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Uncovering dengue hotspots and climatic drivers in an urban district of Malaysia: A five-year geospatial analysis 在马来西亚市区发现登革热热点和气候驱动因素:五年地理空间分析
IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-11-21 DOI: 10.1016/j.cegh.2025.102221
Maizatul Akma Masood , Rahmat Dapari , Mohammad Abdullah , Nazri Che Dom

Problem considered

Dengue fever remains a major urban public health threat in Malaysia, where rapid urbanization and climatic fluctuations intensify transmission. While national and state-level analyses have been conducted, district-level geospatial assessments in Kuantan remain scarce, limiting locally adaptive control strategies. This study aimed to uncover fine-scale dengue hotspots and climate thresholds to guide targeted interventions.

Methods

A retrospective ecological analysis was conducted on 5277 laboratory-confirmed dengue cases from 2019 to 2023. Case data were geocoded and analyzed using GIS-based hotspot detection, mean center shift, and standard deviational ellipse (SDE) methods. Meteorological parameters (rainfall, temperature, humidity, and wind speed) were obtained from the Malaysian Meteorological Department. Temporal correlations and regression analyses assessed associations between climatic factors and dengue incidence.

Results

Over 70 % of cases were concentrated in Kuala Kuantan 1 and 2, confirming persistent urban hotspots. Dengue peaks in 2019–2020 coincided with rainfall exceeding 350 mm/month and humidity above 92 %. Regression analyses indicated a negative association between rainfall and dengue incidence (r = −0.32) due to habitat flushing, while temperature showed a mild positive correlation (r = 0.21) within the optimal transmission range (26–28 °C). Mean center shifts reflected spatial evolution of transmission foci, highlighting urban expansion effects.

Conclusion

This district-level geospatial analysis provides novel, localized evidence that dengue persistence in Kuantan is shaped by urban density and climate thresholds. The findings emphasize that integrating meteorological signals into real-time surveillance can improve early outbreak prediction and targeted vector control. Limitations include the absence of human mobility and intervention data, which should be incorporated in future multi-factorial models. These results offer actionable insights for local policymakers to strengthen climate-sensitive dengue control and early warning frameworks.
在马来西亚,快速城市化和气候波动加剧了传播,登革热仍然是一个主要的城市公共卫生威胁。虽然已经进行了国家和州一级的分析,但关丹地区一级的地理空间评估仍然很少,限制了地方适应性控制战略。本研究旨在揭示小规模登革热热点和气候阈值,以指导有针对性的干预措施。方法对2019 - 2023年5277例实验室确诊登革热病例进行回顾性生态学分析。对病例数据进行地理编码,并使用基于gis的热点检测、平均中心移位和标准差椭圆(SDE)方法进行分析。气象参数(雨量、温度、湿度和风速)由马来西亚气象部门提供。时间相关性和回归分析评估了气候因素与登革热发病率之间的关系。结果70%以上病例集中在吉隆坡1区和2区,确定了持续存在的城市热点。2019-2020年登革热高峰恰逢降雨量超过350毫米/月,湿度超过92%。回归分析表明,由于生境冲刷,降雨量与登革热发病率呈负相关(r = - 0.32),而温度在最佳传播范围(26-28°C)内呈轻度正相关(r = 0.21)。平均中心位移反映了传播焦点的空间演化,突出了城市扩张效应。结论该区域地理空间分析提供了新的局部证据,表明登革热在关丹的持久性受城市密度和气候阈值的影响。这些发现强调,将气象信号整合到实时监测中可以改善早期疫情预测和有针对性的媒介控制。局限性包括缺乏人类流动性和干预数据,这应纳入未来的多因素模型。这些结果为地方决策者加强对气候敏感的登革热控制和早期预警框架提供了可行的见解。
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引用次数: 0
Screen Time Impact on Muscle Health and Sleep Quality in School-Age Children - A cross sectional study 屏幕时间对学龄儿童肌肉健康和睡眠质量的影响——一项横断面研究
IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-11-20 DOI: 10.1016/j.cegh.2025.102233
Tejaswini Manogna , Aruna R.

Problem Considered

Excessive screen time poses significant health concerns for school-aged children. However, the relationships between screen time, muscle quality, and sleep patterns in Indian school children remain inadequately understood. This study examined the associations between screen time, sleep quality, and muscle health indicators in urban school-aged children in India

Methods

A cross-sectional study was conducted on 252 children aged 11-13 years conveniently sampled from an urban school. Anthropometric measurements, Screen time, sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI), Muscle Quality Index (MQI) calculated from handgrip strength and BMI, physical activity levels, and cardiorespiratory fitness via 6-minute walk test.

Results

Higher screen time demonstrated significant associations with multiple adverse health outcomes- Lower physical activity levels, elevated BMI, reduced MQI, and poorer sleep quality. Boys reported higher screen time (7.51±1.98 hours) compared to girls (6.8±2.05 hours, p=0.007). Multiple regression analysis revealed that BMI (β=0.208, p=0.011), MQI (β=-0.263, p=0.019), and PSQI (β=0.217, p<0.001) were significant independent predictors of screen time, together explaining 23.4% of the variance (R2=0.234, p<0.001).

Conclusion

This study demonstrates complex interrelationships between excessive screen time and compromised health outcomes in school-aged children, including deteriorated muscle quality, disturbed sleep patterns, and reduced physical activity. These findings emphasize the critical need for comprehensive interventions incorporating promotion of moderate-to-vigorous physical activity, muscle-strengthening exercises, reduction in recreational screen time, and improvement in sleep hygiene. Future longitudinal research should investigate long-term implications and develop evidence-based interventions tailored to the unique cultural and environmental context of urban India.
过多的屏幕时间会给学龄儿童带来严重的健康问题。然而,在印度学龄儿童中,屏幕时间、肌肉质量和睡眠模式之间的关系仍然没有得到充分的了解。本研究考察了印度城市学龄儿童屏幕时间、睡眠质量和肌肉健康指标之间的关系。方法对252名11-13岁的城市学校儿童进行了横断面研究。人体测量、屏幕时间、使用匹兹堡睡眠质量指数(PSQI)评估的睡眠质量、通过握力和BMI计算的肌肉质量指数(MQI)、身体活动水平和通过6分钟步行测试的心肺健康。结果:屏幕时间过长与多种不良健康结果存在显著关联——体力活动水平降低、BMI升高、MQI下降和睡眠质量下降。男孩的屏幕时间(7.51±1.98小时)高于女孩(6.8±2.05小时,p=0.007)。多元回归分析显示,BMI (β=0.208, p=0.011)、MQI (β=-0.263, p=0.019)和PSQI (β=0.217, p= 0.001)是屏幕时间的显著独立预测因子,共解释23.4%的方差(R2=0.234, p= 0.001)。结论:本研究表明,过多的屏幕时间与学龄儿童健康状况受损之间存在复杂的相互关系,包括肌肉质量恶化、睡眠模式紊乱和身体活动减少。这些发现强调了综合干预的迫切需要,包括促进中度到剧烈的体育活动、肌肉强化锻炼、减少娱乐屏幕时间和改善睡眠卫生。未来的纵向研究应该调查长期影响,并根据印度城市独特的文化和环境背景制定基于证据的干预措施。
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引用次数: 0
Determinants of medication knowledge using DFIT% score in indian geriatric population: A cross-sectional study 印度老年人群中使用DFIT%评分的药物知识决定因素:一项横断面研究
IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-11-19 DOI: 10.1016/j.cegh.2025.102232
Sneha Gowthaman , Mohammed Fayaz Sadiqbasha , Padma Priya Rangachapam Mani , Varun Sundaramoorthy , Dhandapani Chidambaram

Problem

Assessing medication knowledge in older adults is critical for managing chronic diseases, yet existing tools are often impractical or lack specificity. This study evaluates a composite score (DFIT%) assessing knowledge of Dose, Frequency, Indication, and Time of administration.

Methods

A cross-sectional study was conducted among 202 geriatric patients (≥65 years) to determine the association between DFIT% and patient characteristics were analyzed using bivariate tests and logistic regression.

Results

DFIT% was strongly associated with cognitive status; patients without impairment scored significantly higher (67.1 % vs 43.5 %, p < 0.0001). A higher DFIT% score was associated with lower odds of polypharmacy (OR = 0.984, p = 0.018) and recent medication changes (OR = 0.986, p = 0.043). Ability to read English was also statistically associated with (OR = 1.020, p = 0.041) DFIT% score. No significant associations were found with hospitalization or disease duration.

Conclusion

The DFIT% score is a practical tool that identifies specific medication knowledge deficits, which are significant to cognitive function and treatment complexity. It can help target interventions to improve medication safety in geriatric populations.
评估老年人的用药知识对于管理慢性病至关重要,然而现有的工具往往不切实际或缺乏特异性。本研究采用综合评分(DFIT%)评估剂量、频率、适应症和给药时间的知识。方法对202例≥65岁的老年患者进行横断面研究,采用双变量检验和logistic回归分析DFIT%与患者特征的相关性。结果dfit %与认知状态密切相关;无损伤患者得分明显更高(67.1% vs 43.5%, p < 0.0001)。DFIT%评分越高,多药的几率越低(OR = 0.984, p = 0.018),近期用药改变的几率越低(OR = 0.986, p = 0.043)。英语阅读能力与DFIT%得分也有统计学相关性(OR = 1.020, p = 0.041)。未发现与住院或病程有显著关联。结论DFIT%评分是识别特定药物知识缺陷的实用工具,对认知功能和治疗复杂性具有重要意义。它可以帮助有针对性的干预措施,以改善老年人群的用药安全。
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引用次数: 0
Lung cancer risk in Bagmati province, Nepal- A hospital-based spatial study from 2012 to 2021 尼泊尔Bagmati省肺癌风险——2012年至2021年基于医院的空间研究
IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-11-12 DOI: 10.1016/j.cegh.2025.102218
Basanta Kumar Neupane , Min Xu , Chunxiang Cao

Problem considered

Lung cancer is one of the major causes of cancer incidence globally. Developing countries account for a substantial portion of the global lung cancer burden. However, most of the low and middle-income countries (LMICs), including Nepal, still lack spatial-based cancer control and prevention strategies. The study examines the prevalence and spatial distribution of lung cancer at the municipal level in Bagmati province.

Methods

The study utilized hospital-based lung cancer cases to analyze spatial and temporal trends. It supports the development of evidence-based cancer control strategies at the local administrative level. Furthermore, the study examined the spatial-temporal patterns of lung cancer risk at the municipal level from January 1, 2012, to December 31, 2021. Our study utilized GeoDa and ArcGIS to conduct spatial analyses. Each case was cleaned and verified for permanent location and duplication, followed by confirmation of residence via Google Earth. The study followed the overall registration process, including data quality control guidelines and principles outlined by the International Association of Cancer Registries.

Results

The annual mean crude incidence rate of Bagmati province and Kathmandu Valley was found to be 5.16 and 5.53 per 100,000 people, respectively. The temporal distribution of lung cancer risk was calculated, and it was found to be highest in 2021 in Kathmandu Valley. The crude and standardized incidence rates in this year were 6.84 and 7.81 per 100,000, respectively. The crude and standardized incidence rates were high in 2019 in Bagmati Province. Kathmandu Valley has a fluctuating incidence rate; however, Bhaktapur municipality has been identified as the top position in the Bagmati province. Males consistently exhibit a higher risk, particularly in middle-aged and elderly populations.

Conclusion

Lung cancer has been growing as one of the major public health challenges in Bagmati province. Timely screening, cost-effective advanced technology, public awareness, easy access to cancer hospitals, and good treatment should be a government priority.
肺癌是全球癌症发病率的主要原因之一。发展中国家占全球肺癌负担的很大一部分。然而,大多数低收入和中等收入国家(LMICs),包括尼泊尔,仍然缺乏基于空间的癌症控制和预防战略。该研究调查了巴格马提省市级肺癌的患病率和空间分布。方法利用医院肺癌病例,分析其时空变化趋势。它支持在地方行政一级制定循证癌症控制战略。此外,研究还对2012年1月1日至2021年12月31日北京市肺癌风险的时空格局进行了分析。我们的研究使用GeoDa和ArcGIS进行空间分析。每个病例都经过清理和核实永久地点和重复,然后通过谷歌Earth确认居住地。该研究遵循了整个登记过程,包括国际癌症登记协会概述的数据质量控制指南和原则。结果巴格马蒂省和加德满都谷地年平均粗发病率分别为5.16和5.53 / 10万人。计算了肺癌风险的时间分布,发现2021年加德满都谷地的肺癌风险最高。今年的粗发病率和标准化发病率分别为6.84 / 10万和7.81 / 10万。2019年,巴格马提省的粗发病率和标准化发病率很高。加德满都谷地的发病率波动较大;然而,巴克塔普尔市已被确定为巴格马蒂省的最高位置。男性一直表现出更高的风险,尤其是在中老年人群中。结论肺癌已成为巴马提省主要的公共卫生挑战之一。及时的筛查、具有成本效益的先进技术、公众意识、容易进入癌症医院以及良好的治疗应该是政府的优先事项。
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引用次数: 0
Trend analysis of acute diarrhoeal disease patterns among Indian children under five (2011–2024): A systematic review and meta-analysis 印度5岁以下儿童急性腹泻病模式趋势分析(2011-2024):系统回顾和荟萃分析
IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-11-04 DOI: 10.1016/j.cegh.2025.102224
Melissa Glenda Lewis, Diplina Barman, Rounik Talukdar, Suman Kanungo

Objectives

To estimate the prevalence, incidence and frequency of diarrhoeal episodes among children under five in India, identifying trends and associated factors based on studies published from 2011 to 2024.

Methods

A systematic review and Meta-analysis were conducted using the PRISMA guidelines in electronic databases (Web of Science, EMBASE, CINAHL, Scopus, Cochrane Library, PubMed, Google Scholar) between 2011 and 2024. Community-based studies were included focusing on children under five in India, defining diarrhea as three or more loose stools in 24 h, regardless of recall period. Diarrhoeal rates were logit-transformed to generate pooled estimates, and a random effects empirical Bayes model was used for the meta-analysis. Subgroup, sensitivity analysis and meta-regression was performed to assess the heterogeneity and Egger's test for publication bias.

Findings

A total of 64 community-based studies across 21 Indian states (53 cross-sectional and 11 longitudinal) were included in the review. The pooled acute diarrhea prevalence was 22.8 % (95 % CI: 19.5, 26.0 %) from 48 studies, with high heterogeneity (I2 = 99.13 %). Prevalence was highest in Central and North India (24.3 %), followed by East (22.5 %), West (18.8 %), and South (17.6 %). There was a year-to-year variation from 2011 to 2024, ranging from a low of 9.4 % in 2021 to a high of 51.9 % in 2009. The pooled incidence rate from four studies was 21.78 cases per 100 person-years (95 % CI: 12.31, 31.24), while five studies reported 1.73 episodes per person-year (95 % CI: 0.67, 2.79). Meta-regression suggested a marginally significant annual decline in diarrhea prevalence of 1.27 %.

Conclusion

This review provides a comprehensive analysis of the magnitude of acute diarrheal disease in Indian children under five over 13 years. Trend analysis showed a considerable variability across studies with prevalence rates ranging from 9 % to 51.9 %, with half of the studies reporting rates ranging from 17.3 % to 24.5 %. The incidence rate of 21.78 cases per person years highlights the significant burden of diarrheal disease. This study supports the development of evidence-based strategies to lessen the effects of diarrheal illnesses and improve child health outcomes in India by offering insightful information to researchers, policymakers, and medical professionals.
目的根据2011年至2024年发表的研究报告,估计印度5岁以下儿童腹泻的患病率、发病率和频率,确定趋势和相关因素。方法采用PRISMA指南对2011 - 2024年在Web of Science、EMBASE、CINAHL、Scopus、Cochrane Library、PubMed、谷歌Scholar等电子数据库中检索的数据进行系统评价和meta分析。以社区为基础的研究包括针对印度5岁以下儿童的研究,将腹泻定义为24小时内三次或更多稀便,无论回忆期如何。对腹泻率进行对数变换以产生汇总估计,并使用随机效应经验贝叶斯模型进行meta分析。采用亚组分析、敏感性分析和meta回归来评估异质性和Egger发表偏倚检验。研究结果:印度21个邦的64项社区研究(53项横断面研究,11项纵向研究)被纳入该综述。48项研究的急性腹泻患病率为22.8% (95% CI: 19.5, 26.0%),异质性高(I2 = 99.13%)。患病率最高的是印度中部和北部(24.3%),其次是东部(22.5%)、西部(18.8%)和南部(17.6%)。从2011年到2024年,这一比例逐年变化,从2021年的9.4%到2009年的51.9%不等。4项研究的合并发病率为21.78例/ 100人年(95% CI: 12.31, 31.24),而5项研究报告的发病率为1.73例/ 100人年(95% CI: 0.67, 2.79)。meta回归显示腹泻患病率年下降1.27%。结论:本综述对13岁以上印度5岁以下儿童急性腹泻病的严重程度进行了全面分析。趋势分析显示,各研究的患病率范围为9%至51.9%,其中一半的研究报告的患病率范围为17.3%至24.5%。21.78例/人年的发病率凸显了腹泻疾病的重大负担。本研究通过为研究人员、政策制定者和医疗专业人员提供有见地的信息,支持以证据为基础的策略的发展,以减轻腹泻疾病的影响,改善印度儿童的健康状况。
{"title":"Trend analysis of acute diarrhoeal disease patterns among Indian children under five (2011–2024): A systematic review and meta-analysis","authors":"Melissa Glenda Lewis,&nbsp;Diplina Barman,&nbsp;Rounik Talukdar,&nbsp;Suman Kanungo","doi":"10.1016/j.cegh.2025.102224","DOIUrl":"10.1016/j.cegh.2025.102224","url":null,"abstract":"<div><h3>Objectives</h3><div>To estimate the prevalence, incidence and frequency of diarrhoeal episodes among children under five in India, identifying trends and associated factors based on studies published from 2011 to 2024.</div></div><div><h3>Methods</h3><div>A systematic review and Meta-analysis were conducted using the PRISMA guidelines in electronic databases (Web of Science, EMBASE, CINAHL, Scopus, Cochrane Library, PubMed, Google Scholar) between 2011 and 2024. Community-based studies were included focusing on children under five in India, defining diarrhea as three or more loose stools in 24 h, regardless of recall period. Diarrhoeal rates were logit-transformed to generate pooled estimates, and a random effects empirical Bayes model was used for the meta-analysis. Subgroup, sensitivity analysis and meta-regression was performed to assess the heterogeneity and Egger's test for publication bias.</div></div><div><h3>Findings</h3><div>A total of 64 community-based studies across 21 Indian states (53 cross-sectional and 11 longitudinal) were included in the review. The pooled acute diarrhea prevalence was 22.8 % (95 % CI: 19.5, 26.0 %) from 48 studies, with high heterogeneity (I<sup>2</sup> = 99.13 %). Prevalence was highest in Central and North India (24.3 %), followed by East (22.5 %), West (18.8 %), and South (17.6 %). There was a year-to-year variation from 2011 to 2024, ranging from a low of 9.4 % in 2021 to a high of 51.9 % in 2009. The pooled incidence rate from four studies was 21.78 cases per 100 person-years (95 % CI: 12.31, 31.24), while five studies reported 1.73 episodes per person-year (95 % CI: 0.67, 2.79). Meta-regression suggested a marginally significant annual decline in diarrhea prevalence of 1.27 %.</div></div><div><h3>Conclusion</h3><div>This review provides a comprehensive analysis of the magnitude of acute diarrheal disease in Indian children under five over 13 years. Trend analysis showed a considerable variability across studies with prevalence rates ranging from 9 % to 51.9 %, with half of the studies reporting rates ranging from 17.3 % to 24.5 %. The incidence rate of 21.78 cases per person years highlights the significant burden of diarrheal disease. This study supports the development of evidence-based strategies to lessen the effects of diarrheal illnesses and improve child health outcomes in India by offering insightful information to researchers, policymakers, and medical professionals.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"37 ","pages":"Article 102224"},"PeriodicalIF":1.7,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685524","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
Disturbance of the production of TSH and T3 hormones in hypertensive farming and non-farming patients in the Zou department in central Benin: A link with pyrethroid pesticides and phthalates? 贝宁中部邹县农业和非农业高血压患者TSH和T3激素分泌紊乱:与拟除虫菊酯农药和邻苯二甲酸盐有关?
IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-11-01 DOI: 10.1016/j.cegh.2025.102222
Omedine Koukoui , Fidele Sonounameto , Fresnel Cachon , Marcelin Agbo , Santorin Seton , Mansouratou Betira , Jean-Baptiste Amagbegnon , Alphonse Sezan

Problem considered

Hypertension may be caused by disruption of thyroid hormone production linked to contamination by chemical pollutants. The objective of this work was to determine the prevalence of thyroid hormone disturbances in hypertensive patients of Zou department in central Benin, and to see the link with the contamination of cereals and meals with pyrethroid pesticides and phthalates.

Methods

This was a cross-sectional study, involving 80 hypertensive farming patients and 80 hypertensive non farming patients. Median ages were 47.9 ± 12 years among farmers and 52.1 ± 9.9 years among non farmers. The various biological parameters were measured in the blood of the participants. Pyrethroids and phthalates were measured in cereals and meals using a chromatograph coupled with a mass spectrometer.

Results

The prevalence of thyrotropic hormone (TSH) dysregulation in our study population was 31.3 % with a predominance in hypertensive farming patients (p˂0,05). An abnormally low level of thyroid hormone T3 was found in 53.33 % of farming patients and in 46.66 % of non farming patients. Hypertensive farming patients had abnormally high levels of uric acids compared to hypertensive non farming patients (p˂0,05). Corn and bean seeds did not show traces of pyrethroid pesticides. However the dosage of phthalates in meals cooked with plastic packaging showed a very high concentration of Di-n-octyl phthalate.

Conclusion

The disturbances in thyroid hormone production observed in our study population could be linked to chemical compounds, but this remains to be confirmed by measuring exposure biomarkers in the blood of patients.
高血压可能是由化学污染物污染引起的甲状腺激素分泌紊乱引起的。本研究的目的是确定贝宁中部邹县高血压患者甲状腺激素紊乱的患病率,并了解其与拟除虫菊酯类杀虫剂和邻苯二甲酸盐污染谷物和膳食的关系。方法采用横断面研究方法,选取80例高血压种田患者和80例高血压非种田患者。农民中位年龄为47.9±12岁,非农民中位年龄为52.1±9.9岁。在参与者的血液中测量了各种生物参数。采用质谱联用色谱仪对谷物和食品中的拟除虫菊酯和邻苯二甲酸酯进行了测定。结果在我们的研究人群中,促甲状腺激素(TSH)失调的患病率为31.3%,以高血压农民患者为主(p小于0.05)。53.33%的务农患者和46.66%的非务农患者甲状腺激素T3水平异常低。与非农业高血压患者相比,农业高血压患者的尿酸水平异常高(p小于0,05)。玉米和豆类种子没有发现拟除虫菊酯杀虫剂的痕迹。然而,用塑料包装烹饪的食物中邻苯二甲酸酯的剂量显示,邻苯二甲酸二辛酯的浓度非常高。结论在我们的研究人群中观察到的甲状腺激素产生的紊乱可能与化合物有关,但这仍有待于通过测量患者血液中的暴露生物标志物来证实。
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引用次数: 0
A bibliometric assessment of the progress, challenges, and gaps in vaccine uptake studies in Africa 对非洲疫苗摄取研究进展、挑战和差距的文献计量学评估
IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-11-01 DOI: 10.1016/j.cegh.2025.102217
Esu S. Ezeani , Umego Chukwudi Theodore , Uwem O. Edet , Aniekan-Augusta Okon Eyo , Elizabeth Mbim , Nkoyo Ani Nkang , Ama Umesi , Francisca Nwaokorie , Meseko Clement

Problem considered

In Africa, vaccine hesitancy persists despite increasing demand, recent efforts to establish local vaccine manufacturing, and continued calls and programmes to scale up production. This study presents a bibliometric analysis of research on vaccine uptake and hesitancy in Africa, aiming to reveal historical trends, identify knowledge gaps, and inform targeted policies and interventions.

Methods

We retrieved and analysed 1,355 studies from the PubMed® database using a defined search strategy. Data were analysed to evaluate trends in publication volume, study design, authorship, institutional affiliations, and countries of collaborations.

Results

Research output in Africa has grown tremendously since 2010, reaching its peak after 2020. Original research comprised over 78 % of publications, while randomised controlled trials (RCT) and systematic reviews (SR) were comparatively rare. The top three journals were PLOS ONE (123), BMC Public Health (104), and Vaccines (Basel) (100). Frequently used keywords included “vaccination,” “COVID-19,” “vaccine hesitancy,” “child,” “Nigeria,” and “Uganda.” Thematic clusters centred around diseases (HIV, COVID-19, HPV, polio, HBV), target groups (children, adolescents, mothers, healthcare workers), sociocultural aspects (knowledge, attitudes, beliefs), and countries (Nigeria, Kenya, South Africa). Most productive authors included Charles Wiysonge (30 publications), Rosemary Burnett (11), and Moses Mukosha (10). South Africa led the contributors, followed by the United States of America (USA) and the United Kingdom (UK). Institutional collaborations were limited.

Conclusion

Gaps remain in evidence synthesis and inter-institutional collaborations, especially in Africa. Advancing African-led research, fostering regional partnerships, and strengthening the policy relevance of scientific findings are essential to improve vaccine uptake and equity.
在非洲,尽管需求不断增加,最近努力建立当地疫苗生产,并继续呼吁和规划扩大生产,但对疫苗的犹豫仍然存在。本研究对非洲疫苗接种和犹豫研究进行了文献计量分析,旨在揭示历史趋势,确定知识差距,并为有针对性的政策和干预措施提供信息。方法我们使用已定义的检索策略从PubMed®数据库中检索并分析了1355项研究。对数据进行分析,以评估出版物数量、研究设计、作者、机构隶属关系和合作国家的趋势。自2010年以来,非洲的研究产出大幅增长,并在2020年后达到顶峰。原始研究占出版物的78%以上,而随机对照试验(RCT)和系统评价(SR)相对较少。排名前三的期刊分别是PLOS ONE(123)、BMC Public Health(104)和Vaccines (Basel)(100)。经常使用的关键词包括“疫苗接种”、“COVID-19”、“疫苗犹豫”、“儿童”、“尼日利亚”和“乌干达”。专题分组围绕疾病(艾滋病毒、COVID-19、人乳头瘤病毒、脊髓灰质炎、乙型肝炎病毒)、目标群体(儿童、青少年、母亲、卫生保健工作者)、社会文化方面(知识、态度和信仰)和国家(尼日利亚、肯尼亚、南非)展开。最多产的作家包括Charles Wiysonge(30篇出版物),Rosemary Burnett(11篇)和Moses Mukosha(10篇)。捐助国最多的是南非,其次是美利坚合众国(美国)和联合王国(联合王国)。机构合作是有限的。结论aps仍在证据综合和机构间合作中,特别是在非洲。推进非洲主导的研究、促进区域伙伴关系和加强科学发现的政策相关性对于改善疫苗吸收和公平至关重要。
{"title":"A bibliometric assessment of the progress, challenges, and gaps in vaccine uptake studies in Africa","authors":"Esu S. Ezeani ,&nbsp;Umego Chukwudi Theodore ,&nbsp;Uwem O. Edet ,&nbsp;Aniekan-Augusta Okon Eyo ,&nbsp;Elizabeth Mbim ,&nbsp;Nkoyo Ani Nkang ,&nbsp;Ama Umesi ,&nbsp;Francisca Nwaokorie ,&nbsp;Meseko Clement","doi":"10.1016/j.cegh.2025.102217","DOIUrl":"10.1016/j.cegh.2025.102217","url":null,"abstract":"<div><h3>Problem considered</h3><div>In Africa, vaccine hesitancy persists despite increasing demand, recent efforts to establish local vaccine manufacturing, and continued calls and programmes to scale up production. This study presents a bibliometric analysis of research on vaccine uptake and hesitancy in Africa, aiming to reveal historical trends, identify knowledge gaps, and inform targeted policies and interventions.</div></div><div><h3>Methods</h3><div>We retrieved and analysed 1,355 studies from the PubMed® database using a defined search strategy. Data were analysed to evaluate trends in publication volume, study design, authorship, institutional affiliations, and countries of collaborations.</div></div><div><h3>Results</h3><div>Research output in Africa has grown tremendously since 2010, reaching its peak after 2020. Original research comprised over 78 % of publications, while randomised controlled trials (RCT) and systematic reviews (SR) were comparatively rare. The top three journals were <em>PLOS ONE</em> (123), <em>BMC Public Health</em> (104), and <em>Vaccines (Basel)</em> (100). Frequently used keywords included “vaccination,” “COVID-19,” “vaccine hesitancy,” “child,” “Nigeria,” and “Uganda.” Thematic clusters centred around diseases (HIV, COVID-19, HPV, polio, HBV), target groups (children, adolescents, mothers, healthcare workers), sociocultural aspects (knowledge, attitudes, beliefs), and countries (Nigeria, Kenya, South Africa). Most productive authors included Charles Wiysonge (30 publications), Rosemary Burnett (11), and Moses Mukosha (10). South Africa led the contributors, followed by the United States of America (USA) and the United Kingdom (UK). Institutional collaborations were limited.</div></div><div><h3>Conclusion</h3><div>Gaps remain in evidence synthesis and inter-institutional collaborations, especially in Africa. Advancing African-led research, fostering regional partnerships, and strengthening the policy relevance of scientific findings are essential to improve vaccine uptake and equity.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"36 ","pages":"Article 102217"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416292","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
RSV Infection in One Year Olds: measuring economic and epidemiologic burden during five seasonal waves in Italy (2015–2020) 1岁儿童呼吸道合胞病毒感染:衡量意大利2015-2020年五次季节性浪潮期间的经济和流行病学负担
IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-11-01 DOI: 10.1016/j.cegh.2025.102216
Manuela Martella , Eleonora Cugudda , Roberta Onorati , Jacopo Lenzi , Maria Michela Gianino

Problem considered

Respiratory Syncytial Virus (RSV) infection is a leading cause of respiratory illness, particularly among infants. The current research assesses the epidemiologic and economic impact of RSV infection in the Piedmont region among five seasonal waves between 2015 and 2020 among children younger than one year.

Methods

A retrospective analysis of data from the hospital discharge database of infants under one year diagnosed with RSV infection was carried out. Hospitalisation costs were assessed through the Diagnosis Related Group (DRG) payment system. Multivariable logistic regression models were used for access to the Paediatric/Neonatal Intensive Care Unit and the average DRG code allocated at discharge. Time-trend analyses were performed for hospital admissions and related spending during the defined timeframe by computing the Annual Percent Change (APC).

Results

There were 2980 hospitalisations, mostly males (54.7 %), mostly infants under six months of age (83.3 %), and 22.4 % non-Italian. The median cost for hospitalisation was ∼2800 euros. Multivariable regression models revealed a lower risk of assistance at the PICU/NICU for females (OR: 0.66, 95 %CI 0.50–0.86) and infants younger than 3 months (OR [3–6 months] 0.3, 95 %CI 0.21–0.44; OR [≥6 months] 0.17, 95 %CI 0.09–0.32). The allocation of a DRG code higher than 2800 Euros at discharge was lower for children between 3 and 6 months (OR: 0.82, 95 % CI 0.69–0.98) and non-Italian patients (OR: 0.71, 95 %CI 0.60–0.85). A significant upward trend of hospitalisation rate for males (26.4 %), females (22.4 %) and non-Italian (38.2 %) children was found. The spending trends for overall seasonal spending and DRGs over 2800 Euros resulted in a significant increasing APC (23.8 % and 27.9 %).

Conclusion

A significantly upward epidemiological trend of RSV-related hospitalisation, with increasing admissions to PICU/NICU, and the rise of seasonal spending and hospitalisation average costs represent a valuable barometer for further investment in novel preventive measures.
呼吸道合胞病毒(RSV)感染是呼吸道疾病的主要原因,尤其是在婴儿中。目前的研究评估了皮埃蒙特地区2015年至2020年五次季节性RSV感染对1岁以下儿童的流行病学和经济影响。方法回顾性分析1岁以下诊断为呼吸道合胞病毒感染的患儿出院资料。住院费用通过诊断相关组(DRG)支付系统进行评估。多变量逻辑回归模型用于进入儿科/新生儿重症监护病房和出院时分配的平均DRG代码。通过计算年度百分比变化(APC),对定义时间范围内的住院和相关支出进行时间趋势分析。结果2980例住院患者,多数为男性(54.7%),多数为6个月以下婴儿(83.3%),22.4%为非意大利人。住院费用中位数约为2800欧元。多变量回归模型显示,女性(OR: 0.66, 95% CI 0.50-0.86)和3个月以下婴儿(OR[3 - 6个月]0.3,95% CI 0.21-0.44; OR[≥6个月]0.17,95% CI 0.09-0.32)在PICU/NICU接受辅助的风险较低。3 - 6个月的儿童(OR: 0.82, 95% CI 0.69-0.98)和非意大利患者(OR: 0.71, 95% CI 0.60-0.85)出院时DRG代码高于2800欧元的分配较低。男性(26.4%)、女性(22.4%)和非意大利儿童(38.2%)的住院率呈显著上升趋势。总体季节性支出和drg超过2800欧元的支出趋势导致APC显著增长(23.8%和27.9%)。结论rsv相关住院的流行病学趋势明显上升,PICU/NICU入院人数增加,季节性支出和住院平均费用上升,为进一步投资新型预防措施提供了有价值的晴雨表。
{"title":"RSV Infection in One Year Olds: measuring economic and epidemiologic burden during five seasonal waves in Italy (2015–2020)","authors":"Manuela Martella ,&nbsp;Eleonora Cugudda ,&nbsp;Roberta Onorati ,&nbsp;Jacopo Lenzi ,&nbsp;Maria Michela Gianino","doi":"10.1016/j.cegh.2025.102216","DOIUrl":"10.1016/j.cegh.2025.102216","url":null,"abstract":"<div><h3>Problem considered</h3><div>Respiratory Syncytial Virus (RSV) infection is a leading cause of respiratory illness, particularly among infants. The current research assesses the epidemiologic and economic impact of RSV infection in the Piedmont region among five seasonal waves between 2015 and 2020 among children younger than one year.</div></div><div><h3>Methods</h3><div>A retrospective analysis of data from the hospital discharge database of infants under one year diagnosed with RSV infection was carried out. Hospitalisation costs were assessed through the Diagnosis Related Group (DRG) payment system. Multivariable logistic regression models were used for access to the Paediatric/Neonatal Intensive Care Unit and the average DRG code allocated at discharge. Time-trend analyses were performed for hospital admissions and related spending during the defined timeframe by computing the Annual Percent Change (APC).</div></div><div><h3>Results</h3><div>There were 2980 hospitalisations, mostly males (54.7 %), mostly infants under six months of age (83.3 %), and 22.4 % non-Italian. The median cost for hospitalisation was ∼2800 euros. Multivariable regression models revealed a lower risk of assistance at the PICU/NICU for females (OR: 0.66, 95 %CI 0.50–0.86) and infants younger than 3 months (OR [3–6 months] 0.3, 95 %CI 0.21–0.44; OR [≥6 months] 0.17, 95 %CI 0.09–0.32). The allocation of a DRG code higher than 2800 Euros at discharge was lower for children between 3 and 6 months (OR: 0.82, 95 % CI 0.69–0.98) and non-Italian patients (OR: 0.71, 95 %CI 0.60–0.85). A significant upward trend of hospitalisation rate for males (26.4 %), females (22.4 %) and non-Italian (38.2 %) children was found. The spending trends for overall seasonal spending and DRGs over 2800 Euros resulted in a significant increasing APC (23.8 % and 27.9 %).</div></div><div><h3>Conclusion</h3><div>A significantly upward epidemiological trend of RSV-related hospitalisation, with increasing admissions to PICU/NICU, and the rise of seasonal spending and hospitalisation average costs represent a valuable barometer for further investment in novel preventive measures.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"36 ","pages":"Article 102216"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519973","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
Trends of infectious diseases under the Integrated Disease Surveillance Programme (IDSP) from a tertiary care hospital in Chandigarh, India 根据印度昌迪加尔一家三级保健医院的综合疾病监测方案(IDSP),传染病趋势
IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-11-01 DOI: 10.1016/j.cegh.2025.102207
S.R. Ravikumar , Meenu Kalia , Varsha Gupta , Manishika Sharma , Ribhav Thakur

Problem considered

Infectious diseases continue to number among the leading causes of morbidity and mortality in a number of developing countries, including India. The Integrated Disease Surveillance Project (IDSP) was established by the Government of India in 2004 to monitor trends related to the testing and diagnosis of common infections, with one objective being to periodically update programs against infectious diseases based on the data obtained.

Methods

This cross-sectional study analyses data for 11 diseases, reported as part of the IDSP to Government Medical College and Hospital, Chandigarh from 2020 to 2023; rare or clinically-diagnosed conditions were excluded from this analysis. Data analyzed includes percentage of positive cases, and linear trends of each disease.

Result

Significant positive trends were observed for Chikungunya (r = 0.203), Viral Hepatitis A (r = 0.307), and Typhoid (r = 0.436); on the other hand, the incidence of Leptospirosis (r = −0.307), Shigella (r = −0.183), and Scrub Typhus (r = −0.389) were seen to decline during the same period. Dengue and Chikungunya were also associated with seasonal variations, with both diseases peaking in winter.

Conclusion

The findings of this study emphasize the need for improved control of those infectious diseases which show increasing secular trends; in particular, the rise of Typhoid and Hepatitis A may indicate the need for improved control of fecal-oral transmission. The fall in Scrub Typhus, which runs counter to the prevailing national trend, may indicate the increased effectiveness of decentralized disease control programs. Insight gained from this study and other community-based studies is essential to guide effective policy-making and program implementation.
在包括印度在内的一些发展中国家,传染病仍然是造成发病和死亡的主要原因之一。印度政府于2004年设立了疾病综合监测项目,以监测与常见感染的检测和诊断有关的趋势,其目标之一是根据所获得的数据定期更新防治传染病的方案。方法:本横断面研究分析了2020年至2023年昌迪加尔政府医学院和医院作为IDSP的一部分报告的11种疾病的数据;罕见或临床诊断的疾病被排除在本分析之外。分析的数据包括阳性病例的百分比,以及每种疾病的线性趋势。结果基孔肯雅热(r = 0.203)、病毒性甲型肝炎(r = 0.307)、伤寒(r = 0.436)呈显著阳性趋势;钩端螺旋体病(r = - 0.307)、志贺氏菌(r = - 0.183)和恙虫病(r = - 0.389)的发病率同期呈下降趋势。登革热和基孔肯雅热也与季节变化有关,这两种疾病都在冬季达到高峰。结论本研究结果强调了对长期呈上升趋势的传染病加强控制的必要性;特别是,伤寒和甲型肝炎的增加可能表明需要加强对粪口传播的控制。丛林斑疹伤寒发病率的下降与全国流行趋势背道而驰,这可能表明分散的疾病控制方案的有效性有所提高。从本研究和其他基于社区的研究中获得的见解对于指导有效的决策和方案实施至关重要。
{"title":"Trends of infectious diseases under the Integrated Disease Surveillance Programme (IDSP) from a tertiary care hospital in Chandigarh, India","authors":"S.R. Ravikumar ,&nbsp;Meenu Kalia ,&nbsp;Varsha Gupta ,&nbsp;Manishika Sharma ,&nbsp;Ribhav Thakur","doi":"10.1016/j.cegh.2025.102207","DOIUrl":"10.1016/j.cegh.2025.102207","url":null,"abstract":"<div><h3>Problem considered</h3><div>Infectious diseases continue to number among the leading causes of morbidity and mortality in a number of developing countries, including India. The Integrated Disease Surveillance Project (IDSP) was established by the Government of India in 2004 to monitor trends related to the testing and diagnosis of common infections, with one objective being to periodically update programs against infectious diseases based on the data obtained.</div></div><div><h3>Methods</h3><div>This cross-sectional study analyses data for 11 diseases, reported as part of the IDSP to Government Medical College and Hospital, Chandigarh from 2020 to 2023; rare or clinically-diagnosed conditions were excluded from this analysis. Data analyzed includes percentage of positive cases, and linear trends of each disease.</div></div><div><h3>Result</h3><div>Significant positive trends were observed for Chikungunya (r = 0.203), Viral Hepatitis A (r = 0.307), and Typhoid (r = 0.436); on the other hand, the incidence of Leptospirosis (r = −0.307), Shigella (r = −0.183), and Scrub Typhus (r = −0.389) were seen to decline during the same period. Dengue and Chikungunya were also associated with seasonal variations, with both diseases peaking in winter.</div></div><div><h3>Conclusion</h3><div>The findings of this study emphasize the need for improved control of those infectious diseases which show increasing secular trends; in particular, the rise of Typhoid and Hepatitis A may indicate the need for improved control of fecal-oral transmission. The fall in Scrub Typhus, which runs counter to the prevailing national trend, may indicate the increased effectiveness of decentralized disease control programs. Insight gained from this study and other community-based studies is essential to guide effective policy-making and program implementation.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"36 ","pages":"Article 102207"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416293","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
Effects of smartphone-based-interventions on health-related quality of life of adults with type 2 diabetes mellitus. A systematic review and meta-analysis 智能手机干预对成人2型糖尿病患者健康相关生活质量的影响系统回顾和荟萃分析
IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-11-01 DOI: 10.1016/j.cegh.2025.102229
Marietta Yioukka , Petros C. Dinas , Ilias Ntoumas , Christina Karatzaferi , Giorgos K. Sakkas

Background

Although several studies have examined the impact of smartphone-based interventions on health-related quality of life (HRQoL) in adults with type 2 diabetes mellitus (T2DM), their findings remain inconsistent and heterogeneous.Objective: To systematically review and meta-analyze randomized controlled trials evaluating such interventions on HRQoL in adults with T2DM.

Methods

PubMed and LISTA databases were searched for eligible randomized controlled trials published between January 2014 and October 2024. Ten studies with a total of 1715 participants met the inclusion criteria. Standardized mean differences (SMDs) and 95 % confidence intervals (CIs) were calculated using a random-effects model.Results: The meta-analysis showed no statistically significant improvement in HRQoL, likely due to methodological heterogeneity and limited evidence. These factors restrict firm conclusions and highlight the need for further research.

Conclusions

Smartphone-based interventions did not significantly improve HRQoL in adults with T2DM. However, given their potential to support self-management and engagement, future high-quality trials are needed to optimize intervention design and clarify their long-term clinical relevance.
虽然有几项研究调查了基于智能手机的干预对2型糖尿病(T2DM)成人健康相关生活质量(HRQoL)的影响,但他们的研究结果仍然不一致和异质性。目的:系统回顾和荟萃分析评估此类干预措施对成年T2DM患者HRQoL影响的随机对照试验。方法检索spubmed和LISTA数据库,检索2014年1月至2024年10月发表的符合条件的随机对照试验。10项研究共1715名受试者符合纳入标准。采用随机效应模型计算标准化平均差(SMDs)和95%置信区间(ci)。结果:meta分析显示HRQoL没有统计学上的显著改善,可能是由于方法学的异质性和有限的证据。这些因素限制了确定的结论,并突出了进一步研究的必要性。结论基于智能手机的干预并没有显著改善成人T2DM患者的HRQoL。然而,鉴于其支持自我管理和参与的潜力,需要未来的高质量试验来优化干预设计并阐明其长期临床相关性。
{"title":"Effects of smartphone-based-interventions on health-related quality of life of adults with type 2 diabetes mellitus. A systematic review and meta-analysis","authors":"Marietta Yioukka ,&nbsp;Petros C. Dinas ,&nbsp;Ilias Ntoumas ,&nbsp;Christina Karatzaferi ,&nbsp;Giorgos K. Sakkas","doi":"10.1016/j.cegh.2025.102229","DOIUrl":"10.1016/j.cegh.2025.102229","url":null,"abstract":"<div><h3>Background</h3><div>Although several studies have examined the impact of smartphone-based interventions on health-related quality of life (HRQoL) in adults with type 2 diabetes mellitus (T2DM), their findings remain inconsistent and heterogeneous.Objective: To systematically review and meta-analyze randomized controlled trials evaluating such interventions on HRQoL in adults with T2DM.</div></div><div><h3>Methods</h3><div>PubMed and LISTA databases were searched for eligible randomized controlled trials published between January 2014 and October 2024. Ten studies with a total of 1715 participants met the inclusion criteria. Standardized mean differences (SMDs) and 95 % confidence intervals (CIs) were calculated using a random-effects model.Results: The meta-analysis showed no statistically significant improvement in HRQoL, likely due to methodological heterogeneity and limited evidence. These factors restrict firm conclusions and highlight the need for further research.</div></div><div><h3>Conclusions</h3><div>Smartphone-based interventions did not significantly improve HRQoL in adults with T2DM. However, given their potential to support self-management and engagement, future high-quality trials are needed to optimize intervention design and clarify their long-term clinical relevance.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"36 ","pages":"Article 102229"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568714","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
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Clinical Epidemiology and Global Health
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