nutrition education tools lack cultural relevance for South Indian populations, with no existing applications specifically designed for preschool children aged 3-6 years. Poor dietary patterns established during this critical period persist into adulthood, contributing to long-term health complications.

Methods

A user-centered design approach was employed involving stakeholder consultation (n = 15 across focus groups and individual interviews), development of a 1023-item South Indian food database using ICMR-IFCT 2017, and psychometric validation with 35 parents of preschool children over one month in Thiruvananthapuram district, Kerala. Content validity (expert review), face validity, internal consistency reliability (Cronbach's α), and test-retest reliability were assessed across four domains: usability, content quality, perceived effectiveness, and trust.

Results

Content validity was confirmed by expert panel (I-CVI: 0.80-1.00, S-CVI/Ave: 0.92). NutriSmart demonstrated high internal consistency (α = 0.82-0.89) and excellent test-retest reliability (ICC = 0.85-0.91) across all domains. The application achieved a user-centered design score of 9/11, comparable to established paediatric nutrition applications. User feedback during testing led to iterative improvements including enhanced food selection interface and expanded allergen profiles (8 to 14 items).

Conclusion

NutriSmart is a psychometrically validated, culturally relevant digital nutrition education tool for South Indian preschool children, demonstrating strong preliminary validity, reliability, and user acceptance for promoting healthy eating behaviors in early childhood.

儿童营养教育工具对南印度人口缺乏文化相关性，目前没有专门为3-6岁学龄前儿童设计的应用程序。在这一关键时期形成的不良饮食模式会持续到成年，导致长期的健康并发症。方法采用以用户为中心的设计方法，包括利益相关者咨询（焦点小组和个人访谈中n = 15），使用ICMR-IFCT 2017开发1023项南印度食品数据库，并对喀拉拉邦蒂鲁凡南塔普拉姆地区35名学龄前儿童的父母进行心理测量验证，为期一个月。内容效度（专家评审）、面孔效度、内部一致性信度（Cronbach’s α）和重测信度在可用性、内容质量、感知有效性和信任四个领域进行评估。结果内容效度经专家小组确认（I-CVI: 0.80-1.00, S-CVI/Ave: 0.92）。NutriSmart在各领域具有较高的内部一致性（α = 0.82-0.89）和良好的重测信度（ICC = 0.85-0.91）。该应用程序实现了以用户为中心的设计得分为9/11，与已建立的儿科营养应用程序相当。测试期间的用户反馈导致了迭代改进，包括增强食物选择界面和扩展过敏原概况（8至14项）。结论nutrismart是一款经过心理测量学验证、与文化相关的南印度学龄前儿童数字营养教育工具，在促进幼儿健康饮食行为方面具有较强的初步效度、信度和用户接受度。

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引用次数: 0

Knowledge, attitudes, and practices regarding dietary salt intake and its relationship with blood pressure in Vietnamese adults 越南成年人关于饮食盐摄入量及其与血压关系的知识、态度和实践

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-03-01 Epub Date: 2026-02-28 DOI: 10.1016/j.cegh.2026.102323

Hai Thanh Nguyen , Kien Trung Dong , Diem Thi Hong Nguyen , Hong Thi Nguyen , Khoa Xuan Tang , Anh Hai Cao , Linh Thuy Nguyen , Tuyet Thi Hong Nguyen , Duc Minh Cap

Objectives

This study aimed to assess knowledge, attitudes, and practices (KAP) related to dietary salt intake and to investigate the association between KAP and blood pressure among adults in Vietnam.

Methods

A cross-sectional study was conducted involving 2100 participants selected through a multistage random sampling method. Data were collected through face-to-face interviews using a structured questionnaire and anthropometric measurements. Multivariable logistic regression models were employed to identify factors associated with KAP, while multivariable linear regression models were used to examine the relationship between KAP levels and blood pressure.

Results

Among the 2100 participants, 24.9% demonstrated good knowledge, 32.3% exhibited positive attitudes, and 6.5% reported good practices regarding dietary salt intake. Only 11.1% of participants had good overall KAP. Participants with good knowledge had systolic blood pressure that was 1.80 mmHg lower than those with poor knowledge (95% CI: −3.15 to −0.45; p = 0.009). Similarly, participants with good practices had diastolic blood pressure that was 1.83 mmHg lower than those with poor practices (95% CI: −3.40 to −0.26; p = 0.023). Furthermore, participants with good overall KAP had lower systolic (−2.78 mmHg; 95% CI: −4.00 to −1.57; p < 0.001) and diastolic blood pressure (−2.27 mmHg; 95% CI: −4.07 to −0.47; p = 0.013) compared with those with poor overall KAP.

Conclusions

This study underscores the importance of improving knowledge and practices regarding dietary salt intake to enhance blood pressure control. Public health interventions promoting awareness and healthy behaviors may play a critical role in reducing hypertension.

目的本研究旨在评估越南成年人与膳食盐摄入相关的知识、态度和实践（KAP），并调查KAP与血压之间的关系。方法采用多阶段随机抽样法对2100名被试进行横断面研究。数据通过面对面访谈收集，使用结构化问卷和人体测量测量。多变量logistic回归模型用于确定与KAP相关的因素，而多变量线性回归模型用于检验KAP水平与血压之间的关系。结果在2100名参与者中，24.9%的人表现出良好的知识，32.3%的人表现出积极的态度，6.5%的人表现出良好的饮食盐摄入习惯。只有11.1%的参与者具有良好的总体KAP。知识较好的参与者收缩压比知识较差的参与者低1.80 mmHg （95% CI: - 3.15至- 0.45;p = 0.009）。同样，良好习惯的参与者的舒张压比不良习惯的参与者低1.83 mmHg （95% CI: - 3.40至- 0.26;p = 0.023）。此外，与总体KAP较差的参与者相比，总体KAP较好的参与者收缩压（- 2.78 mmHg; 95% CI: - 4.00至- 1.57;p < 0.001）和舒张压（- 2.27 mmHg; 95% CI: - 4.07至- 0.47;p = 0.013）较低。结论本研究强调了提高饮食盐摄入知识和实践对加强血压控制的重要性。提高意识和健康行为的公共卫生干预措施可能在降低高血压中发挥关键作用。

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引用次数: 0

Prevalence and outcome of children with acute viral hepatitis using complementary and alternative medications (CAM) presenting to a tertiary care center of North India: A prospective observational study 印度北部三级保健中心对急性病毒性肝炎患儿使用补充和替代药物（CAM）的患病率和结果：一项前瞻性观察研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-03-01 Epub Date: 2026-02-18 DOI: 10.1016/j.cegh.2026.102304

Prerna Priyadarshini , Sudhir Verma , Manisha Verma , Sanjeev Kumar Verma

Objective

The use of complementary and alternative medicine (CAM) is a widespread practice worldwide for treating a variety of health conditions. The impact of CAM related drug induced liver injury (DILI) in pediatric population is not known. Therefore, this study is planned to examine the prevalence of use of CAMs in children with acute viral hepatitis (AVH) and to describe the outcome of CAM related liver injury (second hit) in children with hepatitis A and E related AVH.

Methods

This prospective observational study included children aged 1 to 18 years with AVH who presented to a tertiary care center in North India between April 2024 and September 2024. Clinical and laboratory details were noted on a predesigned format, including detailed history of use of CAM. Groups of children with AVH with and without use of CAMs were compared.

Result

During the study period 78 patients with AVH presented to the Department of Paediatrics of which 60 were enrolled. Thirty-seven (62%) had history of CAM use in past. On univariate analysis, pruritus (p = 0.021), ascites (p < 0.001), hepatic encephalopathy (p = 0.021), and pediatric acute liver failure (PALF) (p = 0.001) were significantly more common among children with acute viral hepatitis who used complementary and alternative medicine (CAM). Variables found to be significant on univariate analysis were subjected to multivariate analysis. PALF (adjusted OR: 9.141; 95% CI: 1.526–54.764; p = 0.015) was independently associated with CAM use among children with AVH. The mortality rate among children with AVH who used CAM was 5.4% in this study.

Conclusion

The present study clearly highlights the high prevalence of CAM use in the pediatric population with AVH. Pruritus, ascites and PALF complicate, natural AVH course with CAM use.

目的补充和替代医学（CAM）的使用是世界范围内治疗各种健康状况的广泛做法。CAM相关药物性肝损伤（DILI）对儿科人群的影响尚不清楚。因此，本研究计划检查急性病毒性肝炎（AVH）儿童使用CAM的流行程度，并描述甲型肝炎和戊型肝炎相关AVH儿童CAM相关肝损伤（二次打击）的结局。方法本前瞻性观察研究纳入了2024年4月至2024年9月在印度北部三级保健中心就诊的1至18岁AVH患儿。临床和实验室细节记录在预先设计的格式上，包括详细的CAM使用历史。比较使用CAMs和不使用CAMs的AVH患儿组。结果在研究期间，78例AVH患者到儿科就诊，其中60例入选。37人（62%）既往有CAM使用史。在单变量分析中，瘙痒（p = 0.021）、腹水（p < 0.001）、肝性脑病（p = 0.021）和小儿急性肝衰竭（p = 0.001）在使用补充替代药物（CAM）的急性病毒性肝炎患儿中更为常见。在单变量分析中发现显著的变量进行多变量分析。PALF（校正OR: 9.141; 95% CI: 1.526-54.764; p = 0.015）与AVH患儿使用CAM独立相关。在本研究中，使用CAM的AVH儿童死亡率为5.4%。结论本研究清楚地强调了儿童AVH人群中CAM的高患病率。瘙痒，腹水和PALF复杂，自然AVH病程与CAM使用。

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引用次数: 0

Cow's milk protein-induced FPIES: Clinical outcomes in severe cases 牛奶蛋白诱导的FPIES：重症病例的临床结果

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-03-01 Epub Date: 2026-01-17 DOI: 10.1016/j.cegh.2025.102235

Príscila da Silva Pereira Vasconcelos, Tassiana dos Anjos, Juliana Bellote, Elizete Aparecida Lomazi, Maria Ângela Bellomo-Brandão

Problem considered

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a rare and poorly understood condition that primarily affects infants and young children. This study aimed to evaluate the clinical characteristics and outcomes of patients diagnosed with severe cow's milk protein-induced FPIES.

Methods

A case series was conducted involving pediatric patients who underwent oral food challenges OFCs for FPIES exclusively triggered by cow's milk protein, followed at the pediatric gastroenterology outpatient clinic of a quaternary hospital between January 16, 2018, and June 20, 2024.

Results

A total of six patients were included, and 24 OFCs were assessed. The median age at symptom onset was 44 days (range: 3–99 days). Before the first OFC, the median duration of the elimination diet was 11.2 months (Q1: 8.7 – Q3: 27 months; IQR: 18.3 months); for patients requiring additional OFCs, the median duration was 35.17 months (Q1: 27.27 – Q3: 72.2 months, IQR: 44.93). All patients required admission to the intensive care unit. Two patients were formula-fed, three received mixed feeding, and one received whole cow's milk. Three patients had a family history of atopy, and one had a personal history of atopy. One patient had Down syndrome (DS), one was otherwise healthy, one had a genetic disorder (3p deletion/16q duplication), and three patients had cytomegalovirus infection. All patients developed tolerance to cow's milk protein, with a median time of 33 months (range: 17–103 months).

Conclusions

While the overall prognosis of FPIES was favorable, managing cases with severe initial symptoms necessitating ICU admission is complex and frequently involves multiple OFC before achieving tolerance.

食物蛋白性小肠结肠炎综合征（FPIES）是一种罕见且知之甚少的疾病，主要影响婴儿和幼儿。本研究旨在评估诊断为严重牛奶蛋白诱导的FPIES患者的临床特征和预后。方法对2018年1月16日至2024年6月20日在某第四医院儿科胃肠病学门诊接受口服食物挑战OFCs的FPIES儿科患者进行病例系列研究。结果共纳入6例患者，共评估了24例OFCs。出现症状的中位年龄为44天（范围：3-99天）。在第一次OFC之前，消除饮食的中位持续时间为11.2个月（Q1: 8.7 - Q3: 27个月；IQR: 18.3个月）；对于需要额外OFCs的患者，中位持续时间为35.17个月（Q1: 27.27 - Q3: 72.2个月，IQR: 44.93）。所有病人都需要住进重症监护室。两名患者采用配方奶喂养，三名患者采用混合喂养，一名患者采用全脂牛奶喂养。3例患者有特应性家族史，1例患者有个人特应性病史。1例患者患有唐氏综合征（DS）， 1例其他健康，1例患有遗传性疾病（3p缺失/16q重复），3例患者患有巨细胞病毒感染。所有患者均对牛奶蛋白产生耐受性，中位时间为33个月（范围：17-103个月）。结论：虽然FPIES的总体预后良好，但治疗有严重初始症状需要住院的病例是复杂的，并且在达到耐受性之前经常涉及多次OFC。

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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 : 2026-03-01 Epub 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

Decoding the drivers of healthcare utilization: The role of illness burden, lifestyle and household factors in rural North Karnataka, India 解读医疗保健利用的驱动因素：疾病负担、生活方式和家庭因素在印度北卡纳塔克邦农村的作用

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI: 10.1016/j.cegh.2026.102308

Sanjeev Chougule , Padmaja Walvekar , Annapurna Kari

Background

Healthcare utilization in rural India remains uneven despite expansion of public health infrastructure. Identifying factors associated with healthcare-seeking is essential to strengthen service delivery. This study assessed the burden of illness and examined household, lifestyle, and health-related factors associated with healthcare utilization in rural North Karnataka.

Methods

A community-based cross-sectional study was conducted among 1400 adults selected through a cluster-stratified sampling design. Healthcare utilization was defined as at least one visit to a formal healthcare facility within the preceding six months. Data were collected using a structured questionnaire. Multivariable logistic regression with cluster-adjusted robust standard errors was used to identify factors associated with healthcare utilization.

Results

Approximately two-thirds of participants reported healthcare utilization within the previous six months. In adjusted analyses, the presence of an elderly household member (AOR: 3.42; 95% CI: 2.15–5.43), hypertension (AOR: 2.18; 95% CI: 1.41–3.36), and diabetes mellitus (AOR: 1.61; 95% CI: 1.10–2.35) were independently associated with higher healthcare utilization. Ever use of tobacco was associated with lower utilization (AOR: 0.69; 95% CI: 0.50–0.96). Disability status was not independently associated after adjustment.

Conclusion

Healthcare utilization in rural North Karnataka was primarily associated with household context and chronic disease burden rather than individual demographic characteristics. These findings highlight population groups that may benefit from targeted health education, chronic disease management, and outreach services. Longitudinal studies are warranted to further examine causal pathways.

背景：尽管印度扩大了公共卫生基础设施，但农村地区的医疗保健利用情况仍然不平衡。确定与求医有关的因素对于加强服务提供至关重要。本研究评估了北卡纳塔克邦农村地区的疾病负担，并检查了与医疗保健利用相关的家庭、生活方式和健康相关因素。方法采用整群分层抽样设计，对1400名成人进行社区横断面调查。医疗保健利用被定义为在过去六个月内至少到正规医疗机构就诊一次。使用结构化问卷收集数据。采用聚类校正稳健标准误差的多变量逻辑回归来确定与医疗保健利用相关的因素。结果大约三分之二的参与者报告在过去六个月内使用了医疗保健服务。在调整分析中，家庭中有老年人（AOR: 3.42; 95% CI: 2.15-5.43）、高血压（AOR: 2.18; 95% CI: 1.41-3.36）和糖尿病（AOR: 1.61; 95% CI: 1.10-2.35）与较高的医疗保健利用率独立相关。曾经使用烟草与较低的利用率相关（AOR: 0.69; 95% CI: 0.50-0.96）。调整后的残疾状态不独立相关。结论北卡纳塔克邦农村卫生保健利用主要与家庭背景和慢性病负担相关，而与个人人口统计学特征无关。这些发现强调了可能从有针对性的健康教育、慢性病管理和外展服务中受益的人群。纵向研究有必要进一步研究因果关系。

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引用次数: 0

Pediatric Palliative care: Evaluation of knowledge, experience and confidence among physicians in a university outpatient setting 儿科姑息治疗：大学门诊医师的知识、经验和信心评估

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI: 10.1016/j.cegh.2026.102310

Pedro de A.Young , Aline M. de O.Rocha , Simone B. de O. Iglesias , Maria W.L. Strufaldi

Background

Pediatric Palliative Care (PPC) is essential for improving the quality of life of children with life-threatening or life-limiting conditions and their families. Despite its growing relevance, PPC remains underexplored in medical education and clinical practice, particularly among general pediatricians.

Objective

This study aims to describe and analyze physicians' knowledge of Pediatric Palliative Care and identify gaps to improve the provision of such care.

Materials and methods

A cross-sectional study was conducted using an online questionnaire to collect both qualitative and quantitative data. The study population included physicians affiliated with the Department of Pediatrics at an undergraduate institution.

Results

A total of 74 completed questionnaires were analyzed. Although 88% of participants had cared for terminally ill pediatric patients, 65% reported having little or no experience in PPC. Furthermore, 86.5% had not received any formal education on PPC during their undergraduate training. While a majority felt comfortable discussing chronic disease diagnoses (59%) and participating in multidisciplinary PPC discussions (57%), many expressed limited confidence in key areas: explaining PPC to families (72%), managing pediatric pain (81%), performing pain assessment and treatment in terminally ill patients (84%), adopting a holistic psychological approach (77%), and communicating bad news or planning palliative care (70%).

Conclusion

The findings reveal a significant self-perceived lack of training and preparedness among pediatricians regarding PPC, despite frequent clinical encounters with patients requiring such care. These results underscore the urgent need to integrate structured PPC education into pediatric training programs to enhance the quality and effectiveness of care provided.

儿童姑息治疗（PPC）对于改善危及生命或限制生命的儿童及其家庭的生活质量至关重要。尽管PPC的相关性越来越大，但在医学教育和临床实践中，特别是在普通儿科医生中，PPC仍未得到充分的探索。目的本研究旨在描述和分析医生对儿科姑息治疗的知识，并找出差距，以改善此类护理的提供。材料与方法采用在线调查问卷进行横断面研究，收集定性和定量数据。研究对象包括一所大学附属儿科的医生。结果共对74份问卷进行了分析。虽然88%的参与者照顾过绝症儿科患者，但65%的人报告说他们很少或没有PPC经验。此外，86.5%的人在本科培训期间没有接受过任何关于PPC的正规教育。虽然大多数人对讨论慢性病诊断（59%）和参与多学科PPC讨论（57%）感到满意，但许多人对关键领域表示有限的信心：向家属解释PPC(72%)，管理儿科疼痛（81%），对绝症患者进行疼痛评估和治疗（84%），采用整体心理学方法（77%），以及传达坏消息或计划姑息治疗（70%）。结论：研究结果表明，尽管临床经常遇到需要PPC的患者，但儿科医生在PPC方面缺乏培训和准备。这些结果强调迫切需要将结构化的PPC教育整合到儿科培训计划中，以提高所提供护理的质量和有效性。

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引用次数: 0

The role of health insurance in shaping cesarean section rates among Indonesian women 健康保险在影响印度尼西亚妇女剖宫产率方面的作用

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-03-01 Epub Date: 2026-02-13 DOI: 10.1016/j.cegh.2026.102313

Agung Dwi Laksono , Ratna Dwi Wulandari

Background

Understanding how health insurance ownership is associated with cesarean section delivery is essential for assessing maternal health service utilization in Indonesia. This study examines the relationship between insurance type and cesarean delivery among Indonesian women, while accounting for the national survey design.

Methods

This study used secondary data from the 2023 Indonesian Health Survey, including 70,916 women who delivered within five years preceding the survey. Complex survey adjusted logistic regression was applied to account for the multistage and stratified sampling design. Health insurance ownership was categorized as uninsured, government-run, private-run, or hybrid. Adjusted odds ratios and predicted probabilities were estimated. Firth's penalized likelihood regression was conducted as a sensitivity analysis for the hybrid insurance group.

Results

Overall, 25.9% of women reported cesarean delivery. After survey adjustment, cesarean delivery was more prevalent among insured women than uninsured women. Predicted probabilities indicated a higher absolute probability of cesarean delivery among women with government-run, private-run, and hybrid insurance. Estimates for the hybrid insurance group were consistent in direction but should be interpreted cautiously due to the small sample size.

Conclusion

Health insurance ownership is associated with higher cesarean delivery rates in Indonesia. These findings reflect associations rather than causal effects and may be influenced by differences in clinical risk profiles and health system factors.

背景了解健康保险所有权与剖宫产分娩之间的关系对于评估印度尼西亚孕产妇保健服务利用情况至关重要。本研究探讨保险类型与印尼妇女剖宫产之间的关系，同时考虑到全国调查设计。方法本研究使用了2023年印度尼西亚健康调查的辅助数据，包括70,916名在调查前5年内分娩的妇女。采用复杂调查调整逻辑回归来解释多阶段和分层抽样设计。医疗保险所有权分为无保险、政府经营、私人经营和混合经营。对调整后的优势比和预测概率进行估计。Firth的惩罚似然回归作为混合保险组的敏感性分析。结果总体而言，25.9%的妇女报告剖宫产。经调查调整后，参保妇女剖宫产率高于未参保妇女。预测概率表明，在政府经营、私人经营和混合保险的妇女中，剖宫产的绝对概率更高。混合保险组的估计在方向上是一致的，但由于样本量小，应谨慎解释。结论健康保险拥有率与印度尼西亚剖宫产率升高有关。这些发现反映了相关性，而不是因果关系，可能受到临床风险概况和卫生系统因素差异的影响。

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引用次数: 0

Mental health and quality of life in older adults in southern Peru: A cross-sectional study 秘鲁南部老年人的心理健康和生活质量：一项横断面研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-03-01 Epub Date: 2026-02-14 DOI: 10.1016/j.cegh.2025.102276

Carolina Cueto Chavez , Stephanie Echevarria-Dulanto , Sheein Vega Rojas , Javier Flores-Cohaila , Cesar Copaja-Corzo , Brayan Miranda-Chavez

Problem considered

Mental health disorders in older adults significantly impair quality of life; however, data from urban primary care in Peru is scarce. Therefore, our objective was to analyze mental health and its association with quality of life in older adults in a city in southern Peru.

Methods

A cross-sectional study evaluated 500 older adults randomly selected from the Ciudad Nueva Health Center in Tacna. Depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), and health-related quality of life (EQ-5D-5L utility index and EQ-VAS) were measured. Sociodemographic and clinical covariates were recorded. Adjusted β coefficients and 95% confidence intervals were estimated using multiple linear regression.

Results

Positive screen for depression (PHQ-9 ≥ 10) affected 51% and positive screen for anxiety (GAD-7 ≥ 10) affected 51.4%. The mean EQ-5D-5L utility index was 0.5 ± 0.30 and the mean EQ-VAS score was 65.8 ± 17.9. In the adjusted models, the presence positive screen for depression was associated with a reduction in quality of life, reflected by a decrease in the EQ-5D-5L utility index (adjusted β = −0.28; 95% CI: −0.36 to −0.20). Additionally, both being retired and receiving a salary or wage were independently associated with reductions in the EQ-5D-5L utility index (adjusted β = −0.11; 95% CI: −0.20 to −0.02 and adjusted β = −0.11; 95% CI: −0.20 to −0.02, respectively).

Conclusion

High depression rates were associated with markedly lower quality of life in this Peruvian geriatric cohort, underscoring the need for integrated mental health screening and interventions.

老年人心理健康障碍显著损害生活质量；然而，秘鲁城市初级保健的数据很少。因此，我们的目标是分析秘鲁南部一个城市老年人的心理健康及其与生活质量的关系。方法横断面研究评估了从塔克纳市新城市卫生中心随机抽取的500名老年人。测量抑郁症状（PHQ-9）、焦虑症状（GAD-7）和健康相关生活质量（EQ-5D-5L效用指数和EQ-VAS）。记录社会人口学和临床协变量。采用多元线性回归估计调整后的β系数和95%置信区间。结果抑郁筛查（PHQ-9≥10）阳性占51%，焦虑筛查（GAD-7≥10）阳性占51.4%。平均EQ-5D-5L效用指数为0.5±0.30，平均EQ-VAS评分为65.8±17.9。在调整后的模型中，抑郁阳性筛查与生活质量下降有关，这反映在EQ-5D-5L效用指数的下降上（调整后的β = - 0.28; 95% CI: - 0.36至- 0.20）。此外，退休和领取薪水或工资都与EQ-5D-5L效用指数的降低独立相关（调整后的β = - 0.11; 95% CI: - 0.20至- 0.02；调整后的β = - 0.11; 95% CI: - 0.20至- 0.02）。结论在秘鲁老年队列中，高抑郁率与明显较低的生活质量相关，强调了综合心理健康筛查和干预的必要性。

{"title":"Mental health and quality of life in older adults in southern Peru: A cross-sectional study","authors":"Carolina Cueto Chavez , Stephanie Echevarria-Dulanto , Sheein Vega Rojas , Javier Flores-Cohaila , Cesar Copaja-Corzo , Brayan Miranda-Chavez","doi":"10.1016/j.cegh.2025.102276","DOIUrl":"10.1016/j.cegh.2025.102276","url":null,"abstract":"<div><h3>Problem considered</h3><div>Mental health disorders in older adults significantly impair quality of life; however, data from urban primary care in Peru is scarce. Therefore, our objective was to analyze mental health and its association with quality of life in older adults in a city in southern Peru.</div></div><div><h3>Methods</h3><div>A cross-sectional study evaluated 500 older adults randomly selected from the Ciudad Nueva Health Center in Tacna. Depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), and health-related quality of life (EQ-5D-5L utility index and EQ-VAS) were measured. Sociodemographic and clinical covariates were recorded. Adjusted β coefficients and 95% confidence intervals were estimated using multiple linear regression.</div></div><div><h3>Results</h3><div>Positive screen for depression (PHQ-9 ≥ 10) affected 51% and positive screen for anxiety (GAD-7 ≥ 10) affected 51.4%. The mean EQ-5D-5L utility index was 0.5 ± 0.30 and the mean EQ-VAS score was 65.8 ± 17.9. In the adjusted models, the presence positive screen for depression was associated with a reduction in quality of life, reflected by a decrease in the EQ-5D-5L utility index (adjusted β = −0.28; 95% CI: −0.36 to −0.20). Additionally, both being retired and receiving a salary or wage were independently associated with reductions in the EQ-5D-5L utility index (adjusted β = −0.11; 95% CI: −0.20 to −0.02 and adjusted β = −0.11; 95% CI: −0.20 to −0.02, respectively).</div></div><div><h3>Conclusion</h3><div>High depression rates were associated with markedly lower quality of life in this Peruvian geriatric cohort, underscoring the need for integrated mental health screening and interventions.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"38 ","pages":"Article 102276"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397837","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

The state of disease research in the Middle East and North Africa from 1980 to 2023 1980年至2023年中东和北非疾病研究状况

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health

Pub Date : 2026-03-01 Epub Date: 2026-02-11 DOI: 10.1016/j.cegh.2026.102316

Georges Choueiry , Sola Aoun Bahous , Pierre-Marie Preux , Pascale Salameh , Farid Boumediene

Background

The production of disease research in the Middle East and North Africa (MENA) increased in recent decades. However, gaps remain in understanding the topics covered, study designs, funding sources, and institutional involvement. Our objective is to assess the state of disease research in MENA over the past 44 years and identify strengths, challenges, and opportunities for improvement.

Methods

We identified 300,417 PubMed articles affiliated to the MENA region, published between 1980 and 2023, including at least one MeSH term (or keyword) linked to a disease from the Global Burden of Disease database. Our analysis covered research topics, study designs, funding, collaborations, and institutional contributions.

Results

Top research areas included respiratory diseases (16.0%), cardiovascular diseases (10.9%), and neurological disorders (9.6%). Most studies were analytical (48.6%) and the top funder was the United States. We found that information on local funding is severely underrepresented in PubMed. High levels of international collaboration were seen, particularly in respiratory diseases, but large producers like Iran and Turkey had limited international collaborations. The COVID-19 pandemic had a positive impact on overall disease research production, increasing it by 59.2% between 2019 and 2023.

Conclusion

This study highlights strengths and challenges in disease research across MENA and emphasizes the need for tailored strategies to improve its quantity and quality. Despite the growth in output, our findings show dependency, inequality, and misalignment. As U.S. funding faces pressure, the sustainability of research depends on the efforts of each country to align its agenda with its own needs.

近几十年来，中东和北非（MENA）的疾病研究成果有所增加。然而，在理解所涵盖的主题、研究设计、资金来源和机构参与方面仍然存在差距。我们的目标是评估中东和北非地区过去44年来的疾病研究状况，并确定优势、挑战和改进的机会。方法我们确定了1980年至2023年间发表于中东和北非地区的300,417篇PubMed文章，包括至少一个与全球疾病负担数据库中的疾病相关的MeSH术语（或关键词）。我们的分析涵盖了研究主题、研究设计、资助、合作和机构贡献。结果研究领域包括呼吸系统疾病（16.0%）、心血管疾病（10.9%）和神经系统疾病（9.6%）。大多数研究是分析性的（48.6%），最大的资助者是美国。我们发现关于地方资金的信息在PubMed中严重不足。国际合作水平很高，特别是在呼吸道疾病方面，但伊朗和土耳其等生产大国的国际合作有限。2019冠状病毒病大流行对整体疾病研究产出产生了积极影响，2019年至2023年期间增长了59.2%。结论本研究突出了中东和北非地区疾病研究的优势和挑战，并强调需要有针对性的策略来提高其数量和质量。尽管产出有所增长，但我们的研究结果显示出依赖、不平等和错位。由于美国资助面临压力，研究的可持续性取决于每个国家将其议程与自身需求结合起来的努力。

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引用次数: 0